MedStar Health Blog

Michael Sherman, DO, director of MedStar Washington Hospital Center’s Nephrology and Hypertension Clinic, says solving problems and working with people motivated his choice of a career in medicine. Yet, he also felt it was important to get a better feel for the profession to which he would dedicate his life.

So before enrolling at the New York College of Osteopathic Medicine, Dr. Sherman spent a few years in Washington, D.C., working as a research assistant for a non-profit health policy organization.

“There is a non-science side to medicine that I found particularly appealing,” he explains. “It also complemented my interest in osteopathic medicine, which helps you think holistically about a patient’s condition.”

Attracted by the opportunity to live and work in the nation’s capital, Dr. Sherman came to the Hospital Center and MedStar Georgetown University Hospital to complete his residency in Internal Medicine, and his fellowship in Nephrology. Because treatment decisions for chronic kidney diseases are rarely simple, Dr. Sherman uses his diverse training to help patients consider all issues as they choose a path forward.

A Diverse Approach to Medical Care

Dialysis, for example, is an “intensive therapy that requires commitment,” Dr. Sherman says. “It’s life-sustaining, but it can also be a hardship. We want to be sure what we’re doing truly improves the patient’s quality of life.”

Nephrology also provides Dr. Sherman opportunities to help patients tackle these challenges in a variety of settings, from ICU cases to those who visit for outpatient treatment. “I enjoy following these patients for years, and building a relationship with them,” he adds.

Dr. Sherman also serves as medical director of Inpatient Hemodialysis at MedStar National Rehabilitation Hospital, a program that provides on-site dialysis treatment for patients undergoing acute rehabilitation programs.

“This ensures patients get the dialysis treatment they need without cutting into their rehab schedules or delaying their recovery,” he says.

Life Outside the Hospital

Dr. Sherman’s family life provides plenty of practice with managing schedule. With three children, ages 3 to 9, he and his wife devote most of their weekends to going from one activity to another. And having received his undergraduate degree from Duke University, Dr. Sherman is understandably an avid college basketball fan.

“I was one of the ‘Cameron Crazies,’” he says, referring to the Blue Devils’ famed passionate student fans. “From time to time, I’ll get together with my college friends to watch games and relive those days.”

It’s a standard part of most doctor visits: “Tell me about the medications you’re taking.” Some people quickly list a few prescriptions or pull out a list. But patients often don’t think to tell us about ointments or creams they’ve purchased to self-treat skin conditions.

Two of my colleagues and I recently wrote about an experience we had with a patient who came into one of the MedStar outpatient dermatology clinics for help with atopic dermatitis, more commonly known as eczema. This patient had purchased a topical cream that they recognized from back home at a local African store. We found that this medication contained a prescription-strength steroid, and that the cream also was available online with no prescription required.

Taking or using any topical medication without knowing exactly what’s in it and how it could interact with other drugs you’re on is extremely dangerous. It’s critical to check with your doctor before purchasing topical medications to avoid potential harmful effects from products. 

The dangers of using medications made outside the U.S.

It’s easy to think that a medication available without a prescription is safe. But every drug carries the risk of side effects, including topical medications.

Although it’s no substitute for talking to a doctor or pharmacist, basic information about medications is available online. A credible resource patients can use is the Drug & Supplements information from MedLinePlus, which is operated by the U.S. National Library of Medicine. This database provides information about how to use medications, special precautions, possible side effects and more.

If you come across a drug that’s potentially unsafe, you or your doctor can report it to the FDA through the MedWatch reporting form. My colleagues and I did this with the cream my patient bought for eczema, along with reporting it to Amazon. Within a couple of days, the product was no longer available to buy on Amazon.

Your doctor is there to protect you, but you have to have open and honest conversations about the medications you use, including topical creams, so you can work together and avoid harmful side effects.

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People sometimes mistakenly think that accepting palliative care means they have to stop receiving other medical treatment. However, palliative care is a specialty service that can be provided at any point during a patient’s illness. That means that patients can receive palliative care while also receiving treatment to cure disease or extend their lives.

Related reading: 3 common misconceptions about palliative care and hospice

Our team frequently gets requests to help with pain management. Our doctors and pharmacists have expertise in recommending medications for pain. Our social workers and chaplains provide patients with information on non-medical approaches they can use to manage their own pain.

In addition to pain relief, we also help with other symptoms of illness or treatment. For example, we often see patients who have severe constipation, a common side effect of opioid-based pain medications that might be prescribed following surgery. Research in our field has shown that standard laxatives, such as colace, don’t relieve this type of constipation. We see some patients who report abdominal pain and it turns out they’ve gone days without a bowel movement because they’re on prescription opioids. In these circumstances, we educate not only providers on more effective means for treating symptoms, but also patients and families so they can advocate for better symptom management as they continue treatment.

In addition to addressing the physical symptoms of illness and treatment, our team also helps patients and families sort through feelings associated with being sick and in the hospital. Services such as spiritual care, supportive counseling and relaxation therapy are based on patient and family individual needs, and can help patients and loved ones cope with feelings of fear, sadness, frustration or grief.

It’s never too early for palliative care

The goal of palliative care is to maximize quality of life when patients are facing serious illness. Toward that end, we are working within the hospital to promote our involvement earlier in hospitalization or during evaluation for treatment planning. We call this approach “upstream palliative care.”

An area where this is working well is in the advanced heart failure program, where we meet patients who are preparing to undergo bypass surgeries, heart transplants or implantation of heart devices to extend their lives. We work alongside the advanced heart failure teams to help manage symptoms, but also to have discussions about the “what ifs,” the potential complications, and what patients and families might want if those occur. This is an aspect of palliative practice known as “advance care planning.” These can be difficult conversations, but they’re important as sometimes things don’t work out as we hope. It’s preferable, in our minds, to discuss the “what-if” scenario before facing a medical crisis.

We often work with patients who have chronic and progressive conditions, such as kidney disease, dementia or COPD. Over time as these conditions progress, patients come to the hospital more frequently for other problems related to the underlying disease. In these cases, we talk with patients and families about how being hospitalized all the time affects their lives, and whether a different plan of care, which may include hospice, would provide them with a better quality of life.

An important aspect of palliative care is to help both patients and medical teams consider the big picture. For example, we work a lot with patients who have advanced dementia or Alzheimer’s disease, which are progressive and incurable. Often, families will bring patients to the emergency room because they have stopped eating or getting out of bed, both of which are expected complications as the illness progresses. When this happens, families might ask about feeding tubes or home physical therapy. There are cases in which these interventions may make sense. However, when they don’t, we talk to families about options for less aggressive or invasive means of caring for their loved ones.

It’s about making sure our patients understand their options for care and can make informed choices. The earlier we’re brought into the process, the more options our patients can choose from—so they can live their lives on their terms.