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The Healing Garden at UT Medical Center

Soon after I came home to practice, a close friend of my parents asked me to assume his care. I knew him well enough that I had concerns about whether I could be objective, but reluctantly agreed when he said, “Objective is what I got from that other doctor.” He lived for six months after that discussion. His cancer grew through chemotherapy. He had a horrendous paraneoplastic clotting syndrome. He often called me at night or in the early morning, complaining of pain that was “all over” or “deep inside” or “indescribable.” I never felt as if I understood it, much less controlled it despite the liberal use of powerful opioids. Once, when he was vomiting his pills and delirious with pain, I admitted him to the hospital to manage his symptoms. When I rounded the following morning, I found him sitting up in bed, lucid, talking to his brother about his business and how to dispose of it after his death. We had our first conversation in months without his symptoms being the centerpiece of the discussion. His brother later told me that the chaplain had visited earlier. My patient shared with him an experience during WWII that had burdened him for half a century, something he couldn’t share with me. He’d found some measure of peace after they talked, and I started to understand that there is a difference in curing and healing. Even though medicine is a healing profession, the word “heal” is rarely used in the context of medical care. Maybe it’s because healing carries with it a spiritual connotation. “To make whole” doesn’t fit into a treatment algorithm. It doesn’t work as a core measure. The mystery of it can’t be explained in scientific terms. We are much more comfortable with the word “cure.” The discomfort with anything not evidence-based has come to characterize internal medicine. In the pursuit of biologic plausibility, scientists have amassed a formidable library of new and evolving information about the biology of neoplasia, atherosclerosis, Alzheimer’s

and more. Some diseases are now identified by genotype rather than phenotype. There are meaningful treatments for previously untreatable ailments, some aimed at molecular targets. It is reasonable to expect that someday cancer will be managed like hypertension, without regard for its etiology, controlled with a pill or two taken daily with breakfast. Even with all these breathtaking advances, people continue to die. Surgeons replace arthritic joints, but they don’t reverse the ravages of osteoarthritis. Better drugs and minimally invasive procedures dramatically enhance our ability to help patients live longer and better lives, but they ignore the spiritual, emotional and psychological aspects of suffering. The essence of medicine is palliative care at its best. It is a blend of evidence-based treatment balanced with concern for the person and the context in which they suffer. It’s the recognition that the mysteries in medicine, if left untended, can thwart the most elegant treatment plan.

Back in the sanctuary of my office after a long and hectic day of caring for patients, I have a feeling of disquiet, like a lone grey cloud hanging in an otherwise clear blue summer sky. On further reflection, I marvel at the complexity and diversity of illnesses that physicians encounter on a daily basis. Finding the right answers and treatments for a wide variety of problems--for each patient is unique and presents a different set of challenges--makes the practice of medicine such a meaningful profession. Imparting these experiences, and the knowledge they

bring, to students and residents is even more gratifying. Then, why the unease, I wonder? Every teaching physician’s life is stressed because of a host of rules and regulations controlling the number of hours a resident may spend in the hospital and the number of days that they are off each week. With each passing year, the clinician’s focus has shifted from an emphasis on teaching to ensuring that trainees are relieved of their clinical responsibilities and leave the hospital in a timely manner. Traditional team-based bedside teaching is rapidly becoming a relic of the past. Each patient encounter in the clinic has become a battle with a metronome that regulates the time “allocated” to each patient and whose cadence increasingly governs each day. Couple that with a larger number of patients, greater complexity of problems, and heightened expectations, and there’s a recipe for dissatisfaction at all levels. Truly, there are no winners in this constant race against the clock!

A Perspective On Healing

Points of View

Rajiv Dhand, M.D., Chair

Department of Medicine

Connect ing Technolog y, Educat ion and Discover y with Humanism in Medicine Vol. 2 Issue 4 October 2013

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Since its inception in 1987, Endocrinology Consultants of East Tennessee (ECET) has served as teaching faculty for the Department of Medicine while providing comprehensive care for patients with metabolic and hormonal diseases that are complicated or require special expertise. One of their most common referrals is for patients with diabetes. Physicians and extenders at ECET provide ongoing outpatient care for thousands of patients with this disease. They provide an ADA-certified Diabetes Education Program, teaching patients how to better manage their care. Educational efforts are not limited to the individual patient. Representatives of ECET have made many educational presentations to public and professional groups over the past three decades. They have served in leadership roles for the American Diabetes Association (ADA) and the Juvenile Diabetes Research Foundation. While members of ECET consider listening as their greatest asset, they have the technology to evaluate most patients completely in-house. A common referral to ECET is a person with an incidentally discovered thyroid nodule. They often arrive for their consultation anxious, fearing the worst. The physician evaluates the patient, performs an ultrasound of the thyroid, reviews the image along with previous studies when available, then proceeds with fine needle aspiration if necessary. The patient leaves the clinic with a comprehensive treatment plan and the reassurance of having had a thorough evaluation. Bill Law, Jr., MD, Chief of the Endocrinology Division and Past President of the American College of Endocrinology says, “It’s a great time to be an endocrinologist.”

Amyotrophic Lateral Sclerosis (ALS) is a devastating neurodegenerative disease that causes gradual muscle paralysis and death usually within three years of symptom onset. Patients are often misdiagnosed early because it mimics so many other diseases.

Treatment is mostly supportive and aimed at preserving function and maintaining quality of life. Randall Trudell, MD, is the Medical Director of the ALS clinic which moved to the Cole Neuroscience Center in April 2008. His interest in the care of people with this illness is longstanding. He completed a Research/Clinical Fellowship in Neuromuscular Disease at Strong Memorial Hospital in Rochester, NY, and has served as medical director with the Muscular Dystrophy Association/ALS since 1985. Dr. Trudell and a multidisciplinary team composed of a nurse practitioner, registered nurse, social worker, nutrition/dietary expert, mobility specialist, physical, occupational, speech, and respiratory therapist see patients the 3rd Wednesday of each month. An integral part of their treating the whole patient is addressing the suffering experienced by the person with the disease and the people who care for them. Support groups allow both patients and their caregivers to meet with others who share these unique burdens. There is only one FDA-approved drug available for this disease, which in clinical trials slowed progression and extended survival by about three months. In the future, Dr. Trudell hopes to expand opportunities for patients to participate in studies of disease modifying treatments. The clinic, which is partially funded by a grant from the Muscular Dystrophy Association, accepts patients regardless of their ability to pay.

Endocrinology Group Impacts Healing and Education

Amyotrophic Lateral Sclerosis Clinic Provides Supportive Treatment for Devastating Disease

Updates to our department’s listings on Insight, the Pulse, and SharePoint are in process. We will notify everyone when changes have been completed and will ask for your ongoing updates.

Mark your calendar!2nd Annual Medicine CME Update February 28 – March 1, 2014, watch for details

10th Annual Hematology Conference January 11, 2014, watch for details

Department of Medicine Grand Rounds, 8:00 AM, Morrison’s Conference RoomOctober 8: Spotted Fever Group: Rickettsia in TennesseeNovember 12: TBA – Drug Induced Diseases December 10: State of the Department of Medicine

Other important dates:October 22: Department Quarterly Meeting (not for CME credit)

Website Revisions

Continuing Education Opportunities

Endocrinology Consultants of East Tennessee pictured from L to R:Doctors Amit Vora, Allen Moffitt, Casey Page, John Williams, William Law, Jr.,

Peter Campbell, Daniel McCammon, Thomas Doty, and Aaron Bussey

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Kathy Whaley, RN, (center) pictured with Dr. Richard Obenour and Jane Obenour

Clinic Star AwardErick Edwards, DO, received the Clinic Star Award at the 2013 Department of Medicine Residents and Fellows Awards Dinner. The award is given annually by the UT Internal Medicine Center to a third year resident, selected by faculty, peers, and staff, who best exhibits the criteria of excellence in patient care, medical knowledge, interpersonal and communication skills, and professionalism. Congratulations, Dr. Edwards, and many thanks for your wonderful contributions to our clinic!

Teaching Award Richard L. Gibson, MD, was presented with the Excellence in Teaching award at the 2013 Resident and Fellow Dinner and Faculty Awards Presentation held on June 27, 2013. Dr. Gibson is a skilled and knowledgeable physician and is also a very kind and approachable attending for our residents. He is highly intelligent, yet humble, and possesses the reasoning skills, warmth, and empathy to make him a superb teacher. We congratu-late Dr. Gibson on this well-deserved award.

US News and World Report RecognitionThe UT Medical Center, Knoxville, received recognition in the US News & World Report top hospitals edition for the second consecutive year. We are ranked #1 in East Tennessee and #3 in the state. Several subspecialties were recognized, and seven of these subspecialties are part of the Department of Medicine, including oncology, cardiology, endocrinology, gastroenterology, geriatrics, nephrology, and pulmonology.

On Tuesday, July 9, 2013, George Grunberger, MD, Chairman of the Grunberger Diabetes Institute and Clinical Professor at Wayne State University School of Medicine, presented the Department of Medicine Grand Rounds on the management of type 2 diabetes mellitus. Dr. Grunberger serves as the Co-Editor of Diabetes/Metabolism Research and Reviews and as the Associate Editor of the Journal of Diabetes. He has held many leadership positions with the American Association of Clinical Endocrinologists, including the Insulin Pump Therapy and Management Patient Safety Task Force and the Primary Care Physician Diabetes Initiative.

Awards

Guest Speakers

Dr. Erick Edwards pictured with Dr. Juli Williams, Director, Internal Medicine Residents’ Clinic

Richard L. Gibson, MD, pictured with Dr. William Metheny, Assistant Dean

for Graduate Medical and Dental Education (L), and, Amy Paganelli,

Assistant Dean for Finance and Administration (R)

Grunberger speaks on Type 2 Diabetes Mellitus

Lisa McCarty Kennedy, niece of Richard Obenour, MD, Professor and Vice Chairman, Department of Medicine (DOM), lost her 2-year battle with lymphoma in 1994. To honor her memory, her family began the Lisa McCarty Kennedy Oncology Nursing Merit Education Award funded through the RA Obenour, Jr., Endowment within the Graduate School of Medicine, DOM. This annual award is provided to an outstanding oncology nurse who meets the following criteria:

• Excellence in providing compassionate patient care. • Dedication to acquiring knowledge resulting in improved patient care. • Serving as a positive role model for colleagues, patients and their families.

This year’s award recipient was Kathy Whaley, RN. Kathy has been an oncology nurse for over 25 years and currently works with Dr. James Lewis in University Surgical Oncology. She was recognized for her compassion and dedication to her patients and her commitment to furthering her knowledge and nursing practice. Kathy was awarded $1,000.00 towards furthering her oncology nursing education. Past recipient, Barbara Marine, RN, University Cancer Specialists, used the proceeds from the award to attend an Oncology Nursing Certification Review Course sponsored by the Metro Atlanta Chapter, Oncology Nursing Society to prepare for her OCN recertification exam. A 2012 recipient, Crystal Wheelon, NP-C, RN, University Surgical Oncology, recently used the funds to attend the 23rd Annual National Interdisciplinary Breast Cancer Conference in Las Vegas, NV.

Oncology Nursing Merit Education AwardCongratulations to Kathy Whaley, RN, Recipient of the 2013 Lisa McCarty Kennedy Award

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In Touch Volume 2, Issue 4: October 2013

Publishers James Neutens, Ph.D., DeanRajiv Dhand, M.D., Chair

Editor Ronald Lands, M.D.

Administrative Director Susan Burchfield, CAP-OM

Contributors Susan Burchfield Rajiv Dhand, M.D. Christen Fleming, M.D. Ronald Lands, M.D. Jane Obenour

Design J Squared Graphics

In Touch is produced by the University of Tennessee Graduate School of Medicine Department of Medicine. The mission of the newsletter is to build pride in the Department of Medicine by communicating the accessible, collaborative and human aspects of the department while highlighting pertinent achievements and activities.

Contact Us In Touch UT Graduate School of Medicine

Department of Medicine

1924 Alcoa Highway, U-114

Knoxville, TN 37920

Telephone: 865-305-9340

E-mail: InTouchNewsletter@utmck.edu

Web: http://gsm.utmck.edu/internalmed/main.cfm

The University of Tennessee is an EEO/AA/Title VI/Title IX/Section 504/ADA/ADEA institution in the provision of its education and employment programs and services.

Department of Medicine faculty, residents and fellows share their knowledge and experience by publishing and presenting across the world. For a list of our most recent accomplishments, visit http://gsm.utmck.edu/internalmed/scholars.cfm.

Presentations, Publications, Awards

Thank You for Your SupportFor information about philanthropic giving to the UT Graduate School of Medicine Department of Medicine, please contact the development office at 865-305-6611 or development@utmck.edu. If you would like more information about any of the information in this issue of In Touch, please contact the Department of Medicine at 865-305-9340 or visit http://gsm.utmck.edu/internalmed/main.cfm. We look forward to your input. Thank you.

Stay in Touch!Alumni, please update your contact information by completing the simple form at http://gsm.utmck.edu/internalmed/alumni.cfm or by calling the Department of Medicine at 865-305-9340.Thank you!

We wish to congratulate Ronald H. Lands, MD, for earning promotion to full professor in the Department of Medicine. Dr. Lands serves the department in many capacities, including as an attending for the general

medicine, hematology/oncology, and narrative medicine rotations. Dr. Lands is a poet and short story writer, who has had several publications in notable journals. His interest in narrative medicine has expanded the breadth of teaching in our department, and we are grateful for his dedication.

We are pleased to announce that Jonathan Wall, PhD, and his team of researchers received notification that his grant for Preclinical Diagnostic Imaging of Amyloid was renewed for five years by the National Institute of Diabetes and Digestive and Kidney Diseases.

Faculty Announcements Wall Receives Grant Renewal

7,930 miles: the distance from Knoxville to Nairobi, Kenya, the place PGY-3 Dr. Moses Osoro calls home. Raised in East Africa, he then moved to Houston for his undergraduate studies. Following graduation, he attended UT Southwestern Medical School (UTSW) in Dallas. Influenced by the Chief of Medicine at UTSW, he chose to study internal medicine here at the UT Graduate School of Medicine, as he enjoyed the intimate residency size, research opportunities, and people. Currently, he is researching the appropriate ordering of cardiac imaging in chest pain and will present his findings at the National Association for Cardiovascular Imaging. He plans to attend a cardiology fellowship, with hopes to remain in Knoxville.

“Fantastic!” is a sentiment Dr. Osoro uses daily, and this is indicative of his outlook on medicine and his personality. He believes, “healing is more than accurate diagnosis and effective treatment. To me, a healer forms relationships with his patients.” He

“tries to understand what disease means to them” and understands, “what the patient would like out of life and how health plays a role.” We are truly lucky to have such a “healer” in resident Dr. Osoro.

Resident Feature

Dr. Jonathan Wall pictured with his research team from L to R: Angie Williams, Craig Wooliver, Emily Martin, Steve Kennel, PhD, Tina Richey, Jonathan Wall, PhD, Alan Stuckey, and Ying Huang