Preamble to the Profile of Dr Abboud and Reflections on the Future of American Medical Education
See Profile, p 421
I hope that you will enjoy reading this Profile of François Abboud. What an amazing person he is. His illustrious career is a testament to the amazing results that the talent, energy, and vision of a man can produce. François is an extraordinary role model for all of us, an inspiration for his trainees, and a living epitome of the ideal academic physician. His energy and passion are equally divided among the 3 classic facets of academic medicine: patient care, research, and teaching. As he readily admits, he cannot tell you which of these 3 domains has priority over the other. It is like a 3-legged stool, where all 3 legs are equally important. Obviously, such a philosophy requires an enormous amount of energy, but that is not a problem for François; he has an infinite supply of it.
I want to relate a personal experience that illustrates this point. On February 11, 2004, François was in Louisville as my guest (I had invited him to deliver an endowed lecture). I took him to lunch to a prominent downtown restaurant, but when we got there, we found that it was closed, so I decided to walk with him to another restaurant 3 blocks down the road. It was a clear, sunny, but cold day, with a temperature of ≈10°F, exacerbated by a strong wind that drove the wind chill factor to subzero values. That’s when I saw first-hand the legendary energy of this man, as he walked briskly in the cold ahead of me and I could not keep up with his pace!
A description of all of François’ achievements would require more space than I have, and so I will focus on few accomplishments that I regard as particularly salient. First and foremost, I admire the fact that he has built one of the most outstanding academic programs in American medicine. It is amazing how much one person can change an institution. I said this before, and I will say it again. What makes a person a great leader is his/her ability to build something that did not exist. It is one thing to inherit an outstanding academic program and keep it outstanding. It is quite another thing to create an outstanding program that did not exist. Particularly, in geographic locations, such as Iowa City, that are not exactly glamorous. That is really hard, and only few people can do that.
François has been President of the American Heart Association and is a member of the Institute of Medicine. Of special significance for us is the fact that he was Editor of Circulation Research. Many readers know that he was one of the great Chairs of Medicine of the 20th century. He held that position for 26 years. Under his tutelage, the Department achieved great recognition among the top research-oriented Departments of Internal Medicine in the nation, earning François the prestigious Robert Williams Distinguished Chairman of Medicine Award of the Association of Professors of Medicine. A recent review indicated that 10 individuals who had trained in his Department or were affiliated with it as Faculty have become national leaders as Chairs of Departments of Medicine or Deans of Colleges of Medicine.
Of note, he has built a Cardiovascular Research Center that is firmly placed among the nation’s most outstanding research institutions and is supported by one of the oldest (if not the oldest) active Program Project Grants in America, which started in 1971. (François is an expert in funding sustainability; he heads a Training Grant that started in 1975 and was recently renewed until 2016.) The success of the Center in securing grant funding is truly phenomenal, with a consistent record of grant awards for nearly 40 years. During this time, the National Heart, Lung, and Blood Institute (NHLBI) supported research grants, contracts, SCORs, programs, and training initiatives that exceeded $400 million.
But François’ biggest achievement, in my mind, is what he has given to others, for the most important measure of the greatness of a man is how much he adds to the lives of those around him. Small people do not add much, or may actually take away. Great people, however, change and enrich others’ lives, and some very great people transform them in a fundamental manner. There is no doubt that François belongs to this last (minuscule) group. For half a century, he has changed and enriched the lives of innumerable people who interacted with him as patients, students, Residents, Fellows, and colleagues, not to mention the countless people who have benefited from his research. He has trained and nurtured generations of clinicians, scientists, many of whom are leaders in academic medicine.
There are additional points about François that are noteworthy. Besides his inexhaustible energy, his passion must also be highlighted. Anyone who interacts with him, even briefly, is struck by his passion. If there was one word to describe him, that would be passion. Passion for discovery. Passion for learning. Passion for teaching. Passion for healing. Passion for building new programs. You can see it in the twinkle of his eyes, you can hear it in the excitement of his voice, you can sense it in the vivacity of his gestures and body language. This is a man who has lived his life with incredible passion. A passion so boundless that it is contagious. A passion that infects those around him. That passion, combined with his simplicity, his fresh spontaneity, his down-to-earth style, his sincere smile, his optimism, and the fundamental happiness that exudes from every pore of his skin, makes it an exquisite pleasure to interact with François (and puts him in the echelon of my most favorite people).
An aspect of François’ life that is very special to me is the fact that he is an immigrant. I have always been fascinated by the story of this foreigner who started at the bottom and climbed to the top; this unknown research Fellow from a faraway land and a distant culture who landed in a new country with a big dream in his heart, ascended to the Olympus of American academic medicine overcoming all sorts of obstacles through sheer determination, talent, and hard work, and did it all by himself, with no money and no help from acquaintances, relatives, or social networks. (What a lesson for the whiners around us, many of whom did not even have to change country or language, who complain that academia is too hard.) If there was a Society of Self-Made People, François would be its lifetime president. And who, by the way, would ever think of François as a foreigner? He is as American as anyone I have met in this country, for he embodies the virtues of industriousness and self-reliance that constitute the bedrock of this nation (although, in our contemporary culture, these virtues are sadly declining). He is the American dream—a perfect illustration of what has motivated so many scientists and physicians to emigrate to America.
Lastly, it would be impossible to talk about François without mentioning his legendary work ethics. And so, once again (as I have done before in these preambles), I will take the opportunity to preach about the value of hard work, exploiting the fact that François is one of the best examples I know of to illustrate this point. Simply put, I don’t know anyone who works harder than he does. Does he ever sleep? That is one of the great questions of our time. Nobody knows for sure how many hours he sleeps, but they can’t be too many. In discussions with colleagues, I have heard estimates ranging from 2 to 4 hours. Knowing him, I tend to believe the lower range. (He must adhere to the mantra when you sleep, you are dead.) And, this is obviously genetic. If someone could map his genome, I believe that he would find at least one SNP that reduces the need for sleep.
This energy (combined with his talent) has been key to his amazing success. As I have written already, hard work is, by far, the single most important quality necessary for success, and not just in medicine, but in everything in life. It is far more important than intelligence or any other trait. The concept that success is 10% inspiration and 90% perspiration is one of the greatest truisms. Yet, this basic truth is not being taught to the young generations, who are being misled into thinking that success can be achieved with a lifestyle that is comfortable, balanced, and free of stress. In reality, such a lifestyle is a sure prescription for mediocrity.
These reflections lead me to mull the future of medicine and medical research. It was giants like François who advanced medicine in the 19th and 20th century; will these giants still be around in the 21st century? Will we have any more Abbouds, and which educational system will they come from? The signs of the times are not good. For example, the recently implemented policies regulating medical Residents’ hours during their training are antithetical to the spirit and work ethics of the Abbouds of the past—the giants who built the tradition of excellence of our medical system. Just imagine what the Department of Medicine at the University of Iowa would have been if François had adhered to the work hour restrictions that are now mandated for young physicians in training in the United States.
Throughout human history, the world has been moved forward by committed people, who did all that it took to achieve their objectives. The salient characteristic of these people is that they did not count how many hours they spent in the hospital or in the laboratory or how many breaks they took. The wonderful academic and medical system that we enjoy was built by generations of dedicated physician-scientists who did not abide by today’s restrictions on Resident work hours and did not worry about days off, but instead devoted themselves to their profession, sacrificing free time and other interests for the advancement of medicine and science. They lived medicine and research as a mission. They did not look at the clock and say, “Gee, it’s 1:00 PM, I must go home because my time is up, even though the experiment has not been finished or the patient is still unstable.” They never thought of themselves as shift workers. Yet, this is precisely the mentality that is increasingly being inculcated in young physicians nowadays.
Think how damaging this will be to medicine and research. What impact will current Resident hour regulations have on the character and work ethics of future generations of physicians and physician-scientists? Who will teach them that excellent patient care is more important than free time? How will they learn to be physicians dedicated to their patients rather than shift workers? How will they find the motivation to emulate the François Abbouds of the past, living their profession like a mission? If these values are not learned during training, they are unlikely to be learned thereafter.
Training medical Residents involves much more than teaching them the technical skills to be competent doctors. Just as importantly, or perhaps even more importantly, it involves building their character, imbuing them with passion, teaching them work ethics and dedication—for example, making them understand that medicine is a mission and that the welfare of their patients takes priority over their free time. It is hard to teach these values when Residents are required to adhere strictly to their shifts (whose length continues to shorten) and are prohibited from putting in extra time (which is labeled and punished as “violation”).
For many decades, the medical training system in the United States has produced generations of outstanding clinicians and scientists, who were second to none worldwide. But now, this system is changing. Increasingly, young physicians are told that watching the clock, counting how many hours they work, leaving at a predetermined hour, and making sure they do not miss any of their vacation time and free time are categorical imperatives, which have priority over learning more, finishing what they are doing, and making sure their patients get the best care. What message does this system send to the trainees? Who will teach them the importance of hard work, dedication, and sacrifice? Who will instill in them the notion that their patients come first and their free time second? Who will persuade them not to become shift workers? How will they learn that accomplishing anything of any significance requires total dedication to the task? And, how will this system produce more François Abbouds?
Division of Cardiology
University of Louisville
- © 2013 American Heart Association, Inc.