His eye is on the sparrow—the Life of Dr. James Herndon.
For two years, the toddler’s diagnosis had eluded his doctors. “I was examining this child. He was on the exam table with his back to me. There was a pile of books on the edge of the table. I turned around and mistakenly knocked the books over. They hit the floor with a ‘bang, ’ but this young child didn’t hear it. That’s when I realized he was deaf. I actually made my reputation on the pediatric service at ‘Penn’ when I made that diagnosis.”
Talking to Dr. Herndon is a wonderful experience and in his stories one theme emerges—the importance of the little things in medicine (if not also in life and faith).
Like preventable errors.
Each year 44, 000 to 98, 000 people die in hospitals as the result of preventable medical errors.1
After an illustrious career that included chair positions at Harvard, Brown and “Pitt” and as he was waiting his turn in the Presidential line of succession at the American Academy of Orthopaedic Surgeons (AAOS), those words from an Institute of Medicine (IOM) report really hit home. “Here, ” thought Dr. Herndon, “is an opportunity for change.”
“I read the entire Institute of Medicine report, and I began to think more deeply about making hospitals safer for patients. It was evident that my colleagues and I were getting caught up in the intricacies of our days; we were not making time to look at how the flaws in our system put patients in jeopardy.”
Leading AAOS, Teaching Residents
Dr. Herndon was a natural fit for the helm of AAOS. But once the membership learned of his “theme”—patient safety—did they groan? “I had spent a lot of time at meetings about wrong site surgery, time outs, etc., and I felt like we should be a leader in patient safety. And, I felt strongly that if we were going to advocate on ‘the Hill’ for malpractice and Medicare reform, we should have patients with us to advocate for our joint interests. Otherwise, we would be viewed as fat cats.”
There was some grumbling, however, because the fact is that you can’t discuss patient safety without talking about mistakes. And who is fond of that?
“Most of us go along and think that we are doing a good enough job of discussing complications, consulting with other doctors, etc. The problem is that we usually don’t look at the system wide issues. For example, is the culture of the institution such that residents feel comfortable reporting a near miss or are they fearful of being a whistle blower? My recent research on residents shows there is great deal of concern about the repercussions of reporting.”
And, having trained over 300 residents as they rode the roller coaster between exuberance and reality, Dr. Herndon has a good sense of their needs and concerns. He listens, and he counsels.
I tell them, ‘Look, in the first two years out of residency you will feel very confident and on top of the world. The next year you will see things in a different light, and realize that there is always something that you don’t know.
“Part of the challenge is that musculoskeletal medicine is a huge field, but doesn’t get much attention in medical school. My early family experiences rear their head as well…I tell residents that instead of moonlighting they need to spend time with their families.”
And, advises Dr. Herndon, watch for hubris. “Leaders must do the work themselves…not just tell others what to do. I have seen some individuals get overly impressed with themselves and take advantage of the benefits offered by their leadership role. When I see this, I just may pull a colleagues aside and point out the errors in their thinking.”
Hard Earned Lessons
“I was born in Los Angeles, where I lived with both of my parents until they divorced when I was six. I think we never know the exact effect of these things…over the years my wife and kids have asked me about this period in my life, but frankly, I have probably repressed a lot of it. The only positive thing about being a child of divorce is that it has given me a sensitivity to the concerns of patients and families. For example, during my internship at the University of Pennsylvania I had a child die of leukemia. I will never forget the pain involved when I had to tell his family…it was the first time that I had had the full responsibility for someone who died.”
Dr. Herndon’s ability to tune into all aspects of patient care—no matter how small—did not come easily. Before entering medical school a gravely injured Jim Herndon lay in a hospital bed. He, of course, recovered fully but that experience of facing death and recovering changed him more than anything else. “I was a senior in college when I had a catastrophic car accident; I spent several weeks in the hospital with a crushed chest. Although I had lost my (fully completed) medical school applications in the wreck, I persisted, and received significant support from my biology professor, who allowed me to return to school. Throughout this experience I benefitted from the skill and compassion of my doctors, and I came to see that I wanted the challenge of caring for people with major problems.”
For Jim Herndon, this definitely trumped being a butcher. “I was fascinated with anatomy from an early age, and I even worked as butcher in high school and college. I did not, however, advertise this to my patients.”
The Lessons of Chairmanship
Years later, Dr. Herndon was recruited back to his Harvard alma mater, where he distinguished himself as a leader. “I was brought in at the height of managed care to develop an integrated delivery system model for orthopedics at Massachusetts General and Brigham and Women’s Hospital. I created a practice plan at each hospital but could not merge the doctors because the hospitals’ cultures were too different. They have both improved because of the competition, but work remains to be done as far as speaking and acting with a unified voice. For one, I had hoped that we could make it easier to get patients into the hospital. So, for example, if orthopedics was full at Mass General, wouldn’t it be ideal if we could admit patients to Brigham and have the doctor from Mass General come over? I pushed the envelope too far, however…that wasn’t going to happen.”
But he had accomplished his mission, in part thanks to some tough lessons from another university. When Dr. Herndon took the orthopedic reigns at Brown, he encountered resistance. “I was the first full time orthopedic surgeon…and I was young and naïve. There were 80 orthopedists on staff, but nobody was teaching, and nobody was covering the ER or clinics. Over ten years I recruited numerous staff, started labs, and fought with the head of the department of surgery about orthopedics becoming a department. I finally won this battle by going to the university’s board of trustees. After two years of wrangling with the part time orthopedists I just declared that we would all take call, cover clinic, and teach. Twenty orthopedic surgeons got on board while the other 60 said, ‘Go to hell.’ But I received the full support of the trustees and the remaining part time clinicians and additional full time recruited faculty worked well together as the department flourished clinically and academically.”
Once the chair at “Pitt, ” Dr. Herndon also served as Associate Senior Vice Chancellor of the university. “I worked with outside consultants to put together an academic practice plan, mainly because I saw that with all of the evolving issues—physician loss of control, etc.—doctors would have to be more organized. This resulted in great progress for the doctors, and they have been successful in several ways, including in the negotiation of contracts with third party payers.”
Life Outside of the Hospital and Societies
Leading by example, Dr. Herndon has left the comforts of U.S. medicine and gone abroad to help those with severe problems. “I have traveled to Honduras and the Dominican Republic (DR) with the Scoliosis Research Society; in Honduras I also did hand surgery. There was a man who had lost his thumb and couldn’t work; we transposed his index finger into the position of thumb…he only had three fingers but he had a thumb and he could work. In the DR I removed a spine tumor from a teenage girl; soon after, the respirator failed, and the resident and I sat and bagged her for 24 hours.”
Through all of the changes, projects, and frustrations, there is one constant at home…a loving wife of 44 years. “My wife and I met when she was working as a nurse at the University of Pennsylvania. We raised two children, who are now 39 and 35. Our son lives nearby, and works as a businessman; our daughter is an attorney in Alabama. It’s a good life.”
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1 “To Err Is Human: Building a Safer Health System, ” Institute of Medicine, 1999.
