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Great Teachers

Dear Editor,
It was with the greatest of pleasure that I read the story about the great teachers at P&S [Winter 1999]. In fact, almost 10 years after graduating (P&S 1990), I still remember all those teachers you had listed as special. Certainly one teacher that has made an enormous impact on my career and whom I respect enormously for his dedication to teaching and to P&S is Herb Chase. I really viewed him as a mentor at Columbia. His door was always open, for questions ranging from the effects of aldosterone on the distal loop of Henle, to big decisions like surgery vs. medicine as a career, and even personal questions regarding marriage and career. Now that I have finally made it out of residency and have directly fallen into the harsh realities of managed care in an academic center, I realize even more than ever the special nature of doctors like Herb. If all medical schools in the United States had even just one teacher like Herb Chase most medical students would be infused with an enthusiasm that would not be breakable despite the current disturbing climate of the health care world.

Sareh Parangi’90
Department of Surgery
Harvard Medical School

Drs. Shoenberg and Grokoest

Dear Editor,
I was delighted to read Nicholas Christy’s thoughtful tribute to Dr. Bernard Schoenberg [Faculty Remembered, Winter 1999 issue]. It was my privilege to be one of Dr. Schoenberg’s students and later, as a resident at the Neurological Institute, to witness the extraordinary grace and equanimity with which he faced his own last illness.

Dr. Christy referred to Dr. Schoenberg’s “stress upon physician behavior, a matter all but ignored by most faculty members, with the notable exception of the late Albert W. Grokoest, a distinguished rheumatologist in the P&S Department of Medicine.”

As coincidence would have it, it also was my good fortune to be one of four students in my class assigned to Dr. Grokoest for our physical diagnosis instruction, in those days a course referred to as “Introduction to the Patient.” One of the many insights Dr. Grokoest shared with us during our months together related to the importance of maintaining a certain formality within the physician-patient relationship, hardly a fashionable concept among the students of the late 1960s and early 1970s. However, he held that a respectful formality at once protected the dignity of the patient during a moment of great vulnerability and preserved the clarity and abstraction of the clinical encounter as an analytical tool. Dr. Grokoest would summarize all of this for us by explaining that he was teaching us a brief course in “Manner and Bearing,” adding with a chuckle that for some of us the syllabus would more properly be titled “Remedial Manner and Bearing.”

A photograph hangs in my office today which captures in a single image the remarkable effort and care Dr. Grokoest brought to his teaching. It shows him, his group of four students, a nurse, and one of his private patients, all seated around a table in the Presbyterian Hospital medical clinic during one of his tutorial sessions. His technique was to ask one of his “downtown” patients with a particularly instructive history or diagnostic finding to spend the afternoon being interviewed and examined by the group. Once or twice during the term he would also have a photographer join the class, as unobtrusively as possible recording the event. During subsequent meetings with the students, Dr. Grokoest would painstakingly analyze these photographs, drawing our attention to the countless ways we and the patient had communicated by unconscious posture and gesture during our interaction.

Dr. Grokoest would certainly be a worthy subject for one of Dr. Christy’s superb essays. I will watch for it!

Martin G. Luken III’73
(by e-mail)

Editor’s Note: Dr. Christy plans to write about Dr. Grokoest in the Fall 1999 issue.

Dear Editor,
My late husband, Dr. Bernard Schoenberg, was in a host of ways “larger than life.” It is for this reason all the more to Dr. Nicholas Christy’s credit that he so gracefully wove the progression of Bernie’s vast professional career into a concise yet comprehensive narrative.

I am joined by my family—Nara, Jonathan, and Amanda’97—in congratulating and thanking Dr. Christy for his fine tribute.

Coco Schoenberg-Swartchild
Tenafly, N.J.

Fighting the “War” on Breast Cancer

Dear Editor,
I was very gratified to read Barron Lerner’s article about breast cancer screening and treatment [Winter 1999]. As a radiologist it is an issue that concerns me every day. There are a lot of differences how it impacts your life and career, according to where you practice. In a very litigious, uptight environment like New York or Seattle, where I used to be, mammograms are indeed “time bombs”—for the radiologist as well as the unfortunate woman. Out here in the desert where I am now, there is a benign, forgiving milieu.

I’ve seen enough mammograms and seen enough developing breast cancer now to know that breast cancer is idiosyncratic to the extreme. There just isn’t any such thing as a regular doubling time, for example. I’ve seen numerous examples of a lesion that, in retrospect, had been sitting there inconspicuously for five to 10 years, which suddenly decides to grow. I’ve seen other lesions which developed from a flat normal mammogram to disseminated metastatic disease, within the normal one-year screening interval.

The politicos and women’s groups too often ignore or put their own spin on screening efficacy data, with good reason. I think Barron hit it well, stating in so many words that these folks have way too much at stake politically and monetarily to ever want to slow down the screening juggernaut. Now the latest thing is to diagnose breast cancer with hair samples. At least then they can put the onus on the dermatologists.

Richard D. Clark’86
(by e-mail)

Correction

In the Winter 1999 issue of P&S Journal, an article on the Naomi Berrie Diabetes Center failed to acknowledge the leadership of Joseph M. and JoAnn M. Murphy in launching the effort that led to establishing the center on the Columbia Health Sciences campus. Mr. and Mrs. Murphy have been responsible for raising interest in diabetes research and care for many years in the tri-state area and have made numerous contributions to the success of creating a major comprehensive diabetes program at Columbia. In the same issue, Mr. and Mrs. Murphy, as well as the Greenwald Foundation, Valerie and Kenneth Lazar, and Gerald and Janet Carrus, also should have been listed among those funding Drs. David Stern and Anne Marie Schmidt for their research on the cell receptor RAGE, which is involved with complications of diabetes.

Poll

Dear Editor,
I would like to poll P&S alumni concerning the value of cadaver dissection in Gross Anatomy. I ask that interested alumni answer the two questions below.

1. How important has your experience of cadaver dissection in Gross Anatomy proven to be to your current practice as a physician or surgeon?

  • Essential
  • Beneficial
  • Irrelevant

2. Do you feel that Gross Anatomy could be taught equally well without dissection of cadavers by students?

  • Yes
  • No

Please provide this information as well:

Name (optional):

Year of graduation from P&S:

Specialty:

Type of practice:

Other comments on this matter would be welcome.

Please respond to:
Aaron P. Mitchell
Department of Microbiology
Columbia University
701 W. 168th St.
New York, NY 10032
fax 212-305-8251 / email apm4@columbia.edu

Aaron P. Mitchell
P&S associate professor of microbiology

Send letters to:

Editor, P&S Journal
College of Physicians and Surgeons
630 W. 168th St
New York, NY 10032

E-mail: psjournal@columbia.edu

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