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Historical study Tributes to J. Willis Hurst, MD| Volume 109, ISSUE 7, P1074-1075, April 01, 2012

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On Being Dr. J. Willis Hurst's Chief Resident in Medicine

  • D. Luke Glancy
    Correspondence
    Corresponding author: Tel: 504-568-8389; fax: 504-599-0525
    Affiliations
    Section of Cardiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana

    Louisiana State University Interim Public Hospital, New Orleans, Louisiana
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      For the 1964–1965 academic year, I had the good fortune to be Dr. J. Willis Hurst's eighth chief resident in medicine at Atlanta's Grady Memorial Hospital. Willis was bigger than life, an extraordinary physician and teacher, and the year was one of the best of my life. Dr. Hurst had been appointed professor and chairman of the Department of Medicine at Emory University and chief of the medical service at Grady in 1957, at age 36. In 7 years, he had revitalized both institutions. As Dr. Eugene Stead, one of Hurst's predecessors at Emory, told Dr. Mark Silverman many years later, Hurst “gave his all to Emory in a time of great need. He saved the medical school.”
      • Silverman M.E.
      The biography of John Willis Hurst, M.D.
      During my year as chief resident, Dr. Hurst taught me many things, and he continued to teach me until his death on October 1, 2011, at the age of 90. Described here are a few of the multitude of things he taught me.

      Take nothing for granted

      Listen respectfully to the findings and diagnosis of the referring physician, who often is right, but if you accept it all as correct, you will probably arrive at the same diagnosis, correct or not, because most us run diagnostic algorithms the same way. Doing your own history and physical and examining the pertinent studies yourself may provide a new data set, a new algorithm, and a new diagnosis. This trust-but-verify approach is essential for a consultant to be effective.

      High-tech is wonderful, but low-tech is often better

      Technology has always driven medical advances, and we cannot do without it. Dr. Hurst often said that if Osler were alive today, he would make appropriate use of our myriad high-tech diagnostic and therapeutic modalities. “Appropriate” is the operative word, because high-tech is always expensive, may have significant side effects, and unless used selectively may not provide the desired information or result. Low-tech investigation (i.e., history, physical examination, and a few simple tests) will either yield a diagnosis or point to the appropriate high-tech investigation.

      Be reckless and spendthrift with your talent

      One of Dr. Hurst's first hires when he took over as chief of medicine at Grady was Elbert Tuttle, Jr., an outstanding nephrologist. His father, Elbert Tuttle, Sr., a judge on the United States Fifth Circuit Court of Appeals, gave a commencement address to the professional and graduate schools of Emory University that was Willis's favorite speech. This must have been because Judge Tuttle's description of the ideal professional man or woman was the definition of Willis: “So do not try to set a price on yourselves … . Rather be reckless and spendthrift, pouring out your talent to all to whom it can be of service! … Like love, talent is useful only in its expenditure, and it is never exhausted. Certain it is that man must eat, so set what price you must on your service. But never confuse the performance, which is great, with the compensation, be it money, power or fame, which is trivial.”
      • Tuttle Sr, E.P.
      Heroism in war and peace.

      Teach with enthusiasm and patience

      Hurst was the quintessential teacher of medicine in general and cardiology in particular, and his sessions were always lively and usually incorporated a measure of show business.
      • Lindsay J.
      A successful conference includes a dose of show business—an unspoken lesson from a master teacher.
      Bruce Logue, a great teacher himself and a mentor of Willis, described him as “the greatest teacher of cardiology in the world in the last 30 years.”
      • Silverman M.E.
      The biography of John Willis Hurst, M.D.
      His best teaching was at the bedside, where he was a master. Although he was impatient with incompetence, pomposity, and tomfoolery, Dr. Hurst had infinite patience for students at any level who were serious about learning medicine, a key ingredient in his phenomenal success as a teacher.
      • Glancy D.L.
      The patience of Job.

      Optimism is contagious

      Willis was always upbeat, and that kept the rest of us upbeat. No matter how bleak the prognosis, he could always find an uplifting message for the patient and the family. This optimism spread to administrative issues. Despite the pessimistic prognostications of some, Dr. Hurst, myself, and the rest of the medical house staff were enthusiastically optimistic as we planned and carried out the complete desegregation of the inpatient medicine service at Grady on June 1, 1965, by rolling the beds ourselves. All went smoothly. The optimism was always apparent in Dr. Hurst's personal life. Although his nearly complete deafness must have been a great burden to one with unequaled bedside auscultatory skills, he never showed it. He simply became a superb lip reader and went on with his teaching and writing.

      The best way to learn a subject is to write about it

      An interest in the subject is the starting point. Reviewing the published research, collecting and analyzing one's own data, and putting it all into a logical, meaningful, and readable format that can satisfy a rigorous peer-review process teaches the author more than it teaches any of his or her readers. Dr. Hurst was a prolific and insightful writer who often said, “I'm careful about what I say and even more careful about what I write.”

      Continue to learn, teach, and contribute

      Medicine is a profession that allows lifelong participation, which is wonderful. J. Willis Hurst exemplified this best. He took morning report until he was 88 years old. In his “retirement,” he wrote novels and continued to write on medical subjects. His guest editorial in the August 2011 issue of the Texas Heart Institute Journal weaves together 3 of his lifelong favorite topics, medical history, teaching house officers, and the doctor-patient relationship, and is a recommended read.
      • Hurst J.W.
      Dr. Francis W. Peabody, we need you.

      Respect begets respect

      From my first encounters with Dr. Hurst, I was struck by the great respect he had for everyone, never showy or cloying, always understated and genuine. That is one of the reasons for the universal respect paid him. He continued to show his trainees respect by promptly replying to any message, occasionally sending one of his books with a kind inscription, promptly writing letters of recommendation, and so on. While I was at the National Institutes of Health, he would call me whenever he came to Washington to see Lyndon Johnson, who was president then. The first “White House calling” salutation was a bit unnerving, but then he was on the phone, and I realized that show business is meant to have some startling moments. Because of the great respect and affection that Willis showed his trainees, we came to regard him not only as our mentor and chief but also as a friend.
      • Roberts W.C.
      Mentor and friend.
      I will miss him sorely, but am better for having known him.
      By his words and deeds, J. Willis Hurst taught thousands of physicians and inspired us to emulate him.
      • Fred H.L.
      Editorial comment.
      Although the lifelong standard he set may be unattainable, it is worth pursuing.

      References

        • Silverman M.E.
        The biography of John Willis Hurst, M.D.
        in: Hurst J.W. The Quest for Excellence: The History of the Department of Medicine at Emory University School of Medicine. Scholars Press, Atlanta, Georgia1997: 193-200
        • Tuttle Sr, E.P.
        Heroism in war and peace.
        Emory U Q. 1957; 13: 129-130
        • Lindsay J.
        A successful conference includes a dose of show business—an unspoken lesson from a master teacher.
        J Med Assoc Ga. 2000; 89: 20
        • Glancy D.L.
        The patience of Job.
        J Med Assoc Ga. 2000; 89: 26
        • Hurst J.W.
        Dr. Francis W. Peabody, we need you.
        Tex Heart Inst J. 2011; 38: 327-328
        • Roberts W.C.
        Mentor and friend.
        J Med Assoc Ga. 2000; 89: 35
        • Fred H.L.
        Editorial comment.
        Tex Heart Inst J. 2011; 38: 328-329