Interview: Dr. Larry Schwartz

Schwartz pic

Dr. Larry Schwartz graduated from Wayne State University School of Medicine in 1975 and completed his Residency in Emergency Medicine at Henry Ford Hospital.  He has won numerous awards for his dedication to medical student education and humanism in medicine.  Dr Schwartz is a national leader in medical education.

Receiving: You are an icon in medical student education, how did you first get involved in this area?

Dr Schwartz: In 1989, while working at Beaumont Hospital, I started working a few shifts a month at the University of Michigan’s University Hospital. That lead to a stint as a physical diagnosis volunteer at U of M that I did for 1 or 2 seasons. I somehow became more involved in some other medical student teaching at the University of Michigan. In 1992, when I decided that I wanted to change jobs, I talked to Dr. Bock and told him how much I enjoyed working with medical students. At that time he was interested in establishing a mandatory EM clerkship and getting the EM faculty involved with physical diagnosis. It was a natural fit.

Receiving: What are some of the changes you have noticed in medical students from the 1980s to today’s medical students?

Dr Schwartz: I haven’t noticed too much difference. The students, by and large, are still energetic and idealist for the most part. They get excited by clinical medicine. They are caring to patients because they identify many times more with the patient than with the doctor. I find their enthusiasm contagious and they are like a breath of fresh air.

Receiving: In 2006, you were inducted into the Gold Humanism Honor Society.  With increased ED patient volume and the reliance on advanced technology (i.e. multi-detector CT) is “humanism in medicine” fading?

Dr Schwartz: Most patients go to the doctor to see the doctor not the CT machine. The problem we have is the decreased amount of time  we spend with out patients. We need to build up trust in the short time available,  The patient has to feel that the doctor cares about him and his well-being. As healers, we must be able to project a caring attitude. The patient doesn’t leave the ED saying, that state of the art CT machine was terrific! He or she states that the doctors and nurses were kind, caring, professional, and knowledgeable. I’d go back there if I  needed medical care in the future. Or, if unsatisfied with the care, I’d die before I’d go back to that dump again! They never praise or complain about technology, it is the providers and the cleanliness of the environment that make an impression on our patients.

Receiving: What are some of the biggest challenges that today’s medical students are going to face when they are practicing physicians?

Dr Schwartz: I think that the medical care system as we know it is going to change dramatically within 5-10 years. Today’s medical students are going to be at the vanguard of this change. Unfortunately, I don’t know what the changes are going to be. I think they will be imposed from without instead of arising from within Re-imbursement is going to be reduced. Students will come out of med school with huge debt and lower re-imbursement than we have been accustomed to. Unfortunately physicians have lost the role of managers of medicine. Our broken system is going to collapse and need to be rebuilt. That will be painful. Once rebuilt, however, I think it will be more just.

Receiving: Should emergency medicine be a core clinical rotation for medical students nationwide?

Dr Schwartz: YES! Every inpatient room in the hospital is an emergency room when the intern is called because the patient is having an emergency. The house staff must know how to handle these emergencies. Therefore a core EM rotation is necessary for all medical students.

Receiving: Can you tell us one of your secrets to being an influential teacher?

Dr Schwartz: Students have to feel that you respect them, your patients, and that you really care. They want a role model that they can look up to, one that can walk the walk as well as talk the talk. I have tried to meet the same standards I hold the students to. It is very important that we model the behavior we preach. If not, we have no credibility as teachers and mentors.

Receiving: Do you remember a time when “educational research” in medicine was unheard of?

Dr Schwartz: We’re finally realizing that although we may be good doctors, we may or may not be good teachers. I think that medical education research is growing exponentially because we have so many new modalities to study and ways to study them. The introduction of simulation and parts trainers into medical education is a huge new arena to study. Distance learning and interactive computer based training are also a new technologies. As we introduce things, we are studying them. This has opened the door to more and more educational research in medicine.

Receiving: Who is your role model?

Dr Schwartz: I have several. Our own Dr. Dayanandan, or Daya as we used to call him at DRH ED, was a great role model. He was always even-keeled, smart, and kind to everyone. He was well respected by all of the physicians, nurses, students, and patients.  Dr. V. Vaitkevicius, a retired oncologist, is another remarkable man. He is one of the most humanistic doctors I’ve known. He would give his personal telephone number to his patients and was available to them at all hours. Dr. Ronald Krome has been a mentor to me. He taught me about hospital administration and how to be a champion of emergency medicine, the emergency department, and emergency physicians. I learned an incredible amount from him.

Receiving: As the medical student clerkship director for emergency medicine, you were one of the earliest directors to employ “web-based” education by utilizing “Blackboard” and putting the clerkship “on-line”.  How will the web impact medical education?

Dr Schwartz: Dr. Rosh, you can answer that one better than I since you are using the web constantly in your work with the residents. I found that putting a multiple choice exam on Blackboard allowed for immediate scores, better images, and evaluations of the exam. What I didn’t know when I first put the exam on blackboard was about security. Our exam was purloined within the first month or two by a med student who copied, pasted, printed, and distributed it. I found this out about a year or 18 months later. The web is a great aid. However, I don’t think anything takes the place of face-to-face contact in  medical education. The web is a great addition, but it can’t take the place of the apprenticeship model where the more experienced teach the novice.

Receiving: If you were going to practice medicine in a remote village, what is the one medical textbook you would bring with you?

Dr Schwartz: A tough question! I like the Tintinalli book probably because I wrote a chapter in it. These days, I must admit that I go more to the web when I have to look something up. I guess I am going kicking and screaming into the 21st century.

“The Meeting Room” is devoted to interviewing leaders in Emergency Medicine.  Please email me with suggestions on people you would like to see interviewed or if you would like to conduct an interview.

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