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Alumni Spotlight: Jessica McFarlin, MD

Tuesday, June 25, 2019

As a fellow and junior faculty member in the Duke Neurology Department, Jessica McFarlin, MD, was torn between her desire to practice both neurocritical and palliative care. So she took the advice of her mentor Daniel Laskowitz, MD, MHS to “do both.” This week, McFarlin talks to us about her current work in both of these disciplines at the University of Kentucky Healthcare. She also talks about how her time as a resident and fellow at Duke Neurology shaped her career, the most difficult and rewarding parts of her job, and offers advice for residents and medical students interested in neurology.

What are your current responsibilities as division chief of palliative care at UK Healthcare? What does a typical workday for you look like?
When I came to UK part of the goal was to start and grow a Division of Palliative Care. Over the past few years this has involved recruiting an interdisciplinary team of physicians, nurse practitioners, pharmacists, a social worker, and chaplain. We work to take great care of patients and also build resilience for care teams who take care of really sick patients. In the future we hope to have an outpatient program in addition to our inpatient program. The division of palliative care is in Internal Medicine so I have a dual appointment with Neurology. That has made it easy to get to know people throughout the health system.

I also am an attending on the inpatient Stroke/ICU service. I split my clinical time on both services and rather then feeling torn between the two specialties the division helps improve my skills in each.

How much does your current work differ from the role you had at Duke?
The main difference is I have a leadership role with the Palliative Care team. Duke was a great fit for me because I was able to practice both ICU and Palliative Care. Because Dr. Goldstein is our Department Chair at UK, he understood why it was important to me to practice both and how having both skill sets helps patients.

You completed both your residency and a fellowship in neurocritical care (as well as another Duke fellowship in palliative care) within the Duke Neurology Department. What’s one moment or lesson from your residency and fellowship at Duke that stand out as especially useful or memorable?
Two quotes stand out to me as really career shaping for me.

First "What does the patient want?" Joel Morgenlander said this to me after I had raced ahead and set up a feeding tube for a patient with advancing dementia. It is easy to feel pressure to develop and complete plans as a resident instead of stopping to explore goals and values of a patient. Second, "Do both." Danny Laskowitz said this to me when I felt torn between an ICU career or a palliative care career. Turns out they are complementary!

What do you find most rewarding and about working in palliative care? What’s the hardest part of your work?
The best part is generating RVUs for spending time really getting to know patients and their families and work with them to make medical decisions based on their goals and values. The hardest part is being a division chief. It is a challenge to balance the needs of the group with needs of individuals.

What advice or words of wisdom do you have for early-career neurologists or medical students interested in this field?
Find mentors. And not just one. The person that can offer leadership mentorship may not be the same person that helps you learn to be a writer or show you how to provide excellent neurologic assessment.

What passions or hobbies do you have outside of work?
I am an extrovert so I enjoy things that require other people. I play the handbells in a choir, like to travel to New York City with my husband and visit friends across the US. 

McFarlin and her husband enjoy an Easter Sunday service in this photo.