November 22, 1996

Sergent keeps human side of medicine in focus

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Dr. John Sergent confers with third-year medical student Sallie Israelit.

Sergent keeps human side of medicine in focus

Dr. John Sergent examines patient Linda Holder on rounds with medical students (from left) Daniel Penn, Lawrence Berman and Omer Shedd.

Dr. John Sergent examines patient Linda Holder on rounds with medical students (from left) Daniel Penn, Lawrence Berman and Omer Shedd.

Dr. John S. Sergent is many things to many people.

He's well-known in the medical community as a rheumatologist, respected at Vanderbilt University Medical Center as chief medical officer of the Vanderbilt Medical Group, and popular with third-year medical students as a teacher.

But his degrees and appointments and credentials don't hold a candle to what most Nashvillians know him for – his writing.

Sergent, MD'66, HS'70,71, and fellow Vanderbilt physician Dr. Frank H. Boehm, MD'65, write two columns each month for the Tennessean, Nashville's morning newspaper. The column is called "Healing Words."

Sergent has written about everything from the controversial subject of gun control to the childhood memories evoked by the smell of Vicks Vaporub. They are human stories forged by Sergent's experiences. They are also extremely popular with readers.

The two columns receiving the most reader response were Sergent's on his cancer-stricken friend and physician, Dr. Paul R. Michael, and Michael's follow-up column, about his thoughts on dying.

"I love to write about the human side of medicine. It's good if we can present what we do in a human light since so often medicine is reduced to a bunch of statistics," Sergent said.

Sergent said he's "always thinking" about possible column topics. "I like to tell stories and most of my columns are based on stories about patients or physicians. When I'm having interactions with patients and other physicians, I'm usually thinking 'is there a column here?'"

Sergent said both he and the newspaper have received numerous responses, some published in the Letters to the Editor section, about his columns. Some are positive. Some, like the responses to the gun control columns, are downright hateful.

"Those really brought out the kooks," he said, smiling.

Frank Ritter, who edits Sergent's Tennessean column, said surveys have shown that newspaper readers want to read about health care. So not surprisingly, columns written by Sergent and Boehm generate a good deal of response.

"I find that Dr. Sergent can write on just about anything," Ritter said, adding that the two columns by Sergent and Michael were extremely popular.

"They were wonderful columns. And those kinds of dramatic stories are out there by the ton. If you have a doctor like Sergent who is sensitive, the columns can bring these issues home to the readers."

Working two columns into his already packed schedule turns out to be quite a balancing act. When you enter Sergent's office, the first thing you see is a three-dimensional, glassed, pedestal-mounted watercolor of Charlie Chaplain as the tramp. Chaplain is managing to stand up and hold on to his bowler and cane. The piece of artwork, by Nashville artist Red Grooms, was given to Sergent by his wife, Carole, as a reminder of the balancing act his job requires.

Sergent left his Vanderbilt appointment as Chair of the Department of Medicine at Saint Thomas Hospital in 1995 to assume his new role at VUMC. It was a career move like others in his life – a natural progression made only after eliminating other alternatives.

He didn't always know he would be a physician. His father was a bookkeeper and his mother a teacher, and the family moved around quite a bit during his childhood. As a young boy in West Virginia, one of his childhood heroes was his physician. The young doctor took care of Sergent's childhood ailments – colds, stitching cuts, etc. – and quickly became a role model.

Sergent loved science, but also was on the debate team in high school and college and "flirted" with law for awhile.

"I honestly don't have a single reason for ending up in medicine, but nothing else seemed to offer the excitement and satisfaction of dealing with the sick," he said.

Sergent received a Founders' Scholarship to attend Vanderbilt and entered Vanderbilt University School of Medicine as a Senior-In-Absentia in 1962. He had always assumed he would be a surgeon, but fell in love with internal medicine and was heavily influenced by Professors Tom Brittingham and David Rogers.

Although Sergent's career leaves little free time, he is able to sneak breaks for tennis and a four-mile run two to three times a week. He recently took up golf, a game he refers to as "the most frustrating game ever invented."

Sergent also enjoys spending much of his free time with his wife, Carole, whom he met as an undergraduate at Vanderbilt. They both love to travel, and last year were able to expand a medical trip to Australia into a family trip with the couple's two daughters. Ellen, 28, is a third-grade teacher in Metropolitan Davidson County Schools, and Katie, 24, lives in Washington and works for the Freedom Forum Museum.

Sergent assumed his role as chief medical officer with the VMG last year. The VMG is the largest multi-specialty group practice in the region. Sergent is responsible for both the day-to-day management and strategic planning for the practice and The Vanderbilt Clinic.

It's a role he wouldn't have necessarily seen himself in years ago, but it was the right time for something different. He had become involved in the American College of Rheumatology in the late 1970s, and was elected president of the organization in 1992. It was during that year that he became more interested in the "larger picture of medicine."

In 1988 Sergent left private practice to assume his first job with administrative responsibilities – Professor of Medicine at Vanderbilt and Chief of Medicine at Saint Thomas Hospital.

"The appeal was to be involved with third-year students and housestaff," he said. "I regarded the administrative side of that job as a necessary evil in order to do the other parts I wanted to do. As time went by, I began to enjoy it."

He enjoyed it so much that he accepted the offer to become Chief Medical Officer for the VMG, a job that is both uplifting and maddening, he said.

"I really believe that academic medical centers, Vanderbilt specifically, are very vulnerable with the changes occurring in health care. Nobody is really concerned about the fact that a lot of the changes are really putting this whole academic enterprise at great risk.

"I personally believe that we have some great strengths at Vanderbilt and one of our strengths is that if we band together as a single medical group, we could be and should be the dominant medical group in this entire region. As independent physicians we don't have that much clout, but as a group acting together, we are very strong and we have a chance to be the dominant figure in managed care in our region. The challenge of trying to create a cohesive medical group was almost irresistible but there is still much work yet to be done."

Sergent said he believes that an organized group of physicians with a common set of objectives can help raise patient satisfaction, which is a key strength when dealing with managed care companies. In the previous health care environment, a group like VMG might not have been so important. But in the current health care world, where the rules have changed, it's an integral part of the Vanderbilt system, he said.

"Individual referrals from patients and isolated doctors in the region, which we have depended on in times past, won't work under managed care. In most managed care programs, the physician's option on where to refer people to specific institutions is dependent upon who has the contract.

"So we may have a physician who feels very friendly toward Vanderbilt, but if the patient is an employee of a company whose contract doesn't include Vanderbilt, the doctor simply can't refer to Vanderbilt."

Besides bringing physicians together into a cohesive group, the VMG is also working to make Vanderbilt more patient-friendly, creating a "seamless" system in which the patients can be seen quickly and referred to other physicians at Vanderbilt, if needed, without effort.

"We need to examine our way of doing things and reorient the whole system so it's patient-focused instead of institution-focused," Sergent said.

Much of what the VMG is doing is building on what was already strong and in place at Vanderbilt, such as a group of caring physicians.

"Our doctors are nice to patients. But what we sometimes do is create systems that are less friendly to patients. We have done some of these things without really realizing it. We have patients traipsing from here to there and back to do things because it makes it easier for us as an institution to do things that way," he said. "It is not enough to have friendly, caring people. If our entire system is not patient-friendly, starting with the parking lot and ending with the bill, the patient is going to perceive it as an unfriendly place," he said.

Sergent said that although he has some internal goals and timetables in mind, working with the VMG will be a continuous, ongoing process.

"It will be an evolving thing. It will take forever. If we're using the continuous quality improvement model, you never stop because your competition never stops. Once you invent the best system ever made, someone else comes along and beats your socks off. There are endless ways we need to evaluate what we do and improve on that."

Sergent said the satisfactions from his job come in long-term evaluations, unlike the almost instant gratification of teaching or taking care of a patient.

"As a teacher and as a practicing physician, you go home every day feeling good about yourself, knowing that you have accomplished useful things. In this job, there are days when I feel like I didn't accomplish a thing. Some days I feel like I slipped backward in some areas."

So Sergent sees his weekly rounds with third-year medical students as extremely satisfying. He meets with a group of five to six students where cases are presented at the bedside, the students examine their patients, and their written histories and physical examinations are later reviewed by Sergent.

"We do this in groups small enough so that every student gets to know someone on the faculty fairly well, and vice versa. It's not a lecture or a formal class. I don't know on the day I go what's going to happen."

"I would miss it a lot if I didn't teach. Working with these wonderful students is a necessary reminder of why it is important that Vanderbilt and the VMG must not only survive managed care, but must prosper in it. After all is said and done, they and the generations that will follow are the reason we are here."