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Never, Ever Forget the Patient

Posted by Emmi Solutions on Oct 23, 2012 3:30:13 AM
A Letter from the Editor: Geri Baumblatt

Geri Baumblatt Geri Baumblatt, Editorial Director
In yesterday’s article, Dr. Jim Merlino asked, “How do we interact with patients? How do we manage the clinic or bedside encounter? How do we organize information? How do we communicate?”
The day after reading those words, I observed a focus group where the discussion became pretty animated and one of participants said something like, “It’s not like when I was growing up. You just don’t know your doctor that well anymore, and they don’t know you! And they don’t have time to get to know you or explain things to you. Am I right!?” Three others in the focus group nodded in agreement. Happily, two didn’t – and explained they switched to doctors who do spend time with them. Still, 2 out of 6 – not ideal.
Then I read Dr. David Rubin’s amazing tribute to his mentor Dr. Kirsner. And it seemed to encompass so much of the bedside manner, connection and communication patients long for. So today, we share this tribute.

Featured Guest Blogger: David T. Rubin, MD

In Memoriam of Joseph B. Kirsner

David T. Rubin, MD David T. Rubin, MD

We are here today to pay tribute to a magnificent man, Dr. Joseph Barnett Kirsner. I’ve known Dr. Kirsner for half my life. I met him when I was 22 years old and my career in medicine was just starting, but was privileged to know him through the last chapters of his incredible life. He has been my teacher, my mentor and my friend. My wife Becky and sons Danny and Michael and I considered him to be part of our family.

As some here know, my story begins with my Grandmother and my first month of medical school.

She said: “Go see if my doctor is still there. Tell him I said “hello” and “thank you”.

“Who was your doctor?” I asked.

“Dr. Joseph Kirsner.”

Hello and Thank You.” Fateful words that my Grandma Pearl said to me in September 1990. Grandma Pearl had Crohn’s disease. I didn’t even know what Crohn’s disease was at the time.

Dr. Kirsner took care of Grandma Pearl in 1955. 35 years later, she still remembered him fondly and wanted her grandson, the first year medical student and the first Rubin to go to medical school, to meet him. I dutifully went to look for this doctor, who I thought must be long retired by now.

My first meeting was symbolic of who Dr. Kirsner was as a teacher and mentor. I knocked on his door without an appointment, and he answered (his two secretaries must have been out), invited me in, and as I stepped over the threshold into his office, my career in medicine was forever changed.

Dr. Kirsner epitomized everything I could hope to be and imagined a doctor was. I walked into his office, and what an office! He had this large stately wooden desk and he was surrounded by the emblems of his achievements, recognition, scholarship and years of wisdom. Behind him were volumes of books (many written by Dr. Kirsner himself), and on the wall opposite the diplomas and honorary degrees and awards was an entire wall of inspirational quotes. Each one of them had a specific meaning. There were quotes about medicine, about humanity, about fundraising, about loyalty. Each represented the qualities that Dr. Kirsner valued in himself and in others.

I sat in a worn red leather chair opposite him. It felt too big for me.

Dr. Kirsner asked me about my grandmother. “I remember your grandmother,” he said. “She was in a clinical trial we had using steroids for Crohn’s disease”.

Everybody remembered Dr. Kirsner, but could Dr. Kirsner really remember a patient from 35 years ago?

You bet he did. And he remembered so many other patients too.

And of course they remembered him -- they adored him. They worshipped him. Many of them credited him for saving their lives. I later learned that there was a legend that if Dr. Kirsner touched your abdomen, you would be healed. How does a doctor become a legend? It became clear the longer I knew him.

"Everybody remembered Dr. Kirsner, but could Dr. Kirsner really remember a patient from 25 years ago?  You bet he did."

Our meetings continued from that time. He would summon me to his office or I would schedule an appointment. We would meet from time to time, and he would always encourage me in my career. I treasured those meetings and sitting in that big red leather chair.

A number of years later, I was choosing my specialty in internal medicine. Believe it or not, I hadn’t yet decided if gastroenterology was for me, but I also hadn’t discussed it yet with Dr. Kirsner. I was walking down the hallway on my way somewhere else, and happened to run into him. Our conversation was brief. In fact, my recollection is it went something like this. “Hi, Dr. Kirsner.” He responded, in his booming strong voice, “don’t go into cardiology! We need you in gastroenterology.” And then he walked on.

And so it was.

Although I didn’t work with him at his peak time with patients like Steve described, I did have the great opportunity to work with him as a fellow. I witnessed firsthand what so many others had seen and learned and so many patients craved. He was a great interviewer, a marvelous listener, and he provided certainty of diagnosis and HOPE when others could not. He gave a name and a prescription for health when patients had been lost in the desert of illness and seeming incurability. He became the patient’s “quarterback” (a term that I’ve adopted). He earned their trust in a matter of minutes with his interactions.

I watched him examine a woman’s abdomen once: his exam was nothing like what I had been taught as a second year medical student. He was so gentle that at the time I thought he was just touching the patient to let her know he was there. Years of experience later, I learned that his gentle approach was (of course) the best way to examine an abdomen. I’ve taught many fellows and students this since then.

Shortly after I finished my training, Dr. Kirsner, who was 92 years old at the time, called me to his office. I sat in the same red chair that had held me so many times before. He took off his glasses and looked at me. I had never seen him with his glasses off.

“David,” he said, “I’ve decided to retire.”

I think my reply was, “you are kidding me!?” “really??”

To which he said, “In three years--- at the age of 95 -- I am going to stop seeing patients.” He submitted his three year plan to the Dean.

As an aside, Becky and I recently saw a framed letter from the President of the University from 1974 hanging in Dr. Kirsner’s home study. It was congratulating Dr. Kirsner on being named the first Louis Block Distinguished Service Professor, and the letter also let him know that “upon reaching the age of 65, you will be offered a three-year deferred retirement.”

So, here we were 30 years later…His Grand Rounds was brilliant- he delivered it with that booming voice, stood next to the podium but never leaned on it, and ended exactly on time. So of course, shortly after that one, he decided to do it again.

He then submitted a two year plan to the Dean. I asked him why only two years this time. His response: “I’ll be 100 years old. I think that’s a nice round number and a good place to stop.”

So the reprise of Grand Rounds came with more “breakfasts with JBK” and his second Grand Rounds to the Department of Medicine. At the age of 100, he delivered a lecture on “The History of Gastroenterology”. Remember, when he started his training, there were not even antibiotics yet and peptic ulcer disease was a major cause of morbidity and mortality in our country. It was a remarkable presentation. He could have easily called it: “How I created the profession of gastroenterology and what we need to do next…”

It was a tour de force. But so much of what he did was exactly that.

He really put things in perspective for us all. He taught me that we may have made remarkable progress in medicine, but the fundamentals of our educational system and caring for the patient in the modern era remained the most important. He wrote in a paper about education in gastroenterology in 1973 which is equally relevant now: “…the essence of gastroenterology is service to sick people; a function dependent upon the continuing flow of new information, continuing medical education and continuing attention to the human needs of the patient.”

Over time, I came to realize that many of the current challenges we face in medicine today, whether sociological, political or technological, Dr. Kirsner had faced in his own time years ago. And in every one of these situations, he had developed a plan, had intervened in some way, had written about the challenges, but had always remained optimistic and believed that the future would be better. We could all learn from that approach. Dr. Kirsner never shied away from these challenges. He embraced them and worked to solve them.

He was blessed with a long life, and lived long enough to reflect on the successes and failures of medicine and our profession. I think one of his defining moments in the latter part of his career was when he was addressing an international audience in Europe and apologized for the time when gastroenterological illnesses were being driven by psychology, to the exclusion of other scientific investigation or mechanisms. He warned me “Don’t adhere to dogma.” That advice really stuck with me.

Dr. Kirsner truly enjoyed reading about new discoveries and learning about what our colleagues were doing elsewhere. He was known for sending personal notes to the authors, and many have told me how much they treasure those messages, from such a legend, when they hadn’t even met him! Within the University, he would frequently cut out articles or put entire journals into our mailboxes, with a simple note “From the desk of Dr. Joseph B. Kirsner” and “FYI” or “Dr. Kirsner thought you’d be interested.” Even if I had no idea what the article was about, I knew that if Dr. Kirsner sent it to me, I should take the time to review it.

But the ravages of age took their toll. It was a cruel irony that this man of letters, this scholar, lost most of his vision as he aged. That this incredible physician, who taught everyone who worked with him the value of the detailed patient history and listening to the patient’s story, lost most of his hearing as he aged. But thankfully, his other senses were sharp, including his gentle touch, and his clinical insight and intuition. And that booming, strong voice and his incredible story-telling, and the institutional memory of all of our societies and our profession.

Dr. Kirsner became a part of our family. Some of you know that my wife Becky became his secretary and assistant these last two years. She was perfect for the job. She knew all about him, she adored him, and she is an amazing and nurturing caregiver. She and I would compare notes each day on how “Dr. Joe” was doing and what he needed. I am so grateful to Becky for her love and care, and I know Dr. Kirsner was too. He used to light up with a big smile when she came to visit him or to pick him up at home. She loved that smile.

Together we compiled a list of some other things you may not know about Dr. Kirsner:

  • One of the primary reasons Dr. Kirsner dedicated his life to medicine was to make his parents proud. He told us about his father who worked so hard to raise the family, and his mother who he referred to as “an angel.” In turn, he was very proud of his son and grandchildren and great grandchildren and loved to keep us posted of their accomplishments.
  • Dr. Kirsner loved sports, and followed baseball, basketball and football, professional and college. First thing in the morning he would always check the scores.
  • Dr. Kirsner loved eating at the Drake Hotel! Some of you here today I’m sure enjoyed a meal there with him.
  • Dr. Kirsner was fiercely loyal, and valued that quality in an individual as one of the most important.
  • Dr. Kirsner was patriotic and was especially proud on Veterans Day and Memorial Day. He would often wear an American flag lapel pin. He had recently asked Becky to obtain a red, white and blue bow tie.
  • He never missed voting in an election, local or national.
  • He made lists for everything that he did, including how to handle the end of his life and even today- especially today, which he reviewed with me more than once.
  • Becky and I never heard him say a bad word about anyone.
  • He was blessed with amazing and dedicated caregivers and assistants at the end of his life, including Livia, Erica, Harry’s assistant Marianne and my wife Becky, among many others across our university and Chicagoland communities who provided him with the selfless care that he had for so long provided so many others.

We are faced with the end of an era in medicine, and certainly in Gastroenterology. A great leader and a shining beacon of humanity has left us. But it is clear that he made the world a better place, and his legacy is indelible.

He epitomized a life well-lived, and a life of service to others.

What we can learn from Dr. Kirsner:

  1. Strive for excellence in everything you do.
  2. Always have a goal and a plan.
  3. Don’t stop when you reach 100 years old, just modify your plan.
  4. Don’t adhere to dogma. Always challenge the status quo.
  5. The easy path is not always the right one.
  6. Be loyal and patriotic.
  7. Vote.
  8. Remain optimistic about the future, and provide HOPE to those who need it.
  9. When you or your profession make a mistake, own it, apologize for it, and learn from it.
  10. Recognize the achievements of others with a personal note or comment.
  11. Support the next generation by being a good mentor.
  12. Never, ever forget the patient. The patient who is suffering should always be at the center of everything we do.

"He epitomized a life of well-lived, and a life of service to others."

Yesterday I stopped by Dr. Kirsner’s office. The same place where I met him 22 years ago.

I sat in the same red chair, which now felt smaller.

I noticed the inspirational quotes on the walls, and one that I had never noticed before was pinned to the bulletin board behind his desk:

Do not stand at my grave and weep
I am not there; I do not sleep.
I am a thousand winds that blow,
I am the diamond glints on snow,
I am the sun on ripened grain,
I am the gentle autumn rain.
When you awaken in the morning's hush
I am the swift uplifting rush
Of quiet birds in circling flight.
I am the soft starlight at night.
Do not stand at my grave and cry,
I am not there; I did not die.

His legacy lives on through all of us, and through those that we touch and those that our profession will continue to serve. I have no doubt that right now, he is making plans and probably reorganizing everyone in the world to come.

My time with Dr. Kirsner started with “hello and thank you” from Grandma Pearl. Today it ends with “goodbye and thank you” from all of us.

About the Author:

David T. Rubin, MD is a Professor of Medicine, Co-Director of the Inflammatory Bowel Disease Center, and Associate Section Chief for Education at the University of Chicago. He’s also an associate faculty member at the MacLean Center for Clinical Medical Ethics and an associate investigator at the UC Comprehensive Cancer Center. In 2012, he received the CCFA’s Rosenthal Award, a national leadership award honoring a volunteer who has contributed in an indisputable way to the quality of life of patients and families. He’s the editor of a best-selling book on IBD, and an author or coauthor of many peer-reviewed articles on IBD, virtual colonoscopy, genetic testing in IBD, and cancer in IBD.

Topics: Opinions, Patient Communication, Shared Decision-Making, Patient-Centered Care, patient engagement, Evidence-Based Medicine, Health Literacy, Patient Safety, patient experience, empathy, End-Of-Life, Science-Based Medicine, Patient Education

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