A look at the paths four internists took to Fellowship
By Brad Dunevitz
Editor's note: ACP-ASIM Members who advance to Fellowship represent a diverse group of internists who have proven their commitment to continuing scholarship and professional accomplishment. In this article, we highlight several individuals who have recently become Fellows who show the depth and uniqueness of College members.
Years of Service
Charles E. Brown, FACP
Chef Julia Child poured her first television omelet when she was in her 50s. Astronaut John Glenn, at age 76, is suspended in history because of his 1998 space launch.
Charles E. Brown, FACP, of Atlanta, scoffs at those young folks. Last year, at age 87, he became the oldest College member to advance to Fellowship.
While he had always admired the status and recognition that comes with College Fellowship—he calls it a "status symbol among physicians"—he had not applied because of the prior emphasis on being published. When the College broadened its pathways approach, however, he was encouraged to apply by Mark E. Silverman, FACP, the College's Governor for Georgia.
Dr. Brown, who retired from medicine in 1994, shrugs off his slice of fame. "I'm the College's oldest new Fellow, for whatever that's worth," he said.
To his former patients, however, it's a well-deserved honor. Dr. Brown was known for making housecalls during his 47 years of practice in the Atlanta area, right up until his retirement.
He recounted his most challenging housecall, which began with a phone call that jarred him from sleep at 2 a.m. "Dr. Brown, come quick!" the lady's voice cried on the other end of the phone. "Jake's doing it again," she yelled before hanging up.
"I thought, 'Who's Jake, what's he doing again and where does he live?'" Dr. Brown recalled.
After careful thought, he remembered a patient named Jake who experienced convulsions—but had an unpublished phone number. "I racked my memory and recalled he lived on one of three parallel streets in the Morningside neighborhood, on the right side, in a duplex with the address on a tree in the yard," he said.
"I found a duplex with the lights on, the address was on a tree, a lady was at the door, I went in and there was Jake having a seizure."
Housecalls were not the only thing that distinguished his nearly five decades as a physician. On his way to what would eventually lead to College Fellowship, Dr. Brown took a less-traveled path through medical school.
He earned his bachelor's and master's degrees around the time of the Depression, when money was tight. He secured a teaching job at a junior college and worked a part-time job at the pharmacology department at Emory Medical School, where he completed his first year of medical school by attending summer sessions. His sophomore year was spread over six years while he taught part time. During his junior and senior years, he went to school full time. Finally, in 1943, he became a medical school graduate.
Then, in 1945, Uncle Sam came calling. While he was awaiting orders to be stationed in the Pacific, the atom bombs were dropped on Japan. As a result, he found himself in Germany in the medical department of the military government performing nutrition surveys.
After the war, he went into practice in Atlanta, but was called back for 13 more months of service in Korea.
Finally, he returned home and went to work for the Massee, Burge and Brown internal medicine group. He ended his practice career in 1994 as an internist at Piedmont Hospital.
For two-and-a-half decades, he taught—on a volunteer basis—senior students at the diabetes outpatient clinic at Grady Hospital of Emory University's School of Medicine, rising in rank to professor emeritus. He continues to hold a full-time job as medical consultant with the Social Security Administration's disability branch, reviewing claims for people who feel that they have reason to be considered medically disabled.
Balancing professional and family life
Helen Collins-Jones, FACP
One evening, after cooking dinner for her three children, Helen Collins-Jones, FACP, sneaked in a quick trip to the grocery store. Reluctantly, she decided not to buy ice cream because she knew it would melt before she could get home from her next stop: a presentation by a leading rheumatologist.
At the seminar, "I asked my questions and quickly got out of there so the milk wouldn't spoil," said Dr. Collins-Jones, an internist at L.Q. Medical Group in Fresno, Calif., and hospice director at St. Agnes Medical Center.
It was all part of a typical day for the doctor, who works hard to balance her personal and professional lives. Dr. Collins-Jones, who last year became a Fellow of the College, prides herself on her ability to use some of the lessons she has learned from that balancing act to help her patients.
"Whether it's someone with a terminal disease or a teen-ager receiving a physical," she said, "I feel I can help them 'get' this thing called life, usually on some deeper level."
Dr. Collins-Jones said that she likes to think that her approach to medicine brings her closer to her patients. Her empathetic manner made her a natural fit for the job of hospice director, which she said has helped her learn even more about what's really important in life.
"I'm still getting wiser about life and what's important and valuable," she said. "I gather those pearls of wisdom, and I constantly borrow lessons from people who are at the end of their lives."
Her effort to nurture those values attracted her to the College. "The organization appeals to something that I could stick with consistently and could nurture me along beyond medical school," she said.
Dr. Collins-Jones resides in central California, which has no central university medical school. Fellowship in the College, she said, fills that knowledge void. "If the Fellowship wasn't available, I'd be professionally frustrated," she said. "Fellowship gives me a place to manifest growth."
Growth, whether it's personal or for her patients, is a driving factor for Dr. Collins-Jones. In increasing demand as a speaker, she has lectured at Fresno's Martin Luther King Celebration and was this year's keynote speaker at the American Association of University Women's career day.
"If what I do can take people from one place to a better place, I could do that all day," she said.
End-of-life care
Michael E. Preodor, FACP
The young internist watched helplessly as lung cancer stripped away life from an older, suffering patient. After applying the maximum one-milligram dosage of morphine, Michael E. Preodor, FACP, knew this wasn't the proper way to die.
"That day made an indelible impression upon me," said Dr. Preodor, who has since become involved in a pioneering search to improve palliative and end-of-life care. Dr. Preodor, who became a Fellow of the College last year, is president of the nationally renowned Horizon Hospice in Chicago and chair of general internal medicine at St. Joseph Hospital. He is also assistant professor in the department of medicine at Northwestern University Medical School and a general internist at Sage Medical Group.
One of Dr. Preodor's goals is to make sure that physicians assure patients that proper palliative care will be provided. "Patients who are not cured of cancer should at least be promised to have their pain controlled, their wishes met for the aggressiveness and the nature of care, and to have systems available to provide at-home care, if possible," he said.
Unfortunately, he said, medicine has a long way to go. He cited a recent $28 million study of 9,000 patients by the Robert Wood Johnson Foundation showing that physicians consistently misunderstand their patients' needs and wishes. "Even when told of patients' preferences," he said, "we often don't fulfill them. We can make dramatic changes, and we owe it to our patients who face critical illnesses."
A crucial factor, Dr. Preodor said, is physician education. "Physicians want to do what's right," he said. "If they're taught how to do this, and they do it well to the satisfaction of their patients and families and themselves, then everyone wins."
He explained that education is particularly important because end-of-life care rarely raises black-and-white issues. "The decision to treat pneumonia in a 90-year-old person who's at the end of life is not always a clear-cut decision," Dr. Preodor said. "Patients and families may not want to treat every pneumonia. You realize that it may be better to allow that person not to suffer and to die comfortably and peacefully, and to palliate but not necessarily cure."
Dr. Preodor learned many of those lessons when he first entered private practice 21 years ago. As the junior member of an internal medicine group, Dr. Preodor was assigned to a nursing home, light years away from what he experienced during residency. He learned to find strength, however, by watching families and patients support each other through the death of a family member. "When I see what families do for loved ones to help them through this transition, it's really inspiring," he said.
Hospitalism
Paul A. Ragatzki, FACP
Since helping pioneer hospitalism nine years ago at Detroit Medical Center, Paul A. Ragatzki, FACP, has worked hard to refine the movement and take it in new directions.
Dr. Ragatzki said that until recently, the working definition of a hospitalist was an internist who spent one-fourth of his time caring for hospitalized patients. Dr. Ragatzki's denotation, however, is more expansive: physicians who spend almost all their time committed to inpatient care.
"The concept is that a physician is in the hospital around the clock to tend to the patients' needs," said Dr. Ragatzki, who became a Fellow last year and is director of the hospital-based physician program at Harper Hospital, which is part of Detroit Medical Center and affiliated with Wayne State University. "It's a better way to deliver care as long as the number one drawback is resolved, which is maintaining good communication with the outpatient provider."
Harper Hospital's hospitalist program has improved quality of care and reduced lengths of stay and costs per discharge, according to Dr. Ragatzki. "We had fewer code blues in the hospital and mortality rates dropped," he said.
But Dr. Ragatzki hopes that hospitalists will do more than cut costs. In the long run, he foresees the hospitalist model helping physicians become more involved in using evidence-based outcomes to improve care.
"It can take up to five years for evidence-based medicine to reach a patient's bedside," he said. "Physicians' use of proven medical therapy isn't what it could be. ... We're working on monitoring systems to help our physicians practice evidence-based medicine and improve our performance in these areas."
Dr. Ragatzki helped pioneer the course for the hospitalist model when, as a physician at the Detroit Medical Center, he collaborated with the chief of medicine and internal medicine program director to develop the concept that's been popular in Canada, Germany and other countries for some time. He estimates that about 50 different hospitalist models exist in the United States.
An insatiable reader of medical literature who's committed to education, Dr. Ragatzki's goal is to bring industry innovations to his patients' bedsides "today instead of in five years."
"I would encourage the development of information systems with evidence-based guidelines for inpatient care and a code of ethics for conduct in communications to outpatient providers," he said of his medical mission. "I'd hold inpatient providers accountable for sticking to that.
"The final result would be outpatient providers who use hospitalists because they perceive doing so as a benefit to themselves and their patients," he said. "Outpatient providers should be there for their patients in both settings to the fullest extent that they can. When that's not possible, hospitalists can help."
Brad Dunevitz is a freelance writer in Denver.
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