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The Picture of Success
Jeffrey N. Katz, M.D., MSc
“Success” has many definitions. For Dr. Jeffrey Katz, who has a CV that would define success in any context (Director of the Orthopaedics and Arthritis Center for Outcomes Research at Brigham and Women’s Hospital, Professor of Medicine and Orthopaedic Surgery at Harvard Medical School and the author of several seminal research studies) and who is one of the Masters of his profession, “success” has come to mean something deceptively simple and powerful. For Dr. Katz, success emanates from that most honorable position of having a “front row seat in patients’ lives.”
One of the great gifts of writing Orthopedics This Week’s Picture of Success is to meet people like Dr. Katz, for whom the meaning of their stellar careers has become the same meaning that brought them into the profession: a sense of giving and a mission to heal. For us, as observers, we often find that the most credentialed people we interview talk about the most simple, enduring and true aspects of their profession. So it is with Dr. Katz.
How did Dr. Katz develop this rare combination of skill, discipline and compassion? Born and raised in Connecticut, Jeffrey Katz and his two siblings were under the care of parents who held them to exacting standards. “My mom was a teacher and my dad was a pharmaceutical sales rep; they both imparted an extraordinary work ethic to us kids. I studied hard, but it wasn’t until college at Princeton that I even considered medicine. Because I excelled in math and science I initially enrolled in the engineering program; I soon realized, however, that working with people would afford me the chance to get involved in fascinating dilemmas."
I also liked the idea of going to work every day, having a front row seat to human struggles, and helping people find solutions.
But solutions to problems are never as obvious as they might initially appear, as Jeffrey Katz learned when he entered the intellectual hotbed of Yale Medical School in 1984. However, he learned that wandering into uncharted territory, if done with purpose and an analytical mindset, can be productive. “I was fortunate to have been trained in critical thinking and analysis at Princeton. It’s interesting that nearly everything I learned in the 1970s has been supplanted—everything except for how to take a critical approach to thinking and writing. Today I teach students that these are the most important skills they can develop.”
A cool-headed thinker, Dr. Katz did find himself heating up when it came to certain less-than-professional behavior he encountered in his early years of training. “It was the 1980s and there was still some overt sexist and racist language being used during rounds. I learned that these early training years are a time during which budding doctors must ask themselves, ‘How much of what I hear do I want to internalize?’ When I began to move into positions of authority I set expectations about what kinds of discussions regarding patients were unacceptable. I told my trainees, ‘Their backgrounds and what brought them here are not ours to judge.’”
Interested in the fundamentals of orthopedics, but of the opinion that he wasn’t “much good” with his hands, Dr. Katz pursued an internal medicine residency at Yale-New Haven Hospital, followed by a rheumatology fellowship at Brigham and Women’s Hospital. It was during this time that he fully understood that curiosity, rather than judgment, leads to compassion. “I worked with patients who were in the hospital for self destructive reasons, such as smoking or drinking."
I have always tended to view self destructive behavior as a symptom of a difficult social circumstance or as part of the person’s primary disorder. The fundamental thing is to meet the patients where they are. It is only then that we can help them move forward.
Often, meeting a patient where they are means temporarily leaving behind where you are. Dr. Katz: “Sometimes patients want to have a test done that you think is unnecessary. Because as physicians we have a responsibility to spend resources wisely, there is an inherent conflict because we are also supposed to be the patient’s advocate. I talk with patients and try to understand where their impulse to have the test is coming from. I’ve often found that regardless of the MRI results, patients can be as unhappy as they were before the test. Typically, patients will not engage in a technical argument with a doctor; instead, they just feel that more should be done because they are suffering. Underlying this is often a feeling that the doctor may not really care.”
One way of building trust, be it with an easygoing or more challenging patient, is to build bridges. “I teach residents that a great way to lower a patient’s guard is to identify an area of shared interest. I ask about patients’ favorite baseball team, the books they enjoy, etc. Going ‘off agenda’ helps to humanize the interaction and makes it safe for patients to open up…and easier for you to help them.”
Dr. Katz is also one of the most prolific research scientists in the United States, having been awarded funding from the National Institutes for Health (NIH) and other entities on multiple occasions.
“I am the Principal Investigator (PI) on the Meniscal Tear in Osteoarthritis Research Trial, an NIH funded, seven center randomized controlled trial of arthroscopic meniscectomy versus nonoperative therapy in patients with symptomatic meniscal tear and concomitant osteoarthritis. While there have been several trials of arthroscopy and osteoarthritis, none of these examined meniscal tears. At this point we have nearly 75% of patients enrolled, with our target being 340 participants. The challenge is to keep the entire team—about 75 people around the U.S.—stimulated and engaged.”
“I am also the PI on a project regarding the failure of total hip replacement. At present we have hip replacement data from 29 states going back to 1995. We are now determining what the predictors of revision were, and should have definitive answers next year.”
And to benefit future clinician-researchers, Dr. Katz is making strides via COMET, the Clinical Orthopedic and Musculoskeletal Educational and Training Program. “I am the PI and Program Director for COMET, an NIH funded pre and postdoctoral training program for clinical research in musculoskeletal disorders. While NIH has funded numerous research training programs, not many of them are clinical in nature.”
In 2007 Dr. Katz received the Clifford Barger Award for Excellence in Mentoring from Harvard Medical School. “I’m very proud of that award as I take the mentoring relationship seriously. I caution future mentors that it is easy to take talented people and guide them in furthering your own research interests. It is harder to help people grow into their own potential when it doesn’t further your particular research interests.”
As the Deputy Editor for Methodology for the Journal of Bone and Joint Surgery, Dr. Katz is influencing the quality of research and treatment for generations to come. “Many people aren’t trained in methodology; I see my job as applying high methodological standards so as to sharpen the quality of research. As we elevate the standard of these journals, researchers will hopefully realize that they should think more carefully about design and methodology during the early stages of their work. We sometimes find problems that can’t be fixed at the writing stage and so we must reject the submission."
The fact that researchers are still doing studies with no controls or doing case series (which is not methodologically rigorous), is proof of the need for more formalized research training.
Of his particular specialty—arthritis—Dr. Katz notes, “Regarding osteoarthritis (OA), the most common form of arthritis, to date there is no structure modifying drug. Fortunately, the surgical management of OA is very successful. Going forward, we should focus on catalyzing drug development, as well as on establishing a plan to determine which of our treatments are actually successful.”
While data often need a fresh set of eyes, at times, so does one’s perspective on medicine. Each spring Dr. Katz is afforded a renewed appreciation for patient care. “I do volunteer work in the Dominican Republic with Operation Walk Boston, a wonderful medical service organization. It is so inspiring to witness the resilience of the Dominican patients, their appreciation for our work, and the speed with which they rehabilitate. It is heartening the way patients there seem more ready to trust the doctors; they are very willing to share the private aspects of their lives.”
When he steps off a plane or locks up the lab for the night, Dr. Katz returns to a place of repose. “I have a delightful wife and two sons, one 18 and one who is 14 years old. When not ‘hanging out’ with my family, I clear my head by biking around our neighborhood in Massachusetts, and keep up with the latest reading ‘assignments’ of my book club.”
As for the future of the medical world, says Dr. Katz, physicians should rely on some fundamentals. “Medicine changes so rapidly that it is difficult to keep up with all of the advances. Patients are good teachers…we doctors have to be good students. It’s all about figuring out how to help them handle their suffering.”
Dr. Jeffrey Katz…who has built his exemplary career around the true definition of success—namely, that it is all about what you do when you are in that most honorable position of being at the “front row seat in patients’ lives.”