Dr. Jay Perman, new president of the University of Maryland,… (Amy Davis, Baltimore Sun )
The seven people seated around the conference table want to know why Maia Brittingham isn't growing.
The 11-year-old's mother has driven three hours from the family's home outside Ocean City to seek answers at the University of Maryland Medical Center. The case is now before Dr. Jay Perman, a veteran pediatrician who also happens to be the new president of the University of Maryland, Baltimore.
As Perman leads five students and a resident through Maia's medical history, a question arises about the answers her mother has given. "Would this tell us the mother is less reliable with the history?" asks Bryna Shmerling. "She seems to be, I guess, misdiagnosing."
"You mean she's interpreting," Perman says. "This raises the interesting question of how much history one can get from a child. The parents' history is biased for a lot of reasons. They might be worried, they don't know the history or they feel they have to embellish to get the doctor's attention."
Conversations like this happen every day in teaching hospitals around the country. But this one is different because Shmerling is not training to be a doctor or nurse. She's a second-year law student. Her peers around the table include an aspiring social worker, a future dentist and a pharmacy student. This blending of disciplines represents Perman's vision for a university that has long been known as a collection of independent fiefdoms.
He believes that if students from different schools watch one another in action, they will gain greater understanding of each discipline's value to a given case. In turn, he believes patients will receive more comprehensive care, though he acknowledges a lack of studies demonstrating this benefit.
"There's no question that most community practices cannot be done this way," he says. "But what students can learn to appreciate is how a professional of a different stripe can serve the patient. Even if that just means they pick up the phone and call for another viewpoint in the future, I think that makes it worthwhile."
Though his job is more often associated with fundraising and speech-giving, Perman is not only practicing medicine, he's using his clinic as a sort of social experiment.
His right-hand woman, nurse practitioner Elsie Stines, began setting up the program as soon as Perman reached campus last summer. Every Tuesday, he works through his cases with an array of students and professors from the university's six pre-professional schools.
The program seems popular with students. Shmerling, for example, has an important law exam coming but has opted to take four hours away from studying to participate.
"I'm normally reading about this stuff in a book," says the student of health care law. "But here I am in a hospital watching everything come together. It's a wonderful opportunity."
"I think it's great that the president of the university is spearheading this kind of campaign," adds Sylvia McKown, a second-year social work student who is also working Maia Brittingham's case.
Perman says his belief in collaboration grew out of his experience working closely with nurse practitioners. Watching him interact with Stines, it becomes clear that he doesn't say this simply because it sounds good.
The two riff off each other like seasoned jazz musicians, with Stines often finishing Perman's thoughts. He is the encouraging one, always telling students how incisive their questions are. She is the commanding counterpoint, jumping in to focus the discussion or add pertinent details that a medical student has neglected.
After touching on everything from Maia's lunching habits at school to her need for a root canal to her parents' separation, the group of seven gets down to brass tacks. "So what do we think?" Perman prods.
An allergy to milk protein seems the most likely culprit, the students agree. There are tests for that, Perman says, but there are also hints that Maia has started to grow in recent months. Maybe the test should wait if nature is taking its course, he suggests. "Am I being too aggressive?" Perman asks. "If this were your clinic, would you do this?"
"No," replies medical student Sarah Smith.
"Well, I better listen then," Perman says. "It sounds like the vote here is that we do some observation. All right then, that's what we'll do."
The group proceeds out of the conference area and crowds into the room where Maia sits. "What I think we ought to do is give her another three months to see if we can get some vertical growth," Perman says.
The next case, involving a 17-year-old girl with crippling abdominal pains, verges into less comfortable territory. The girl has been treated for sexually transmitted diseases, says she sleeps 14 hours a day and began to cry when asked about her family. That leads Edward Pecukonis, a professor in the school of social work, to wonder why the students didn't ask about her sexual activity while taking the medical history.
"The teaching point is: What prevented you from asking?" he says.