reprinted from Issue 10, Spring 2010 of Frontiers of Medicine (PDF)
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Recognizing Clinical Excellence
reprinted from Issue 10, Spring 2010 of Frontiers of Medicine (PDF)
Each year, the Department of Medicine recognizes outstanding physicians who have exceptional knowledge, superior teaching and communication skills, and an ability to provide compassionate, appropriate, effective and high quality patient care. The newest members of the Council of Master Clinicians are profiled here.
Improving Hospital Care
"Hospitalizations are incredibly trying times for patients and their families," says Hugo Quinny Cheng, MD. "Even though it can be challenging, it's important to find the time to talk things over with families, answer their questions, and let them know you are there for them."
Cheng is a hospitalist, a relatively new type of specialist who oversees care of hospitalized patients. In 2007, he established the Comanagement with Neurosurgery Service, providing a full-time hospitalist to partner with neurosurgeons in caring for patients recovering from surgery for brain tumors, spine disease and other complex neurological disorders.
These patients often have other serious conditions and an increased likelihood of developing medical complications, such as blood clots in the leg, which can be fatal if they travel to the lungs and obstruct blood flow. "As hospitalists, we automatically follow these high-risk patients' vital signs and labs and manage their medications to prevent complications, and are readily available to address any complications much more quickly than would otherwise happen," says Cheng. The new service has helped improve the quality and safety of care, and has increased provider satisfaction on the neurosurgery service.
Cheng says one of the most enjoyable parts of his job is teaching and learning from medical residents. "It's a real treat to work with what are clearly the best residents in the country, with their passion, knowledge and skill sets," says Cheng. One focus of his teaching is helping them cultivate their sense of informed judgment when caring for patients before and after surgery. "Rather than following guidelines by rote and automatically ordering a fancy diagnostic test, I encourage residents to think through how the results of that test would change their management of that specific patient," he says.
Cheng is widely admired by his faculty colleagues. "Quinny isn't flashy, he just always gets the job done – with great integrity, good humor, and unflagging dedication to doing what's right for patients," says Robert Wachter, MD, chief of the Division of Hospital Medicine.
Cheng says he is humbled to be recognized as a master clinician. "I'm incredibly honored to have been given this recognition," he says. "The people who have received this honor previously are physicians I have the greatest admiration for, and I'm stunned to be included among them."
Cheng lives in Pacifica with his wife, Mary, a biologist, and their son, Marcus. Cheng enjoys playing electric guitar, and says he cultivates a secret hope of someday joining a rock band.
Captain of the Emergency Department
Before becoming a doctor, Jonathan "Jody" Garber, MD, traveled the world as a cook on a merchant ship. In addition to baking sometimes lopsided sheet cakes – one of the vessels permanently listed to one side – he also learned a lot of people skills. "Working on a ship is not unlike working in a medical center, where you are in close quarters with people under somewhat stressful conditions," he says with a laugh.
Garber applied those skills when he became chief of the San Francisco Veterans Affairs Medical Center (SFVAMC) Emergency Department in 1998. At that time, it was a temporary moonlighting perch for former residents, but Garber transformed the department. He built a seasoned team of dedicated faculty members who are passionate about caring for acutely ill patients. In addition, Garber has also worked locally and nationally on disaster preparedness, planning for catastrophes such as earthquakes and pandemic flu.
"His encyclopedic knowledge of urgent care medicine and internal medicine makes him the de facto consultant for the ER's faculty and residents," says Gurpreet Dhaliwal, MD, a colleague at the SFVAMC. "The degree of commitment to his job can be simply summarized: 24/7 there is no voicemail. You will always reach Dr. Garber, unless he is already occupied helping someone else."
Garber is a beloved teacher who says that careful listening is essential to his work. "One of the beauties of working at the VA is we see patients with such a variety of backgrounds – some live in small trailers on the sides of mountains, others are middle class or are marginally domiciled," says Garber. "They all have their own fascinating stories to tell. We're taking care of people, not problems."
Despite his reputation as a stellar diagnostician, Garber says he is humbled and surprised every day. "When I was in training, I was told it takes 15 to 20 years to feel comfort-able in your skin as an internist," he says. "That's still a work in progress. It's building an ever-expanding database, which is your day-to-day experience." He credits his jobs before medical school with giving him a head start.
In addition to working as a merchant seaman, Garber also worked as an orderly and physician's assistant. In the early 1980s, one of his roles was roaming the streets, cafés and methadone clinics of New York, using a 50-page questionnaire to interview injection drug users in an effort to discover what factors might be contributing to the HIV/AIDS epidemic. He also worked at a large detox hospital in Lower Manhattan, learning about the manifestations of substance abuse.
Today, Garber lives in San Francisco with his wife, Ellen Griffin, who is the communications director for San Francisco State University. Their son, Sam, studies acting at New York University's Tisch School of the Arts.
Writing the Book
"Sir William Osler said it's more important to know the patient who has the disease, rather than the disease the patient has," says Margaret Wheeler, MD, referring to one of the founders of modern medicine.
Wheeler, a primary care physician at San Francisco General Hospital (SFGH), recalls a patient with diabetes and hypertension who complained of chest pain while praying. "I thought, that's a pretty sedentary activity," says Wheeler. "Then I asked him, 'Show me how you pray.'" The patient, an imam, demonstrated several of the postures used in Islamic prayer – which include standing, bowing and kneeling in quick succession. "I thought, of course he has heart disease!" she recalls with a laugh.
Wheeler has a large primary care practice at SFGH, including many patients with complex social histories and chronic diseases. "She combines top-notch clinical expertise with an extraordinary degree of insight and compassion for her patients," says Alicia Fernandez, MD. "Dr. Wheeler sets the standard for clinical excellence in primary care at UCSF."
Before attending medical school, Wheeler worked as an English teacher and freelance editor. Those skills proved valuable when she and colleagues at SFGH edited Medical Management of Vulnerable and Underserved Patients: Principles, Practice and Populations. It is the only existing textbook of its kind, and includes best practices for caring for marginalized groups such as seniors, immigrants and homeless people.
"When teaching residents and seeing patients, we realized there weren't easy places to go for reference for things that came up all the time," says Wheeler. "For example, what do you do when a patient can't read? We wanted the book to be evidence-based, so it wouldn't just be some soft-hearted doctor saying that prison is bad for your health. Can we document that? What are the illnesses that are worse for you in prison? How many are incarcerated for substance use? Is prison preventable? We wanted to address issues faced by vulnerable populations in the same way as other medical issues."
In addition to her clinical duties, Wheeler is the SFGH site director for medical student clerkships, and leads projects with the California Emerging Infections Program on diseases including whooping cough and Creutzfeldt-Jacob disease, a rare brain disorder. She has also worked with torture victims seeking asylum through Survivors International, a San Francisco-based nonprofit, and provided care to the uninsured in West Yellowstone, Montana.
In her free time, Wheeler enjoys hiking and reading. She is married to David Large, PhD, a history professor who divides his time between Montana and California. They have a daughter, Alma, and a son, Josh.