John (“Jack”) Hughes, MD, professor of medicine (general medicine) and associate director, Program for Biomedical Ethics, has retired.
“Jack defined the ‘triple threat’—a faculty member who excelled at patient care, teaching, and research,” says Patrick O’Connor, MD, MPH, MACP, Dan Adams and Amanda Adams Professor of Medicine and section chief, General Internal Medicine. “For trainees and faculty at all levels he has been an inspiring role model of the academic physician—thoughtful in his approach, critical in his assessments, and inspiring in his accomplishments. Jack is a master clinician to whom we all look for clinical pearls and wisdom.
“Jack has also made highly meaningful contributions to our healthcare system through his research on patient classifications and risk adjustment mechanisms. The impact of his work and its impact on the financial infrastructure of American medicine in general and academic health centers in particular is unquestionable.”
Among the numerous teaching awards Hughes has received (some more than once) are the Ashgar Rastegar Housestaff Teaching Award, the Francis Gilman Blake Teaching Award, and Teacher of the Year Award (awarded by the Yale School of Medicine Class of 2007).
Hughes came to Yale as a member of the first cohort of the National Clinicians Scholars Program at Yale (NCSP) (nee Yale Robert Wood Johnson Clinical Scholars Program) in 1974, after receiving his undergraduate and medical degrees at the University of North Carolina and doing his internship and junior assistant residency at Ohio State University. He did his last year of residency at Yale New Haven Hospital, and then spent six years at the Fairhaven Community Clinic, followed by working as an attending physician in internal medicine at Yale New Haven Hospital and the VA Connecticut Healthcare System.
Hughes says he became interested in bioethics in medical school. While he was a clinical scholar at Yale, he took a course at Yale Law School with Jay Katz, a well-known bioethicist at the time. In 1998, he began teaching a course for first year students called Professional Responsibility.
“The course addresses the healthcare system and how it's organized or not organized, how it's paid for, or not paid for, in many cases,” says Hughes. “We talk about the ethics of human research. We talk about the legal and ethical implications of reproductive medicine. We deal with death and dying. We deal with violence. We have a session on climate change. We have some sessions on the history of medicine. It’s a survey course of things that don't get addressed anywhere else in the preclinical curriculum.”
Hughes has also spent many years as a general internist working in the general medicine clinic and supervising on the wards at the VA in West Haven.
“When Jack sees patients, the room loses its sterile air, the fluorescent bulbs seems to change to a warmer hue, and it feels less like a clinical encounter than a reunion of friends, says Pranay Sinha, MD, assistant professor, Section of Infectious Diseases, Boston University School of Medicine. Hughes was Sinha’s mentor during his residency.
“I also loved that Jack didn’t restrict his mentorship to the biomedical realm. On slow days, we would set up shop in his clinic room as he incited thought provoking debates on the practice of justice, politics, and moral philosophy. We would discuss the importance of neck vein examination and the danger of neofascist ideology in the same session.
“Perhaps the most dramatic moment we shared was when one of my patients declared his intent to perpetrate mass murder. I was shaken to the core and felt rudderless. Thankfully, Jack is imperturbable in tough situations. He helped me clear the clinic and surreptitiously called for psychiatric backup that helped the patient get the care he needed and avoid multiple casualties.
“Quite simply, I consider Jack to be one of the best doctors and teachers I have every had the privilege of learning from and hope to approximate his example as a clinician and mentor as best as I can.”
In 1979, The Healthcare Financing Administration awarded the Yale Institution for Social and Policy Studies a contract to revise and update the initial version of the Diagnosis Related Groups (DRGs)—the system that Medicare uses to pay hospitals. The implementation of the DRG based Medicare Inpatient Prospective Payment System (IPPS) in 1983 revolutionized hospital management and saved the Medicare hospital trust fund from insolvency.
“Along with Jack, the core clinical team for the DRG update included another NCSP clinical scholar and an ex-navy surgeon who were very opinionated and had great difficulty reaching consensus and finalizing clinical decisions,” says Richard Averill, MS, MA, former senior vice president, 3M Health Information Systems, Inc., and former director of Health-Related Research, Yale School of Management. “Without Jack’s clinical insights and consensus building skills, we would never have met the contract completion deadlines.”
Mark R. Mercurio, MD, professor of pediatrics and director, Program for Biomedical Ethics, not only admires Hughes for his intellect and teaching skills, but also his affability and sense of humor.
“Jack and I taught together at the annual Fellowships at Auschwitz for the Study of Professional Ethics,” Mercurio says. “This involves two intense weeks in Germany and Poland with medical students from around the country discussing contemporary medical ethical issues in the setting of atrocities committed by Nazi physicians. It is a powerful experience for students and teachers alike. Jack was, no surprise, an inspired and inspiring teacher. He had a special way of connecting with the students on this trip. And, from my point of view, he was a wonderful partner and travelling companion.
“He’s a good guy with a superb moral compass, he’s extremely bright, and he's funny. He would be sorely missed by a lot of people, myself included, if he stepped away from the ethics work at Yale. My hope is that he's going to stay involved in the ethics work for years to come. We'll be a lot better off for it.”
Hughes says he has no “retirement skills,” and that the idea of being called professor emeritus “freaked him out” for a long time. He plans to remain involved in the biomedical ethics program and continue to teach in the professional responsibility course.
“The combination of intellectual activity and service that that goes on here at Yale is remarkable,” he says. “Yale is a wonderful place with a wonderful group of people to work with. The medical school is huge, and there are a lot incredibly well-intentioned, highly motivated and very effective folks working here. “It’s been privilege to work with them. It's been a delight.”
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