Pearls of wisdom from years on the wards

In the fall of 1960, Lewis Landsberg, M.D. ’64, HS ’70, first set eyes on the legendary Paul Beeson, M.D., at a Saturday morning medical ground rounds. As Beeson entered Fitkin Amphitheatre, the renowned chair of internal medicine at Yale took his usual seat in the first row on the right-hand side of the lecture hall. Then the learning began with the clinical presentation of real patients, who were frequently in attendance. It didn’t take but a couple of months for Landsberg, then a first-year medical student, to realize that he was no longer interested in a career in psychiatry.

“Internal medicine at Yale was exciting and compelling,” said Landsberg about his choice of specialty. “Intellectually challenging, it was an area of medicine I wanted to pursue.” And indeed he did—becoming a leader in his field and reaching the highest ranks of academic medicine.

Landsberg’s leadership roles took him from Yale to Harvard and finally Northwestern, where he served as dean of the medical school. During almost half a century of experience as a clinician and teacher, Landsberg distilled his knowledge into aphorisms to teach budding physicians the art and science of caring for ill patients. He often offered his “pearls” of clinical wisdom on rounds and during morning report, but he never wrote them down—until recently.

Prompted by colleagues and students, Landsberg spent a little over a year recalling from memory the many “pithy statements of fact” now featured in the new book On Rounds: 1000 Internal Medicine Pearls—Clinical Aphorisms and Related Pathophysiology (Wolters Kluwer, 2016). The pocket-sized book presents the pearls by organ system for easy reference, featuring information Landsberg deemed most critical to developing mature clinical judgment. For example, a favorite Landsberg aphorism, “Never let a single laboratory result dissuade you from a diagnosis strongly suggested by the weight of the clinical findings,” reminds inexperienced-to-seasoned clinicians not to rely solely on the numbers.

The book also includes a few faux pearls to keep readers on their toes. For example, a widely held belief is that antibiotics should be avoided in cases of Salmonella enteritis because treatment may result in a prolonged carrier state. Not true, according to Landsberg. “The point is to be aware,” he said. “Not everything people tell you is correct.”

A master clinician in his own right, Landsberg learned from the very best. A member of Beeson’s last internship group, known as the Iron ’Terns, the native New Yorker went on to become chief resident in medicine at Yale-New Haven Hospital under the mentorship of Philip K. Bondy, M.D. Landsberg then completed a research fellowship at the National Institutes of Health in the laboratory of Nobel laureate Julius Axelrod, Ph.D., before returning to Yale as a junior faculty member. In 1972, former Yale professor Franklin H. Epstein, M.D., moved on to Harvard Medical School and lured Landsberg away from his alma mater. During his 18-year tenure at Harvard, Landsberg served as chief of the Division of Endocrinology and Metabolism. Leaving Boston for Chicago in 1990, he became chair of internal medicine at Northwestern and a decade later, dean.

In 2007, Landsberg stepped down from the top spot to launch the Northwestern Comprehensive Center on Obesity. Running the center has given him the opportunity to tackle the problem of obesity with novel clinical approaches and advancements in research, including his own. He has long conducted studies in the areas of catecholamines, dietary intake and the sympathetic nervous system, and obesity and hypertension. It also has afforded him the time to return to teaching medical students and residents—and sharing his pearls.

Landsberg dedicated his book in part to his intern group at Yale, “whose friendship has been a lifelong treasure.” He also acknowledged some of the many mentors who helped shaped his career, including Yale professors Beeson, Bondy, and Epstein. Additionally, he thanked his son Judd, a 1996 graduate of Yale’s medical school, for “many fruitful discussions” as the book came together.

Released last September, the book has already started reaching its target audience. At Northwestern, the Department of Medicine distributed it to residents and faculty members. Internal medicine residency program director Aashish Didwania, M.D., describes it as “extremely accessible and clinically relevant,” and containing pearls not easily found in textbooks. Chief medical resident Natasha Nichols, M.D., often uses Landsberg’s book after a heavy call day to look for teaching points to discuss on rounds.

While he doesn’t carry the book in his white coat, second-year resident Andrew Davis, M.D., appreciates having Landsberg’s tried-and-true observations close at hand. “The book taps into how a master clinician thinks, which is one quality that makes it unique.”