74LA, 77MD, 80R, 81F - Internal Medicine
What is your hometown?
Carroll, Iowa
How/when did you become interested in science and medicine?
I always had an interest in science, from elementary school on. I primarily was interested in electronics, especially computers during high school with a secondary interest in biology.
What interested you to pursue a career in medicine and medical education?
For some reason in my senior year of high school, I decided to become a doctor and I am unsure why. However, I remember back when I was building a digital computer for my sophomore or junior year science project, my mother asked me if I ever thought of being a doctor and I said “not really”; so I wonder if this suggestion was subconsciously triggered as I planned to go off to college. I was goal-directed from then on and began undergraduate school in 1970 and finished my fellowship in 1981, entirely at the University of Iowa. I am a dyed-in-the-wool Hawkeye.
Please highlight your major career achievements, awards, discoveries, etc.
My major achievement is undeniably a direct result of my comprehensive education and postgraduate relationship with the University of Iowa Carver College of Medicine. My medical mentors at the University of Iowa taught me to approach clinical situations with an open mind and a humanistic but also scientific approach, whereby new medical discoveries could be realized if the opportunity arose. Such a situation presented itself roughly ten years ago. I practice mainly gastroenterology and when doing a colonoscopy on a patient with a history of polyps and routinely inspecting the terminal ileum, I found ulcerations. My first inclination was to diagnose Crohn’s disease, a chronic and incurable condition, but the case was atypical and I was reluctant to make that diagnosis outright.
With a heightened awareness, I began finding more of these lesions at subsequent colonoscopies and after collecting over twenty of these cases and analyzing the potential clinical factors causing these, I presented my series at the semiannual Iowa Digestive Disease Society at the University of Iowa, where private practitioners interact with the faculty of the Division of Gastroenterology in a series of academic presentations and private gastroenterologists can present interesting cases. I presented my series of ulcerative ileitis patients and related a strong association with non-steroidal anti-inflammatory drugs, especially low dose coated aspirin, which had previously not been well described in the medical literature.
Dr. Konrad Schulze (77F-Internal Medicine), Professor in the Internal Medicine department, felt the concept should be published and elicited the expertise of Dr. Frank Mitros (78R- Pathology), Professor in the Department of Pathology. With Dr. John Brennan, a Dubuque pathologist and University of Iowa Carver College of Medicine and University of Iowa Department of Pathology graduate, we formed a collaborative team and published a clinicopathologic analysis of a larger series entitled “Ulcerative Ileitis Encountered at Ileo-Colonoscopy: Likely Role of Nonsteroidal Agents” as the lead article in Clinical Gastroenterology and Hepatology in May 2003. We emphasized in the article the relatively high prevalence of this disorder in a general gastroenterology practice, the high association and the likely causative role of nonsteroidal drugs (mainly low dose coated aspirin), and the caution of misdiagnosing this as Crohn’s disease as the pathology has some similar features.
This collaborative research article struck a chord and was well received. Inquiries on this study came in from around the world and it has been referenced in subsequent research articles on nonsteroidal drug damage to the small bowel, and was chosen as one of eleven notable articles in the annual Updates in Gastroenterology and Hepatology at the American College of Physicians meeting in 2004 which was subsequently published in the Annals of Internal Medicine. It has been reviewed and referenced in authoritative sources such as “Journal Watch: Gastroenterology and UpToDate” and was quoted recently in the latest edition “Feldman: Sleisenger and Fordtran’s Gastrointestinal and Liver Disease”. In this major textbook, our concept of diagnosing this common but rarely recognized disorder with terminal ileoscopy was cited, which had not been suggested in the medical literature prior to our research paper.
I believe this is a great example of the University of Iowa Carver College of Medicine’s ongoing productive relationship with its graduates and in this case, it furthered the growth of medical knowledge as a result.
Is there a teacher, mentor or Carver College of Medicine faculty member who has helped shape your education?
I find it virtually impossible to relate only one mentor when one has done his medical, residency and fellowship training at, and practices with an ongoing close relationship with, the University of Iowa Carver College of Medicine. Dr. William Lawton was a great influence in my decision to go into internal medicine as my teacher on my junior medical rotation. Drs. James Christiansen and Robert Summers (65MD, 68R, 70F- Internal Medicine) were not only great teachers of clinical medicine in my residency training but significantly nurtured my interest in gastroenterology as a subspecialty during my fellowship. Dr. Ken Hubel, also a professor of gastroenterology, whose quote to me “to cure sometimes, to console always”, still resonates to me to this day. Dr. Charles Helms sparked my interest in clinical research during my fellowship while Dr. Konrad Schulze (77F- Internal Medicine) has been a remarkable and invaluable mentor and collaborator for research in my postgraduate career.
How or why did you choose the University of Iowa for your education and medical training?
After choosing to go into medicine, it was an easy decision to attend the University of Iowa as an undergraduate. My father graduated from the University of Iowa in business, it had the only medical school in the state, and many of my cousins and high school friends were attending undergraduate school there. The University of Iowa Carver College of Medicine was my only serious consideration for my education, because of its excellent reputation and its program of early acceptance after three years of undergraduate education, thereby receiving one’s BS degree after the freshman medical year. That fit my career goals nicely.
What kind of professional opportunities or advantages has your University of Iowa medical training provide?
My education at Iowa opened up many opportunities and I sought positions widely when I left training in 1981. I interviewed mainly in the Sun Belt and had excellent opportunities there, but decided to remain in Iowa and settled in Dubuque- a decision that I’ve never regretted and has been an exceptional professional opportunity in retrospect. Staying close to my mentors and the expertise at the University of Iowa has been invaluable.
Please describe your professional interests.
I practice primarily gastroenterology but also internal medicine at Dubuque Internal Medicine, P.C., a thirty-member group with adult primary care, specialty and subspecialty internal medicine. I’ve been privileged to be its president over the last 20 years and have served with a team that has fostered impressive growth and excellent patient care in nearly all of the subspecialties of internal medicine. The group is one of the largest internal medicine based health care groups in the state.
What are some of your outside interests?
While medicine is my vocation, art history is my avocation, specifically concentrating on the work of Grant Wood. I’ve been a passionate collector, researcher, curator and lecturer on Iowa’s most famous artist and the creator of the most recognized work of art in American culture, American Gothic. His life is one in which he overcame many obstacles to become world famous in his profession, living nearly all his life in eastern Iowa. This life story has been inspiring in my own life and professional endeavors. I have embodied this inspirational message in a presentation entitled “Grant Wood: Artistic Rags to Riches- An American Success Story”, which I’ve given often at eastern Iowa art venues.
When I came to Dubuque I discovered that the community had two Grant Wood masterpieces but no art museum. Therefore I decided to collect his works and went on the board of the Dubuque Art Association (now the Dubuque Museum of Art) and have served in this capacity for over twenty years, two years as its president. I endeavored with other like-minded Dubuquers and subsequently donated nearly thirty Wood works to the museum over the last eight years. With these works, in combination with other more significant community donations and loans, Dubuque now has a world class Grant Wood collection in its own nationally accredited museum of art.
Somewhat coincidentally, Grant Wood’s last artistic work was a lithographic series entitled Family Doctor, which were largely signed in his hospital room at University Hospitals in Iowa City, shortly before he died in 1942.
Do you have an insight or philosophy that guides you in your professional work?
As one involved in the administrative as well as the clinical aspects of medicine, my guiding principle is embodied by the expression that good medicine is good business; in other words, the financial challenges of private practice will be met by practicing quality patient care.
If you could change one thing about the practice or business of medicine, what would it be?
Improving the poor reimbursement for the care of Medicare and Medicaid patients, particularly in the state of Iowa, is the biggest challenge in medicine today in my estimation.
What is the biggest change you've experienced in medicine since you were a student?
Undoubtedly, it is the broad advance of technology in pharmacology and noninvasive procedures in internal medicine, whereby the patient’s quality and length of life has improved dramatically with less risk and discomfort by preventing, controlling or curing previously poorly treated serious disorders.
What one piece of advice you would give to today's medical students?
Medicine is one of the best professions to which one can aspire, despite its ever-present challenges. I would like to echo the advice of one of my medical mentors in one’s approach to patients: to cure sometimes, to comfort always.
What do you see as "the future" of the medicine?
The future of medicine involves balancing the financing of the continued exponential advance of medical knowledge and expertise with the challenge of making it available to all Americans. The answer to that balancing act is presently being politically and publicly debated and I presently do not have a crystal ball to predict the outcome.