Ignoring Well-Intended Advice, EP Advances the Specialty through Research

Of all the indignities Gabor Kelen, MD, had to endure as a young emergency physician 20 years ago — the snubs in the hall by physicians of other specialties, the condescending tone of colleagues in meetings — it's the incident in the radiology department that's as fresh as yesterday. Radiology had just dispatched some images requested by Dr. Kelen, but learning he was an emergency physician, the radiologist on duty literally snatched them back from Dr. Kelen's hands. “He thought it was okay if we took care of things like finger infections,” recalled Dr. Kelen from his office at Johns Hopkins University School of Medicine where he is a professor and the chairman of emergency medicine. But possession of diagnostic films? By an emergency physician? Totally unacceptable. It was events such as this one that steeled Dr. Kelen's resolve to win recognition at an institution he already had come to love despite the fact that emergency medicine was so far down the pecking order that some physicians literally never bothered to talk to him once they found out his field of practice. In fact, the emergency department itself was seen as a repository for junior house staff, a place where they could get in some clinical practice. “People who gravitated to this field were willing to stand up and do so almost alone,” he observed. “We were underdogs, fighting upward.” Acquiring Prestige Dr. Kelen, also the director of the Johns Hopkins Bayview Medical Center, the director of its emergency medicine residency program, and the director of the Johns Hopkins Office of Critical Event Preparedness and Response, proved all those disparaging fellow physicians wrong. How did he do it? By choosing to ignore some well-intended advice. When he joined the faculty at Johns Hopkins University in 1984 on the heels of his residency, Dr. Kelen was told time and again the key to building respect for emergency medicine “was to show how good we were clinically.” But he could see the way in which prestige truly was acquired — through performance in academic research. “I sized up the place, its culture, and its mission,” he said. The result: He decided to throw his efforts into fortifying what he calls “academic might.”Figure: Dr. Gabor KelenThe pursuit of scholarship was easier said than done. His first stab at a $10,000 grant was turned down. Undeterred, he hit on a plan to finance his own research, and sought to collaborate with someone who could show him the ropes of grant funding. He found such a person in Tom Quinn, MD, an infectious disease specialist who was looking at the spread of a newly discovered virus and thought the emergency department was a good place to start. By 1987, Dr. Kelen had his first publication on the then-unrecognized human immunodeficiency virus, and not only did it appear in the New England Journal of Medicine, it was the first original publication the journal ever published by an emergency physician. “That made it for me,” he said, pointing out that his institution now has the “number one, NIH-funded emergency department in the country.” He learned some things from Dr. Quinn that he said help him to this day: the power of collaboration, the benefits of good medical writing skills, and the need to foster relationships with professional peers in fields not necessarily directly related to emergency medicine. ‘Cooped Up’ A Canadian by birth, Dr. Kelen grew up in the province of Ontario and attended a local university before going on to medical school in Toronto. Married for 28 years, he and his wife have a 15-year-old daughter and a 14-year-old son. As a child, he remembers watching his father, who was trained in veterinary medicine and worked for the Canadian government, conduct research in his office lab. As a 12-year-old, he recalls telling his dad's boss: “I don't know what I want to be when I grow up, but it sure isn't going to be something where I am cooped up in a lab all my life.” Early in his medical career, he thought he'd done just that — avoided the confining research-oriented life — by choosing emergency medicine, which was relatively freewheeling. But it also had no specialty status, and so, Dr. Kelen eventually chose to go to Baltimore to pursue it as a field. As a resident at Johns Hopkins, he felt the pull of research, and began looking at statistics and methodology. “My dad and I have since talked about this,” he said, noting that he no longer uses the word “cooped up” to describe research tracks. In fact, by 1992, when he took over the emergency department at Johns Hopkins, he instituted a policy that everyone was expected to engage in some sort of a scholarly pursuit. In addition, he wanted every emergency physician to cease wearing casual attire at: ties are mandatory for men at official functions. “This was the right strategy.” Dr. Kelen said, although it made him temporarily unpopular with the boot-wearing, jean-clad crowd of young EPs. Dr. Kelen observed that he has received a lot “external validation” in the past decade about his department's achievements. He now serves on several high-visibility committees, including the professorial promotions committee and the advisory board of the medical faculty. He also is a widely published medical scientist. Yet he doesn't consider himself one of the pioneers of the specialty. “I never considered myself one of the original creators of emergency medicine,” said Dr. Kelen, also the director of Johns Hopkins' Office of Critical Event Preparedness and Response, the director of the Johns Hopkins Bayview Medical Center, and the director of the emergency medicine residency program. That title needs to be bestowed on those who fought for it to be recognized as a bona fide specialty, he asserted. He just wanted to win newfound respect for it, which has come to pass. “I have seen the emergence of emergency medicine. I have seen it takes it rightful place,” he said, acknowledging the change brings him untold professional satisfaction. And what about the radiologist who once grabbed film back from that young emergency physician? “He is still here,” said Dr. Kelen. “And as soon as the story comes out in Emergency Medicine News, I might just show him a copy of it.” EMN Profiles 25 Years of Emergency Medicine A celebration of EMN's 25 years of publication is actually a celebration of the specialty itself, without which EMN certainly wouldn't be possible. To honor those who created and shaped emergency medicine, EMN will present profiles of the specialty's pioneers throughout the year.

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