Health Sciences Report Winter 2005

What principle that you learned as a medical student has remained fundamental to your medical practice through the years, especially when considered against the ever-changing background of scientific discoveries and technological developments?

  • Hiroshi Kuida, M.D.
    Class of 1951

    I was an impressionable (and ignorant) third-year medical clerk when I was assigned to a private patient of Maxwell M. Wintrobe, M.D., Ph.D., who had been referred because of an abdominal mass thought to be an enlarged spleen. Besides being examined by me, the patient was examined by a medical intern, assistant medical resident, chief medical resident, hematology fellow, and Dr. Wintrobe himself. There was unanimous agreement that the mass was, indeed, an enlarged spleen in the left upper abdominal quadrant. Consultation from Phillip B. Price, M.D., chief of surgery, was requested prior to a prospective splenectomy.

    Dr. Price arrived on the ward and asked me to accompany him on his examination of the patient. I was spellbound (flabbergasted, actually) by the exquisite attention he paid to the details of his abdominal examination, which included palpation while the patient was asked to position himself in every conceivable posture, including on his hands and knees on top of the bed.

    I lost all track of time, but I believe this process took more than 30 minutes, at the conclusion of which Dr. Price told me that he felt the mass represented a tumor of the mesentery! The next day, that was surgically confirmed, and the mass was resected.

    Two years later, I elected to take a two-month rotation on the surgical service to enhance my exposure to Dr. Price and his "classical" approach to medical practice: painstaking, patient, nonjudgmental, objective, undistracted, humble, and compassionate. Dr. Price personified the highest standard of Oslerian medical practice and, along with other faculty member (such as Val Jager, M.D., Ralph C. Richards, M.D., and Gerald Perkoff, M.D.) served as a model for my emulation. It is to the extent that their high expectations became our own that we alumni measure personal achievement and a sense of accomplishment.

    Dr. Kuida, professor emeritus of internal medicine, retired from the U School of Medicine in 1991 after serving 17 years as chief of the Division of Cardiology and nine years as associate dean for student programs.

  • Camille Collett, M.D.
    Class of 1983

    I still remember one of the classes I took in my first year of medical school. This was an elective entitled "Patient Advocate Course." The purpose was to allow the freshman student actual contact time with a patient. The student could get to know the patient's condition, but more importantly, get to know the patient.

    My assignment was a woman with placenta previa, who had been confined to her bed at her home. I was to be a communication channel to her physician, Klea Bertakis, M.D., a family practice resident at the time. The patient shared with me her concerns and needs, so that I could be her advocate. I spent time getting to know how this complication of pregnancy affected her and her family. Dr. Bertakis appreciated the information her patient had shared with me, and she proved to be a wonderful mentor. When the woman went into labor, Dr. Bertakis called me to watch the delivery. The previa had resolved, and I witnessed the miracle of birth.

    It takes time to be an advocate for a patient and time to be a mentor. I appreciated the opportunity to learn how to be an advocate for the patient and enjoyed the mentoring provided by Dr. Bertakis, who later became chair of the Department of Family Practice at the University of California, Davis. I have had many mentors during my medical school training. Two others whom I want to thank for teaching me how to be a patient's advocate are Kristen Ries, M.D., professor in the U Division of Infectious Diseases, and Barbara D. Reed, M.D., M.S.P.H., who was associate residency director of the U Family Practice Program when I was in training and is now professor of family medicine at the University of Michigan.

    Medical knowledge is constantly changing with new technologies and discoveries, but the human factor in the doctor-patient relationship is fundamental to the art of medicine.

    Dr. Collett is assistant professor of family and preventive medicine at the U School of Medicine, and practices family medicine with obstetrics at Oquirrh View Community Health Center in Kearns, Utah.

  • James L. Parkin, M.D.
    Class of 1966

    During the 1964-65 academic year, I was on the medical wards at the old county hospital as a junior medical student. A patient referred from Kansas was admitted with a stated bleeding problem. He reported hemorrhaging after cuts and was frightened, because he was scheduled for surgery and did not want to bleed to death. I was assigned to his case and did a thorough history, physical, and laboratory testing.

    Since Maxwell M. Wintrobe, M.D., Ph.D., was the attending, you can be assured the workups by me, the intern, the resident, and the fellow were thorough. We then gathered and discussed the case before presenting it to Dr. Wintrobe. Since all of the lab tests were normal, we started a conversation about hypochondriasis, crockery, serum porcelain levels, etc. Dr. Wintrobe, after hearing our presentation, ordered an additional blood sample drawn, which was taken to his research lab. This blood test revealed the patient had a rare subfactor VII deficiency, not described then in the textbooks, which explained his bleeding disorder.

    This amazing teacher, Dr. Wintrobe, not only taught me that day about coagulation disorders, he also taught by example an important principle about how to approach patients with inexplicable complaints. That experience assisted me throughout my years of training and practice. When I encountered patients whose problems were not clearly diagnosed by a thorough work-up, I did not jump to the hypochondriasis conclusion, but tried to remember that, as smart as I thought I was, and as smart as others were, and as smart as lab and radiographic studies were, we still did not understand everything. I tried to give the benefit of doubt to the patient and not make a psychological diagnosis I did not understand.

    We continue to make amazing new scientific discoveries and technological advances. If we knew everything, these advances would be superfluous. Progress will continue to provide answers to questions for those with inquisitive and open minds.

    Dr. Parkin, professor emeritus of surgery, retired from the School of Medicine in 1996 after serving as chair of the Department of Surgery for two years and as chief of the Division of Otolaryngology, Head and Neck Surgery for 18 years.

  • Richard Black, M.D.
    Class of 1974

    As a surgery resident, I was asked to consult on a man who had severe abdominal pain. His symptoms and signs were puzzling. After examining the patient, reviewing the pertinent laboratory and X-ray studies, I presented the findings and a list of differential diagnoses to my attending, Ralph C. Richards, M.D., professor of surgery. He was a favorite among the housestaff in general surgery and beloved by his patients. He asked me thought-provoking questions and then told me that, when I came to a decision as to what course of action to follow, to let him know.

    I was hoping he was going to make the diagnosis for me and prescribe a course of treatment. He did neither, but he did give me some advice that has stayed with me all these years. Dr. Richards said, "This man is counting on you to care for him, to make the correct diagnosis, and render appropriate care, and, above all, to render that care with the compassion that you would afford a family member."

    The words of my mentor, over four decades ago, are even more cogent today in our fast-paced, impersonal system of medical testing and treatment.

    Dr. Black is professor of surgery in the Division of Pediatric Surgery at the U School of Medicine and practices at Primary Children's Medical Center in Salt Lake City.

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