Rheumatologists who are outstanding clinicians provide consistently exceptional care to patients and serve as role models for colleagues and trainees are in the spotlight in our “Lessons from a Master Clinician” series. Here, we offer insights from clinicians who have achieved a level of distinction in the field of rheumatology.
Calvin R. Brown Jr., MD, professor of medicine in the Division of Rheumatology of the Feinberg School of Medicine, Northwestern University, Chicago, is a member of a number of professional organizations, including the ACR and the American College of Physicians, and he is a past president of the Chicago Rheumatism Society. His research has been published in such journals as Arthritis & Rheumatology and The Journal of Rheumatology. He is the author of several textbook chapters dealing with arthritis, and his areas of focus include education in the rheumatic diseases, sports medicine and disability evaluation.
Dr. Brown was one of two recipients of the ACR’s 2018 Distinguished Fellowship Program Director Award. At that time, he told The Rheumatologist, “I devoted my entire career to training rheumatologists. To be recognized for this now, at the final stage of my career, caps off my career in the most gratifying way I could possibly imagine.”
What differentiates the master clinician is his or her ability to express knowledge to patients & trainees & to do it with a combination of confidence & humility.
TR: In your opinion, what makes for a master clinician?
Dr. Brown: To quote former Supreme Court Justice Potter Stewart, ‘I know it when I see it.’ [A master clinician] usually has tinges of gray hair and is engaged and active in professional meetings. The master clinician never gets a certificate to show that he or she has reached a level of mastery, which makes it hard to define. I think the ultimate sign of having achieved a level of significant skill and acumen is when other physicians seek you out to be their doctor. I never thought I had achieved a level of mastery, but the fact that other physicians have sought me out is one of the most gratifying experiences I can imagine.
TR: Who were some of your clinician role models and what qualities did you admire in these individuals?
Dr. Brown: At Wayne State University School of Medicine, Detroit, Mich., there were limited funds for research, and the medical school was full of clinicians who loved seeing patients. I was inspired to go into academic medicine from observing these role models in my medical school. This was especially true of internal medicine. I was in awe of how these clinicians could construct such brilliant differentials and cite the evidence supporting their diagnostic decisions. They knew the clinical literature inside and out.
Martin Lerner, MD, PC, MACP, was a specific mentor of mine. He was the chair of medicine and head of the infectious disease service. He had trained in Boston, and he wore a bow tie and was very proper on rounds. He was extremely clever and very knowledgeable. Oftentimes, before he went home in the evening, he looked up the patients who had been admitted that day so he could be prepared for rounds. He was brilliant and had very high expectations of those around him.
TR: What are some habits a fellow in training or junior rheumatologist can incorporate into their daily practice to build on their skills as a clinician?
Dr. Brown: The single most important habit is to be a really good listener. I was a training program director for 32 years, and I have listened to thousands of presentations. It is easy to let the mind wander onto other topics—Which train will I catch home? Do we need to fix the furnace?—but the most important thing is to listen carefully to trainees during case presentations. In the late stages of my career, I have begun to practice mindfulness to let extraneous thoughts go in order to be fully engaged. These skills and habits of mindfulness and attentive listening extend to the rest of life as well.
TR: What lessons have you learned from patients that have contributed to your own growth as a clinician?
Dr. Brown: The most significant thing I have learned is that the diagnosis may not be as important as how you relate that diagnosis to the patient. It is less essential to teach the classification criteria for lupus to a [fellow] than to teach how to express to a patient what it means to have lupus. Possessing knowledge is important, but even more so is showing what you can do with that knowledge.
TR: What do you think the master clinician of the next century will be like, and is there anything that will be new and different than what we have seen in these individuals in the past?
Dr. Brown: The master clinician used to be someone with an encyclopedic knowledge of medicine, with the ability to cite every fact from memory. Now, even the medical student can find almost any information on his or her phone or computer. More than ever, the master clinician must possess the skills of listening and learning from patients. What differentiates the master clinician is his or her ability to express knowledge to patients and trainees and to do it with a combination of confidence and humility. Master clinicians possess both of these qualities. They rarely express anxiety over knowing or not knowing, and they have solid, grounded reasons for their thoughts and decisions. I may not be very confident when having completed a consultation, but more specifically, I am confident in the process and not always with the diagnosis. Confidence is not being 100% right—showing humility and having faith in the process.
TR: What was the most memorable part of being a fellowship program director?
Dr. Brown: I can tell you that, even in my 32nd year as a program director, I would wake up in the morning and I couldn’t wait to go to work to see what patients we would see on rounds.
I have a wonderful wife and family, and I, thus, also couldn’t wait to go home and relax and unwind in the evenings.
My time on the wards and clinics was filled with amazing people and stories. But the most memorable thing is the family that I have seen and helped grow in the field of rheumatology. Every fellow I have ever trained is a part of this family, and we have a huge, diverse family—one that I find very special.
Jason Liebowitz, MD, recently completed his fellowship in rheumatology at Johns Hopkins University, Baltimore, where he also earned his MD. He is currently in practice with Arthritis, Rheumatic, and Back Disease Associates, New Jersey.