Hooked on ID with Ayesha Appa, MD
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As a prior history major, I was drawn to infectious diseases by the patient stories, by the high value that the field placed on patients’ narratives and social contexts.
During medical school at the University of California, San Francisco (UCSF) and internal medicine residency at the University of Washington, I saw ID physicians ask, “Why?” — why this host, why this microbe, why this community, etc. — and that led to a deep understanding of who the patient was. I found this shared curiosity and compassion incredibly appealing.
Around this time while preparing for my chief residency year, I attended a training program in addiction medicine run by Boston Medical Center, which involved spending time with people in recovery. As I shared a meal with an older gentleman with a substance use disorder in remission, he told his story. He had been hospitalized at least 12 times for soft tissue infections — but no physician treating his infections ever addressed his substance use. The root cause of his multiple, life-threatening infections (his “why”) had been ignored. Unfortunately, this story was and may still be common.
I began infectious disease fellowship at UCSF motivated to dive extensively into diseases like HIV and Staphylococcus aureus infections that tend to follow marginalization and substance use. Realizing I wanted equally strong training in addiction medicine, I am now completing fellowship training in both fields, thanks to very supportive UCSF program leadership. As Serota and colleagues have called for in their excellent article, I hope this path only becomes more well traveled. Opportunities to improve HIV/infection prevention and treatment in people who use drugs are vast; our patients have an endless amount to teach us.
— Ayesha Appa, MD
Infectious diseases and addiction medicine fellow
University of California, San Francisco