For the past fifteen years, the focus of much of my clinical and administrative work, as well as my teaching and research has been respiratory physiology. Within this broad field, I have developed a particular interest and expertise in the area of the physiology and language of dyspnea. I have had the unique opportunity to integrate the three major facets of my professional academic life in such a way that each component offers insights that strengthen my capabilities in the other areas. By providing care for patients afflicted with respiratory discomfort, for example, I have gained knowledge that has led to the development and testing of research hypotheses that have broadened our understanding of the physiology of dyspnea, and of the interactions between chemoreceptors, upper airway, pulmonary and chest wall receptors in the generation and modulation of breathlessness. My research on the language of dyspnea, the terms used by patients to describe their breathing discomfort, has, in turn, made me a more astute clinician.Additionally, these clinical and research efforts have made me a far stronger teacher. In fulfilling my educational responsibilities, which range from directing the integrated human physiology course for first year medical students at Harvard to continuing education courses at the annual meetings of the American Thoracic Society, I am able to make the physiology “come alive,” to make it relevant based on my own experiences in the laboratory and at the bedside. It is immensely helpful when questioned by a student about ventilatory control, for example, to be able to say: “Yes, we studied that - what do you think the subjects did under these circumstances?” Because of the trend in recent years for biomedical research to become more focused on cellular biology, there has been a movement to segregate researchers from medical educators. For me, active work as a clinical investigator has been critical to enhancing my capabilities as a teacher and has allowed me to provide a model for students to consider as they contemplate their own career choices.
In the past several years, I have added a new dimension to my teaching activities. Healthcare in America is changing at a rapid pace as the pressures of limited resources and managed care become more prevalent. It is my belief that the training of new physicians must incorporate a solid understanding of healthcare financing along with traditional clinical skills if we are to prepare them for the future. Consequently, with funding provided by the Merck Foundation, I developed a three-year program in medical economics, cost-effective and evidence-based medicine for the medical housestaff at the Beth Israel Deaconess Medical Center, and serve as a mentor for senior residents pursuing projects in healthcare economics. Again, I hope to demonstrate to interns and residents that one can be a quality clinician and researcher and still be cognizant of the pressures and demands of the society in which we live.