The doctor is in; so is the president of the university
UMB's leader takes a break from administration to heal and to teach
Seven-month-old Quinn perched on Jay Perman's lap, pulling off the doctor's glasses and cooing.
Perman sat at a table, surrounded by students from the University of Maryland, Baltimore's schools of medicine, social work, pharmacy and nursing. Amanda Mahle, a third-year medical student, ran down the baby girl's medical history: Almost from birth, she arched her back and screamed in pain after eating. No treatments have helped, including an acid reflux medicine and a nonallergenic formula that costs her parents $500 for a 12-can supply.
It's a teaching moment for Perman, the university president.
“Important lesson for everybody,” he said. “These formulas, you have to think about them the way you think about pharmaceuticals, because there's a great deal of expense associated with them, and one needs to be very thoughtful about whether there's a rationale for it — which there may be here.”
Every Tuesday afternoon, Perman, a pediatric gastroenterologist, sees about a half-dozen patients in a four-hour session called the President's Clinic. He's joined by students from each of UMB's disciplines, which are nursing, medicine, law, dentistry, social work and pharmacy. The unusual clinic is intended to teach the students about what they can learn from their colleagues in different fields. For Perman, it's a way to remain hands-on with patients and students despite his busy schedule.
Dressed in a suit and tie and black sneakers, Perman clearly relishes his time at the clinic, whether he's holding a baby, cracking jokes with parents or calling on students.
“My career has evolved, so now I do a lot of administration,” he said. “But I can't give this up, because I enjoy it too much. So as much as I may give these students — and hopefully the patients — I get it back double.”
Perman started a scaled-down version of the clinic while dean at the University of Kentucky College of Medicine, then brought it to UMB when he arrived six years ago to lead the university. He has made interdisciplinary collaboration a priority as president and established the Center for Interprofessional Education in 2013 to train students.
Interdisciplinary work can help students see the perspective of professionals in other fields, Perman said. For example, a parent bringing in a child with lead poisoning might need medical assistance but also might need a social worker to help with other problems at home and a lawyer to go after a landlord to remediate the lead paint problem.
Elsie Stines, an advanced practice nurse who works with Perman, estimated that 350 to 400 students have worked in the clinic since it began. Patients are referred by their doctors or ask for an appointment themselves. The clinic isn't free but accepts insurance, including the Maryland Children's Health Program, which covers low-income kids.
Given the demands on their time, it's unusual for presidents of universities to see patients or teach classes. John E. Prescott, the chief academic officer of the Association of American Medical Colleges, said he had never heard of a university president who still saw patients.
“He was the first person that really spoke to me about interdisciplinary education and interprofessional education and the need for teams to be working together,” Prescott said. “The university president almost has no time for themselves. But I believe Dr. Perman will tell you he's a better president for doing this. It keeps him grounded.”
On the recent Tuesday, when Sarah and Dominic DeLauney brought daughter Quinn to the clinic, the students
Mahle said she was awed meeting Perman and that she had never before had the experience of working closely with students from different disciplines.
It was helpful to learn from people in different fields who were fellow students, she said, “not a pharmacist who's been there for 20 years that I'm a little bit intimidated by.”
Halaby said at first she wondered what role she might have in Quinn's care.
“I wasn't sure where the social work would fit in, but once they started talking about her medical history, you just listen for snippets, what pertains to social work,” she said. “I enjoyed seeing the big picture of what the family is going through. Even though they're dealing with one situation ... so many different parts are affected from this one issue.”
Despite the baby's ordeal, which keeps her from sleeping through the night, the DeLauneys were upbeat.
“We just want her fixed,” said Dominic DeLauney, bouncing Quinn on his lap.
After the examination was completed, the family gathered in another room with Perman and the students as they tried to diagnose Quinn's problem and prescribe a course of treatment. A previous doctor had said Quinn might have Sandifer syndrome, a condition that includes gastrointestinal symptoms and spasms that look like seizures.
Perman said Sandifer syndrome was likely, “but that's not going to help in what the parents really need, which is: What are we going to do about this?”
The students tossed out the possibilities of gastrointestinal reflux disease or a food allergy. The acid reflux medicine should be controlling her symptoms, Perman countered. And the formula she was eating, which is made of pure amino acids, shouldn't be triggering any allergic response.
“So here's the problem I'm gonna 'fess up to everybody,” Perman said. “Either one of these is a possibility. I don't know which one she's got. Meanwhile we're keeping her on medication for the acid and we're keeping her on a fancy formula, which has economic implications. … I'm saying I'm confused.”
Ultimately, Perman recommended the baby have an endoscopic exam, a procedure that involves inserting a flexible tube with a tiny camera at the end down a patient's throat to visually examine the esophagus and upper digestive system. The test would help determine whether Quinn has peptic esophagitis, which means she would need a higher dose of the acid reflux drug, or a food allergy that was still active after only a month on the new formula.
Stines recommended a higher dose of the medicine while Quinn waited for her endoscopy appointment.
Perman said the clinic allows him to lead by example.
“It gives me a chance as the boss to not simply tell everybody else what's important,” he said. “I feel very strongly that it also allows me to be a leader that says, ‘I'm not just telling you to do it; I do it.'?”
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