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an online version of the magazine Spring/Summer 2005
Circling the Dome
Two quadriplegics, physician S.B. Lee and patient Randy Carroll.
IS HE MY DOCTOR?
Two quadriplegics, physician S.B. Lee and patient Randy Carroll.
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Is He My Doctor?

On the night in 1987 before Robert Seung-bok Lee's life changed forever, he made a vow: He'd prove to his parents that even in the United States their first-born son could make it big.

Back then, Lee was a recent Korean immigrant and one of the nation's most promising young gymnasts. In his senior year of high school, he'd just earned a spot on the Korean men's gymnastics team for the Summer Olympics in Seoul , and he was ready to show the world what he could do.

Practice the next morning changed all that. As Lee flew into the somersaulting dismount he'd executed hundreds of times before, he missed and landed on his chin. Immediately he sensed that something terrible had happened. “I felt weird, like I was floating.”

And indeed, by hyperextending his neck, Lee had damaged his seventh vertebra, shutting down all four of his limbs and turning himself into a quadriplegic. His first thought was that now he'd disappoint his parents.

But determination and tenacity don't just go away when conditions turn bad. Today, “S.B.” Lee is finishing up as chief resident in Hopkins' Department of Physical Medicine & Rehabilitation (where his syndrome is known as tetraplegia) and one of only two practicing physicians in the nation with his condition. According to Sam Mayer, a senior physician in the department, “he provides a sense of hope that able-bodied doctors simply can't” for the 200 or so patients he sees in a year with spinal cord injuries. He's also juggled a flood of offers to join prestigious rehab departments, but will spend one more year at Hopkins doing research on spinal degeneration.

“An ideal time to launch rehab,” Lee says, “is during the first stage—denial—before the harsh reality of the traumatic injury sinks in.” After his own accident, he spent three months in an acute-care hospital, then eight months at New York 's Rusk Institute. Instead of triple somersaults, he began concentrating on perfecting finger flexes. Much of the time, his head was immobilized in what's called “halo traction.”

“I hated those exercises,” Lee says. “I was lifting five-pound weights when I'd been doing triple flips and somersaults.”

But with Olympian diligence, Lee turned each rehab baby step into a milestone, and slowly he regained some mobility in his arms and hands. Then, using a device created especially for people with paralyzed arms, he learned to hold a pen. Finally, it was the famous physiatrist Howard Rusk who suggested that Lee think about becoming a rehab physician himself. And in 1993, he became the first tetraplegic student ever admitted to Dartmouth Medical School .

Today, watching Lee glide through the hallways of the Hospital's rehab unit, paralyzed patients can't believe he's their doctor. “How fast can you go in that wheelchair?” they'll ask. “How do you get back on it when you fall?” But it's only when they demand, “How long will it take me to learn how to do that?” that Lee knows they're ready to get on with life.


Judith Minkove


Osler Lives On

Randy Barker, a master of the doctor-patient relationship.
> Randy Barker, right, a master of the doctor-patient relationship.

As a young attending in the 1970s, David Kern remembers examining one patient as though she were merely a diagnosis. “It was very mechanical, all about getting the data,” says the co-director of internal medicine at Johns Hopkins Bayview Medical Center . “She became really angry with me, and rightly so. I knew better.”

Three decades later, what proves to Kern that he's learned a thing or two about talking to patients is the feedback he gets from the medical students and residents who observe him in action. Their comments—“Diabetes is so different in every person!”—show him they're grasping the side of medicine that William Osler, Hopkins ' first physician in chief, summarized in his famous dictum, “Care more particularly for the individual patient than for the special features of the disease.”

Yet figuring out how to effectively practice that maxim, Kern says, is very different from learning how to determine the cause of, say, chest pain. Even brilliant physicians may ignore patients' worries and fears, or be unable to fathom how a disease takes its toll on daily life. To help young doctors learn that how they communicate with their patients is as vital as what they communicate, Kern and other clinician educators here who've long been modeling the Oslerian mind-set launched the Osler Center for Clinical Excellence three years ago.

“We know that patients with diabetes, for example, have better outcomes when physicians involve them in decision making about their treatment,” says Kern.

“New physicians often think that, once they know the diagnosis, all they have to do is tell the patient what to do. It comes as a surprise that people may be unwilling or unable to change their behavior to carry out a doctor's recommendations. So we demonstrate how to listen to patients, find out what their barriers are and build that perspective into the management plan.”

And for physicians of all ages who want to polish their bedside manner, three other Bayview-based faculty have come up with “52 Precepts That Medical Trainees and Physicians Should Consider Regularly.” Published in the April issue of The American Journal of Medicine, the gems were pulled together by Bayview internist Scott Wright, Department of Medicine Director David Hellmann and Internal Medicine Program Director Roy Ziegelstein.

Among their pearls: Be wholly present when interacting with patients and avoid unnecessary interruptions. Learn who your patients are and consider sharing something about yourself with them. Understand that medicine is a public trust. Be thankful and happy that you are in medicine.


Mary Ann Ayd


Minnesota Grit

When word got out early this year that Ed Miller, Hopkins Medicine's dean/CEO, was appointing a new senior vice president to mesh the clinical activities at all Hopkins ' outpatient sites with those at its three hospitals, no one was surprised to hear the position would go to Steve Thompson. From the moment Miller walked onto campus in 1994 to become the new chairman of Anesthesiology and Critical Care Medicine, Thompson has been his right hand. Which is interesting, because the two never knew each other before then.
Steve Thompson, the dean/CEO's right hand.
> Steve Thompson, the dean/CEO's right hand.

Thompson is a living example of the American adage that work and determination pay off. A Minnesota native, he started as a pump technician in surgery who ran the heart-lung machine during bypass operations, then moved into training other perfusionists. He'd just finished an MBA and changed to the business end of medicine when Miller arrived and followed up on a suggestion that he consider Thompson for his administrator in Anesthesiology.

“As soon as I met Steve,” Miller says, “he impressed me with his forthrightness. He said he wasn't an expert in anesthesia billing, but that he'd learn. He had an ease about him—no hidden agenda. He's so comfortable with himself, others are comfortable with him.”

By the time, Miller was named head of the whole Johns Hopkins medical organization three years later, he knew he wanted the young Midwesterner working with him. Miller brought Thompson on board to organize the School of Medicine 's new presence in Singapore and over the next five years made him successively head of Johns Hopkins International, vice president for ambulatory services and vice dean for administration.

In his new job, Thompson combines all those earlier titles and roles into one neat senior vice presidency. He'll report to Miller and to Ron Peterson, who heads The Johns Hopkins Hospital and Health System, and take charge of the planning, integration and growth of all the hospitals and outpatient sites in the Hopkins clinical network.

Miller says Thompson never fails him. “He's not afraid to speak his position, but he analyzes how to use what other people bring to the table for the greater good.” Still, one of the qualities he values most in Thompson is how he troubleshoots behind the scenes. “If something comes up that doesn't fall into someone else's bailiwick, I call on Steve,”Miller says. “Faculty and staff don't always know what he does or how he does it, but they see results.”

 


Back in the Saddle Again

After one year of slippage, leaders at the School of Medicine were bucked up to hear this spring that the medical school had regained its #2 place in the U.S. News & World Report annual rankings of grad schools. Just as it had from 1990 through 2003, Johns Hopkins' medical school came in second only to Harvard's, according to the magazine. No one said much last year when Washington University in St. Louis suddenly assumed the runner-up spot, pushing Hopkins down a notch, but everyone likes this year's results better. In a survey of deans and department directors, the 2005 rankings put the School of Medicine in the #1 position in internal medicine, drug/alcohol abuse treatment (tied with Harvard) and geriatrics. We came in #2 in AIDS care (behind the University of California , San Francisco), #3 in pediatrics, and #4 in women's health.

 


Swaddled In Scaffolding

Johns Hopkins Hospital's trademark dome
For almost a year now, The Johns Hopkins Hospital's trademark dome has assumed the look of a trapeze set. Surrounded by support rods and crawling with workmen, the airy cupola is undergoing a significant facelift as part of a 15-month, first-ever renovation of the whole exterior of the Hospital's Broadway side. Due for completion at the end of this summer, the work will give new slate roofs, pointed brick and copper trim to the three original 1889 buildings—Billings, Marburg and Wilmer—all now on the National Register of Historic Places. Meanwhile, for a few more months, visitors to the Hospital will have to enter through one of the underground tunnels or attached buildings as the Broadway entrance remains roped off.



Pinch Hitters

It's 5 o'clock on a cold December morning. Rotating on the trauma service, Jonathan Cohen is checking overnight labs, vital signs and charts when a page comes in—gunshot wounds to the abdomen. Cohen speeds to the OR to assist in the exploratory laparotomy.

There's just one thing: Cohen isn't an M.D. He's a physician assistant, one of a half-dozen who jumped at the chance to enroll in Hopkins ' inaugural postgraduate surgical residency program for P.A.'s. Established in response to the reduction in working hours for medical residents mandated two years ago by the Accreditation Council for Graduate Medical Education, the one-year program aims to produce highly qualified physician assistants who can help bridge potential gaps in coverage.

Like nurse practitioners, P.A.'s emerged in the late 1960s, mostly in response to a nationwide doctor shortage. After completing their two years of training (Cohen, for example, graduated last September from Yale's P.A. program), they can write orders and practice medicine under the supervision of a physician. Residencies, which provide specialized training, are optional. The program here—one of only 15 in the nation offering postgrad surgical instruction—received 72 applications for its six spots.

Trainees rotate through the intensive care units and spend seven or eight weeks in various surgical specialties. They attend grand rounds, specialty lectures and morbidity and mortality conferences. They handle many of the same tasks as medical interns, such as taking histories, doing physicals and writing orders. They also learn invasive procedures and surgery techniques, which they can perform with appropriate physician oversight.

And, like their M.D. counterparts, these P.A.'s put in 80-hour weeks. Still, says Lisa Rotellini-Coltvet, “we have only one year of this rigorous schedule. The medical residents have many more ahead. It makes you appreciate the physician you work for.”


Student Aid

The three deans:  Michael Barone, Crystal Simpson, Redonda Miller.
> The three deans: Michael Barone, Crystal Simpson, Redonda Miller.

One thing became abundantly clear when Frank Herlong stepped down last spring to end his 15-year run as associate dean of students. “The man,” says Michael Barone, “was a magician.”

Indeed, the job of advising the School of Medicine 's more than 400 students has become so large that Barone is just one of three faculty members who've been tapped to shoulder the expanding role with Tom Koenig, who assumed Herlong's former title last July. Also joining Barone as new assistant deans in the student affairs office are Redonda Miller and Crystal Simpson.

Among the undertakings that put Barone in such awe of Herlong's prowess are the personalized, five-to-six-page letters that go out every fall to residency program directors on behalf of the 125 or so fourth-year students. “It's a monumental effort that takes about seven hours per letter,” Barone says of analyzing transcripts and interviewing all members of the graduating class about their achievements and aspirations. “And Herlong used to write every single one. We got on the treadmill going about a hundred miles an hour but I think we ended up doing a really good job.”

Besides jumping in as career counselors to the entire student body and making themselves easily accessible for any students who may be having a rough go, the new deans also are being asked to weigh in about revisions to the medical school curriculum. And for that task, all have a natural bent. Simpson, for example, who's heading the newly created Office of Diversity within student affairs, started a highly visible summer scholars program in geriatrics here two years ago that's attracted minority medical students nationwide. Barone previously ran the clerkship in Pediatrics for six years, and Miller, long an active member of national clinical educational organizations, only recently relinquished her role as associate program director for the Olser Residency Program.

Also on their agenda: Collaborating with Koenig to revamp the advising system. One idea they've been tossing around is moving to what they call the “college” system, in which students still have one primary mentor but can seek out other faculty members as well. That concept, they stress, is still in its infancy and could easily change as they move forward. What's obvious already, though, is how much they enjoy bouncing ideas off each other. “We do work well together,” says Miller.

Mary Ann Ayd



Secrecy Rules

Just when everyone was getting the hang of the Health Insurance HIPAA posterPortability and Accountability Act (HIPAA), along came another deadline. By April 20, all health care organizations had to have ways to keep patient health information stored on computers secure. To illustrate the importance of maintaining confidentiality online, posters like this one went up throughout Hopkins . The send-up of the comic-strip paintings by pop artist Roy Lichtenstein was developed by Peter Tully Owen, a staff graphic designer.

 

Anne Bennett Swingle

 

 


A Culture All Its Own

The Micro Lab
Few people here are more attuned to germs than the staff in the Medical Microbiology Laboratory. Amid a warren of labs in the Meyer basement, the Micro Lab hums 24/7, testing for viral, bacterial, fungal and parasitic infections, and providing results on 460,000 patient specimens a year. It's hardly all microscopes and reports, though. The lab recently completed a clinical trial of a faster method for detecting methicillin-resistant staphylococcus aureus (MRSA), a superbug not only well established in hospitals everywhere but now also turning up in the community. Molecular testing expert Mian Cai developed a polymerase chain reaction test that identified the particular toxin in an MRSA strain that brought several previously healthy people to Hopkins last winter. The Micro Lab became one of the first clinical labs in the country to use this assay and is now receiving requests for it from throughout Maryland and beyond.

Anne Bennett Swingle


Freedom is Academic

 

The Dutch have a word—gedogen, something that's tolerated but not approved—that sums up their approach to difficult social problems. The sense of that word also suits this country's response to the political dilemma posed by embryonic stem cell research. While the federal government, remains neutral on the conduct of the work, though clear on what will be publicly funded, the state of Maryland , home base for this University, still has no policy at all. Johns Hopkins, however, is decidedly unambiguous on this issue. It has issued a firm public statement in support not only of stem cell research but also of using research cloning to produce stem cell lines genetically identical to the donor of the original cell nucleus. And not surprisingly, the University strongly opposes using that latter technology to create a cloned human being.

The Hopkins policy, posted on its Web site in July 2004, provides a clear and specific rationale for support of stem cell research from embryonic, fetal and adult tissue. It also supports therapeutic cloning. “It's a significant statement,” says physiologist John Gearhart, one of the first researchers in the world to recognize the amazing plasticity of undifferentiated stem cells and their potential for replacing cells in the body that have been damaged. The policy, Gearhart says, shows unequivocally “that the University is in favor of research using human embryos to derive stem cell lines that could match a patient or be used to study different disease processes.”

Deborah Rudacille 

 
 
 
 
Features
 Change of Heart
 Irrepressible Dr. De
 The Heat Is On
 
Departments
 Circling the Dome
 Medical Rounds
 Annals of Hopkins
 
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 Learning Curve
 Post-Op
 
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