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Carrying the torch

Medicine@Yale, 2011 - Nov Dec


Physicians must hold fast to a focus on the patient, says clinician-educator

That Margaret J. Bia, M.D., is a perennially favorite target in the annual Second Year Show—a traditional night of song and dance in which Yale medical students poke fun at their faculty mentors—is a measure of the deep impression she makes on each class. But it’s not who she is, Bia says, but what she stands for, that accounts for her impact.

Raised in Brooklyn in a largely Irish neighborhood, Bia, professor of medicine, lost her father when she was 11. With seven children to care for, Bia’s mother began taking in foster children for income. “There were tons of babies,” Bia says. “And I had tons of cousins. Practically every woman was either the mother of seven or eight kids, or a nun. I didn’t want to be a mother of ten children, and I didn’t want to be a nun. I wanted to do something women didn’t do.”

So Bia entered medical school in the late 1960s—when fewer than 8 percent of American physicians were women. “They hardly ever made women doctors,” she says, “but I thought it looked like a good way to serve.”

Bia and her husband, Frank J. Bia, M.D., M.P.H., professor emeritus of medicine, attended Weill Cornell Medical College as a couple, and were accepted jointly to residency programs at the University of Pennsylvania Health System.

“I was going to be an internist, but all the smartest people there, the best teachers, were nephrologists,” Bia says. So she changed course and—again, with her husband—came to Yale for a fellowship in nephrology. “I was fascinated with the hard body of knowledge of nephrology. That I could understand it, and then teach it to others, really turned me on.”

Now director of the medical school’s Clinical Skills Program—a program she built with several colleagues over many years—Bia is responsible for seeing that medical students gain hands-on experience through practice sessions and by interviewing and examining patients with the guidance of clinical tutors. It’s a valuable opportunity, she says, for students to build the skills required for truly understanding their patients.

Bia joined the faculty of Yale’s Department of Internal Medicine as a transplant specialist in 1978. At that time, a kidney transplant’s odds of success were about 50 percent, only young patients were allowed to have the procedure, and the powerful immunosupressant medications given to patients were harmful. Today, the rate of success for kidney transplants is over 90 percent for the first year after surgery, and over 80 percent for the first five years. A vastly expanded body of knowledge and refinements in technology and medications account in large part for this difference in outcomes. But equally important, Bia insists, is a patient-centered approach to treatment, in which transplant clinicians work as a team and apply a particular set of skills in order to learn what influences a given patient’s behavior.

“You could know everything in the medical textbooks,” she says, “but if you don’t know other things, like your patient’s culture and the context in which they live, a lot of your efforts are squandered.”

Recognizing the value of patient-centered medicine is especially critical in today’s atmosphere of medical practice, Bia says, because “the patient is no longer at the center of patient care. It’s profit. The more procedures you do, the more money you make.” But thanks to advocates like Bia, patient-centered medicine is now a core part of Yale’s medical curriculum, and educators can point to a body of data showing that this approach yields better outcomes.

“Talking to patients doesn’t always pay well, but good patient care means you have to connect,” Bia says. “I see myself as a torchbearer.”

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