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Spring 2014
BMM Current Issue
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Letter from the Dean

Never a Dull Moment

It’s been quite a spring in Providence. Match Day is always exciting, and this year the students matched at many of the best residencies in the country. In fact, one-third matched at top-10 medical schools, as ranked by US News and World Report. As always, we held a big celebration. Students opened their envelopes, yelled, hugged their friends and families, and texted everyone they know. This year the celebration was held in the new Medical School building, with a big balloon drop in the atrium. See complete Match results in this issue.

We are sorry to note that this is our last semester with Brown’s iconic leader, President Ruth Simmons. During her years here, President Simmons has pushed Brown toward becoming an outstanding research university while preserving the unique undergraduate environment—quite a feat. Her vision of meaningful, truly interdisciplinary research has been achieved in many areas, such as the Institute for Brain Science (BIBS). BIBS has superb scientists on the Brown campus who are collaborating with their hospital colleagues from several clinical departments. Their work is highlighted in these pages. Another example of superb science is described in the profile of Professor Aggie Kane, chair of the Department of Pathology and Laboratory Science. Aggie, who collaborates with Professor Robert Hurt in Brown’s School of Engineering, is a leader in the application of nanotechnology.

Sadly, this has been a season of farewells. Nelson Fausto in particular will be missed. Nelson was among the founding fathers of our Medical School and a dedicated mentor and educator in pathology at Brown University. He inspired numerous graduate students, medical students, postdoctoral researchers, and young faculty to pursue research in environmental health and human disease.

Edward J. Wing

Letter from the Editor

Time Lapse

Thanks to a scheduling fluke and a show of faith, I was given the opportunity last fall to teach an adult writing course for Brown’s Office of Continuing Studies. The exhaustion of preparation on top of the demands of full-time life almost killed me, but I signed on for a second semester. Why? Because of the students. I love them.

Every week when I walk into the classroom, my heart lifts. Class takes place in the early evening, just as most of the working world is calling it quits and putting its feet up. My students have all had full days, but they come back, week after week, and open their notebooks and minds. There is a moment in every class when I look out at their faces, see them squinting at the page and then at me and then back at the page, puzzling out restrictive and nonrestrictive clauses and semicolons and dashes, caring, perhaps for the first time, about words and how they work, and I am moved. They bring curiosity and skepticism and a willingness to learn. I hope that our medical students,too, as they graduate and grow up and older, will make good on their commitment to lifelong learning.

Two milestones are looming at Brown: the end of the presidency of Ruth Simmons and my 25th reunion. While one will be recorded in the annals of the University and one will not, both are hard for me to apprehend. Didn’t I just meet my freshman hallmates—people who have shaped my life—a moment ago? Could almost 30 years have passed since we played that find-the-matching-shoe icebreaker? And wasn’t the campus just recently rejoicing over the news of Ruth’s appointment? This inability to grasp the linearity of time reminds me of E. B. White’s description of a young circus performer riding her horse in circles under the Big Top: “She is at that enviable moment in life,” he wrote, “when she believes she can go once around the ring … and at the end be exactly the same age as at the start.” I could be that girl’s mother, but I feel exactly the same way.

Sarah Baldwin

Letters to the Editor

As Seen on TV

In “Sorry, Dr. House” (Winter 2012), Noah Rosenberg is absolutely correct, and his father-in-law overlooks some serious chinks in Gregory House, MD’s armor. Most notably, House never gets it right. At least not right away. It is understandable that a physician misses the correct diagnosis once in a while, but EVERY SINGLE WEEK? True, he comes through in the end, but not before two erroneous guesses and as many cardiac arrests, near-exsanguinations, and other disasters befall his patients. His “team” is reminiscent of rock musicians who, as an encore, play each other’s instruments: the endocrinologist operates, the infectious disease specialist performs ultrasounds, the nephrologist treats teen pregnancies. And the legal team on Harry’s Law couldn’t save his h ospital from loss of accreditation, considering the weekly sins against conflict of interest, confidentiality, personal health information protection, and other violations. (As everybody knows, there is nothing worse than to watch your favorite medical show with a doctor. Or a cop show with a police officer, or Six Feet Under with a funeral director. Unless you enjoy hearing someone complain incessantly about how they got it all wrong.)

But I don’t agree with his main gripe with House—that the days of the doctor as individualist are gone. Despite the strength of the team, the importance of a multidisciplinary approach and the partnership between physicians, nurses, operating room technicians, respiratory therapists, and other health care professionals, the patient forms a unique, one-on-one relationship with “his” doctor. That doctor can be a family physician, an emergency medicine specialist, a hospitalist or a surgeon—but the degree of trust it takes for someone at his most vulnerable to place his life in someone else’s hands implies a very personal bond. Medicine is not a democracy, but a consultative dictatorship. There is no excuse for yelling at a nurse, belittling a resident or throwing a bloody sponge at a student, Medical decisions, however, are not made by consensus—certainly not the urgent ones, and current medical practice relies as much on the leadership of the physician as it did in John Hunter’s days.

Sure, when things go well, the doctor may get much more credit than he deserves— it is, after all, thanks to an entire team that the operation was a success, the delivery went without a hitch, or the treatment worked. And when things don’t go so well, the patient’s doctor may get more blame than he deserves— one person cannot be expected to know everything and be present at all times. Communication is more important than ever in medicine, as are collaboration and consultation. But one person ultimately answers to the patient. And the patient is less likely to ask “Who is my team?” than “Who is my doctor?”

François Luks, MD, Professor of Surgery, Alpert Medical School

Home Delivery

I was intrigued by the report on associate professor Catherine Beard’s clinical trials to test the efficacy of therapy delivered by computer to treat social anxiety (Winter 2012).

My mother-in-law spent her empty nest years working with high-risk youth in the small, economically depressed and insular community where she’s resided for nearly three decades. Since her retirement, the episodic panic attacks that have plagued her since youth have increased in frequency and intensity to the point where her participation in even relatively straightforward tasks is significantly compromised.

Finding confidential therapeutic intervention locally proved impossible due to her former professional relationships with mental health professionals, so she drives more than an hour for each appointment with a therapist in the town where her son and I reside. While Medicare lowers her out-of-pocket costs, the $45 co-pay is still significant for someone on a fixed income. Then there’s the rising cost of gasoline and the fact that Mom can’t make the commute alone in one day, so she and my father-in-law make an overnight trip for each appointment.

Projects like Dr. Beard’s could be transformative for my entire family. Electronic delivery of mental health care is promising not only for underserved populations, including low-income, house-bound, and elderly people, but also for those with concerns about confidentiality.

Name Withheld

 
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