reprinted from Issue 13, Fall 2011 of Frontiers of Medicine (PDF)
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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.
Matching Wits with Infectious Disease
"I'm constantly surprised by diseases that I'm supposedly an expert in," says Henry "Chip" Chambers, MD, chief of the Division of Infectious Diseases at San Francisco General Hospital (SFGH). "They keep finding new ways to trick me."
Recently, he saw a patient with an overwhelming staphylococcal infection that was unresponsive to treatment. A few weeks earlier, she had presented with what appeared to be ovarian cancer, a seemingly unrelated diagnosis. However, as it turned out, the patient did not have cancer after all; the ovaries proved to be the source of infection – a very rare manifestation for which he only found one citation in the medical literature.
"People who are good clinicians are methodical," says Chambers. "There are a couple approaches: you can generate an exhaustive list and hack through it to get to the right answer. I favor the approach of discarding the stuff that's probably a sideshow, but you always have to go back and double-check if you haven't figured it out with your first list. In this case, the sideshow turned out to be the main show."
His colleagues prize his expertise. "Dr. Chambers is the consummate consultant and teacher," says Margaret Wheeler, MD, a colleague at SFGH. "When wrestling with a complex case, 'Let's ask Chip,' is a common refrain. He distills complex information into a form that is accessible and relevant."
Chambers was an infectious diseases fellow at SFGH in 1981 when AIDS made its first appearance. "I was watching something that was a big-time, major world development in my subspecialty," he says. "It was like discovering coronary artery disease – it was intellectually exciting. On the other hand, we were taking care of people who had a death sentence, and were our age or younger. We had to be very frank about the limits of our knowledge and skill. And while I'm not at all religious, I quickly learned that I shouldn't preach atheism to somebody for whom God was important."
Compared to the dismal prognosis for HIV/AIDS at that time, studying the Staphylococcus aureus bacteria felt more manageable. That year he conducted his first experiment on methicillin-resistant Staphylococcus aureus (MRSA), which is now one of his main areas of research. To help reduce the development of resistance to a dwindling number of drugs available to treat infection, Chambers is currently trying to define which staph infections actually require treatment with antibiotics. For example, simple abscesses often can be surgically drained and do not need further treatment. He is also researching ways to improve outcomes for patients with the most serious staph infections.
Chambers is married to Joyce Hansen, MD, an internist at California Pacific Medical Center. They have two grown children, and enjoy tending their vineyard in Sonoma.
Better than Gold
John Imboden, MD, recalls the limited tools he had at the beginning of his rheumatology career 30 years ago. "We had steroids – which had a lot of toxicity – and gold injections," he says with a rueful laugh.
The emergence of targeted drugs has transformed the field. "Now when I see someone with new onset rheumatoid arthritis, I'm thinking, 'I want to get a long-term remission,'" says Imboden, chief of the Division of Rheumatology at San Francisco General Hospital (SFGH) and holder of the Alice Betts Endowed Chair for Research in Arthritis.
As the point person for rheumatology referrals from safety net clinics throughout San Francisco, Imboden fields nearly a thousand electronically submitted referrals to the SFGH rheumatology clinic each year. "If it looks like someone has new rheumatoid arthritis or another rheumatic disease, we'll see them within a week or two," Imboden says. "If we start treatment early, we can really have a positive impact."
"Dr. Imboden has built an extensive, interdisciplinary program focused around health disparities in the rheumatic diseases," says David Wofsy, MD, George A. Zimmermann Distinguished Professor of Medicine and Microbiology/Immunology and the former chief of rheumatology at the San Francisco Veterans Affairs Medical Center (SFVAMC). "He has… made cutting edge experimental therapies available to patients who would not otherwise have access."
Imboden and colleague Jonathan Graf, MD established the Rheumatoid Arthritis Observational Cohort Study, which has enrolled 650 diverse patients at SFGH and UCSF Medical Center and has facilitated research at UCSF on this important disease.
In addition to rheumatoid arthritis, Imboden also cares for patients with lupus, gout, scleroderma, vasculitis and other rheumatic diseases. He is renowned for his abilities to perform a thorough physical exam, a skill he cultivated partly in response to a medical school experience, when he overlooked a patient's enlarged spleen. "The then-chief of rheumatology came in, examined the patient, and found the spleen – in front of two rheumatology fellows, several residents and interns, and me," says Imboden. "If you miss something and somebody points it out to you, it really encourages you to be vigilant. I haven't missed too many spleens since then!"
Imboden spent much of his career researching the activation of T cells, a type of white blood cell that plays an important role in immune response. "My scientific background has been helpful in cultivating a certain rigor in the way I think, in terms of getting data exactly right," he says. This approach helps him do the detective work when investigating unusual forms of rheumatic disease that might be symptoms of another condition.
In his spare time, Imboden enjoys reading about World War II history, and aspires to break 80 once again in his golf game. He is married to Dolores Shoback, MD, an endocrinologist at the SFVAMC; they have two grown children.
An Educational Legacy
As a first-year medical student at UCSF in 1981, Harry Lampiris (pronounced "lam-PEER-us"), MD, began hearing about a puzzling new disease that would later be identified as AIDS.
"Witnessing the rapid spread of HIV/AIDS in San Francisco and UCSF's response to the epidemic was career-changing," says Lampiris, now an expert in HIV medicine. He also serves as acting chief of the Infectious Diseases Section at the San Francisco Veterans Affairs Medical Center (SFVAMC), and associate program director of the UCSF infectious diseases fellowship program.
Lampiris provides care and supervises trainees at the SFVAMC and the Parnassus HIV Clinic. When confronting a difficult case, he scours the medical literature, consults with other experts and applies scientific intuition. "For many years HIV treatment was rapidly changing, and many of our treatment decisions were not evidence-based," he says. "Clinicians who inspired me confronted the limitations of the data, and rapidly changed their practices as more information became available. In addition, the community of patients with HIV/AIDS has always helped to keep clinicians and researchers honest about the limitations of our knowledge."
Lampiris is also well-versed in the broad spectrum of infectious disease and directs the inpatient infectious disease consultation service at the SFVAMC. "Part of why this field is fascinating is because patients' behaviors and exposures have a significant impact on what is going on for them," he says. "There are often details of a patient's history that could lead you to a diagnosis, but can also be misleading." He recalls discovering that a patient with a mysterious fever was a lizard handler who fed live rats to his charges. Lampiris eventually diagnosed him with leptospirosis, a rare bacterial infection sometimes caused by exposure to rodent urine.
He considers his greatest legacy to be training medical students, residents, and infectious disease and HIV specialists over the last 20 years. Lampiris also traveled several times to Côte d'Ivoire (Ivory Coast) in West Africa as a clinical faculty mentor with the UCSF Project ASPIRE, an international HIV/AIDS education and training program run by the Positive Health Program at San Francisco General Hospital.
"Dr. Lampiris has an encyclopedic knowledge of infectious disease and HIV medicine, which he is always willing to share with colleagues and trainees with great clarity and enthusiasm," says Paul Volberding, MD, chief of the medical service at the SFVAMC.
A biochemistry and comparative literature major in college, Lampiris speaks French, German and Greek, and is also a classical pianist. He and his partner, Paul Lee, live in San Francisco.