Harvard medical alumni bulletin

2009·6.5 MB·English

by  Harvard Medical Alumni Association

SPRING 2009
m
i i
ALUMNI BULLETIN
DI^jz- 11
If you want to be happy,
resolutely turn the spot-
light off yourself. Forget
own
your self-importance,
your aches and pains, your
feelings and fears. Instead,
get busy. The world is wic
and fascinating, and it
CnNTW
SPRING 2009 • VOLUME 82, NUMBER 2
DEPARTMENTS
Letters 3
Pulse 6
HarvardMedicalSchoolstudentstake
tothestagewhilealumnitaketothe
smallscreen
President's Report 8
byStevenE.Weinberger
Bookshelf 9
Benchmarks 10
Promisingresearchonatopicaltreatment
forherpesandasurgicalsafetychecklist SPECIAL REPORT: THE HOLLYWOOD ISSUE
Class Notes 64
InMemoriam 67 12 Special EtteCtS Whatcanthedramatic artsteachdoctors about
ThomasH.Weller improvingtheirperformances? t> alice flaherty
Obituaries 68 lo rlOyinCJ UOClOr Televisionphysicianshavedevolvedfromsaintsto
—
sinners withoutsacrificingratings, by allan j. Hamilton
24 Ihe LOSt World Aformerclas—smatereflectsonMichaelCrichtoris
yearsatHarvardMedicalSchool andcelebrateshislifeandwork.
by WILLIAM IRA BENNETT
Zo Idles UUT 0l jChOOl Listeningto patients' stories makes forgood
—
doctoring andsharingthosestoriesmakesforgoodTV. by neal baer
34 Cinema Veritas Ablondebombshell, adeathonthedunes, anda
handsomeleadingmanare allpartofHarvardMedicalSchool's
celluloidhistory, by massad Gregory joseph
DO bCript UOClOrS WhetherpenninglinesforHouse,MDorproducing
independentfilms, theseHarvarddoctors alwayshave anaudience.
by JESSICA CERRETANI
44 We're Ready for Our Close-Up onebelieves hes God; another
performs exorcisms. One commits murder,while anothermerelyhurls
catsinfits ofpique. Meet thefictionalgraduates ofHarvard Medical
School, ty PAULA BYRON
Design for Life 54 52 Watch and Leam Hollywoodhaslongofferedarangeofmedicalrole
Fromsharkstosnails,bearstosnakes, models. Fromwhichscreendoctorsshouldyoutakeyourcues?
% frogstobacteria,Earth'sbiodiversity
° holdsmedical—treasureswaitingto 72 Changing Channels Whenyou'veworkedalldayasadoctor,some-
< bediscovered andcryingouttobe
timesthelastthingyouneedismoremedicaldramainyourlivingroom.
1 conserved, byEricChivian
VICTORIA MCEVOY
1))
I DoctorWho? 60
2 Testyourwitsonthewisdomofcenturies ThecoverphotoillustrationbyStephenWebsterfeaturesthe1978movieComa,basedonanovelbyaformer
- ofHarvarddoctors, byFredR.Shapiro facultymemberofHarvardMedicalSchool,RobinCook,anddirectedbyanalumnus,MichaelCrichton.
M
Harvard
edical
ALUMNI BULLETIN
EDITOR-IN-CHIEF
WilliamIraBennett'68
EDITOR
PaulaBrewerByron
In This Issue ASSOCIATE EDITOR
AnnMarieMenting
ARVARDHASITSHISTRIONICSTREAK. THEHASTYPUDDINGCLUB,HOMEOF
ASSISTANT EDITOR
dragtheatricalsandcurrentlyHollywood'smostdurableandpubli- JessicaCerretani
EDITORIAL INTERN
cizedfanclub,wasfoundedonlyadozenyearsafterHarvardMedical
RyannBurnett
School. The School's SecondYearShowhasbeenrunningsince1907, andthe BOOK REVIEW EDITOR
traditionhasoutlastedmuchofwhatwastaughtintheclassrooms andclinics ElissaEly'88
ofthatera. Forthatmatter,the SecondYearShowisolderthanHollywood, EDITORIAL BOARD
JudyAnnBigby'78
whichhosteditsfirstmovieproductionin1910. RafaelCampo'92
ElissaEly'88
NoneofthiswouldleadmetosaythatHarvardhasanythingmorethanits DanielD.Federman'53
— TimothyG.Ferris'92
first andlastlettersincommonwithHollywood,exceptthatitdoes ifonly AliceFlaherty'94
AtulGawande'94
onlyforitskeensenseofthevalueofbranding. Giventheirshareddramatic RobertM.Goldwyn'56
PerriKlass'86
traditionsandmasteryofpublicity,itishardlysurprisingthatthetwoinstitu- VictoriaMcEvoy75
James O'Connell'82
tionshavedevelopedasymbiosis. In"Hollywood,thedreamfactory," as anthro- NancJ.yE.Oriol79
AnthonyS.Patton'58
pologistHortense PowdermakercalledtheAmericanmoviebusiness, Harvard MitchellT.Rabkin'55
JasonSanders'08
has aratherspecialrole. EleanorShore'55
—
RealHMS alumnidonothavemuchofanon-screenpresence exceptfor DESIGN DIRECTOR
thelong-runningcastofNOVA's documentaryseriesthatbeganwith"CanWe LauraMcFadden
Make aBetterDoctor?" in1988. Mostly,ourscreengraduatesarefictional,and ASSOCIATION OFFICERS
StevenE.Weinberger73,president
anyresemblancetopersonslivingordeadispurelycoincidental. Oneliving JudyAnnBigby78,president-elect1
GilbertOmenn'65,president-elect2
alumna,however,cameveryclosetobeingresembled,not atallcoincidentally, KenOffit'81,vicepresident
NeilRPowe'80,secretary
inatelevisionserieswhosepilotwasfilmedbutnotaired, andshetellsthe DouglasGKelling72,treasurer
storyinthisissue. COUNCILLORS
H.ThomasAretz76
Harvardgraduateswithdiplomasdogoto Hollywood,however, aswriters RosaM.Crum'85
forandconsultantstotheindustry'smanydoctordramas. Tosaythatthereare LJaiurmiYeoGnlgimKcihmer'8766
"droves" ofHMS alumniinTinseltownmaybeashadeexpansive,but"pack"or TristeN.Lieteau'98
EileenReynolds'90
"pride" seemsfairenough. Manyofthemedicalseriesofthepast20yearshave MichaelRosenblatt73
RahulSakhuja'03
drawnontheexperienceandskillofanHMS alumnusorfacultymember,most JohnD.Stoeckle'47
notablyER,whichwasconceivedbythelate MichaelCrichton'69 soonafterhe CHAIR OF ALUMNI RELATIONS
GeorgeE.Thibault'69
graduated,althoughitdidn'tdebutuntil1994. Inthisissue,weofferasampling
ofthewaysthatHMSdoctorshaveparticipatedinwhatHortensePowdermaker REPRESENTATIVES TO THE
HARVARD ALUMNI ASSOCIATION
calledthe"massproductionofprefabricateddaydreams." JosephK.Hurd,Jr.'64
JohnD.Stoeckle'47
TheHarvardMedicalAlumniBulletinis
,-Uf&H 1/lA at25SphuabtltiuschkedSttrhereete,tBiomsetsona,yMeaAr02115
*HarvardMedicalAlumniAssociation.
Phone:[phone]•Fax:[phone]
Email:[email protected]
ThirdclasspostagepaidatBoston,
Massachusetts.Postmaster,sendform3579
to25ShattuckStreet,Boston,MA02115
ISSN01917757•PrintedintheU.S.A.
HARVARD MEDICAL ALUMNI BULLETIN • SPRING 2009
FT
— US
"\ ' T"
SECOND OPINIONS FROM OUR READERS T I I ±
i ^ i j .L_ r1
Navigational Aids
DanielFedermarfsthoughtfulandcogent
pieceabouttheproblemsfacingmedicine
makes a strong case that HMS students
and graduates should be agents for
changeinreformingourpresentdysfunc-
tionalhealthcaresystem. Indeed,anum-
ber of HMS graduates, such as Donald
Berwick72,haveplayedprominentroles
inthisarea,despiteitsoveralldominance
bylobbyists,healtheconomists,andlarge
corporatehealthcarepurchasers.
Dr. Federman's proposal to apply
thestandardsofmedicaleducationtothe
problems of health care needs to be put
intocontext,however.Anychangeinour
health care system will, of necessity,
involve government participation and
actiontoamajorextent.Assomeonewho
spenteightyearsworkingfull-timeinthe
U.S. Senate on healthissues, I can attest
that the concepts of logic and evidence
thatdominatemedicaleducationaregen-
—
erally subordinate factors and some-
—
Second,fornationalhealthinsurance timesonlyminorannoyances inaworld
All Aboard tosucceed,wemustbolsterprimarycare, ofgovernmentpolicyinwhichpolitical
A hearty welcome to the search Daniel which has been attracting fewer young agendas and personal relationships
Federman '53 conducted in the Spring physicians everyyear. Insuccessfulsys- reign supreme. Our future agents of
2008 issue ofthe Bulletin, using a nauti- temsaroundtheworld,two-thirdsofdoc- changemustbe specifically taught how
cal metaphor, for a system of universal tors areinprimarycare. Inthis country, tooperateinthisverydifferentworldif
healthcarethathaslongbeeninplacein theratio is less than one-third. Specialty they want to succeed; "evidence-based
everyotherdevelopedcountry.Actually, care,withitsemphasisondiagnosticand politics" is a wish for the future, if not
wemaybeclosertoDan's"clearsailing" therapeutic procedures, is inherently anoutrightoxymoron.
than his metaphor suggests. Two major expensive.ThisispartlywhytheUnited Similarly, HMS graduates must prac-
initiativeswillbe crucialto the success States spends twice as muchper capita tice medicine in a world where, at least
ofnationalhealthinsurance. asothercountries.Tomakeprimarycare for the foreseeable future, the rules that
First,for-profitinsurancecompanies moreattractive,Drs.ArnoldRelmanand governsuchpracticearenotsetbyHMS.
must get out of health care. Hundreds MarciaAngellhavecalledforamajorover- Inparticular,Dr. Federman'sadmonition
of billions would be saved, as their haulofphysicianreimbursement. that HMS graduates should "change the
overhead of 25 to 30 percent could be While the Bulletin has visited the world" if they are unable to practice as
reduced to Medicare's efficient 2 to 3 issue in articles and letters since 1999, theywere taught seems a bit glib. Until
percent. No more advertising. No more the gap between outstanding care at the HMS agents of change can succeed,
administrative efforts to reduce bene- great centers like Harvard and the the School's graduates will be carrying
fits,andnomoreprofit.Medicareforall diminishingnumberofpeopleitreaches out their profession in a world where
istheaimoftheUnitedStatesNational has become more and more unaccept- non-physicians decide what constitutes
Health Insurance Act, or H.R. 676, able. Now is the time for the Harvard performance in a world increasingly
which has more than 60 cosponsors in Medical School family to get on board dominated by pay for performance;
the U.S. House ofRepresentatives. Dan the good ship Federman and set course where others determine how physicians
doesn't have to look far for first-rate toabrighterfuture. shouldbalancededicationtotheindivid-
scholars and advocates for such a solu- JAMES S. BERNSTEIN '52 ualpatientwithaneedtohusbandlimit-
tion. SeveralareHMSfacultymembers. NEW YORK, NEW YORK edmedicalresources;inshort,wherethe
SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN
—
LETTERS
^>
SECOND OPINIONS FROM OUR READERS
rulesofthegamearenotsetbytheplay-
SHELF EXAM ers. HMS has an obligation to teach its
In thispoem, Ioffera reaction to whatappears to beourpernicious and students how to practice the art and
inexorableslide towardjudgmentofeach otherandourstudents through craftofmedicinesuccessfullywithinthe
multiplechoiceexams. confines of a health care system that is
ultimately designed by the citizenry at
1. A doubtful man, bemused by paper-green pictures of presidents (metal largeandnotjustbyphysicians.
coins are more convincing), has job and car and house and wife fading To extend Dr. Federman's sailing
toward transparence. He can feed: metaphor,noamountofmaneuveringwill
a. the diabetes and the cat helpyounavigatewellinthedarkofnight
b. the copay and the cold pain through a channel loaded with mines
c. Timmy's faded teachers unless you have the proper equipment
d. tides of tax andmaps. ItistheobligationofHMS to
e. none make sure its graduates know how to
find and use the tools they will need to
—
2. A doubtful doc reaches each station asymptotically almost, nearly completetheirjourneyssuccessfully.
but never, in these winding days, the tight fit of ligand and ligandee. A ALLAN R. GLASS '71
foot pointed where. His jagged REM is colored by: BETHESDA, MARYLAND
a. paper people and carnal lab slips
b. a beeper at an orgasm
c. the electronic medical rectum Transcript of Events
d. wrong third-grade answer recalled I enjoyed very much reading the letter
e. no one MassadJoseph 77 wrote in the Spring
2008 issue in which he recounts a boy-
3. A doubtful copy of the educator class, crazed quantifiliac, lately cott by the Class of 1977 protesting a
cloning influence to see if the number of numbers will surpass the macro- grading system with more categories
electronic storage crates. Escaping enumeration is (are): thanthepassorfailwehadbeenexpect-
a. mother's heartcramps ing. I was troubled to realize, though,
b. the stars in disguise that I had no recollection of a pass/fail
c. primes between ten and a lot system,aboycott,orDeanRobertEbert's
d. the shelf in the self warning thatwewere all easilyreplace-
e. not one ableifwedaredexecuteaprotest.
EBRDOWOAKRLDINRE.,WMOALSPSAOCWHU'6S3ETTS clasIs,domurcehmetmobtehre,chhaogwreivnerof,thtihsatthoeun-r
poorboy,refusedto acceptstethoscopes
from a pharmaceutical company (I
believe it was Eh Lilly) in an advanced
statementofprotestagainstthepharma-
ceuticalindustry(ofwhichIsubsequent-
ly became and remain a member). I also
was perplexed as to howwe couldhave
created a system whereby each student
wasassignedanumber,howwerecruit-
edafacultymembertoassistusinthese
endeavors, and whether any student
actually, as part of the proposed honor
system,turnedhimselforherselfinasa
"failee" of the physiology course. Last,
wouldn't such a system have required
100-percent participation and how
would a boycotter of the boycott have
beentreated?
4 HARVARD MEDICAL ALUMNI BULLETIN • SPRING 2009
'During the dinner,
Mrs. Castle served a
I scurried to my files and found my homemade chicken
four-yeartranscript, which, inblackon
white,providedseveralcluessuggesting potpie. 'What, no liver?'
that Massad was mistaken. The tran- I shouted. The professor
script containedalegendatthebottom broke into a profound
with the categories of E (excellent), S laughter. He explained
(satisfactory) and U (unsatisfactory).
Mygradesfellintothreecategories:S,E, that he would not eat
and"-". Fortunately I didn'treceive any liver, even ifhewere
grades of U, though one might argue starving to death."
that I might have duringmypsychiatry
rotation, as theresidents andattending MURRAY STROBER '51
criticized me for refusing to accept the
teachings of Freud. What, though, did
the"-"represent?
I do recall that our class was either
thefirstoroneofthefirsttobetoldwe
wouldn'treceiveclassrankings.Perhaps me I'd failed physiology. Mrs. Castle phone call, describing the pranks that
that's what Massad was recalling; my must have thought that I was mentally had been played on me. When I added
transcriptdoesn'tshowanyranking. disturbed, as I repeatedly challenged the story about preparing for the visit
I do hope that this provides some the veracity ofher call. The next day I byboninguponhisresearch, Dr. Castle
clarificationaboutthereportedboycott. overheard another student claiming brokeintothunderouslaughter.
I still have questions. Did we in fact thathe andhis wifewere invitedto the At the end of the evening, Dr. Castle
reject the free stethoscopes, and was it samedinner. Surely,Ithought,thisinvi- declared that he and his wife had had a
Lilly that made the offer we turned tation must be a prelude to a final wonderfultime.Heplannedtomakethis
down? And can someone please tell me examination to determine whether I typeofdinneranannualevent.
whatagradeof"-"means? could graduate from the Medical Aftergraduation I startedmyintern-
MARK A. KLAUSNER 'JJ School. I immediatelybeganreadingup ship on the Downstate University Ser-
PRINCETON, NEW JERSEY onDr. Castle'sresearch,suchashisdis- vice at KingCounty Hospital in Brook-
coveryofthegastricintrinsicfactor. lyn, New York. One day, a rumor was
The next dilemma occurred on the circulated that Dr. Castle was at the
Semiformal day of the dinner, when my wife and I hospital to see his old friend, William
Earlyinmymedicalschoolcareer, Iwas couldn't decide how to dress. I had my Dock, who had been a house officer at
sent, along with several students, to suit pressed and my shoes shined. My Peter Bent Brigham Hospital in 1923.
Boston City Hospital for a conference wife donned her finest dress, adding a Apparently, Dr. Castle asked Dr. Dock
with William Castle '21, a pioneer in hat and white cotton gloves. When we whether I was an intern on his service.
hematology. Uponourarrival,wefound arrivedatthedesignatedaddress,Ireal- While making rounds on one of the
the professor in overalls; he had been ized the invitation had indeed been wards, Dr. Castle saw me and rushed
repairingthehospitalelevator. Hestart- authentic. Inthedrivewaywas Dr. Cas- overtoembracemewarmlyandinquire
ed his lecture by complaining that the tle's 1933 Model T Ford. Dr. Castle aboutmywife. Iwas the topi—cofhospi-
repairmenhadhadtheaudacitytowant responded to my ringing the doorbell. tal gossip for some time and my
to charge the hospital five dollars per He was wearing an open shirt, dunga- appointmentto thenextyear'sresiden-
hourfortheirrepairwork. rees, andsneakers, andhehadaglassof cyprogramwas assured.
Toward the end of my fourth year, beer in his hand. With his melodious MURRAY STROBER '51
mywifeandIreceivedanunusualtele- bassvoicehewelcomedus. PASSAIC, NEW JERSEY
phone call. The caller announced that Duringthedinner,Mrs.Castleserved
she was Mrs. William Castle, and she ahomemade chickenpotpie. "What, no The Bulletin welcomes letters to the editor.
invited us to a Sunday dinner at her liver?" I shouted. The professor broke Pleasesendlettersbymail(HarvardMedical
home. At first I thought it was a prank into profound laughter. He explained AlumniBulletin,25ShattuckStreet,Boston,
call;myclassmateswerealwaysputting that he would not eat liver, even if he Massachusetts 02115);fax[phone]);or
some womanup to call me, claiming to werestarvingtodeath. Ilaterexplained email ([email protected]).Lettersmay
be from the dean's office and informing my confusion with Mrs. Castle's tele- heeditedforlengthorclarity.
SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN
PTIT.SK
MAKING THE ROUNDS AT HMS
Ready for Prime Time Players
D
HEUNTHINKABLEHASHAPPENED:
HMS has dropped to number
two in the medical school
rankings, losing out to some
school in Baltimore. What is a dean of
medical education to do? In the 102nd
SecondYearShow,JulesDienstagsetsout
to restore HMS to its former glory by
craftingthenew,new,newcurriculum.
He's Got Curriculum, directed by Paul-
valery Roulette and Ibrahim Khansa,
takes much ofitsinspirationfromtelevi-
sion. Dienstaggivesagroupofprofessors
one last chance to reconfigure their
courses andhelpbringHMSbacktothe
topspotintherankings. Eachprofessor's
new(butnot-so-improved)courseispre-
sented via a spoof on a television show,
after which he or she must enter the
boardroomandreceiveDienstag'sverdict.
ChrisDeSesa'sturnasDienstagmakes
the show. Part Dr. Evil, part Donald
Trump, DeSesa's Dienstag gleefully tPhLeAYnIeNwGcIuTrCriOcOuLl:umT.he Class of 2011 devotes its Second YearShowto poking fun at
insults and then fires each and every
instructor, with impecca- of a speaking part, his antics as Evan terfully delivered the concluding song,
ble comic timing. An frequentlyhadtheaudienceinstitches. "This Is How We Do It (HMS and
unabashed blowhard In between send-ups like "MCM HSDM Style)." Another musical high-
who "eats success Bachelor," a Dating Game-style show in light was ShermanJia's violin accompa-
for breakfast," he which cell biologist Randy King (Adam nimenttoareadingofthechildren'sbook
tells course direc- Donnell) must find his biochemistry FerdinandtheBullduringintermission.
tor Kate Treadway queen,the audiencewastreatedtocom- It would not have been the Second
(Katherine Walker) mercials for faux pharmaceuticals like Year Show without searing parodies of
that her introductory Gunnopril (for the treatment of idio- everything HMS holds dear. Referring
course needs "a little pathic gunner syndrome) and Geico to Patient-Doctor I, a student asks,
less Introductionanda DentalInsurance("Soeasy,evenaDental "Why do we have to take a class to
little more Profession." candoit!").Thosehankeringfordancing learn to pretend like we care?" HST
No wonder Trudy Van gotanoccasionalfix. students, as hopelessly nerdy and
Houten(ReganBergmark) Several musicians from the Class of socially inept as ever, demand to be
calls him "Dr. Mean- 2011 stood out. Chinyere Obimba, who known by their new culturally sensi-
stag." Dienstag's buf- served as the production's music direc- tive name: the London Society. Even
foonery is further tor, got the show off to a strong start SarahPalinis skewered.
enabledbyhisadorable with "Study, Study, Study," set to the As usual, the breadth of talent was
assistant Evan, played tune of"For the Love of Money" by the impressive. If the second-years want
by Jordan Strom, O'Jays, and later stole the scene during HMStoregainitstopranking,theymight
who eagerly caters "Physiology Magic School Bus." Nadia consider challenging those students in
to Dienstag's every Farjo's vocal talent was kept under Baltimoretoatalentcompetition.
whimStrom's acting wrapsuntiltheend,when,dressedasan <
chops were evident, ob/ob mouse in tribute to HMS Dean Emily Lieherman is the editorial assistant
since despite his lack Jeffrey Flier's obesityresearch, she mas- forFocus.
Linked In
HAT DO URBAN PLANNINGAND will unite researchers from the Harvard means to generate the preliminary data
neuroimaging have in com- UniversityGraduateSchoolofDesignand needed to apply for long-term funding.
mon? What about smogand MassachusettsGeneralHospital.TheHar- Lastly, the grants help focus scientific
kidney disease, or cancer vardSchoolofPublicHealthandBrigham resources and expertise on high-risk,
vaccines andpolymers? These arejust a andWomen's Hospital willjoin forces to high-impact areasofresearch.
fewoftheintriguingresearchcollabora- studytheeffectsofairpollutiononkidney "The pilot grants of Harvard Catalyst
tions to receive grant funding from disease. And the Dana-Farber Cancer demonstrate the drive among the faculty
Harvard Catalyst, the Harvard Clinical Institute andtheHarvardSchoolofEngi- to collaborate on unique problems," says
andTranslationalScienceCenter. neeringandAppliedScienceswillcollabo- JeffreyFlier,deanofHMS."Watchingthis
Thefirstroundof62pilotgrantrecipi- rateontheroleofpolymersinvaccinations. process unfold has confirmed my deep
ents,announcedthisspring,connects218 With these one-year, $50,000 grants, conviction that we can most effectively
investigators from 23 Harvard schools HarvardCatalystaimstostimulateclini- impacthumanhealthbyencouragingpeo-
andacademichealthcarecenterswiththe cal and translational research in three ple from across Harvardwho have never
sharedgoalofaddressingimportantissues ways. First,thegrantsenableresearchers workedfacetofacetoworktogether."
inhumanhealth. Theurbanplanningand to jointly address important scientific For more information, visit http://
neuroimaging collaboration, for example, questions. Second, they provide the catalyst.harvard.edu.
Reel Medicine
Making His Move
D N I987, THE CREW OF THE
televisionprogramNOVAarrived GEORGE THIBAULT '69 HAS ANNOUNCED
on the HMS campus to begin his plan to step down as HMS chair of
shootingwhat wouldbecome alumni relations in October. Thibault, the
700hoursoffootageofsevenfirst-year former director ofThe AcademyCenterfor
student—s. The resulting documentary Teaching and Learning at Harvard Medical
series "Can We Make A Better School, has spent mostof his medical
—
Doctor?" aired in 1988 and portrayed career at HMS and its affiliated hospitals.
the stress, drama, and rewards ofmed- He has served as chief medical officer at
ical school. Subsequent episodes Brigham and Women's Hospital and as
detailed the doctors' residencies and vice presidentofclinical affairs at Partners
earlyyearsofpractice. HealthCare. A cardiologist by training,
This spring, a two-part installment Thibault has been presidentoftheJosiah
called Doctors' Diaries catches up with Macy, Jr. Foundation sinceJanuary 2008.
the physicians for an update that is, at In anticipation of the change, Alumni
times, poignant: One doctor no longer Council President Steven Weinberger '73
sees patients; others have faced chal- has convened a nominating committee
lenges with their health or personal to begin the
relationships. Still, these alumni have search process
Leadership Sought
few regrets. "In my years ofpractice, I for Thibault's
have seen all the ranges of extreme successor. "George's recent tenure as chair of alumni TO NOMINATEYOURSELFORANOTHER
tragedy, extreme joy," says Tom Tarter relations has capped off a long and distinguished record HMS graduate to take on the role
'91 of his experience. "I can't think of of contributions to HMS," Weinberger says. "Throughout ofchair ofalumni relations, contact
anything that has grounded me so his career, he has exemplified the 'quadruple threat' Debra Metcalfe, directorofalumni
muchinmylife asbeingadoctor." through excellence in patient care, teaching, research, relations, at617-384-8518 or
debra [email protected].
To learn more, visit www.pbs.org/ and administration."
wgbh/nova/doctors.
SPRING 2009 • HARVARD MEDICAL ALUMNI BULLETIN
PRESIDENT'S REPORT
Course Adjustments
m
EALTH CARE FACES TRULY DAUNTING ISSUES AS WE rience and professional development. As a consequence, the
approach the second decade of the twenty-first outpatient setting must play a greater role in training future
century: 47millionuninsuredAmericans; Medicare physiciansandmustassumeafocusonpreventionandonbet-
expensesthatconsume16percentofthefederalbud- termanagementofchronicillnesstoavoidhospitalization.
get andareprojectedtogrowto 20percentby2016;physician Limitationsondutyhours. In recent years, regulatory bodies
shortages,particularlyinprimarycare;andahealthcaresystem have imposed restrictions on resident work hours, with the
that achieves stunningly poor outcomes despite staggering intentofreducingresidentfatigueandimprovingpatientsafe-
costs.Atthesametime,themedicaleducationcommunitycon- ty. The subsequent increase in physician-to-physician hand-
fronts a widening array of challenges in training tomorrow's offshas led, however, to concerns about diminishedcontinu-
physicians,challengesthataffectbothundergraduateandgrad- ityandthepotentialfordecreasedqualityofcare.Reconciling
uate medical education and are often related to changes in theseconcernsnecessitatescreativeapproachestoscheduling
healthcareandinthetrainingenvironment. andpatient coverage thatbalance andbestmeettheneeds of
Given my local and nationalperspectives onmedical edu- bothtraineesandpatients.
cation—gathered during more than twenty-five years as a Pressures on teachingfaculty. Faculty members need time and
clinician-teacher and medical educator at HMS, and, more support for the responsibilities that are critical to the profes-
Students and trainees must understand the
importance of assessing and continually
improving the quality of care they provide.
recently,fiveyears directingmedicaleducationattheAmeri- sionaldevelopmentofstudentsandtrainees:evaluationthrough
—
can College of Physicians I decided to use this column to directobservation,frequentandhigh-qualityfeedback,mentor-
discuss four major environmental changes affecting health ship,androlemodeling.Yetfacultymembersareunderincreas-
careandmedicaleducation. ing pressure to generate more revenue through either clinical
Emphasisonqualityofcare.CatalyzedbytheInstituteofMedi- productivityorgrantfunding.Asteachingactivitiesdonotgen-
cine's Crossing the Quality Chasm report, physicians are now eraterevenue,clinicalinstitutionsrequireclinician-teachersto
judgednot onlybywhat theyknow,butmoreimportantlyby seeagreaternumberofpatients,amovethatlowersthepriori-
—
what theydowhencaringforpatients thatis,thequalityof typlacedon their teachingresponsibilities. Fortunately, many
care theyprovide. Students andtrainees must be educatedin institutions have acknowledged the need to support teaching
an environment in which quality of care is a core value, and facultybyremuneratingtheireducationaldutiesandemphasiz-
they must also understand the importance of assessing and ingqualityandquantityofteachingincriteriaforpromotion.
continuallyimprovingthequalityofcaretheyprovide.Faculty These four areas do not capture all the changes affecting
whosupervisethesestudentsmustembraceacultureofquali- medical education; notably absent are the pressures accompa-
ty, commit to teaching the principles ofquality improvement nyingthe current economic downturn. Theydo,however,rep-
andthedeliveryofhigh-qualitycare, andserveasrolemodels resentareasoverwhichmedicalschools,teachinghospitals,and
fortheimplementationofsuchimprovementandcare. educational leaders have some control. How well institutions
Changeinthenatureofinpatientcare. Forseveralyears now, the addressthesechallengeswilldeterminehowwelltheycanmeet
inpatientsettingisnolongeranidealplacefortraineestolearn theeducationalneeds ofstudentsandtrainees andtheclinical
how to diagnose acute illness, follow the course ofacute dis- needsofpatients.
ease, andtakeprimaryresponsibilityforpatientcare. Instead,
preadmission diagnoses, shortened inpatient stays that focus StevenE.Weinberger73isseniorvicepresidentformedicaleducationat
on throughput, and the delegation of decisions to attending theAmericanCollegeofPhysiciansinPhiladelphia.Hecanbereached
physiciansandconsultantsalldetractfromthestudent'sexpe- [email protected].
HARVARD MEDICAL ALUMNI BULLETIN • SPRING 2009