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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:(617)432-7878•Fax:(617)432-0089 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(617-432-0089);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

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