My second year of medical school is off to a great start. I applaud the psychological considerations that went into making cardiology our first sequence of the year because I've never been so alert in class. It's no surprise now as to why so many people want to become cardiologists--the electrophysiology, pathophysiology, and the pharmacology of the heart is awesome stuff!
Because heart disease remains the number one killer of Americans, the scientific advancements in the field and the amount of potential in uncharted territory in regards to genomic and vascular manipulations to cure disease are astounding. Only at the University of Michigan would we have a lecture about the legendary football coach, Bo Schembechler, to illustrate the complexities of managing heart disease and the scientific advancements of the last forty years that have made living with heart disease a possibility.
Bo Schembechler coached the University of Michigan Wolverines football team from 1969-1989. He led the team to 13 Big Ten Conference titles and holds a career record of 234–65–8. I don't really follow football, so I'm going to focus on his medical narrative.
Every time Bo Schembechler had a coronary event, starting from his first heart attack at age 39, a new scientific therapy was available to him:
- 1960s: Coronary Bypass Surgery (vein grafts)
- 1970s: Aspirin, blood thinners, beta blockers, diuretics
- 1980s: Internal mammary artery grafts, statins, diet
- 1990s: ACE inhibitors, ARB's, spironolactone, ICD's
- 2000s: BiV pacers, hemoperfusion
Bo Schembechler needed all of these new treatments. It is not uncommon to find a patient these days who is managing heart failure, hypertension, hypercholesterolemia, arthritis, and diabetes all at once. What makes Bo Schembechler a remarkable case study is how his disease course outlines the history of how we manage cardiovascular disease. His life was changed tremendously with each scientific advancement. Bo Schembechler is not just a University of Michigan story, but a medical success story that anyone who has ever spent time with a biochemistry textbook dreams about.
The Bo Schembechler medical narrative doesn't stop there. The lessons we can learn from him extend far beyond the biomedical disease model. Extending his coaching career into his health, Bo realized that an integrated team of health professionals who practiced patient-centered care was the best play in the game of achieving a healthy life. As Dr. Eagle describes:
- He had an integrated medical team. He chose his doctors based on whether they communicated well with him and other physicians. He said to me, "I want to go to a doctor who makes me feel that I am their only patient at that time. If they are looking at the computer or writing; they ask me two questions and then say see you later, then they are not on my team."
- ...a lot of times, we rush through. And modern medicine rewards that. More RVUs, more revenue, less personal touch. So one of the challenges you will have is to do that. You will have choices. You will have choices to see more patients and make more money, or see fewer patients and connect. I would argue that modern medicine can never take the professionalism away. Only you can give it away. If you choose to, you can. But don't. Resist that temptation. Design your professional life so that you can connect. Because most of you came into this because you have a yearning to have that connection. To get paid to hep people is an amazing gift. But, to focus on helping them requires discipline.
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