Teaching and Learning Moments
Facing the attending physician was more difficult than usual. Although stunning, the light reflecting off Lake Michigan caused all members of the medical team to squint while on chief of service rounds. It was an unusually warm Thursday in April 1983 at Chicago’s Michael Reese Hospital, at the time a nationally renowned teaching institution and major affiliate of The University of Chicago.
The student subintern presented the story of a man who came to the emergency room 72 hours earlier with frothy urine, an impaired sense of taste, and shortness of breath. After reciting the differential diagnosis, the student awaited the drill of questions and the inevitable moment when, without an answer, the focus would turn to others on the team. This afternoon, however, the chief of service engaged the student and the patient in a conversation not about the differential diagnosis of amyloidosis but of the patient’s life—his family, occupation, interests, and hobbies—and how this diagnosis would impact the patient and his wife, his work, and his prognosis.
I was the fourth-year-student presenting at the bedside on that April day and Dr. Jordan Cohen, then chairman of the Department of Medicine, was conducting chief of service rounds. I learned a foundational lesson for my career in medicine that day on 6 Main Reese. Beyond cutting-edge technology and scientific advances, there is a patient with a story whose life in context means far more than diagnosis and prognosis in isolation. In this bedside teaching session, Dr. Cohen communicated the values of humanism and professionalism, which lie at the core of the doctor–patient relationship and of medicine itself. Most of all, our conversation regarding this patient left an indelible mark that is still with me more than 20 years later.
Little did I know then, that this was the first of many lessons I would learn from Dr. Cohen. Over the years, he became a role model, a mentor, the wise one—whose advice I would later seek for my own career path. The compelling themes about science and values and the profession that he professed at the bedside in 1983, I would later hear him espouse from the podium at national meetings, in written papers and transcripts, and in personal conversations. His voice united us when government and insurers sought to pull us apart. His voice called for collaboration, compassion, and professionalism at a time when others were unwilling and always less articulate in laying out the challenge and calling us to action. His is a courageous kind of leadership offering a refreshing sense of hope and optimism when the profession has needed it most. Most of all, his voice is unwavering and steady in these turbulent times.
The same compassionate and steady voice that I heard at the bedside more than two decades ago is the voice that has led academic medicine faithfully and boldly into the 21st century. Boldness without a moral framework will not stand the test of time; and so his commitment to the higher purpose found in becoming a physician has kept the dream alive for all of us. Today, I squint not because of the sunlight, but in restraining the emotions of deep gratitude for the multiple moments in my own career when academic medicine’s chief of service touched my life.
By strengthening our explicit commitment to the ethical underpinnings and moral imperatives of the doctor–patient relationship, and by making that commitment unmistakably visible to applicants, to our students, to the public at large, and to ourselves, we can ensure that the best and brightest continue to clamor for entry into medicine, the most appealing of all possible human endeavors.
—Jordan J. Cohen, MD, from the President Address presented at the plenary session of the 112th annual meeting of the Association of American Medical Colleges. This address was published in Academic Medicine (2002;77:475–80).
Holly J. Humphrey, MD