An ongoing dialogue on HIV/AIDS, infectious diseases,
June 15th, 2023
Clinical Teaching at the 99.9th Percentile: Dr. Martin (Marty) Samuels
One of the true joys of practicing at academic medical centers is working alongside great clinical teachers.
No one exemplified this talented group better than Dr. Martin (Marty) Samuels, former chief of neurology at Brigham and Women’s Hospital (where I work), and professor of neurology at Harvard Medical School. He was quite simply the best clinical teacher I’ve ever encountered.
Marty died last week, and our world is sadly now a less interesting and less fun place. What made him so special? Here are a few thoughts:
He had endless enthusiasm for clinical neurology. You could just see his eyes light up when a resident presented him a case. The combination of clinical problem solving together with a group of trainees eager to learn visibly energized him.
And the enthusiasm didn’t end with neurology. He embraced all of medicine, including its history, which he loved to connect to neurology — cardiology, nephrology, hepatology, ID. Watch him discuss a case of an older man with mental status changes during a “virtual” Neurology Morning Report, done on Zoom during the pandemic. He deftly describes his clinical reasoning, interweaving Kahneman’s Thinking, Fast and Slow, pathophysiology, and his experience working with the great British hepatologist Dame Sheila Sherlock.
Note also the natty cartoon Dalmatians bow tie, both very New England-academic and very mischievous at the same time. So Marty.
His lecture topics often had simple titles: Dizziness. Headache. Dementia. Weakness. But they were hardly simple. No one who has heard his talk on dizziness forgets the first thing to do when a patient says they are dizzy. Namely, you pause, and repeat back — Dizzy? — and let them explain what they really mean!
He always knew his audience. One of the most difficult skills for clinician-teachers is explaining complex topics to people outside their field. (For you ID/HIV docs out there, just try to summarize the available antiretroviral agents. Ouch.) Experts routinely forget how to communicate with non-specialists — they are so immersed in their work that they assume everyone understands their arcane language.
Not Marty. He intuitively pitched his talks at the perfect level for the learners. You came away knowing that he was a true expert, but you were never baffled (or bored) by minutiae or jargon.
I have given a talk to the medical residents on, well, how to give a good talk. (I hope it’s a good talk!) Here’s one of the slides, with the Key Message repeated 4 times for emphasis — it’s that important:
Marty embraced this principle better than anyone.
He never let technology take center stage. Marty’s slides were often bare bones, just a few lines of text. His lectures were about what he was saying, not what he was showing. I heard him speak on dementia at a large medical education conference when the slide system failed; there were hundreds of clinicians in the cavernous conference hall. No matter — he held them spellbound with just his extemporaneous comments, presenting a few clinical cases and how he’d approach them. Everyone left with a clinical pearl they could apply to their practice.
If anything, Marty’s talks were better without slides. Anyone eager for a refresher on how to do the neurologic examination can find a 7-part (!) series on youtube, just him and a sample patient — no slides. Here’s a brief clip.
He wasn’t shy about expressing his opinion. Marty was the longtime editor of NEJM Journal Watch Neurology, so we attended several editors’ meetings together. One memorable time, the assembled (myself included) were trading ideas about how to keep up with the ever-growing volume of research, citing newer (at that time) techniques such as listservs, signing up for electronic tables of contents (“eTOCs”), and message boards.
Marty didn’t participate in the discussion — until finally, he said, “Isn’t it more important that we get it right, rather than get it fast? Because I confess this entire conversation fills me with a profound sense of ennui.” That ended the discussion!
He deeply distrusted “systems” that attempted to interfere with clinical care in the name of efficiency for efficiency’s sake or, even worse, just to save money. He found it particularly ironic that many of the very people espousing such systems would, when confronted with an illness in themselves or their family, immediately try to circumvent the system they had created.
He wasn’t shy about giving a name to this practice, either — specifically, hypocrisy. I encourage you to read the linked post, it’s a classic.
He wasn’t afraid to share the fact that he made mistakes. We all make mistakes — we’re human, after all — and Marty believed that these mistakes make us better clinicians when we think through why we made them, and what we can learn. One of his very best talks even had the title, “What My Mistakes Taught Me”, and he commissioned a bunch of us to come up with similar talks. What a challenging exercise!
He likened these mistakes to the genetic errors that get weeded out through evolution. We don’t try to make a mistake — but they happen. We acknowledge it. Analyze why it happened. We then learn from the error, with the goal of not making that mistake again.
Evolution at work.
He was funny. So very funny. A colleague recently told me that Marty did stand-up comedy after graduating from college, and I’m not surprised — his timing was perfect. I remember he gave medical grand rounds several years ago, and began it with a particularly good joke, but one that would easily qualify as “blue” humor. Let’s just say that my editors here at NEJM Journal Watch would never let me repeat it in this post.
After he got a big laugh (and he always got a big laugh), he looked at us and said, “That joke has nothing to do with my lecture. I just wanted to see if I could get away with saying it in front of the Dean of Harvard Medical School, who I knew would be attending today.”
Even bigger laugh.
Wrapping up, I can do no better at showing what a captivating speaker he was than to share this talk he gave just over a decade ago at an ethics forum run by the Massachusetts Medical Society — our publisher. It’s an excellent use of 25 minutes of your time, but if you’re busy, start at 16’43” when he presents a case he saw for discussion.
Rest in peace, Marty. We’re really going to miss you.