Back to the Future: Past RIV Winners Talk About What the Recognition Meant for Their Careers

Larry Beresford


The Hospitalist. 2013;17(9):1,35-38. 

In This Article

Paul J. Grant, MD, FACP, SFHM

Title: Director of perioperative and consultative medicine

Institution: University of Michigan, Ann Arbor

Year: 2006

Riv: "Disseminated Histoplasmosis Presenting As Painful Oral Ulcers" (clinical vignettes)

Dr. Grant's winning vignette presented a patient with a complex medical history, including heart disease and four months of painful oral ulcers, for which prior evaluations had been inconclusive, despite conducting biopsies. Following administration of highdose corticosteroids, the patient's condition worsened on multiple fronts. The vignette showed how the medical team was able to diagnose an unusual presentation of a fungal infection called histoplasmosis, which is prevalent in parts of the Midwest surrounding the Ohio and Mississippi river valleys.

"We see a lot of cases in the hospital where there are different angles you could take to turn it into a clinical vignette or a nice poster with good teaching points," Dr. Grant says. "In this case, just digging deeper into the actual diagnosis was important because the empiric use of steroids can be fatal for some patients. Steroids are given for a lot of good reasons, but in this patient they caused immune suppression, allowing a smoldering infection to become very active."

Dr. Grant did not submit the vignette for publication. "That was probably a mistake on my part," he says, acknowledging the common complaint of too little time and too many competing priorities. But his interest in research has continued.

"I became involved at a national level with issues of perioperative medicine and last August published a textbook on the subject," he reports.[1] "VTE is another area of interest I have developed since my hospital medicine fellowship."

He serves as the VTE resource expert on the Michigan Hospital Medicine Safety Consortium, a quality collaborative of more than 40 hospitals with Blue Cross/Blue Shield of Michigan. "It's exciting to be able to look at the risk factors, what kinds of patients get VTEs, and whether they were appropriately prophylaxed in the hospital," he says.

VTE is a national quality priority, and Dr. Grant expects abstracts to emerge from the consortium's work.

He says he appreciates the opportunities that arise from participating in poster sessions at SHM, where medical students, residents, and working hospitalists talk to the presenters of interesting cases.

"It gives you a real back-and-forth, which is good for the person asking the question and for the presenter," he says, noting hospitalists from other parts of the country were not as familiar with histoplasmosis.

He says winning the HM06 poster contest helped him "get his feet wet" and feel more prepared for a career in academic hospital medicine. "I'm sure the award solidified my employers' satisfaction in hiring me—and in giving me more desirable academic roles and responsibilities," he adds.