Raj Bhui, MD, entered our sleep medicine fellowship not as a neurologist, but as a family medicine physician. For this week’s “Spotlight” interview, Bhui talks to us about why he feels this rare combination (fewer than 150 are certified in the United States) is an invaluable one and how he hopes this set of skills will help his future patients and trainees. He also shares how the Durham area is surprisingly similar to his native Vancouver and how he wants a position akin to a “firefighting superman astronaut” within the medical world once he finishes his fellowship.
Before coming to this fellowship, you were practicing in family medicine. What drew you to our sleep medicine fellowship?
As of my last check late in late 2018, fewer than 150 family physicians nationwide have ever been board certified in sleep medicine through the ABFM. However, while being a sleep specialist with a family medicine background is exceedingly rare, I believe it is actually an invaluable combination and I am grateful to the program for giving me the opportunity to be their first non-neurologist sleep medicine fellow.
As a family medicine physician who wore multiple hats, one of my common roles was to help my patients and community manage their chronic health conditions, including high blood pressure (hypertension), heart failure, abnormal cholesterol (dyslipidemia), obesity, depression, diabetes, and abnormal heart rhythms (dysrhythmias). Many sleep disorders, such as sleep apnea, have systemic effects when undiagnosed or undertreated and may lead to the development or deterioration of other health conditions while making them harder to control.
For example, treating previously undiagnosed sleep apnea in someone with hypertension that is difficult to control may allow their doctor to reduce the dosage or number of blood pressure medications they take. Conversely, if their underlying sleep apnea remains unrecognized, that same person may end up on additional blood pressure medication(s) - which increases their risk of side effects, medication interactions, and blood pressure dropping too low (hypotension) - while remaining at higher risk for the long-term sequelae of untreated sleep apnea, which includes most of the above conditions. Other sleep disorders are closely linked to other conditions that may appear entirely unrelated on the surface, such as the increased risk of obesity in people with a certain type of narcolepsy. One hypothesis is that a specific substance in the body (hypocretin/orexin) has a hand in stabilizing wakefulness and sleep transitions, appetite, and satiety (the feeling of fullness).
One concern that I have heard over the years is that specialists can sometimes become so focused on their own niche that they forget to consider the overall picture. Having spent so many years focusing on and managing "everything" and seeing the interaction between various conditions and stimuli, I have a profound appreciation for the "big picture." People are much more than simply their health condition(s) or diseased organ and their individual health conditions do not exist isolated in a void. Health is but one small facet of most people's lives.
Ultimately, while sleep is itself an integral and fascinating part of overall health and wellness, it and its related pathology is too often overlooked. I wanted to learn more so that I can take better care of my patients and teach my future medical trainees.
How do you hope to integrate this training into your future work?
While I love clinical medicine and primary care for many reasons, I believe I can be more effective in providing care in the role of a sleep specialist. With that goal, I plan to focus on practicing sleep medicine while being cognizant of my patients' overall health and lives.
What plans do you have for after you complete your fellowship? If you could have any job in the world, what would it be?
My plans remain open and I am currently looking for the right sleep medicine position to start after completing my fellowship.
I love clinical medicine and enjoy teaching and learning. Additionally, my background, experiences, and interests are diverse, including medical leadership, medtech, healthcare policy, non-clinical medicine, entrepreneurship, startups, and consulting. I have a strong appreciation for the importance of clinical experience in healthcare leadership and administration.
Ideally, my future career would facilitate some semblance of a reasonable work-life balance, while allowing me to remain in clinical practice, teach, and have a meaningful leadership/administrative role. The latter have the potential to allow me to improve healthcare on a larger scale than seeing individual patients.
I suppose it is akin to a little boy saying they want to be a firefighting superman astronaut when they grow up.
What’s been the biggest surprise you’ve encountered about moving to the Triangle?
Before 2018, I had only ever been to or through North Carolina once: as a layover on the residency interview trail. At that time, there was a severe blizzard that resulted in flight after flight being canceled. I wound up having to (try to) sleep in the airport that night (and possibly the next one, as well - it's been a few years), though I eventually made it out to another interview. However, I had to go to the program director's office directly from the airport, in jeans, and without a shower or much sleep. My memory of that day is fuzzy, but it certainly serves as a reminder about the effects of sleep deprivation on function!
Two main things have surprised me since moving to the Triangle: how much it reminds me of home (Vancouver, Canada) and the temperate weather. Having grown up on the West coast and then spent many years in the cold winters of the Midwest during the course of medical training and working, I learned that I enjoy warmer climates. I suppose a third surprise is that there were two hurricanes in our vicinity during the first half of fellowship.
What other passions or hobbies do you have outside of the Department?
This is a tough question because I love what I do. While many of my hobbies have been on hiatus, such as kayaking, Toastmasters, medical writing, weightlifting, debating, and growing my IT skills, learning and teaching remain two of my guilty pleasures. To that end, I have been taking courses at Duke outside of fellowship, including bio design, lean startups, and inventing medical devices.
I always have a great time teaching others about sleep medicine, both at Duke and at our neighboring VA, whether it is presenting at interdisciplinary rounds, Grand Rounds, or even just explaining various aspects and nuances of sleep pathology to residents and other colleagues. Working with the Duke GME Resident Council has also been enlightening.
Of course, I also enjoy meeting new friends (and their dogs) and learning more about the world of sleep!