Recognizing Clinical Excellence

reprinted from Issue 15, Fall 2012 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.

Breadth of Excellence

Pulmonologist James K. Brown, MD, says that the direction of his career depended a lot on two key transitions. After medical school and two years of residency at Johns Hopkins, in 1974 he moved to UCSF where he encountered inspiring teachers of pulmonary medicine. "Though Hopkins had provided outstanding training, I didn’t hear much about lung diseases," says Brown. "UCSF was leading the growth of this subspecialty. The teaching in pulmonary medicine here was inspiring, as were the very committed investigators."

Brown completed his medicine residency, plus a year as a chief resident working under Lloyd H. "Holly" Smith, Jr., MD. He subsequently entered UCSF’s pulmonary medicine and research fellowship program. Then came the second transition. "Dr. H. Benfer Kaltreider, chief of pulmonary medicine at the San Francisco Veterans Affairs Medical Center (SFVAMC) at the time, called me one day," recalls Brown. "He described the VA as the best kept secret at UCSF. After eventually moving to the VA, I came to agree. It is a wonderful hospital to work in. The patients are appreciative of the care, the quality of staff at all levels is quite high, and the smaller scale of the facility makes it easy to seek out advice from colleagues."

At the SFVAMC, Brown currently oversees a large outpatient pulmonary clinic, which provides care for about 60 patients weekly. He directs the pulmonary function laboratory and helps to coordinate care for patients with lung cancer including through regular attendance at a weekly multidisciplinary thoracic tumor board. He also directs the program for patients with sleep apnea, which affects about 20 percent of veterans, and, in 2011, co-founded a sleep laboratory with neurologist Graham (Alec) Glass, MD.

Brown serves as SFVAMC site director for the UCSF Pulmonary and Critical Care Medicine Fellowship Program. He cultivates a learning environment for trainees, organizing teaching conferences as informal talks, reviews of difficult cases and journal clubs. He has won teaching awards from residents and fellows and also attends in the SFVAMC’s ICU.

"He artfully juggles a large and varied load of clinical responsibilities without losing focus on what is best for patient care," says George H. Caughey, MD, chief of the Division of Pulmonary, Critical Care and Sleep Medicine at the SFVAMC and the Julius and Lillian Nadel Endowed Chair. "Dr. Brown is an accomplished academic physician with a rare combination of skills and a stellar reputation as clinician and educator."

Brown conducts research on the causes of the abnormal growth of smooth muscle cells that occurs in the airways of patients with several pulmonary disorders.

In his spare time, Brown plays squash. He is married to Tish Brown, ADA coordinator for the Fine Arts Museums of San Francisco; they have three grown children.

Never Give Up

As an internist and liver specialist at San Francisco General Hospital (SFGH) for more than 30 years, F. Joseph Roll, MD, has cared for patients struggling with big challenges, including psychiatric disease, addiction and homelessness. Yet no matter how difficult their situations, he finds quiet joy in helping them.

"Listening to patients’ stories is intensely fascinating, and I appreciate thinking creatively about ways to solve problems," says Roll. "I try to accept where they are, and get some clues about what they would rather be doing. Most people want a more stable life, and if you give people time and opportunities, they naturally try to approach better health. Often the answer comes from the patient."

After finishing his fellowship training in hepatology and pathology, Roll was recruited to SFGH in 1981 as assistant director of the Rice Liver Laboratory. He investigated the scarring process that occurs in liver fibrosis and cirrhosis, as well as factors involved with alcoholic liver disease. Roll also treated hospitalized patients and those visiting the SFGH Liver Clinic, eventually transitioning to providing clinical care full-time.

For 11 years, Roll was the medical director of SFGH’s Emergency Department Case Management Program. This innovative program helps patients who frequently visit the emergency room, making at least five ER trips per year and sometimes up to 75 visits annually. The program connects them with a team, including a nurse practitioner, psychiatrist, medical doctor and social workers, to address underlying causes of their health crises.

"It is an amazing project, and the social workers are really trained to figure out interventions to help them," says Roll. The team often visits patients wherever they are living, whether it is under a freeway or in a shelter. "It gave me insight into the tough circumstances that people live in, and how unsafe and traumatized they can be," says Roll.

Despite these grim conditions, Roll keeps an open mind. "One of the things that graduates of the program have said is how much they appreciate that we never gave up on them," he says. "You see people making big changes in their life – kicking their drug habit, going back to school." The team recently helped a patient in his 70s who had been homeless for decades find housing.

"He embodies commitment, compassion, clinical astuteness, humility and kindness," says Dean Schillinger, MD, chief of the SFGH Division of General Internal Medicine. "Joe is universally loved by his patients, and the residents’ nickname for him – ‘St. Joe’ – speaks volumes. His unusual decision to transition from lab research into full-time primary care was particularly noteworthy, and capitalized on his penchant for working on complexity."

Roll recently retired to spend more time with his two grandchildren, but continues to train SFGH residents one afternoon a week. He is married to Joel Anne Chasis, MD, a hematologist/ oncologist who also recently retired from UCSF and Lawrence Berkeley National Laboratory.

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