Robert L. Barchi, MD, PhD
Message
from the
President
Contents
Jefferson Alumni Bulletin
Winter 2012
Volume 61, Number 1
Senior Vice President,
Jefferson Foundation: Frederick Ruccius
Vice President for Development and COO,
Jefferson Foundation: Stephen T. Smith
Interim Editor: Karen L. Brooks
Design: JeffGraphics
Bulletin Committee
William V. Harrer, MD '62 Chair
James Harrop, MD '95
Cynthia Hill, MD '87
Larry Kim, MD '91
Phillip J. Marone, MD '57, MS '07
Joseph Sokolowski, MD '62
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THOMAS JEFFERSON UNIVERSITY
On the cover: David Loren, MD,
associate director of medical endoscopy
at Jefferson
As the financial drivers in U.S. health care
shift from volume-linked reimbursement
toward payment based on episodes of care,
medical outcomes and quality, Jefferson
graduates have a distinct advantage.
Medicine is indeed both an art and a
science. On the science side of the ledger,
our knowledge of disease pathophysiology,
our diagnostic arsenal and our therapeutic
options have all increased dramatically
over the past 50 years. Yet there remains
a critical component of medicine that is
still an art, one that forms in many ways
the basis for the intangible doctor-patient
relationship at the very core of the medical
profession. Certainly, a clinical history can
be obtained using a computer to interro-
gate a patient before the physician arrives.
This method is more efficient, perhaps, but
lacks the personal contact of a concerned
physician speaking directly to an anxious
patient. Likewise, a battery of initial labora-
tory tests might provide quantifiable clues
about that patient's illness, but the laying
on of the physician's hands in a skillful
physical examination will often yield those
insights more quickly, while at the same
time strengthening the supportive and ther-
apeutic bond that must develop between
patient and physician. It would indeed be
a tragedy if modern medicine lost the value
of the "art" because of the overwhelming
pursuit of the "science."
As a generation of senior faculty begins
to retire, instruction in these clinical diag-
nostic skills is becoming a lost art at many
other medical schools. Physicians trained at
Jefferson have the best of both worlds. They
are fully versed in the science of medicine
and skillfully deploy the latest medical tech-
nologies, techniques and diagnostic studies.
But they're also equipped with a deep appre-
ciation for the art of medicine, including the
elucidation of the medical history and the
physical exam that still form a critical basis
of our profession.
In my own specialty of neurology, the art
of clinical observation was a highly refined
skill in the generation of clinicians who were
my mentors and role models. Even now, I
learn more about a new patient's problems
merely by observing him walking into my
office than I do from all the forms he filled
out prior to being called into consultation.
Before my patient even says hello, I know a
tremendous amount: how he gets up from a
chair, what his gait looks like, how he carries
his arms or how his eyes move. This focuses
the history I take and helps me identify
whether the primary complaint is the core
problem or a symptom of a condition the
patient doesn't know about yet. While a full
neurological exam could take hours, like
other neurologists with my training, I have
already picked through the tree of physical
diagnoses as applied to what I have seen
and heard and can efficiently streamline
my interactions without sacrificing clin-
ical accuracy. Physicians with such skills
can develop a differential diagnosis in their
minds that others might only obtain by
ordering layers of tests.
Jefferson has imbued its graduates with
expertise in physical diagnosis for nearly 200
years. Today, our curriculum explicitly rein-
forces these skills. We provide structured
practice with standardized and simulated
patients at Jefferson's Clinical Skills and
Simulation Center. Our faculty teach new
ways to use old-fashioned tools, such as
a stethoscope, to assess the heart, liver,
lungs and even bowels. They demonstrate
and validate students' auditory detection
skills, for instance, by using a stethoscope
connected to infrared headphones that allow
students and faculty to listen to the same
sounds simultaneously.
As a result, our graduates know how to
take a clear and accurate patient history, how
to use their senses and intuition in a physical
exam to accelerate the path toward diagnosis
and, not least, how to express concern and
caring. They have a more balanced view of
the patient and his or her disease rather than
treating a patient as a set of symptoms and
laboratory studies.
Physical diagnosis skills are part of what
elevate a technically skilled physician to a
truly great clinician who doesn't waste time
or money getting to a correct diagnosis.
Technology and testing are essential tools
to confirm or narrow down a differential
diagnosis and identify an effective course
of treatment. But they should never be a
crutch. Physicians who lack physical diag-
nosis skills tend to order significantly more
studies and scans.
As the economics of health care continue to
evolve, Jefferson-trained physicians possess a
competitive advantage that will serve them
well. We pass along this legacy of physical
diagnosis skills, derived from the collective
wisdom of earlier generations of physicians,
not as a romantic notion or historical artifact
but as a necessity for accurate and efficient
diagnosis and treatment.
At Jefferson, we teach physical diagnosis
skills because it's good medicine.
Sincerely,
Robert L. Barchi, MD, PhD
President
Thomas Jefferson University
FEATURES
6
The Gift of Time for Patients with Advanced Bile Duct Cancer
10
Celiac Disease: Overcoming a Stealth Public Health Menace
14
Light Therapy for a Blue Planet and Beyond
DEPARTMENTS
2
DEAN'S COLUMN
4
FINDINGS
Could a Tumor Suppressor Also Fight Obesity?
16
FACULTY PROFILE
Kathleen Squires: Working to Make a World of Difference for Patients with HIV
18
STUDENT PROFILE
For Former Actor, Pediatrician is the Role of a Lifetime
20
ON CAMPUS
24
CLASS NOTES
26
ALUMNUS PROFILE
Irving Danesh, MD: The Physician Behind the Scenes
28
IN MEMORIAM
29
BY THE NUMBERS