A Personal Perspective on...
ACP Internal Medicine 2008 – Washington,
D.C., May 15–17, 2008
Lawrence E. Klein, M.D., F.A.C.P., practices internal medicine
at Foxhall Internists, where he is vice president and laboratory director
of the 14-member practice in downtown Washington, D.C. Dr. Klein graduated
from M.I.T., where he was a Phi Beta Kappa scholar and president of
the Chemistry Honorary Society, before going to Johns Hopkins Medical
School. After completing two years of residency training at Strong
Memorial Hospital, he returned to Johns Hopkins as one of its first
two Henry J. Kaiser Foundation Fellows in Internal Medicine. He spent
four years on the full-time faculty at Johns Hopkins before going
into private practice. Dr. Klein continues to hold part-time faculty
appointments at both Johns Hopkins and the Georgetown University School
of Medicine. He is a past president of the D.C. Society of Internal
Medicine and is currently governor of the D.C. chapter of the American
College of Physicians, a member of the ACP Coding and Payment Subcommittee,
and a member of the ACP Marketing and Communications Committee. A
native of Cleveland, Ohio, Dr. Klein currently lives in Maryland,
just beyond the city limits of Washington, D.C.
About Washington, D.C...
What’s best about living in Washington, D.C?
Living in Washington is exciting because of all
the opportunities in terms of museums, theaters, restaurants…just
lots and lots of things to do. And lots of them are free. Also,
it’s within an easy plane, train, or car ride to Philadelphia,
New York, Boston, or anywhere up and down the East Coast. We also
have lots of great tourist activities in the surrounding states,
so it’s a very manageable city for me and my family and a
very nice place to live.
…and practicing in nation’s capital?
In terms of practicing, the range of individuals
I get to see makes it exciting. I meet all sorts of people with
all different backgrounds. I’ve taken care of key White House
advisers, senators, congressman, foreign ambassadors, U.S. ambassadors—and
other people, too. As a result I’ve gotten invited to a variety
of diplomatic functions. Perhaps the range of people that I get
to take care of is the best perk of practicing in Washington D.C.
What brought you to Washington?
Like so many things, coming here was more chance
than anything else. After four years on the full-time faculty at
Johns Hopkins, I ran the general medicine fellowship program and
the senior ambulatory elective. I also did research. While that
was all going well, I didn’t really like being in the middle
of a giant institution. So I decided to go into private practice.
Only one private practice in medicine admitted to Hopkins, and
they had no space for me. They said they were moving and would
have space and that I should wait, but there was no exact date
for the move. Since I didn’t want to sit around and wait,
they referred me to a practice in Washington—and I’ve
been here ever since. As it turned out, it took seven years for
the Baltimore practice to move, so that would have been a long
wait indeed!
How do you like to spend your off time?
I spend long hours at the office and a lot of hours
as ACP governor, so it doesn’t give me too much off time.
I make time to spend with my kids. And my wife and I made a point—even
before we had children—to get out to dinner every Saturday
night, either by ourselves or with friends. Sometimes we go to
one of the smaller theaters in town, as well.
What are some insider suggestions for things to do in the
city?
Everybody goes to the National Mall and the
Smithsonian museums, and people certainly should. Be sure to
see the newer monuments—the World War II monument and
the FDR monument, which is a semi-museum and a favorite of
mine.
In terms of museums, the Textile Museum is unusual
and quite interesting and not far from downtown and also, the
Spy Museum has a remarkable collection of spy paraphernalia
as well as exhibits on the history of spying. Make reservations
ahead of time, though, because it’s popular and gets
booked up. The Washington Cathedral, just north of the Spy
Museum, is an impressive structure, and the tours are well
done. And the National Zoo is always fun—and free.
Traveling across the Potomac to Virginia, Alexandria
has a quaint downtown that’s fun to wander around. There’s
a place there called the Torpedo Factory—which is, in
fact, an old torpedo factory—that now houses several
floors of crafts workshops.
What are a few of your favorite Washington
restaurants?
Near the Convention Center, Coeur de Lion (928 Massachusetts
Avenue NW; 202-414-0500) in the Henley Park Hotel has very good
food; it’s a beautiful place with very good service. Then,
Kinkeads (2000 Pennsylvania Avenue NW; 202-296-7700) is a wonderful
seafood restaurant downtown—the usual seafood prepared in
a variety of unusual ways — and always excellent. Also, Bistro
Lepic (1736 Wisconsin Avenue NW; 202-333-0111) in Georgetown is
great for people looking for classic French bistro food. And then,
Ardeo (3311 Connecticut Avenue NW; 202-244-6750) in Cleveland Heights,
a little north of downtown, serves excellent New American cuisine.
About internal medicine and the upcoming ACP Internal Medicine
2008…
Why did you specialize in internal medicine?
I’m a generalist. I’d be frustrated
if I could only deal with one system in the body, and I really
wanted the opportunity to work with people. I’ve had some
patients for as long as 25 years—sometimes three generations
of a family. I find the family dynamics fascinating. And every
day is different. Choosing general internal medicine rather than
some subspecialty is really kind of unusual for a Johns Hopkins
Medical School graduate. Almost all of my fellow medical students
went into subspecialties of one kind or another, but I wanted to
take care of people as a whole.
I actually did a Henry Kaiser Family Foundation fellowship at Johns
Hopkins that gave me a general view of medicine. I had done theoretical
chemistry at MIT, where I sat at a desk working over matrices.
It was fascinating but a little too isolating. So going into general
internal medicine gave me the opportunity to take care of patients
over extended periods of time.
From a practical point of view, I think the two most useful occupations
are probably either a doctor or a plumber. There are always health
questions and there’s always plumbing problems. I’m
close to my family, including my parents, and internal medicine
is a career, through which I can also be helpful to them.
What gratifies you about internal medicine?
Taking care of some patients is absolutely gratifying and,
frankly, I’m always learning something new. I had run an ambulatory
senior elective at Hopkins and saw people from all over the world come there
for complicated medical problems. I had all kinds of textbooks around the
corner from my office and referred to them when a patient had a difficult
or unusual problem. I feel comfortable telling a patient that I’d like
to check a few sources to get the most up-to-date information before giving
my thoughts about the problem. And patients seem comfortable with that. At
MIT, I met world-renowned people who routinely told me that they didn’t
know everything. And if they didn’t know everything, no one could.
What’s challenging about patient care today?
The most challenging part of patient care at the moment
relates to financing issues—particularly providing comprehensive,
caring treatment to patients (especially Medicare patients) with low
reimbursement rates. It’s particularly challenging when patients
have multiple medical problems. You want to attend to them. You’re
trying to coordinate their care with subspecialists and with the family.
And sometimes you need to explain what the subspecialist said, because
the patient didn’t understand or the doctor was in a hurry. All
that takes a lot of time with little reimbursement. And if you’re
talking on the phone, you don’t get paid at all.
I continue to remind myself that patient care is what I like
doing. At the end of the month, though, you wonder how you can give
the patients good, thorough, comprehensive care when the average office
visit is supposed to last 15 to 20 minutes, according to Medicare or
a lot of the HMOs. That’s just not enough time to do the job.
Overhead has really shot up, as well. I’m in a particularly expensive
practice, where the overhead for myself alone is close to a third of
a million dollars a year. You have to work awfully hard to pay that
off. The costs are enormous, and the number of hours that you can work
is finite.
What important trends are happening?
Information technology is an important trend. Going through
MIT, I got started early on computers; but more and more doctors are using
the Internet regularly and installing software on their computers that allows
them to call up information quickly. All of this will make a major change
in the quality of medical care—if doctors can afford to pay for it.
And non-interventional techniques and less interventional approaches to
taking care of problems are certainly revolutionizing medicine. Removing
a gall bladder with a laparoscope was revolutionary, but that’s become
routine. Less invasive procedures allow us to do a lot of things for patients
that we couldn’t do before.
What’s new for ACP Internal Medicine 2008?
There’s a whole range of medical topics—updates
in various areas of internal medicine—that are always well attended.
It’s a concentrated way to get an overview of each medical field
in a brief period of time. This year, ACP has added a hospitalist track.
ACP is working hard to make hospitalists feel at home in the organization,
because we feel that most hospitalists are internists at heart. Some are
anesthesiologists or go through pulmonary, cardio, or other types of training,
and those specialties have their own organizations. But for the hospitalists
trained as internists, ACP is trying to respond to their needs. Having
a specific track at the meeting is a new concept and, I think, a very
smart one.
And although it may not be a “hot” new thing, established
doctors may forget that there’s a Herbert S. Waxman Clinical Skills
Program at the meeting. We see a lot of the medical students and residents
going there, but I like to go every year to update my clinical skills.
Looking back, can you describe an inspirational moment in your career?
It’s not a particular “aha” moment, but six months of
working with Dr. Philip Tumulty, a professor of medicine at Johns Hopkins
and a leading clinician, was probably the major influence on my medical
career. He was a humble man, great with patients, and just a wonderful
human being.
* * *
-Interviewed by Jane E. Zarem, Contributing Writer Physicians' Travel & Meeting Guide.
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