After 37 years in medicine, Auguste Fortin VI, MD, MPH, MACP, professor of medicine (general medicine) will retire on June 30, 2022.
Growing up in idyllic West Townsend, Mass., he had spent a lot of time outdoors with the explorer scouts, which would help hone his future career path. But figuring out his specialty took more time.
“In medical school, I thought I would have a career in tropical medicine. I really loved the bugs and drugs, and the worms and parasites. When I finished medical school, I was at Bellevue Hospital, right at the height of the AIDS epidemic before there were any medications to treat it. People my age and younger were dying. I saw the face of the specialty of infectious disease really, really change and it was overwhelming,” recalled Fortin. “I also had the good fortune of coming in contact with some people who were training in primary care internal medicine, and I realized that that was my phenotype, and that I was destined to be a general internal medicine doc and not a sub-specialist, and so I joined the primary care track during my intern year and never looked back.”
He completed his residency at Bellevue in 1988, and served in the United States Navy, which had awarded him a scholarship to help pay for his medical education. He was stationed at the Naval Hospital in San Diego, Calif. From 1990-1991, he cared for soldiers as a battalion surgeon in the 2d Battalion, 7th Marine Regiment in support of Operations Desert Shield and Desert Storm.
After his three-year commitment was completed, he relocated to Baltimore. Md. to complete a general internal medicine fellowship at Johns Hopkins University School of Medicine, to learn how to be a better educator, and how to design and develop curriculum.
“I opened the New England Journal of Medicine, and there was a job ad for an associate program director for the Yale Primary Care Internal Medicine Residency Program. So I applied there, and applied to a lot of other places, but really fell in love with what I saw when I came up to New Haven,” said Fortin. “Steve Huot was the program director. The program was only six years old at the time, and really had a small cadre of devoted faculty.”
Stephen Huot, MD, PhD, professor of medicine (nephrology); and senior associate dean for Graduate Medical Education, recalls talking to Fortin about the role.
“We were looking to recruit a group of academically-oriented general internal medicine physicians, and Auguste had a primary care residency and a general medicine medical education focused fellowship. He also had a real interest in communication skills, the humanistic aspects of medicine, and those are some of the key underpinning values of the primary care residency program. So, bringing him in, not only as a core faculty member, but also in a leadership position for the residency with those values, that training, that expertise, which was very much what we were looking for,” said Huot.
He worked as associate program director for six years while developing his psychosocial curriculum. Patrick G. O'Connor, MD, MPH, MACP, Dan Adams and Amanda Adams Professor of General Medicine; and chief, Section of General Internal Medicine, applauds Fortin’s leadership in this area.
“He was a thought leader in doctor-patient communications, and humanism in medicine nationally and internationally. Auguste brought his keen intellect, thoughtful creativity, and boundless energy to his role as a member of our faculty. He's highly effective as an educator and scholar, prolific teacher, and the theme of humanism in medicine is something he exemplifies,” explained O’Connor. “He is a role model for everyone in the section, department, and in the school. He is also a wonderful role model for training students and residents, in terms of showing how physicians can incorporate the best of doctor-patient communication, psychosocial medicine, and humanism in medicine at the bedside.”
According to O’Connor, trainees would comment on how Fortin inspired them to keep the patient first and to keep the humanistic aspects of medicine first, so they don't get lost in all the administrative activities that necessitate practicing medicine these days. “The Fortin Approach is highly relevant to trainees and faculty alike from first year medical students to senior faculty and everyone in between,” said O’Connor.
One such trainee is Katie Gielissen, MD, MHS, assistant professor of medicine (general medicine) and of pediatrics (general pediatrics). Gielissen was a resident in Yale’s Combined Medicine/Pediatrics Residency Program. She recalls the first time she met Fortin. He made quite an impression.
“The first time I met Auguste was in the weekly intern support group, which he created. I was an intern at the time, and there was this attending who I hadn't met before because being Med-Peds you don't get part of the Primary Care orientation stuff. He had a ponytail, and meditation chimes. He sat with us and listened to all the trials and tribulations of the intern year,” she remembered. “He was so patient, he's so thoughtful and really listens, and so my first meeting with him was that. It stuck with me for quite a while because intern year is a tough year for anyone and having time to reflect and think, is a very precious and very rare thing. He has always been that kind of person to stop and reflect, and he pulled me along in all kinds of activities like that. And really taught me how to model that behavior for my students and residents. So, he's been such a great role model for me for a long time.”
Gielissen started to learn more from Fortin when she became faculty. Her interest in education grew as did the opportunity to teach alongside him as part of the communications course. She was impressed by what she saw. “I got to see Auguste modeling the communication skills to the students, and I was blown away by the technique, because I hadn't been taught that method in medical school. This experience really informed the way that I've been talking with patients ever since I started teaching the course.”
“Every time there's an opportunity to teach in the communications course, I sign up immediately because it's just so fun. And it really has an impact on students. You just say Auguste's name, and they're like, ‘Oh, I gotta communicate better.’ He has this presence and reputation for being an amazing communicator, and you can tell that students are really impacted by him, and not only the explicit way of knowing him, but also in the way that they talk with patients, because you can see that in action when you're working with them on the wards, you can see them talking with patients in a patient-centered way, in a thoughtful way, and that's all because of him. It's amazing,” said Gielissen.
During his time as associate program director, Fortin worked with Andre N. Sofair, MD, MPH, professor of medicine (general medicine) and of epidemiology of microbial diseases. The pair attended on the wards, in clinic, in morning reports, and bounced cases off each other. A friendship quickly blossomed. While their roles have changed over the past 20 years, Sofair sees Fortin’s impact across the hospital.
“I’ve seen the mark that Auguste has left on the residency program through his interest in teaching doctor-patient communications. You talk about dealing with a complex patient, how do you model for the house staff? How do you work with a difficult interaction with patients at the bedside both in the inpatient and outpatient setting? How do you give people a background on how to work on that? So that's really been a lot of what his impact has been,” said Sofair.
Sofair was so impressed with Fortin’s teaching that he invited him along on a trip to Rwanda to train physicians there on doctor-patient communications.
Sofair is not only amazed by Fortin in the clinic, but also outside of it.
“If one were to ask how I would characterize Auguste as a doctor, but also as a human being, I would say that he's one of the kindest people that I know. He is very empathetic. He's very open to people's points of view and is not somebody who's going to pigeon somebody into what he thinks. He is understanding, compassionate, and supportive of people, both patients and trainees, and I think that is why he's so regarded because of those aspects. That's why he's won so many awards, because of that's just who he is, not just as a doctor, but also as a human being,” commented Sofair.
Fortin has won numerous education awards from organizations ranging from the American College of Physicians (ACP), to the Society of General Internal Medicine and the Association of American Medical Colleges. In 2018, he won the Jane F. Desforges Distinguished Teacher Award from the ACP and received a prestigious Mastership from this organization. He was one of the only faculty members to win Yale School of Medicine’s Charles W. Bohmfalk Teaching Prize twice. He has taught nearly 400 seminars around the globe on physician communications, patient-centered interviewing, improving patient health outcomes, and psychosocial curriculum.
Huot thinks that Fortin was ahead of his time with his work around communications skills and well-being and the integration of those topics into graduate medical education.
“Not everything you bring forward in medical education ends up standing the test of time, but what Auguste brought forward in these areas certainly does. If you look at all the conversation that's evolved in a more proactive way over the last eight years or so around physician well-being and burnout, a lot of what Auguste was driving towards was really thinking about that: work-life balance, professional satisfaction, skills to improve our well-being. We used different words when he first joined the faculty, but that's really the direction that he was trying to move us in. I think the primary care residency program has benefited tremendously from that having become part of the fabric of what the program offers,” said Huot.
As Fortin looks towards the future, due his numerous outside interests such as sailing, flying, meditation, and traveling, everyone knows that he won’t be bored, but he will miss the work.
“What I've started telling people is I'm doing this as a one-year vacation and then we'll see what happens. I anticipate I'm really going to like sailing in the Caribbean for the winter, and we’ll want to do that every winter, but I also anticipate that I'm going to miss being directly of service to others. That's the hardest thing for me to wrap my head around right now is how will I continue to live a life of service in ways other than being a doctor, and can I let myself just enjoy leisure time also without feeling guilty about not being of service. For me the biggest struggle of this decision is thinking that through. I'll see how it plays out, but the one thing that wakes me up at night is that thought,” said Fortin.
In the meantime, he and his wife of 31 years, Pongprayong “Oi”, will sail. For Fortin, who has been sailing since age 4, the thought of retiring to sail is a full-circle moment. As a medical student, he crewed for physicians who wanted to sail their boats from Boston to Martha’s Vineyard but was too busy during residency to get out on the water.
“In residency, I didn't do any sailing, but I would look out the window at Bellevue longingly on the East River and see boats going up and down the river and thinking one day that'll be me.”
After he left the Navy, he bought a 38-foot boat and lived on it with Oi during his fellowship in Baltimore. When he got the job at Yale, they sailed to their new home.
“We literally sailed the boat from Baltimore to New Haven, actually passing by Bellevue Hospital up the East River, which made me cry, to be honest. Seeing that, I felt like I'd come full circle and was realizing this dream that I'd had as a sleep-deprived intern.”
Fortin will be honored with emeritus status as of July 1, 2022. “While he may be retired, we all look forward to interacting with soon-to-be Professor Emeritus Fortin for years to come,” said O’Connor. “Auguste’s ongoing inspiration, even in retirement, will continue to motivate us all to be the very best clinicians, educators, and scholars that we can be!”
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