resident expert - geisel school of medicine at...

Dartmouth Medicine 11Summer 2005

F A C T S & F I G U R E S

Resident expertTraining tomorrow’s doctors

104,521Total number of medical residents training in the U.S.

(residents are physicians who have graduated from medical school and are doing added training for their licensure; they provide care at

teaching hospitals under the supervision of faculty physicians)

3 to 8Number of years typically required to complete

residency, depending on the specialty

8,227Number of accredited residency programs in the U.S.

1944Year residency programs were established at Hitchcock

315Number of residents in New Hampshire in 2003-04

46Number of accredited residency and fellowship programs at DHMC

329Number of residents and clinical fellows at DHMC

12Number of states with fewer than 400 medical residents

SOURCES: DHMC AND ACCREDITATION COUNCIL FOR GRADUATE MEDICAL

EDUCATION; DHMC FIGURES ARE 2004; OTHERS ARE 2005 UNLESS NOTED OTHERWISE

VITAL SIGNS

If question on grads’minds is “Got match?” answer is “You bet!”

J effrey Barrett and Sue AnnHennessy couldn’t stop grin-

ning. They hugged, exchangedexcited chitchat, and huggedagain—looking more like a cou-ple of teenagers than a fourth-year medical student and an as-sistant dean.

Barrett, originally from Ja-maica, had just learned that hehad been assigned by the Na-tional Resident Matching Pro-gram (NRMP) to do his psychi-atry residency at MontefioreMedical Center in the Bronx—his first choice. “We’re so proudof the accomplishment he’smade,” Hennessy, assistant deanfor student affairs, said later. “Dr.Martha Regan-Smith, myself,and a lot of other deans at theMedical School, we’ve been hisfamily away from home.”

Incredible: When Barrett re-ceived his “Match Day” enve-lope—and the letter insidetelling him where he would bedoing his residency—he alsosought out Dr. David Nieren-berg, senior associate dean formedical education, to shake hishand and give him a hug. “Hehas been a mentor and incredi-ble teacher to me,” said Barrettof Nierenberg.

The hugs, smiles, and excla-mations of Barrett and his men-tors were actually not the excep-tion but the norm for DMS stu-dents on Match Day 2005 inmid-March. Students and theirspouses, partners, and friends, aswell as numerous professors and

administrators, filled the chairsand overflowed into the aisles ofAuditorium G at DHMC for theMatch ceremony. Given the im-portance of residency in a physi-cian’s training, the excitementwas understandable.

Hugs: Match Day is “a high-light of [students’] medical edu-cation. . . . It’s everything thatthey have worked for,” said Hen-nessy, by way of explaining theemotion in the room. “You know,when you’re happy you usuallyhug the people you love or youcare about . . . who [have] beenthere for you. . . . And generally,”she adds, “students are very, veryhappy with their matches.”

This year, more than 25,300medical students participated inthe NRMP, which uses a com-puter algorithm to match med-ical school graduates with open-ings in more than 8,000 accred-ited U.S. residency programs.Nationally, the most popularspecialty choices this year weredermatology, emergency medi-cine, and several surgical disci-plines; DMS graduates, however,once again showed a commit-ment to primary care, with fam-ily practice, internal medicine,and pediatrics topping the list.

Practice: Dale Ross is one ofthe ’05s who chose family prac-tice. Originally from northernIdaho, he is particularly interest-ed in rural family practice and“getting out in the community.”His wife, Angel, and their twochildren donned black cowboyhats for Match Day, and thewhole family is looking forwardto moving to Casper, Wyo.,where Ross will be training atthe University of Wyoming.

12 Dartmouth Medicine

“We’ve enjoyed our time atDartmouth—it’s been a greatplace for us,” says Ross. But “weare looking forward to headingback out West.”

Ross is the only DMS gradu-ate bound for Wyoming. Massa-chusetts (where 11 students aregoing), California (10), and NewYork (7) proved the most popu-lar destinations; three ’05s willremain at DHMC next year.

The Match placements for allDMS ’05s, plus placements forthe ’05 graduates of the Brown-Dartmouth Program, are listed inthe adjacent box.

DMS’s dean, Dr. StephenSpielberg, applauded the stu-dents’ achievements but added,“It’s also a little bit sad becauseit’s kind of the beginning of theend of us having you all here.”

Welcome: While Match Day isa time to say goodbye to gradu-ating students, it’s also a time towelcome incoming residents. InJuly, more than 100 new resi-dents from all over the country—and the world—will arrive atDHMC. In addition, the NewHampshire-Dartmouth andMaine-Dartmouth family prac-tice residency programs will wel-come 18 new residents. “Thisyear we had the strongest class ofinterviewees to date,” says Dr.Gail Sawyer, director of the NewHampshire-Dartmouth program.“We are very excited to welcomethe Class of 2008.”

Perhaps Dr. Susan Harper,DMS’s assistant dean for medicaleducation, summed up this year’sMatch best when, at the begin-ning of the ceremony, she de-scribed the results as “awesome!”

Jennifer Durgin

Summer 2005

VITAL SIGNS

Results from Match Day 2005DMS ’05s are entering these residency programs this year:AnesthesiologyJessica Holland, Maine Med Ctr (UVM)Christian Renaud, Dartmouth-HitchcockEmergency MedicineJennifer Boyle, Maine Med Ctr (UVM)Paul DeKoning, U North Carolina Hosp Catherine Lenkoski, Los Angeles County-Harbor-UCLA Shannon Lucas, Hosp of U of PennsylvaniaFamily PracticeTrevor Braden, Central Maine Med Ctr (Boston U)Rachel Eelkema, UCLA Med Ctr-Santa MonicaLisa Holland, Allina Family Residency ProgMichael Kim, Northridge Hosp Med Ctr (UCLA)Benjamin Mailloux, Virginia Commonwealth U Dale Ross, University of Wyoming-CasperMary Smith, Sutter Health (UC Davis)Tara Thacker, Kaiser Permanente-Los AngelesKristen Thornton, Mayo Matthew Weitzel, Lancaster Gen HospInternal MedicineKelly Bodio, Beth Israel Deaconess (Harvard)Marilena Caldarusa, Rhode Island Hosp (Brown)Rebecca Cogswell, UCSF Med CtrLaura Noddin, Beth Israel Deaconess (Harvard)Hadas Shiran, U Michigan HospKatherin Sproul, Dartmouth-Hitchcock Geoffrey Walford, Brigham & Women’s Hosp (Harvard)Charles Wicks, Hosp of U of PennsylvaniaInternal Medicine (Preliminary)Jose Carrillo, St. Joseph’s Hosp (U Arizona)Joi Carter, Beth Israel Deaconess (Harvard)Corey Couto, Rhode Island Hosp (Brown)Kristin Elias, St Vincent’s Hosp (NY Med Coll)Erin Salcone, Caritas St. Elizabeth’s Med Ctr (Tufts)David Wartman, Beth Israel Deaconess (Harvard)Internal Medicine (Primary Care)Evan Dvorin, Brigham & Women’s Hosp (Harvard)Obstetrics-GynecologySum Cheung, Loma Linda UKathleen DelGrosso, Georgetown U HospCara Mathews, Women & Infants Hosp (Brown)Orthopaedic Surgery Patrick Denard, Oregon Health & Science UBryan Mitchell, Strong Mem Hosp (U Rochester)Nikhil Thakur, Rhode Island Hosp (Brown)PathologyBryan Coffing, U Michigan HospThomas Kirn, Hosp of U of PennsylvaniaJonathan Marotti, Beth Israel Deaconess (Harvard)PediatricsMalinda Danforth, Baystate Med Ctr (Tufts)Jaclyn Davis, New York Presbyterian Hosp (Cornell)Tobias Hays, Children’s Hosp-Oakland (UCSF)Linda Lee, Georgetown U Hosp Jennifer McGuire, U Colorado Sch of MedJaime Walford, McGaw Med Ctr (Northwestern)Stanley Weinberger, U MinnesotaPatricia Wurster, New England Med Ctr (Tufts)Pediatrics (Medical Genetics)Benjamin Solomon, NIH/Children’s National Med CtrPediatrics (Preliminary)Orville Hartford, U of Louisville Plastic SurgeryAnthony Perrone, Strong Mem Hosp (U Rochester)Matthew Stanwix, Johns Hopkins/U Maryland Prog

PsychiatryJeffrey Barrett, Montefiore Med Ctr (Albert Einstein)Thaddeus Shattuck, Brown UJulie Young, UC Davis Med CtrAnthony Wolf, U Michigan HospSurgery (General)Rebekah Kim, St. Luke’s-Roosevelt (Columbia)Franklin Margaron, Virginia Commonwealth U Nicholas Osborne, U Michigan HospSurgery (Preliminary)John Gachiani, Louisiana State U Health Sci CtrBrian Kowal, Dartmouth-Hitchcock Sylvan Maginley, Bassett Healthcare (Columbia)Alaka Pellock, Beth Israel Deaconess (Harvard)Hussein Samji, Stanford U Med CtrNwamaka Tagbo, Washington Hosp CtrYoussef Tanagho, U Hosp (Case Western Reserve) TransitionalChristine Haughey, Hennepin County Med Ctr (U Minn)Asef Khwaja, St. Barnabas Med Ctr

Brown-Dartmouth ’05s are entering these residency programs:Family PracticeElizabeth Moran, U Arizona Affil HospJustin Wheeler, Oregon Health & Science UInternal MedicineMatthew Frances, UC Davis Med CtrMichelle Morreale, New England Med Ctr (Tufts)Louai Razzouk, Mt. Sinai Hosp Sch of MedInternal Medicine (Preliminary)Charles Chia, St. Vincent Hosp (NY Med Coll)Felicia Chu, Beth Israel Deaconess (Harvard)Kristen Koconis, Hershey Med Ctr (Penn State)Internal Medicine (Primary Care)Amy Noack, San Francisco Gen Hosp (UCSF)RadiologyDorothy Shum, Kaiser Permanente-Los Angeles

In addition, these 2005 graduates have been accepted intoadvanced programs that they will start in July of 2006:AnesthesiologyAlaka Pellock, Beth Israel Deaconess (Harvard)Child NeurologyJennifer McGuire, Children’s Hosp of Philadelphia (UPenn)DermatologyJoi Carter, Dartmouth-Hitchcock Charles Chia, U Washington Med CtrOrville Hartford, Fletcher Allen Health Care (UVM)Christine Haughey, U MinnesotaDavid Wartman, Rhode Island Hosp (Brown)NeurologyJose Carillo, Los Angeles County-Harbor-UCLA Felicia Chu, Beth Israel Deaconess (Harvard)NeurosurgeryJohn Gachiani, Louisiana State U Health Sci CtrOphthalmologyErin Salcone, Massachusetts Eye & Ear (Harvard)OtolaryngologyHussein Samji, Stanford URadiologyCorey Couto, Rhode Island Hosp (Brown U)Kristin Elias, NYU Med CtrAsef Khwaja, U Maryland Med CtrKristen Koconis, Hershey Med Ctr (Penn State)UrologyBrian Kowal, Dartmouth-Hitchcock Nwamaka Tagbo, Washington Hosp Ctr Youssef Tanagho, U Hosp (Case Western Reserve)


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Hugs and high-fives were clearly the order of the day when the DMS ’05s got theirresidency assignments. Pictured are 1 Joi Carter and Laura Noddin—both ofwhom are headed for Harvard’s Beth Israel Deaconess Medical Center; 2 Jef-frey Barrett—sharing with Senior Associate Dean Dave Nierenberg the news thathe’s going to Montefiore Medical Center in New York City; 3 Kathleen DelGrosso andBen Solomon—upon finding out they’re both bound for the D.C. area, she to George-town and he to the National Institutes of Health; and 4 Geoffrey Walford (left, whomatched at Harvard’s Brigham and Women’s Hospital in Boston) and Tobias Hays(right, who’s heading west to UCSF’s Children’s Hospital), celebrating with a friend.

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extra work. Interacting with herfellow student editors was a plea-sure for Young. For the first timesince entering medical school,she was working with peoplewho were “speaking the samelanguage—the same editoriallanguage” she did.

Although Student JAMA wasa small section—appearing oncea month within the larger week-ly journal—and was run by stu-dents, it was no less rigorous inits editorial standards. “Eventhough this was sort of a studentpublication,” explains Dr. Ste-phen Lurie, former senior editorat JAMA who worked closelywith Young, “there was the ex-pectation that it would be up toJAMA’s usual standards.”

Contributing authors were of-ten surprised by this and put offby the numerous revisions re-quested by the student editors,Young explains. “They didn’t un-derstand that JAMA was tellingus, ‘Look, if you don’t changethis, we’re not publishing it.’”

Grateful: Yet despite the strug-gles with authors and the longhours (and her dismay whenJAMA discontinued the studentsection last year), Young is grate-ful for the experience. “I feel,now, a lot more confident that ifI want to publish a paper, I havea pretty good idea of what’s re-quired,” she says.

In addition, Student JAMA“totally changed” Young’s resi-dency application. “Every inter-view that I went on, that’s thefirst thing they’d ask me about—the JAMA experience,” she re-calls. “And it actually deter-

J ulie Suzumi Young, DMS ’05,is adept at putting words to-

gether on paper but can’t find anice way to say that she “hated”the first two years of medicalschool. “How can you say thatnicely?” she asks. “Every singlething I did, everything I learned,was completely alien.”

Zone: Young was in her latethirties when she decided toleave an established career as adietitian and start all over againas an M.D. student. She felt outof her comfort zone.

One major enjoyment miss-ing from her life was writing,which had been a constant eversince college, when she haddreamed of becoming a journal-ist. But that dream fizzled onceshe got to know the daily grindof journalism as an intern for theLos Angeles Times.

She kept writing, though, foremployee and professional soci-ety newsletters and for Japanesenewspapers. It wasn’t until med-ical school had consumed herlife that she realized how muchshe missed working with otherwriters and editors. So when sheheard that the Journal of theAmerican Medical Association(JAMA) had editorial openingsin its student section—MedicalStudent JAMA (later StudentJAMA)—she applied for andlanded one of the positions.

“I think it’s safe to say that[Student JAMA] really changedmy medical school experience,”says Young. She spent three yearsas the student section’s deputyeditor, spreading out her clinicalrotations to accommodate the

DMS ’05 was the deputy editor of Student JAMA

14 Dartmouth Medicine Summer 2005

VITAL SIGNS

From the left, tile artists Simon, Wikoff, and Eisenhardt.

Julie Young spent the last few yearshelping to edit JAMA’s student section.

mined my number-one spot . . .UC-Davis.” Young knew thatshe wanted to enter the psychia-try residency at the University ofCalifornia at Davis after she cor-responded with the chair of psy-chiatry there, Dr. Robert Hales,who is also editor-in-chief for thebook arm of American Psychi-atric Publishing. After that in-teraction, UC-Davis “was theonly place I wanted to go be-cause of the opportunity to workwith Dr. Hales,” says Young.

Mutual: The feeling seems tohave been mutual, since Youngwas accepted to the programand, even before arriving in Cal-ifornia, already had gotten a fewassignments from Hales.

“Right after the Match,” saysYoung, “I e-mailed him, ‘Hey!I’m coming to UC-Davis!’ Sothen he e-mails me back, ‘Okay,I’ll give you a project.’ ” Whilesome students might have ruedthe extra work, Young’s assess-ment was: “It’s just fun!”

Jennifer Durgin

Tile construction beautifies Chilcott Auditorium stairwell

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A Godzilla-like creature opens its large, toothymouth. Nearby, streaks of light from a blaz-

ing sun bounce off a rocky landscape. These arejust two examples of 104 beautifully detailedclay tiles made by DMS students, faculty, andstaff. The tiles have been assembled into a col-lage-like work of art that was recently mountedin the stairwell of Chilcott Auditorium onDMS’s Hanover campus.

The idea for the project came about whenElizabeth Eisenhardt, now a third-year student,met Naj Wikoff, director of the Healing and theArts Project at DMS’s Koop Institute. Theywanted to reinforce the presence of the arts andbeautify the Medical School’s facilities. They de-cided on a group tile-making project as their firsteffort, seeing it as a perfect way to involve lotsof people. Taking a simple carving tool and cre-ating an image in a square of wet clay is also fair-ly easy to teach.

Clay: At tile-making workshops in the DMSStudent Lounge, they invited passers-by to comein and render something important to them—nature scenes, faces, hobbies, or cultural icons.Eisenhardt’s passion is ballet (she danced pro-fessionally before medical school), so her tile hasa silhouette of a leaping ballerina.

“Naj was a great teacher,” says second-year

student Laura Simon, who took over the projectthis year and oversaw the installation. “A lot ofstudents started off saying, ‘I don’t know how todo this. I don’t know anything about art.’ Butworking with clay is such a great medium thatthey started using their hands and getting intoit.” Simon’s tile features a bright sun against animpressionistic landscape. “Sitting in the loungewith friends and classmates really does inspireyou and gives you a sense of community,” shesays. “This made me think of a sun.”

The tiles were arranged as a single, dramaticwork with two large parts—a beige diamond anda blue diamond—each made up of many dis-tinct, small parts. Rather like the big institutionthat the construction now beautifies. M.C.W.


A mericans know more aboutthe safety, quality, and effi-

ciency of the cars they drive thanof the places they seek medicalcare. Why? Because over theyears not many hospitals andclinics have collected data abouttheir performance—such as thenumber of inpatients who diefrom a heart attack or the satis-faction of patients upon dis-charge—and only recently havea select few made such dataavailable to the public. (See page16 for news on DHMC’s actionsin this regard.)

But measuring and reportingoutcomes is just what’s needed toimprove U.S. health care andstymie skyrocketing costs, saidsix national health-care leaderswho gathered for a symposium atDHMC in late May.

“We have made a commit-ment to transparency, a commit-ment to making the informationthat patients need . . . available,and using that information forimprovement,” says Paul Gar-dent, executive vice president ofDHMC, after the event. But “wedon’t want to simply look with-in the walls of our medical cen-ter,” he adds. He and other Dart-mouth-Hitchcock leaders wantto “think more broadly and morestrategically about the health in-formation needs” of the future.

Ideas: To bring forth newideas, Gardent and Dr. ThomasColacchio, president of the Dart-mouth-Hitchcock Clinic, host-ed a symposium titled “Med-

VITAL SIGNS

DHMC symposium:Health-care datashould be made public

Richard Reindollar, new ob-gyn chair.

OveR Infertility Treatment Tri-al), for women 40 to 43.

Reindollar received his M.D.from Bowman Gray, did his resi-dency at York (Pa.) Hospital,and completed a fellowship inreproductive endocrinology andgenetics at the Medical Collegeof Georgia. He stayed on the fac-ulty there for five years, never ex-pecting to one day specialize ininfertility, let alone run clinicaltrails. “We trained in pure repro-ductive endocrinology—sexualambiguity, delayed and preco-cious puberty, and menstrual ab-normalities,” he says.

In 1986, he was hired as di-rector of the Division of Repro-ductive Endocrinology at TuftsNew England Medical Center;he also set up a molecular biolo-gy lab at Tufts Medical School.Ten years later, he moved acrosstown to Harvard.

Reindollar now looks forwardto moving north. “It will be real-ly exciting for me to leave thebustle of a very competitive butlarge patient base and come to amore rural community,” he says.He’s impressed with the collabo-rative spirit that “permeatesthroughout the entire MedicalCenter and Medical School.”

In his new role, he hopes tostrengthen local and regionalclinical care; build the teachingand research programs; establishfellowships in reproductive en-docrinology, maternal-fetal med-icine, and urogynecology; andexpand the reproductive medi-cine network in northern NewEngland. “Barry Smith put to-gether this very, very strong pro-

H e expected to follow in hisparents’ footsteps and be-

come a schoolteacher. Instead,in September, Dr. Richard Rein-dollar will follow in Dr. BarrySmith’s footsteps and becomechair of the DMS Department ofObstetrics and Gynecology.

Funding: Internationally recog-nized for his work in reproduc-tive endocrinology and infertili-ty, Reindollar has been on thefaculty at Harvard since 1997.He is also director of reproduc-tive endocrinology and infertili-ty at Beth Israel Deaconess Med-ical Center and principal inves-tigator for the two largest clinicalinfertility studies in the nation;he’ll bring oversight of the trials(and their funding) with him toDartmouth this fall.

The studies, which are look-ing at the cost-effectiveness ofdifferent approaches to infertili-ty care, are being run with sever-al Boston organizations; DMS’sDepartment of Community andFamily Medicine and Center forthe Evaluative Clinical Scienceswill join the collaborative andanalyze the data when the stud-ies are completed.

“We are studying whetherconventional infertility treat-ments are appropriate as the firstline in moving toward in vitrofertilization, or whether it’s costeffective to move rapidly into invitro fertilization,” Reindollar ex-plains. About 500 couples areenrolled in the FASTT (FastTrack and Standard TreatmentTrack) trial, for women under 40years old. About 450 will be en-rolled in FORTT (Forty and

Richard Reindollar is named chair of ob-gyn

gram and really developed strongties throughout the region andespecially the southern part ofthe state,” Reindollar says. Healso looks forward to collaborat-ing with Dr. Emily Baker, who asinterim chair “continued to growthe department and to lead in afashion that I’ve just not seen forinterim chairs.”

Leadership: Reindollar is a del-egate to the American Board ofObstetrics and Gynecology, thespecialty’s certifying organiza-tion, and has held leadershiproles—including as president—in several other national and re-gional specialty societies.

His parents may have beenteachers, but his family now in-cludes a couple of doctors. Hiswife, Dr. Ann Davis, is an ob-gynwho specializes in pediatric andadolescent gynecology; she iscurrently on the faculty at Tuftsand may join the DMS facultynext year. And his identical twinbrother is a gastroenterologist inNorth Carolina. But it’s too soonto tell in whose footsteps his twoteenage sons will follow.

Laura Stephenson Carter

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WELL-HEALED: The Norris Cotton Cancer Center ran a series of five Healing Tapestry workshops in April. Cancer

survivors were invited to work with a visiting artist to createpersonal, expressive “tapestries” of textured, handmade paper.


VITAL SIGNS

vide better information to pa-tients to help them make health-care decisions; to increase trustin DHMC’s role as a charitable,nonprofit organization; and tostimulate improvement in thequality of care. “We define qual-ity broadly,” Gardent says, “to in-clude clinical outcomes, as wellas patient satisfaction and cost ofservices.”

Putting flesh on the bones ofthose simple-sounding goals tooksome time, however. MelanieMastanduno, a clinical measure-ment analyst at DHMC, saysthat administrators spent about15 months answering the ques-tion “How would transparencylook?” Based on information andopinions from national consul-tants, patient interviews, and fo-cus groups, DHMC decided tocreate a Web site that would givepatients accurate and honestdata about the Medical Center’sperformance. “Our mission is tocontinually improve the scienceof clinical practice,” she says,“and we believe that publishingboth health information andquality reports is a valuable toolin that mission.”

Quality reports: The site, whichcan be reached by going towww.dhmc.org and clicking on“Featured Section: Quality Re-ports,” went live a year and a halfago. Most recently, in Februaryof this year, charges for services—including office visits, diag-nostic tests, and surgical proce-dures—were added to the site.DHMC is not only one of thefirst institutions to publish itscharges, Mastanduno points out,

I f you put the word “trans-parency” into the news search

engine LexisNexis, virtually allthe hits have to do with interna-tional affairs. But that was theword chosen by the Institute ofMedicine (IOM) in a 2002 callfor an overhaul of the domestichealth-care system. The IOM’s“Crossing the Quality Chasm”report challenged hospitals toimprove the quality of care, re-duce medical errors, and increase“transparency” about their per-formance.

Dartmouth-Hitchcock notonly didn’t have to ask what theIOM meant by transparency butwas poised to respond. “DHMCand DMS have a long history,”says executive vice presidentPaul Gardent, “of measuring per-formance in the interest of qual-ity improvement.”

This approach, based on workat Dartmouth’s Center for theEvaluative Clinical Sciences(CECS), rests on the underlyingprinciple of informed patient de-cision-making. “Given our his-toric interest, and the call by theInstitute of Medicine,” Gardentcontinues, “we needed to em-brace transparency and to be-come a national leader in trans-parency.” (See page 15 for a sto-ry on a related effort.)

Post charges: The latest step inthat process came a few monthsago, when DHMC became oneof the first medical centers in thecountry to post charges for itsservices on its Web site.

But back to the beginning:After the IOM report came out,DHMC set three goals—to pro-

Cost of services is part of transparency at DHMCicine, Metrics, and Transforma-tion: Making the ImportantChoices.” More than 250 clini-cians and administrators from re-gional hospitals, clinics, and or-ganizations, as well as govern-ment officials, attended.

Keynote: The keynote speakerwas Dr. Kenneth Kizer, who asundersecretary for health in theDepartment of Veterans Affairswas largely responsible for trans-forming the ailing VA medicalsystem into one of the best in theworld. “Modern health care isthe most information-intensiveenterprise that human beingshave ever engaged in,” Kizer toldthe audience. “Yet we’re tryingto manage it, and trying to oper-ate in many cases, the same waywe did 100 years ago. We simplycan’t get to where we need to gotoday without bringing healthcare IT [information technology]into the 21st century.”

But getting “where we needto go” is about more than com-puters and data, Kizer and theother speakers said. “The otherpiece . . . is leadership and com-mitment and understanding ofthe direction in which [the data]can take you,” said Dr. LouiseLiang, senior vice president ofKaiser Permanente, a nonprofitHMO and the nation’s largest. “Ithink it’s very clear,” she added,“that [DHMC], this community,has [that] other piece.”

Dr. Donald Berwick, CEO ofthe Institute for Healthcare Im-provement, also praised DHMC,reminding attendees to stay fo-cused on patients—“a reminderyou don’t need at Dartmouth.”

DHMC is indeed a nationalleader in outcomes reporting and

quality improvement, as recentarticles in the Wall Street Journal,the New York Times, and theWashington Post have attested.Faculty in Dartmouth’s Centerfor the Evaluative Clinical Sci-ences (CECS)—such as Dr. JohnWennberg, the first person todraw attention to regional varia-tions in care—have been study-ing the delivery of care for morethan 20 years.

Two CECS faculty members,Dr. Elliott Fisher (whose re-search suggests that 30% of U.S.health-care dollars go to unnec-essary treatments) and Dr. Ger-ald O’Connor (who cofoundedthe Northern New EnglandCardiovascular Disease StudyGroup) also spoke. Both talkedabout how data can change clin-ical outcomes. O’Connor, for ex-ample, described a collaborationamong five hospitals that hasdramatically cut their combinedmortality rate for heart-bypasssurgery.

Fisher and O’Connor alsourged academic medical centersto lead the way. “If we . . . look athow we compare to other acade-mic medical centers,” pointedout Fisher, “we can teach our res-idents and our students about re-flective practice.”

“We have gotten a lot ofrecognition for our efforts,” Gar-dent says later. But he’s carefulnot to exaggerate DHMC’s ac-complishments nor to diminishthe challenges that remain. It’sthe combination of “science plusmeasurement plus reporting,”adds Gardent, “that will lead tomuch higher levels of qualityand reliability.”

Jennifer Durgin

WASTE NOT, WANT NOT: DHMC received one of only eightnational Environmental Leader Awards from Hospitals for aHealthy Environment. The awards recognize efforts to cut waste,phase out toxic substances, and eliminate the use of mercury.


VITAL SIGNS

but one of the few to represent“the full retail price,” includingthe charge for both hospital anddoctor services.

In the “Quality Reports” sec-tion of the site, people can, forexample, click on breast cancerand learn that the five-year sur-vival rate for patients with Stage1 breast cancer who were treatedat DHMC is 93%, comparedwith a national average of 87%.They can check the numbers ofprevious patients who have cho-sen specific treatment options,such as lumpectomy, mastecto-my, or simultaneous breast re-construction and learn about thesatisfaction rates of each group ofpatients. “A Typical Patient’sJourney: The ComprehensiveBreast Program” offers a step-by-step guide from diagnosis totreatment options.

And clicking on the new“Charges for Health Care Ser-vices” section reveals, for in-stance, that a low-complexitynew-patient office visit costs$94, a bilateral diagnostic mam-

mogram costs $413, and a breastbiopsy costs $6,700.

Further, the site provides in-formation about payment op-tions and financial aid for med-ically necessary services for pa-tients who are under- or unin-sured. Those who do have insur-ance are directed to a toll-freephone number that allows themto talk with a financial counselorto determine their out-of-pock-et expenses ahead of time.

Improvement: “We are in thebusiness of continual improve-ment,” Mastanduno says. Shewould like to see more disease-specific information on the site.And, she adds, “we would love itif there were a calculator patientscould use that would let them in-put their insurance informationand give them a read-out of theirexpenses.”

In the meantime, patients arenoticing the new information. InApril alone, Mastanduno says,there were 450 hits just on the“Charges for Services” link.

Catherine Tudish

paign that was launched in No-vember of 2004.

“The College and the Med-ical School have developed com-mon values and a shared com-mitment to integrative educa-tion that builds bridges betweenthe faculties of medicine, artsand sciences, engineering, andbusiness at the College, and allthe cl inical enterprises ofDHMC,” said Dartmouth Presi-dent James Wright at the DMS-DHMC launch. “This campaignis also one of the keys to the con-tinuing preeminence of the over-all Dartmouth experience.”

Components of the $250-million goal include:

< $85 million for support offaculty, primarily through the es-tablishment of endowed chairsfor senior faculty and endow-ments for junior faculty develop-ment. Scholarships for DMS stu-dents are also being sought.

< $98 million for key clinicaland research programs, most no-tably within Norris Cotton Can-cer Center, the Children’s Hos-pital at Dartmouth, and theCenter for the Evaluative Clini-cal Sciences, as well as researchin areas such as neuroscience,cardiovascular research, immu-nology and infectious diseases,orthopaedics, and genetics.

< $67 million for new re-search facilities at DHMC, in-cluding a Translational ResearchBuilding and a Center for theEvaluative Clinical Sciencesbuilding; renovations to the Vailand Remsen research buildingson DMS’s Hanover campus; anda $2-million contribution to the

T he mood was celebratory. Thesun was shining. The news

was great. On Saturday, May 21,Dartmouth Medical School andDartmouth-Hitchcock MedicalCenter announced to the worldthat they were launching a $250-million campaign—the largest intheir history—that aims to trans-form the way medicine is deliv-ered both in their own backyardand around the world.

Endowment: The appropriatelynamed Transforming MedicineCampaign will raise funds to in-crease endowment for facultysupport and program develop-ment; to advance research, aca-demic, and clinical initiatives;and to build new facilities.

“Together we will transformnot just medicine, but lives, herein the Upper Valley, in the re-gions of New Hampshire andVermont, and throughout ourcountry and our world,” said Al-fred Griggs, chair of both theDHMC and Mary HitchcockHospital Boards, in officiallylaunching the campaign.

The previous record for aDMS or DHMC campaign was$95 million, raised as part of theDartmouth College Will to Ex-cel campaign, which ended in1996. Although TransformingMedicine has just gone public,it’s been accepting advance giftssince July 1, 2002—and as of thelaunch, nearly $91 million hadalready been committed towardthe $250-million goal.

The Transforming MedicineCampaign—which will runthrough 2009—is part of a $1.3-billion Dartmouth College cam-

Transforming Medicine Campaign goes public

This is the new Web site where DHMC posts charges for its services and links to in-formation to help patients determine payment options specific to their situations.


new Norris Cotton Cancer Cen-ter-North in St. Johnsbury, Vt.

Lead gift commitments madeduring the quiet phase of thecampaign included $5 millionfrom Dean LeBaron to build acommons to connect BorwellResearch Building to future re-search facilities; $5 million fromJennifer and Peter Brock for thegenetics department; $5 millionfrom the Theodora B. Betz Foun-dation to study brain tumors atNorris Cotton Cancer Center;$3 million from Johnson &Johnson for a psychiatry depart-ment project to help people withsevere mental illness gain inde-pendence by obtaining commu-nity-based employment; and $2million for scholarships from Dr.Norman Payson, a 1973 gradu-ate of DMS.

Difference: Payson, former CEOof Oxford Health Plans as well asa DMS Overseer, also spoke atthe launch. “Today,” he said, “inheath-care policy, practice, med-ical education, patient empow-erment, understanding of dis-ease, advances in diagnosis andtreatment, this medical centerand medical school are making adifference.”

“What we export from theUpper Valley are the ideas, themodels, the practices,” notedDHMC’s senior nurse executive,Nancy Formella, who roundedout the slate of speakers. “Thecare and the innovations in care,the improved treatments andtherapies—they start right herein this community and theywork every day to benefit the pa-tients of our region” . . . and, ul-timately, the world.


Summer 2005

VITAL SIGNS

1 The Transforming Medicine Campaignfor DMS and DHMC went public on May21 with 2 a launch announcement at-tended by more than 300 people, in-cluding, 3 from the left, MHMH Presi-dent Jim Varnum, campaign cochair Pe-ter Williamson, Clinic President TomColacchio, and DMS Dean Steve Spiel-berg; four speakers, including 4 fromthe right, alumnus Norm Payson, boardchair Al Griggs, Dartmouth PresidentJim Wright, and 5 nursing executiveNancy Formella; 6 plus many others.

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GOOD WORD: At the campaign launch event, word wasannounced of a new, anonymous $1-million commitment to the Center for the Evaluative Clinical Sciences, which is working to transform the delivery of care nationwide.


VITAL SIGNS

L adies and gentleman, we willbegin boarding in a moment,”

said a voice over a loudspeaker—an appropriate announcement toany passengers at any airport.But these weren’t just any pas-sengers; they were party guests intuxedos and ball gowns. And thiswasn’t just any airport; it was aprivate hangar in Lebanon thathad been transformed into an el-egant banquet hall, completewith crystal chandeliers.

Garb: The “passengers” wereguests at a black-tie fund-raisinggala to celebrate the Transform-ing Medicine Campaign (seepage 17 for a related story). Asthey arrived, the 500 guests weregreeted by “stewardesses” in vin-tage garb and serenaded by bar-bershop and doo-wop quartets.Then they sipped on cocktails;chatted with actors dressed asaviation pioneers Wilbur and Or-ville Wright; bid on silent auc-tion items; and admired antiqueaircraft. “This is a fabulousevent,” said Dr. Ira Byock, direc-tor of DHMC’s Palliative Med-icine Program. “It’s unique . . . alittle history and a great deal offun. It’s amazing to see everybodyhere supporting this remarkableeffort. And we are indeed here totransform medicine.”

During dinner, historical im-ages of DMS and DHMC flashedon giant screens, while swingdancers jived and bands played.Later, a voice announced, “Weare about to begin our in-flightmovie.” After a short film cele-

Aviation-themed galagets capital campaignoff the ground in style

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brating institutional successes,there were brief remarks byemcee Susan Dentzer, DC ’77,health correspondent for PBS’sNewsHour, a DHMC Trustee,and a DMS Overseer; campaigncochair Dr. Peter Williamson,DC ’58 and a DHMC neurolo-gist; and retired NBC correspon-dent Bob Hager, DC ’60. Hagerspoke of ways that Dartmouthmedical pioneers are transform-ing medicine, just as the Wrightbrothers transformed flying.

Memorable: Finally, as everyonedeparted, they stopped at “Bag-gage Claim” to pick up mini-suit-cases filled with mementos of amemorable evening.


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It took an airplane hangar to hold the 500 guests at a May 21 DMS-DHMC fund-raising gala, but 1 the space didn’t look much like a hangar, decked out in crys-tal and calla lilies. 2 Two Boston-based bands played for the occasion, 3 while theevent’s aviation theme included “stewardesses” in vintage suits. 4 Susan Dentzerof the PBS NewsHour emceed the festivities, 5 and a good time was had by all.

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VITAL SIGNS

M edical opinion in the U.S. regarding water births runs . . .well . . . hot and cold. As of 2001, the latest year for which

figures are available, about 140 hospitals offered the procedure,but many did not. Dartmouth Hitchcock-Keene/Cheshire Med-ical Center strongly supports the concept and has done over

1,000 water births since starting a program in 1998.DHMC in Lebanon offers underwater labor, but notwater births. In England, though, feelings are far fromlukewarm. In 1992, the House of Commons passed a

resolution that all maternity services providewomen the option of labor or delivery in water.

In a recent grand rounds presentation at DHMCtitled “Water Births: Dolphins and Whales Do It—

Should Humans?” Dr. Kisha Destin described compli-cations associated with underwater births, such as neonatal wa-terborne infectious disease and cord rupture with neonatal he-morrhage. It’s assumed that the rates of these complications arelow, said Destin, but she noted that no large randomized con-trolled study has ever been done on the process. M.C.W.

T hough patients’ experiences often end up in papers for med-ical journals, it’s rare that they play a role in a literary career.

But not impossible. Several years ago, Catherine Tudish—thena member of the Dartmouth Medicine staff and now one ofthe magazine’s regular freelancers—visited the Norris CottonCancer Center infusion suite to write a story about a patient be-ing treated there. “I was given a tour of the suite and was par-

ticularly struck by the children,” Tudish recalls.“Those impressions stayed with me, becomingmore powerful with time, until I had no choice butto write a story about a child with leukemia. Thatstory was published in Green Mountain Review andread by Nat Sobel, who is considered one of thetop New York agents.” Sobel took Tudish on as aclient; encouraged her to build a collection of sto-ries around that first one—“The Infusion Suite”;

and found a publisher for the book—titled Tenney’s Landing.“So Dartmouth Medicine played a key role in launching

my literary career,” Tudish adds, “though it’s much too soon toactually claim a ‘literary career.’” Hardly. The book was just re-leased by Scribner, and a review in Publishers Weekly called it an“eloquent, emotionally authentic debut.” A.S.

T H E B I R T H O F A N O T I O N

B O O K D E B U T H A S D M S R O O T Spage 40), remains controversial,the benefits of AAA screeningare conclusive. “If we find ananeurysm before it’s ruptured, wehave a 95% to 98% cure rate,”says Zwolak. And unlike cancer,there are clear benchmarks forwhat size aneurysms are likely tocause problems. “If it’s a ‘baby’aneurysm, you might follow itonce a year with an ultrasoundbecause that’s how slowly theygrow,” Zwolak says. “If it’s medi-um, say between four and fivecentimeters in diameter whenit’s discovered, you’d look withan ultrasound every six months.And then when it gets abovefive—in men we think five and ahalf is the magic number—that’sthe point at which the risk of thething rupturing is significantenough that it’s worth under-taking a fairly large-magnitudesurgery to fix it.”

Fix: AAAs can be “fixed” withopen surgery or with a newer,less-invasive procedure. In opensurgery, a piece of synthetic tub-ing is sewn in place of the weaksegment. “In concept, it’s in-credibly simple,” says Zwolak.But in practice, it’s a “very bigoperation”; even when done ona nonemergency basis, 3% to 4%of patients don’t survive.

The less-invasive procedurehas much better outcomes—just1% to 2% mortality. It involvesonly a small incision in an arteryin the leg. A device about the di-ameter of a pen is then fed upinto the abdominal aorta. Oncein place, the device deploys astent graft that spans the lengthof the aneurysm and descends

J ust below the kidneys runs asection of the abdominal aor-

ta, a blood vessel about the sizeof a small garden hose. It’s aworkhorse, delivering blood tothe whole lower half of the body.But after 50 or 60 years of use, itswalls can weaken, sometimescreating a dangerous bulgeknown as an aneurysm. If theaneurysm gets too big and tooweak, it can rupture.

Huge: “That’s a calamity thatmost people don’t survive,” saysDr. Robert Zwolak, a vascularsurgeon at DMS. “Of those luckyenough to get to the hospitalalive, there is a huge emergencysurgery,” and about 50% of thosewho undergo emergency surgerydon’t survive. Some 15,000 peo-ple die each year in the U.S. ofruptured aortic aneurysms.

Zwolak was tired of seeing pa-tients die from aneurysms thatcould have been detected by ul-trasound and treated before theyruptured. So in February 2004,he helped the Society for Vascu-lar Surgery found the NationalAneurysm Alliance (NAA), anorganization dedicated to reduc-ing deaths from abdominal aorticaneurysms (AAAs). As the headof the NAA, Zwolak has beenlobbying Congress since mid-2004 to require Medicare to cov-er ultrasound screening for thoseat risk of AAA—which includeseveryone over 55 who smokes orhas smoked, has high blood pres-sure, has evidence of atheroscle-rotic vascular disease, or has afamily history of AAA.

Though screening for manydiseases, especially cancer (see

Surgeon leads aneurysm screening campaign

MUSIC TO THEIR EARS: DHMC is aiming to fill somenursing positions by offering an iPod digital music player as a signing bonus for new nurses. The nationwide nursingshortage clearly calls for unusual . . . well, measures.


into the iliac arteries. Now, saysZwolak, “more than 50% of[elective AAA surgery] patientsat Dartmouth—and I thinkthat’s pretty representative ofmajor medical centers across thecountry—are getting these min-imally invasive grafts.”

Though lobbying is a newrole for Zwolak, he’s found it rel-atively easy because, he says, he“can obviously speak with greatsincerity and experience.” Heand the NAA got a boost intheir campaign when earlier thisyear the U.S. Preventive Ser-vices Task Force endorsed AAAscreening for men aged 65 to 75who smoke or have smoked. “For. . . men smokers they got it righton the nose,” says Zwolak. “But Ireally think they dropped theball for women,” he adds, and“for people with family historiesthat are positive.”

Soon: But armed with that rec-ommendation, and bipartisansupport, the NAA hopes to getits legislation before Congresssoon. “We’re cautiously opti-mistic that before they go homefor Christmas this year, we’ll getthis passed,” Zwolak says.

Jennifer Durgin

VITAL SIGNS

G ood doctor-nurse relation-ships are essential for good

health care. But such relation-ships—often forged in a hecticand stressful environment—have historically been a littlerocky. DMS recently establisheda nurse shadowing program thataims to help medical studentsbuild strong relationships withnurses, so they can collaboratemore effectively.

The elective course was start-ed by Joseph O’Donnell, M.D.,senior advising dean at DMS,and Ellen Ceppetelli, R.N., di-rector of nursing education atDHMC. They got the idea whenthey co-taught a session of aDMS course called Health, So-ciety, and the Physician. “One ofthe things that we realized as wewere talking to the fourth-yearstudents,” says O’Donnell, “wasthat they really didn’t have agood picture of what nurses didand how they added to thehealth-care team.”

Caring: “I started thinking inmy mind how could we get thesewonderful, caring, holistic youngpeople to think about what rolea nurse plays in health care,”adds Ceppetelli.

O’Donnell and Ceppetelliwanted the program to be as col-laborative as a real doctor-nurserelationship should be. So it wasleft to the nursing directors,nurses, and participating DMSstudents to determine how bestto structure the shadowing expe-rience. “I think we were afraid of

“Me and my shadow”is mantra for a new medical student elective

T here isn’t a day I go home that I can’t say I learned two newthings,” says Jill Polito. A technical specialist in DHMC’s

clinical laboratory, she’s speaking to a group of University ofNew Hampshire (UNH) students who are visiting DHMC.Next, Polito helps the students gaze through a multiheaded mi-croscope, so they can see slides of spinal meningitis and acuteleukemia. Playing an important role in patientcare by helping to make such diagnoses is whatPolito “loves about being a med tech,” she adds.

Polito was one of several DHMC technologistswho met recently with UNH sophomores to culti-vate their interest in the field of medical laborato-ry science. The two institutions collaborate to of-fer a degree in the field, with UNH providing theclassroom work and DHMC the clinical training in a six-month internship. During the internship, students complete ro-tations in the four subsections of the clinical pathology lab—the blood bank, hematology, chemistry, and microbiology—andbecome integrated into the often hectic workflow. “‘Stat’ is oneof [the students’] major words,” Polito noted. J.D.

I t was unusual as student gripes go: these fourth-year Dart-mouth medical students weren’t belly-aching about their

course load or bemoaning a boring lecture. Instead, they werelamenting, “Isn’t it sad that really good role models sometimesdon’t get recognized?” Each year, the DMS graduating classpicks two faculty members and one resident to receive teach-ing awards at Class Day, but these students wanted to show theirappreciation for the many clinicians whose bedsidemanner and compassionate care they seek to emu-late. “So then I said, ‘Why don’t we recognize themsomehow?’ ” recalls Julie Young, DMS ’05.

Initially, the group intended to honor just a fewclinicians, but when they opened the idea up tothe entire class, the nominations swelled. Notwanting to turn it into a competition, the studentschose to honor all of the nominees—25 attendingphysicians, four residents, and one optometrist. “Thank you foryour part in our educations,” the students wrote in a memo ex-plaining their Outstanding Physician Role Model Award. “Dueto your efforts, we have had plenty of wonderful people whohave shown us how to become ‘good docs.’” J.D.

T E A C H I N G T E C H S I N T H E L A B

R O L E C A L L F O R M E N T O R S

Zwolak: now a political “operator,” too.

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it being too structured—that itwould almost be a barrier,” Cep-petelli says.

In the course’s first offering,this past spring, each medicalstudent had six shadowing expe-riences—each one lasting be-tween two and four hours. Afterevery two experiences, all partiesinvolved met to share informa-tion and reactions.

“The biggest asset a physicianhas is a wise nurse by their side,”says Donna Brown, R.N., nurs-ing director of medical special-ties, who helped recruit nurses totake part in this initiative. “Thenurses were extremely thrilled toknow that young med studentswould be interested in learningabout the work of a nurse.”

Side by side: Students observedthe range of duties that a nurseperforms, from monitoring thecondition of patients to ascer-taining when a palliative-careteam should be brought in. “Themedical students were encour-aged to work side by side withthe nurse and to ask as manyquestions about what was hap-pening with the patients as wellas [about] the processes . . . in-

volved in nursing,” says Brown.Students had a variety of rea-

sons for enrolling in the elective.First-year student Laura Shivelywas aware of poor doctor-nurserelationships. “I come from afamily of doctors and nurses sohave heard experiences fromboth sides,” she explains.

“I knew it was going to beclinical time in the hospital, andso I wanted to be able to interactwith patients,” says Shively’sclassmate Rusty Phillips. Nor-mally, first-year students don’thave a chance to work with hos-pitalized patients.

Upon completing the six ex-periences, all participants at-tended a dinner hosted by emer-itus professor Frances Field,M.N. “She was the first nurse onthe faculty at DMS and has al-ways been a great advocate ofnurses and doctors working to-gether to produce good out-comes,” says O’Donnell. “At thedinner, I was blown away by thecomments the nurses and stu-dents made.”

“There was no negative, ab-solutely no negative—they werejust delighted because they hadthis opportunity to work togeth-er,” says Ceppetelli.

“I thought it was very useful.I would like to see it as a part ofa [required] class versus part of anelective,” says Shively.

The nurse shadowing experi-ence will be offered again nextyear as an elective. “You cannotcollaborate with people unlessyou see them as competent,” saysCeppetelli. “This is an opportu-nity to communicate with peo-ple and develop trust.”

Sion E. Rogers

Summer 2005

VITAL SIGNS

Jessica Ash, left, was one of the nursesshadowed by medical students like,here, Rusty Phillips and Laura Shively.

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courage you to remember yourloved one by lighting a candle atthe front of the chapel.” As fam-ily members filed up to light can-dles, the evocative sounds ofPachelbel’s Canon in D Majorechoed through the chapel.

“I cannot put into words howmuch we have all learned, bene-fited, and grown from the contri-butions of your loved ones,” be-gan Nathaniel Link, a first-yearstudent. Next at the lectern wasDr. Martha McDaniel, chair ofanatomy. She told the families alittle about the students, point-ing out that although the serviceis obviously meaningful to thefamilies, it’s amazing how impor-tant it is to the students, too.

Poignant: Heather Sateia, thefirst-year student who organizedthis year’s ceremony, read a workby Henry David Thoreau. Thepoignant words told of complet-ing a cycle and returning tosomething greater—like a bladeof grass to the earth.

Next was a time for reflec-

E ach spring at DartmouthMedical School, first-year stu-

dents hold a memorial service forthe families of the cadaversthey’ve studied all year. It’s a wayof honoring the body donorswho’ve become the students’silent teachers.” The voice say-ing these words was familiar—Scott Simon, host of WeekendEdition on National Public Ra-dio (NPR), was introducing asegment reported by Susan Keeseof NPR’s Vermont affiliate.

“During the months theyspend dissecting the cadavers,”Keese explained, “the studentsknow only their age and cause ofdeath. In the spring, when thecremated remains are returned tothe relatives, they learn more.”

Held in Dartmouth’s RollinsChapel, the service was attendedby students, faculty, and friendsand families of the donors. “Thismemorial service is in recogni-tion of your loved ones’ generos-ity and in celebration of theirlives,” read the program. “We en-


tion. The students had encour-aged family members to submitmemories of their loved onesahead of time. Six students cameforward to read excerpts. Somepassages were light-hearted rec-ollections of feeding birds andhandcrafting rugs, while otherstold of fleeing the Nazi regimeand traveling the globe. The stu-dents interspersed these taleswith mentions of their own ex-periences, their gratitude, theiradmiration for the donors.

“You opened your heart andhome to many Dartmouth stu-dents and gave them the ulti-mate gift, your remains, to helpthem in their life work. You willbe with us always,” said Sateia.

Then the donors’ names wereread aloud, one by one, before amoment’s silence in their mem-ory. Again music swelled andeveryone sang “Amazing Grace”as the candles burned brightly.

“After the service,” reportedKeese, “the future doctors andthe families mingled and talked.The students recalled how hardit was at first to take apart a hu-man body.”

As the NPR segment ended,music filled the airwaves. “Thestudents say that knowing thatthe donors wanted their bodiesto be used in this way makes thelab work easier, but often a hintof red nail polish or a tattoo re-minds them that someone spe-cial is in their hands. For NPRNews, I’m Susan Keese.”

“A lot of my friends,” recalledSateia a few days after the event,“went into the ceremony not ex-pecting to become emotional—but found themselves crying.”

Sion E. Rogers

deciliter. “Why was lead so per-vasive?” Sargent asked. Substan-dard housing with lead paint waspartly to blame, but the biggerculprit was the lead being addedto gasoline to increase octanecounts. It took 23 years, from1973 to 1996, for the U.S. Envi-ronmental Protection Agency tocompletely phase out leadedgasoline for on-road vehicles.

“Now lead poisoning is not apervasive exposure; it’s a pointexposure,” said Sargent. “It’s theexposure of a kid that happens tolive in a house where the leadpaint’s deteriorating.”

Exposure: When Sargent has apatient who tests positive forlead poisoning, he counsels theparents on how to reduce oreliminate the child’s exposure tolead paint. Sometimes, the bestsolution is for the family tomove, but many families cannotafford to do so. Even though inmost states, lead poisoning is aviolation of sanitary codes, en-forcement programs often lacksufficient funding, so propertyowners are rarely pressured to

VITAL SIGNS

This 1910 ad—which cheerily touts thebenefits of lead paint—was Exhibit Ain a recent joint DMS-Vermont LawSchool class focused on lead poisoning.

Murray, chief of occupationalmedicine at DHMC and codi-rector of the DMS course.

Leifer lectured the class onthe history of lead paint in theUnited States from the late1800s through the 1970s, whenit was finally banned. He is cur-rently representing Rhode Islandin a lawsuit against the paint in-dustry, which continued produc-ing paint with lead long after itstoxic effects on children wereknown. The difficulty of such lit-igation, Leifer explained to thestudents, is proving causation—that children’s disabilities are adirect result of the industry’s ac-tions, or lack thereof. To do this,Leifer must rely on medical ex-perts like Sargent.

“The goal of a medical expertis not to impress jurors with cre-dentials,” Leifer explained, “butto educate them.”

Sargent then talked about thetoxicity of lead; the effects oflead poisoning—such as anemia,abdominal pain, brain damage,and, in extreme cases, enceph-alopathy; and the first nationallead-screening programs.

In the 1970s, when the Cen-ters for Disease Control and thePublic Health Service “startedscreening kids, they found outthat lead was pervasive in thecities, especially in the ghettos—the inner cities of the easternseaboard,” Sargent told the class.Today, the average human leadconcentration is about 2 micro-grams per deciliter of blood, ac-cording to Sargent, but in the1970s, inner-city kids were aver-aging 25 to 30 micrograms per

S ay the words “lawyer” and“doctor” and most people

probably think “malpractice.”But law and medicine intersectfor other reasons, too, often inthe public’s interest.

“We look to the public-health community in my profes-sion to tell us what’s wrong,”Boston attorney Neil Leifer toldDMS and Vermont Law School(VLS) students at a joint classduring spring term. (Leifer, of thelaw firm Thornton and Naumes,is best known for leading Massa-chusetts’s successful fight againstthe tobacco industry.)

Cases: Litigation “doesn’t startwith the lawyers. We don’tdream up the cases—despitewhat the doctors are taught inmedical school,” he joked.

For several years, Leifer andDr. James Sargent, a Dartmouthpediatrician, have co-taught aclass on lead poisoning for VLSenvironmental law students.More recently, Sargent beganlecturing on the topic in a courseon environmental and occupa-tional health for DartmouthM.P.H. students. By combiningthe lectures into one joint ses-sion, Sargent reasoned, VLS andDMS students would have achance to interact and gain morefrom the experience. The coursedirectors at both schools agreed,and the session was combined forthe first time this past spring.

“I hope this becomes an an-nual event to go back and forthand look for ways to build on thereally rich aspects of this topicfor public health and environ-mental law,” noted Dr. Carolyn

Joint class on law and lead looks for solutions

A HELPING HAND: In FY04, DHMC provided $16.7million of financial assistance to under- and uninsuredpatients, plus $70.9 million in care uncompensated bygovernment insurance (mostly Medicare and Medicaid).


VITAL SIGNS

SUNDAE SCHOOL: Several times each summer, DHMCsponsors ice-cream socials that are open to all employees.Even better than the ice cream (with all the fixings) is thefact that it’s scooped up by the institution’s senior leaders.

I ’m kind of into the danger and excitementsorts of fields,” says Dr. Elizabeth Weber, chief

resident in orthopaedics at DHMC. One couldalso add “male-dominated” and “fiercely com-petitive” to her list of adjectives. Before medicalschool, Weber spent six years in the Air Force,three of them as a combat pilot. And as of June,she’ll be only the third woman to completeDHMC’s orthopaedics residency.

Exciting: “You may have some ideas about whatyou want to do, both in medicine and in the mil-itary, when you start,” Weber explains, “but ifyou tend to be a competitive person—which Iam—then you very quickly figure out what’s themost prestigious and exciting thing to do.” We-ber was the only woman in her pilot trainingclass of 60 and one of only about 20 who grad-uated. While in the Air Force, she flew all overthe world, transporting generals and dignitarieson Lear jets and then, during the Gulf War, fly-ing combat missions on KC-135s, which areused to refuel other planes in flight.

“I think the biggest problem with being awoman in the Air Force . . . was [when] we werebased in Riyadh, Saudi Arabia,” during the GulfWar, says Weber. As commander of a combatplane, she was responsible for her craft and crew,but she couldn’t perform many of her duties be-cause of Saudi attitudes toward women. “Theywouldn’t give me gas because women can’t talkto men there,” Weber recalls. “It’s one thing notto respect a gender because that’s the way you

were brought up, but not to respect the rank ofa military officer . . . it was very bothersome.”

She hasn’t encountered any such obstacles atDHMC. “My peers in this program are ab-solutely amazing,” she says. “They are well-spo-ken, articulate, smart, fun, funny . . . just a greatgroup of guys. I haven’t felt any animosity aboutmy gender.” She does admit that at times “it’s alittle socially challenging.” But challenge isclearly what Weber thrives on. Come July, she’llbe starting a new challenge—a pediatric or-thopaedics fellowship in Australia. J.D.

Former combat pilot is still in the hunt for excitement and challenge

Weber, with a T-38 during her pilot training in the 1980s.

way since Elizabeth Blackwellbecame the first female physicianin the U.S. in 1849 (and sinceher sister Emily was rejected byDMS, in 1852, on the basis ofher gender).

But still more needs to bedone before women achieve trueequality with their male col-leagues, Novello insisted. “Wemust demand that women be en-couraged by schools, propelledinto academic excellence by uni-versities, recognized by theirmale counterparts, and appoint-ed to positions of distinction—on their merit—equal to those ofmen.” Novello, the first womanand first Hispanic surgeon gener-al, is currently health commis-sioner of New York State.

Passion: Inspired by Novello’spassionate talk, the nearly 150attendees, mostly women, wenton to participate in sessions onsuch topics as career strategies,leadership skills, burnout, men-toring, and personal/profession-al balance. Among the 25 pre-senters at the day-and-a-half-long conference were a careerdevelopment coach, a medicalhistorian, DMS faculty membersand alumni, spouses of femalephysicians, and even a currentDMS student.

Career development and ex-ecutive coach Janet Bickel, a for-mer executive at the Associationof American Medical Colleges,counseled participants on waysto recognize and develop leader-ship skills and to achieve successin their careers.

But attendees were also cau-tioned to avoid letting their jobs

T o those who live with glassceilings, let’s start teaching

them how to throw stones!”challenged Dr. Antonia Novel-lo, former U.S. surgeon generaland the keynote speaker at Dart-mouth Women in Medicine, aconference held this spring.

Women have come a long

Novello keynotes Women in Medicine conference

‘abate the hazard, noted Leifer.

“Frankly,” explained Sargent,“the reason I became interestedin lead poisoning is because itwasn’t a problem that I couldsolve in the office. I was frustrat-ed by it. These kids would getlead poisoning, I’d send themback out to the house, they’d getpoisoned again. I knew thatthere had to be a bigger solution

to this. I wanted to make a dif-ference in a bigger way than Icould in the office.”

Linked: “The big picture,” headded, “is that lead poisoning isa public-health problem . . . andit is inextricably linked with cor-porate behavior, the legal system,and the political system. . . .Neil’s taught me that.”

Jennifer Durgin

‘


VITAL SIGNS

I N V E S T I G A T O R I N S I G H T

I n this section, we highlight the human side ofbiomedical investigation, putting a few ques-

tions to a researcher at DMS-DHMC.

Laura Flashman, Ph.D.Associate Professor of PsychiatryFlashman uses a combination of cognitive testing,anatomic imaging, and functional magnetic reso-nance imaging to understand the brain and behav-ior. Her work focuses on schizophrenia and otherpsychiatric diseases, mild cognitive impairment, ear-ly Alzheimer’s, and traumatic brain injury.

How did you decide to go into your field? Before graduate school, I took a fantastic coursein Behavioral Neurology at the Harvard Exten-sion School. Each week the professor presenteda case with the person present—one week some-one with aphasia, one week someone withtemporal lobe epilepsy, one week someone with

spatial neglect. Iwas hooked andknew that I wantedto study neuropsy-chology.

If you weren’t ascientist, what wouldyou like to be? I would like to bean actress (I havebeen accused of be-

ing overly dramatic!), but I get stage fright. Ithink I probably would be an accountant.

Are there misconceptions people have about your work?I deal with really basic misconceptions all thetime when I talk to people about both neu-ropsychology (“Does that mean you can read mymind?”) and schizophrenia (“Isn’t that havingmultiple personalities?”).

What kind of books do you like to read?I read fiction avidly, mostly mysteries, romance,and popular fiction. I am currently reading TheNamesake by Jhumpa Lahiri. I keep meaning toread anything by Jane Austen but continue topass her books over for more relaxing reading.

What’s your favorite nonwork activity? I really like taking photographs anddoing things outside (hiking, skiing,walking on the beach). I have enjoyed doingthese activities with my children and watchingthem become more independent each year.

What’s the last movie you saw? The Incredibles. I saw it in the theater originally,but we also own the video. I love to go to themovies but haven’t had a chance to see anythingbut children’s movies for the past several years.I’ve probably seen the Harry Potter movies adozen times each.

If you could travel anywhere you’ve never been, wherewould it be? Australia, Nova Scotia, and Banff are on mymust-see list. I also want to visit all 50 UnitedStates and have four left: Arkansas, Montana,North Dakota, and South Dakota.

What famous person, either living or dead, would youmost like to meet?I’d like to meet John Nash, the Nobel-Prize-win-ning mathematician [and the subject of A Beau-tiful Mind] who also suffers from schizophrenia.

What about you would surprise most people? I am something of a thrill seeker—I havejumped out of an airplane and white-water raft-ed and enjoy scuba diving.

What do you admire most in other people? Integrity, intelligence, ability to share knowl-edge in a way others can understand, produc-tivity, and a sense of humor.

What’s the hardest lesson you ever had to learn? In research, you have to develop a thick skin,because papers and grants get rejected often.Learning to move past that, and to benefit fromreviewer criticisms and get your work out thereanyway, is a hard but important lesson.

What do you ultimately want to discover? A way to improve the quality of life for peoplewho suffer from severe mental illness.

Alumna Karen Hein, left, chaired theDMS conference at which Antonia No-vello, right, was the keynote speaker.

be the sole focus of their lives.“It’s important to realize that ourroles change over time, and asthey do they create differentstressors in our lives,” said Dr.Leslie Fall, a DMS alumna, a pe-diatrician at DHMC, and one ofthree panelists at a session onjuggling multiple roles. “The wayI’ve tried to manage that is bystaying very organized and beinghonest about what I can andcan’t do,” she said.

Wellness: Other presenterswarned that many physicians, es-pecially women early in their ca-reers, are at high risk for burnout.“We must create a culture thatencourages and rewards physi-cian wellness,” said Dr. LisabethMaloney, executive medical di-rector at DHMC.

Nevertheless, Novello ex-pressed confidence in the abilityof DMS alumni, faculty, and stu-dents to throw stones at thatglass ceiling. “I see such strength,such accumulated experience,such intelligence—that despiteserious obstacles—I believe thatwe women will not have to wor-ry about full and complete accessand achievement in any chosencareer in the 21st century.”



VITAL SIGNS

I t’s hard to decide if they’re more unlikely as re-searchers, matchmakers, or TV personalities,

but Dr. Nancy Beck and Bridget Decker are allthree. In the lab, Beck, a postdoctoral fellow inmicrobiology, and Decker, a graduate student inbiochemistry, work “mostly with men, who com-plain that they can’t find anyone to date in theUpper Valley.” And they also happen to have afriend who works at Hanover’s public-accesstelevision station. So the pair, who were lookingfor something to do with their creative energies,put one and one together and came up with aTV show for singles.

Joke: It’s not quite like any show you’ve everseen. Beck—who is dark and glamorously made-up—and Decker—who has a goofy laugh and amore than passing resemblance to actress DrewBarrymore—sit on a brown velvet couch in avintage clothing store and giggle at their ownand each other’s jokes as their interviewees,mostly men, answer questions about themselves.

The production values remain solidly in thecable-access realm, though there’s some mildlyadventurous camera work and viewers occa-sionally get to see the studio audience, whichincludes people standing on chairs, beers inhand, to get a better view.

The show’s name, Fresh Meet, is a wee bitnaughty, like Beck and Decker. They’re the two

women who, if you knew them, you’d neverhave a dinner party and not invite, becausethey’re lively and funny and unselfconsciouslyinterested in other people. “We’re the most pop-ular show on the station,” Decker says, and thenasks not to be quoted, “because we don’t want tomake Roz, the Humane Society lady, feel bad.She used to be the most popular show. And wewant her to come on our show.”

Beck says their secret is that “we don’t askthe cheesy questions. We focus on the inter-viewees themselves, not what they’re looking forin a date. It makes people feel pretty comfort-able, and their personalities come out throughtheir body language and their interactions withus.” It may also help that the hosts themselvesare not in the dating market—Beck is marriedand Decker has a significant other.

They both work in labs that study yeast butpoint out that Decker’s work, in Dr. WilliamWickner’s biochemistry lab, is with “friendlybread yeast,” while Beck’s, in Dr. Deborah Ho-gan’s microbiology lab, is with “pathologicallynasty yeast.”

Mate: “What we study has nothing to do withdating,” Decker says. “Except occasionally,”Beck adds, “you do get the yeast to mate.”Which may be even harder than encouragingUpper Valley residents to do the same. M.M.

Researcher-matchmakers mix biochemistry with social chemistry

Bridget Decker (left) and Nancy Beck spend days in the lab and occasional nights as matchmakers on a cable TV show.

CH

RIS

MIL

LIM

AN

J ames Varnum, the presidentof Mary Hitchcock Memorial

Hospital for the past 27 years,has announced that he will re-tire in April 2006.

His has been a career markedby both constancy and change.He has been the president ofMHMH since 1978 and of theDartmouth-Hitchcock Alliance(DHA) since 1983. Yet stasis inhis title has not meant stasis inthe organizations he’s headed.With the leaders of DartmouthMedical School and the Dart-mouth-Hitchcock Clinic, he hasplayed a major role in bringingDHMC to national prominence.

“Jim Varnum is an exception-al leader who is respected notonly in the Upper Valley but alsonationally,” said Alfred Griggs,chair of the MHMH and DHMCBoards, in an announcement ofthe retirement. “Jim has man-aged a very large, complex orga-nization in an ever-changing en-vironment by keeping foremostin his mind the importance ofpeople. The result is that loyaltyto Jim goes down the organiza-tional structure as well as up.”

Consortium: Among Varnum’sachievements have been guidingthe hospital through its 1991move from Hanover to Lebanon,overseeing a subsequent $224-million expansion of the Leb-anon campus, and establishingthe DHA—now a consortium of11 hospitals and organizations inNew Hampshire, Vermont, andMassachusetts. His commitment

Hospital presidentJames Varnum plansto retire in 2006


VITAL SIGNS

C L I N I C A L O B S E R V A T I O N

I n this section, we highlight the human side ofclinical academic medicine, putting a few

questions to a physician at DMS-DHMC.

Kristine Karlson, M.D.Assistant Professor of Community and Family Medicineand of Surgery Karlson joined the faculty in 1997. Winner of twoworld championships in rowing, she was also teamphysician for the U.S. National Rowing Team atthe 2000 World Championships.

What made you decide to become a physician?I can’t remember actually making the decision.Since high school, it seemed somehow the rightplace for me and nothing ever changed my mind.

What are your clinical interests?I trained as a family physician first, then did afellowship in sports medicine. I see both prima-ry-care patients and sports-medicine patients. Ienjoy the challenges and joys of following peo-ple over time but also am happy that I can com-bine my medicine and athletic backgrounds inproviding care for athletic people of all ages.

What books have you read recently?Alice Sebold’s books The Lovely Bones and Luckyare two I’ve read recently. In both she addressesviolence from interesting perspectives.

What’s your favorite nonwork activity? Since 1997 I have really gotten excited aboutcross-country skiing, particularly skate-skiing.It’s such a joy to be out in the woods on a clearwinter day in a fast, fluid workout.

What about you would surprise most people?I was not an athlete until college. My motherstill says that if she had to pick which one of herfive kids would have made an Olympic team, itdefinitely would not have been me. (I was onthe 1992 Olympic rowing team and on four na-tional rowing teams in the years prior to that.)

What do family and friends give you a hard time about?Patience. When I decide I want to get some-thing done, I usually want to do it now.

Of what professional accomplish-ment are you most proud?Having been board certifiedin sports medicine in only 1999, I wasasked in 2002 to be on the committeethat writes the board exam and was subsequent-ly asked to chair the committee. It was a majorhonor and I think happened because I studiedvery hard for the exam and did very well on it.A smart colleague who I respect had failed theexam, which got me scared, so I studied harderthan I would otherwise have—but it paid off!

What advice would you offer to someone contemplatinggoing into your field?Students interested in family medicine and oth-er primary-care specialties are given a hard timeby specialists who say they are wasting their tal-ents. But where else do people come in with avariety of complaints and undifferentiated prob-lems, asking you to figure it out? By the time apatient reaches a specialist, somebody else hasoften already made a diagnosis and decidedwhich specialist should see the patient. But wejuggle a lot of potential diagnoses and start theprocess to find the right one.

What’s the hardest lesson you ever had to learn?That hard work and wanting something badlydon’t necessarily mean you’ll get it. After mysports fellowship, I trained again for rowing andtried but failed to make the 1996 Olympic team.

I have no regrets—it was worth trying,but it was a disap-pointment.

If you could live in anytime period, whenwould it be?Maybe turn theclock back 30 to 40years. It’s temptingto yearn for simpler

and safer times. However, in almost any othertime period my opportunities as a woman inboth medicine and sports would have been sig-nificantly more limited or nonexistent.

to this regional network—whichis based on strong, independentcommunity hospitals—has con-tributed significantly to the qual-ity of care in the region, accord-ing to Mary Susan Leahy, chairof the DHA Trustees.

Roots: “Jim never forgot MaryHitchcock’s roots as a communi-ty hospital,” Leahy said in theannouncement. “His passionatebelief in patients being able toreceive care in their own com-munity when appropriate ,backed by the services and re-sources of a major teaching hos-pital, was the founding impetusfor the Dartmouth-HitchcockAlliance. He brought a new spir-it of cooperation and collabora-tion to the region that has bene-fited hospitals, communities, andthe patients we all serve.”

A 1962 graduate of Dart-mouth College, Varnum earneda master’s in hospital administra-tion at the University of Michi-gan. He was CEO of the Uni-versity of Washington Hospitaland of the University of Wis-consin Hospitals and Clinics be-fore returning to Hanover to leadMary Hitchcock.

Alan Smithee

Jim Varnum has been president of MaryHitchcock Hospital since 1978. He willbe retiring as of April 2006.


VITAL SIGNS

M E D I A M E N T I O N S : D M S

A mong the people and programs coming in forprominent media coverage in recent months

was a DMS neurologist who was quoted in nu-merous reports about Terri Schiavo—the brain-damaged Florida woman whose parents petitioned

the courts to keep her alive.“The persistent vegetative stateis a chronic disorder of con-sciousness in which the centersof the brain that are responsiblefor awareness have been dam-aged or destroyed, but the cen-ters of the brain responsible for

wakefulness remain intact,” Dr. James Bernat ex-plained on National Public Radio’s All ThingsConsidered. “So the patient has the tragic andironic combination of wakefulness without aware-ness.” Bernat was also sought out for commentaryby many other news outlets, including the Wash-ington Post, Newsweek, USA Today, the Los An-geles Times, and NPR’s Talk of the Nation.

“At Dartmouth-Hitchcock Medical Center, doc-tors are trying out a radical new concept for theirpatients: full disclosure of their success rate formedical treatments—even when they don’t mea-sure up,” began a piece in the Wall Street Journal.“Of course,” the article went on, “disclosure is eas-ier when a hospital has a stellar record. Con-sumers would be hard-pressed to find mortalityrates at . . . DHMC . . . not on par with or better

than national averages for anycondition.” But, noted the Jour-nal, even at DHMC, “‘there wasinvariably some skepticism andquestioning,’ says D-H Execu-tive Vice President Paul Gardent.But doubters were eventuallypersuaded that disclosure of less-

than-perfect performance could provide ‘an addi-tional stimulus for improving quality.’” (See pages15 and 16 for more on this initiative.)

A DMS research team helped the public makesense of various medical topics in the press thispast spring by speaking with Consumer Reports,U.S. News & World Report, and ABC News.“Medical news often seems to follow an all-too-fa-miliar pattern: New drugs or therapies are intro-

duced with glowing reports, followed a few yearslater by headlines blaring their dangers,” said Con-sumer Reports. “‘That pattern leaves many peopleconfused or even angry,’ says Steven Woloshin, M.D.,a professor at Dartmouth Medical School.” One ofWoloshin’s research colleagues also aimed to tem-per such hype, in an ABC report about ways toprevent breast cancer and heart disease: “‘It’s im-portant that we not say more than we know,’ saidLisa Schwartz, M.D.” The team also writes a regular se-ries of articles for the Washington Post; their latestpiece was titled “Overstating Aspirin’s Role InBreast Cancer Prevention: How Medical Re-search Was Misinterpreted to Suggest ScientistsKnow More Than They Do.”

A recent Dartmouth study about the relation-ship—or the lack thereof—between malpractice

awards and insurance premiumsdrew press from all over thecountry, including the BostonGlobe, the Philadelphia Inquirer,the Associated Press, NationalPublic Radio, and the Los Ange-les Times. “Physicians and insur-ers may fear multimillion-dollar

jury awards,” the LA Times reported, “but the av-erage court judgment in 2003 was $461,000, saidAmitabh Chandra, a Dartmouth College economist andone of the authors. And 96% of malpractice cas-es that year were settled out of court for an aver-age of $257,000, he said. . . . The researchers con-cluded that malpractice payments had risen inline with medical care costs, while doctors’ insur-ance premiums grew far faster—by double-digitpercentages for some specialties. They suggest thatrecent malpractice premium increases may havehad more to do with insurers’ documented lossesin the bond market from 1998 to 2001.”

A recent feature in the New York Times Magazineabout the importance of autopsies in assessing “di-agnostic and treatment routines” and catching“mistakes and bad habits” said few hospitals to-day value autopsies. But “hospitals that do—teaching hospitals like New York’s Mount Sinai;Dartmouth-Hitchcock Medical Center, in Lebanon, N.H.; andBaylor University Medical Center, in Dallas—manage to absorb the costs [and thus] have a

Worthy of note: Honors, awards,appointments, etc.Jay Dunlap, Ph.D., a professor andchair of genetics, received the

first Robert L.M e t z e n b e r gAward f romthe GeneticsS o c i e t y o fAmerica, forhis contribu-tions to under-

standing the genetics of the fun-gus Neurospora; the award waspresented at the annual FungalGenetics Conference.

Allen Dietrich, M.D., a professorof community and family medi-cine, received the 2005 Curtis G.Hames Research Award. The

award honorsdedication tor e s e a r c h i nfamily medi-cine; the recip-ient is selectedby the Societyof Teachers of

Family Medicine, the AmericanAcademy of Family Physicians,the North American Primary-Care Research Group, and theHames Endowment.

Surachai Supattapone, M.D., Ph.D.,an assistant professor of bio-

chemistry, wasnamed a mem-b e r o f t h eClinical Neu-roimmunologyand Brain Tu-m o r s S t u d ySection of the

National Institutes of Health.Nancy Speck, Ph.D., a professor of


VITAL SIGNS

much better idea where their errors are” andhow to improve the care that they deliver.

In a story about the steps hospitals are tak-ing “to prevent one of the most surprising

and dangerous hazards fac-ing patients: falls that canlead to severe injury oreven death,” the WallStreet Journal interviewedDHMC’s director of nurs-ing research. “Surgical pa-tients can be at special

risk, notes Suzanne Beyea, Ph.D. . . . In cases shestudied, falls occurred moving patients ontooperating beds or when staffers weren’t clearon who was supposed to be watching the pa-tient after safety straps are removed,” wrotethe Journal. “Patients may also try to get upand walk after surgery before they are steadyon their feet,” Beyea also noted.

“When Lloyd Kasper [top photo] and his col-league Randolph Noelle [bottom photo] set out

in the 1990s to invent anew drug,” an article inthe Financial Times of Lon-don began, “they were ex-ploring the frontier be-tween research and busi-ness. . . . The Dartmouthresearchers thought they

had found a way to block the biochemistrythat spurs MS [multiple sclerosis].” TheTimes went on to recount the struggles theresearchers have faced during their 14-yearquest to bring a new drug to market. A sim-ilar but more in-depth piece by the same

writer also appeared in Sci-ence magazine: “The Dart-mouth pair, still con-vinced their discovery cantransform the lives of MSpatients, are beside them-selves with frustration. . . .But not enough [frustra-

tion], it seems, to prompt either Noelle orhis friend of 20 years to capitulate, even astheir options for reviving the drug dwindle.”

To find out “what, exactly, are Americanspaying for” when it comes to health care,Forbes consulted “Elliott Fisher, a professor ofmedicine in Dartmouth’s influential healthcosts group, [who] says that the two most ex-pensive decisions a doctor makes are to senda patient to the hospital and to schedule anew appointment. Yet the benefit of moredoctor visits is pretty much unproven, he ar-

gues. In fact, switchingfrom specialist to specialistmay just provide more op-portunities for doctors to‘drop the ball,’ he says. Ar-eas with more intensivehealth care often wind upwith patients who are less

healthy,” Forbes said. “‘The U.S. could the-oretically send one-third of the health-careworkforce to Africa,’ says Fisher, ‘and im-prove the health of both continents.’”

In a New Yorker piece about doctors’ salaries,Dr. Atul Gawande cited the work of a DMSphysician-researcher. “William Weeks . . . foundthat, if you view the expense of going to col-lege and professional school as an invest-ment,” wrote Gawande, “the payoff is some-what poorer in medicine than in other pro-fessions. Tracking the fortunes of graduates

of medical schools, lawschools, and businessschools with comparableentering grade-point aver-ages, he found that the an-nual rate of return by thetime they reach middle ageis 16% per year in prima-

ry-care medicine, 18% in surgery, 23% inlaw, and 26% in business. Not bad, in any ofthese fields, but the differences are there.”

The New Yorker also recounted a now-leg-endary DMS story: “In the 1970s, a doctornamed John Wennberg conducted a study in hishome state of Vermont and found that, evenin his small and relatively homogeneous cor-ner of the country, doctors in different areasadopted wildly different approaches.” The

article updatedthe story, too:“A recent set ofDartmouth studies, ledby Wennberg, looked at theway top teaching hospitals treated elderlypatients in the last six months of their lives.. . . At ‘high-intensity hospitals’ patients sawdoctors, consulted with specialists, and weregiven tests far more often than at low-in-tensity ones.” And all that care “did littlebut drive up the cost of treatment.”

Referring to the notoriously corrupt 15th-century Borgia family, a DMS pharmacolo-gist responded cleverly to a question posed

by National Geographic in astory on toxins. “Is arsenica poison or a drug?” thewriter asked. “ ‘It’s both,’says Joshua Hamilton. ‘It de-pends: Are you talking to aBorgia or are you talkingto a physician?’” The arti-

cle also recalled the tragic death of “KarenWetterhahn, a professor of chemistry atDartmouth, [who] spilled a drop, a tinyspeck, of dimethylmercury on her left hand,”and later died as a result of the exposure.

“Doctors may no longer make house calls,”the New York Times said, “but they are an-swering patient e-mail messages—and . . .medical groups around the country are nowbeginning to pay doctors to reply by e-mail,just as they pay for office visits.” Amongthose quoted was DHMC’s senior medical

director. “ ‘Patients lovethis stuff; I love this stuff;the staff loves this stuff,’said Dr. Barbara Walters. Onebenefit of online messag-ing—perhaps because itcan be done in a settingless harried than a doctor’s

office—is that it gives patients a greater de-gree of control. ‘Patients can describe what’sgoing on with them,’ [Walters said,] ‘if giv-en the chance and given the time.’”

A N D D H M C I N T H E N E W S


VITAL SIGNS

I n this section, we highlight tidbits frompast issues of the magazine. These mes-

sages from yesteryear remind us of the pace of change, as well as of some timeless truths.

From the Summer 1990 issueFifteen years ago, Dartmouth Medicine invited MontgomeryBrower to write a feature. A 1981 Dartmouth College graduatewho’d been a staff writer for People magazine for seven years, hedescribed, at age 31, a change of heart:

“I hesitated when the chief of cardiac surgery at Leningrad’sPavlov Institute of Medicine invited me, on a visit to Russiaback in 1986, to observe some of his doctors at work. During myfive years as a magazine journalist, I had so far avoided any con-spicuous gore, and I was not sure I could stomach the sight of aSoviet citizen laid open by a scalpel. But before I could musterany excuses, I had been masked and gowned and led into theoperating room, where one of the surgeons motioned me to stepup onto a stool on the floor behind the patient’s head.

“I braced myself for a shock, stepped up, looked down, andwas instantly awestruck. There before me lay a secret revealed:the heart tossing in its place, the lungs emptying and filling ina steady rhythm, every part real and alive. . . . For the next halfhour, I watched and listened, my fears forgotten. . . . Later, as I

left the operating room, I felt anew excitement. ‘I wonder,’ Ifound myself thinking, ‘if I couldbe a doctor.’ . . .

“As an undergraduate at Dart-mouth, I had seen myself as strict-ly a humanities type. Although Ihad enjoyed my science courses inhigh school, I had concluded, af-ter some unhappy experienceswith mathematics, that I was con-stitutionally incapable of graspingquantitative subjects. I vilifiedmost premed students as unimag-

inative careerists and celebrated my own literary bohemianism,probably in part because I feared the science that I was sure Icould never understand, let alone enjoy. . . . The scientist andthe humanist within us make rival claims to truth, and in the20th century neither seems to understand the other. In thatepiphanous moment over the operating table in Leningrad, I be-lieve I saw the human heart in both its guises: as a wellspringof feeling and as a wonderwork of biological engineering.”

Writing’s loss has clearly been medicine’s gain. Brower grad-uated from Cornell Medical College and is now deputy medicaldirector of Massachusetts’s Bridgewater State Hospital.

P A G E S P A S T

It’s never too late to consider acareer change, even into medi-cine, DC grad Brower concluded.

Manager of the Year and FederalEmployee of the Year by the Fed-eral Association of Vermont.

Dean Seibert, M.D., an associateprofessor of medicine emeritus,was elected to the DMS chapterof Alpha Omega Alpha (AOA),the national medical honor soci-ety. Three third-year DMS stu-dents were also elected to AOA:Lisa Ernst, Greg Fuhrer, and John Raser.

Jeffrey Barrett, a fourth-year med-ical student, was awarded a Mi-nority Medical Student TravelScholarship by the AmericanPsychiatric Association.

Karen Skalla, A.R.N.P., receivedthe Oncology Nursing SocietyPat McCue/New Orleans Chap-ter End-of-Life Nursing CareerDevelopment Award. She is anoncology nurse practitioner atthe Claremont, N.H., Valley Re-gional Hospital, part of DHMC’sRegional Cancer Program.

Dartmouth Medical School was againranked among the top 50 med-ical schools in the nation byU.S. News & World Report.

DMS was 35thin the researchcategory and34th in a cate-gory that fac-tors in the per-c e n t a g e o fgraduates who

go into primary care. DMS wasalso 17th in the “Rural Medi-cine” specialty category. Therankings are based on reputation,research funding, student selec-tivity, and faculty/student ratios.

The DHMC Adult Diabetes Self-Management Program was recently ac-corded recognition as an “out-standing program” by the Amer-ican Diabetes Association.

biochemistry, was appointedchair of the HematopoiesisStudy Section of the NationalInstitutes of Health.

Gilbert Fanciullo, M.D., an associ-ate professor of anesthesiology,was elected to the board of theAmerican Pain Society.

James Bernat, M.D., a professorof medicine, testified before theU.S. Senate Committee onHealth, Education, Labor andPensions about end-of-life issuesand advance directives. He isformer chair of the AmericanAcademy of Neurology’s ethicscommittee.

Ronald M. Green, Ph.D., an ad-junct professor of communityand family medicine, was re-cently awarded a fellowship bythe John Simon GuggenheimMemorial Foundation. The fel-lowship will support his exami-nation of ethical, religious, andliterary perspectives on geneticenhancement.

Patricia Ernst, Ph.D., an assistantprofessor of genetics, received aKimmel Scholar Award from theSidney Kimmel Foundation.

Nicholas Shworak, M.D., Ph.D., anassistant professor of medicine,

was selected asthe AmericanHeart Associa-tion’s LobbyDay represen-tative for NewH a m p s h i r e .One researcher

was chosen from each state toexemplify the objectives of theassociation’s funding process.

Andrew Pomerantz, M.D., an asso-ciate professor of psychiatry,based at the White River Junc-tion, Vt., VA, was honored as

resident expert - geisel school of medicine at...

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