Internists are a strange mix of both detective and engineer. We are drawn into internal medicine because we are at heart not just problem solvers, but fixers as well. That is, we want to identify the solution, and apply that solution ourselves to the problem. Internal Medicine therefore encompasses both the diagnostic work of a medical detective, and the interventional work of an engineer, as we try to rebuild our patients’ health. We want not only to find the piece of the puzzle that fits, we want to put it into place ourselves, and the satisfaction when a piece pops into its place is immense. The reward for fitting that puzzle piece into place is seeing someone get out of the hospital who would not have gotten out if not for us.
This challenging and diverse skill-set is crucial to the success of all internists, yet what drives these skills is just as important. Our department is motivated by the twin principles of caring and investigation. These principles not only define who we are as a group, they also drive what we do. We strive to care for not only our patients, but each other as well. We also seek to not only be medical technicians, but medical investigators. With every patient and every situation we continually striving to discover a better way of doing things, because the status quo is not acceptable. Too many people still die from diseases we do not know how to treat.
It is these two principles that all 237 faculty in the department want to convey first and foremost. But we also want to systematically impart medical knowledge to students and trainees. We have set-up a large medical education group to maximize this, both with inductive and didactic teaching methodologies. We are developing specific tracks within the residency program, in hospital medicine and global health. Future plans include adding more tracks, such as adolescent/young adult health, public health, and complementary medicine, besides the current outpatient clinic training.
We strive to teach trainees to identify the patients’ problems, develop a differential diagnosis, define that diagnosis in an investigative manner, and then plan for treatment, also in an investigative manner. We desire trainees to become even more sensitive and responsive to the needs of patients, which must come first before all other endeavors. This is foundational to our culture of caring. By virtue of becoming physicians, we have made a promise to our patients that we will always care for them, with our hearts as well as our minds. Part of that caring is never accepting the status quo, but always investigating how we can do even little things better. Thus, in our department the nurse administering medication, the tech rooming a patient in clinic or the scheduler booking a patient visit are as much investigators as the scientist in the lab or the principal investigator in a clinical trial.
Internal medicine departments cannot slowly evolve; the health care environment is changing too radically and rapidly, and we need to rethink how we function in such departments. If we are not proactive, change not of our choosing will be forced upon us. Traditional divisional definitions are giving way to trans-divisional disease-centered programs with teams of clinicians and scientists, all investigators, providing care in a local manner. Decentralizing the UF Department of Medicine does not mean less connection within divisions, but rather freedom to decrease barriers, and authority to increase collaboration.
One of our major goals here is to promote a culture of experimental risk, and enhance collaborative team- and center-based research. There is an inertia, largely based on the addiction of institutions to indirect costs from grants, that subtly alters the ability of the research faculty to take experimental risk. Chairs should promote highly innovative research, research that will actually provide paradigm alterations, open up whole new fields, and ultimately markedly improve the health of patients. Such research is often based on trans-divisional teams, centered on diseases, as mentioned above. Thus, it is even more complex and frustrating to generate, with failure highly possible, but rewards are possible that benefit patient care forever. The goal of our department’s research should not be to plow fields of knowledge, diffusely studying every possible topic, but rather to dig wells, deeply understanding not just phenomena but mechanisms. The research success of our department in the next decade should be measured in major advances in biomedical thought, and changes in medical practice, and not only in quantity of publications and grants. One advantage our department has in fostering such innovative, high-risk, research is the Gatorade endowment, which provides annual research funding for such projects. In FY11, the department ranked 52nd in NIH funding with more than $15 million in grants annually. Our goal is to be in the top 40 in 3 years. Our NIH-funded UF Clinical and Translational Science Institute has been a strong partner with the shared goal of enhancing clinical and translational laboratory research.
Consistent with our culture of caring for each other is the goal of developing personal relationships within the divisions and department. Each division strives to become a tight-knit team working towards mutually agreed upon goals, and the department is a resource to help them reach that goal. In addition, we seek to make every other department in UF’s College of Medicine better as well, to create shared opportunities for growth. Finally, our department has a remarkable relationship with Shands Hospital and the Malcolm Randall VA Medical Center. Our relationship with them is very important to us, and they represent a wonderful patient care, educational, and investigative resource. The basis for this relationship is our shared culture of investigation and caring, both for the ill and for each other. This shared culture has resulted in five of our clinical programs being ranked in the top-50 by U.S. News & World Report in 2012- Cancer, Gastroenterology, Heart & Heart Surgery, Kidney Disorders, and Pulmonology. We were ranked as the best clinical program in the state of Florida in three of these specialties – Heart & Heart Surgery, Kidney Disorders, and Pulmonology.
The reason for being for our department is the same as it has been since its founding only a half a century ago, and it remains one of the most noble of all endeavors, which is to systematically relieve human suffering. That is never far from the minds of all the members of our department, as it enables us to work through adversity, and provides us direction in the most complex of circumstances.
Robert Hromas, MD, FACP
Chair and Professor
Department of Medicine
University of Florida & Shands Hospital
Chairman and Professor
University of Florida Department of Medicine