Leadership Spotlight: Mitchell T. Rabkin, M.D.
A graduate of Harvard Medical School (HMS), Mitchell T. Rabkin, M.D., became president and CEO of the former Beth Israel Hospital in 1966 at the age of 36 and subsequently became the CEO of CareGroup, BIDMC’s nonprofit parent organization, upon its formation in 1996. Today Dr. Rabkin serves as professor of medicine at HMS and as a distinguished institute scholar at the Carl J. Shapiro Institute for Education and Research at HMS and BIDMC. 2016 marks the 50th anniversary of his association with the medical center. Q: What brought you to BIDMC, and what made you stay? A: The opportunity arose with the departure of Dr. Sidney Lee, then the hospital’s CEO. I knew a bit about BI [Beth Israel Hospital] from my HMS [Harvard Medical School] student rotations, but had no plans to become a hospital administrator, enjoying patient care, teaching medicine, and engaging in endocrinology research at MGH [Massachusetts General Hospital]. Out of courtesy to Samuel L. Slosberg, then Board chair, whom I had met at a Marlboro Festival concert, I responded to his invitation. I was impressed deeply with the quality of the Board members interviewing me, including Irving W. Rabb, who chaired the search committee. The seriousness and thoughtfulness of their commitment led me to contemplate becoming a doctor for a community—the hospital—rather than a doctor for individual patients, taking on that challenge and giving it a try. I was helped greatly through support from Drs. David Freiman and Howard Hiatt, respectively pathologist-in-chief and physician-in-chief at BI, and Dr. William Silen, who arrived as surgeon-in-chief on the same day I came on board, and by Jack Kasten, then functioning as chief operating officer at BI. He could have taken the position that he should have been the one selected for the CEO role, but instead was a great mentor and coach. Already being a member of the HMS faculty didn’t hurt, either.
A: Typically, hospital nursing in the mid-’60s was “team nursing,” with each nurse assigned a specific task for all patients on a floor—taking vital signs, giving meds, or doing bed-baths, etc. No nurse really got to know well an individual patient. By contrast, the primary nurse is assigned to five or so patients, and has the responsibility to create the nursing care plan for those patients, using both the physician’s diagnosis and treatment plan, and her (or his) own clinical observations and judgment. The primary nurse then cares directly for those patients (with others as appropriate) according to the plan and the patients’ courses. She (for simplicity I’ll say “she” but it could just as easily be “he”) then conveys their situations to the nurse on the next shift, and she to the nurse on the subsequent shift. So when the primary nurse returns the next morning, she has the advantage of getting a report on how the patient has done over the 16 hours she was off duty. She can size up how the patient is at that point and then confer with the doctor to develop the new day’s plan. This continuity in the nurse’s knowledge of the patient is shared with the doctor, making for both better care of the patient and underscoring the professionalism of nursing, something that some physicians and administrators had denigrated—more so in the past and less so today, thanks to primary nursing. It took a great deal of thought, effort, and time on the part of our Vice President for Nursing and Nurse-in-Chief Joyce Clifford, R.N., Ph.D, her colleague Trish Gibbons, R.N., Ph.D., and many BI nurses to implement primary nursing throughout the hospital, a first in the nation. Upon the BI’s merger with Deaconess, one couldn’t simply dictate its establishment on the West Campus, but what importantly remains on both sides of Longwood Avenue are the professionalism of nursing and the co-equal colleagueship of nurses and doctors, each complementing the other for the best in patient care. This has distinguished BI and then BIDMC nationally and beyond.
A: Initially, in the constellation of Harvard Medical School affiliated hospitals, we couldn’t match MGH or the Brigham [Brigham and Women’s Hospital] in the range of all their offerings, simply because we were half the size of either. But we could do so as educators, and the bottom line is—the better our education programs are, the better we will attract doctors of the highest quality as residents and faculty. And that means better patient care. Today, our advances in medical education have highlighted BIDMC under the direction of Dr. Richard M. Schwartzstein, who heads our Center for Education and its Shapiro Institute for Education and Research. His leadership and the achievements of that group and our faculty in general extend beyond our walls across HMS and nationally. Q: What are some of the most memorable milestones you have witnessed and/or participated in over the course of your involvement with the medical center? How have they prepared us for a successful future? A: I think of the generous support from our Boards and our community in general, support that comes from a true understanding of our mission. A simple example early on is the building of the Dana research building atop the Slosberg-Landay research building. Support from the Dana Foundation would accommodate two of the possible four floors, but requests from our faculty called for an additional third floor, for which the Boards and community found the funds. Then I argued that since the building was structured for four floors total, if we didn’t build that fourth floor now, its loss would become a permanent regret. That consideration prevailed over the challenge of funding, and we completed the structure—which remains busy and productive as anticipated. Of the many milestones of achievement, many mentioned elsewhere, we think of research advances such as the elucidations of VEGF by Dr. Harold Dvorak, and PI3-K by Dr. Lewis Cantley, and insights into the molecular biology of malignancy by Dr. Pier Paolo Pandolfi. We think of the international educational work of Dr. Ram Chuttani in concert with his world-class clinical endoscopy service here at BIDMC; the national leadership in surgical care, education, and research by Drs. William Silen and Elliot Chaikof; the succession of excellent chairs in medicine, including our current chair Dr. Mark Zeidel; the leadership in medical education developed by Dr. Richard Schwartzstein; the innovative growth of the BIDMC enterprise under President and CEO Kevin Tabb and his team; and so much more. I could go on and on… Q: What is the most important lesson you learned during your tenure at the medical center? A: Be sure brain is engaged before putting mouth in gear! Q: What is your fondest recollection from your time at the hospital? A: The insight and support from my wife, Adrienne, even as I remained circumspect in what I shared with her about the goings-on at the hospital. Q: What has changed most since you started in medicine? What has stayed the same? A: Much has changed. When I started, one could go through a textbook of medicine and be pretty well informed. Now both knowledge and its rate of change have burgeoned, as have the rules and restrictions imposed by third-party payers. Before the computer, my printed (and translated) weekly Dear Doctor and Employee newsletters went to all staff and employees; now it is hard to know what most actually get out of what I’d call “the news and the weather” about the hospital and the medical school. Transparency is critical, but it must be shared since knowledge of what is going on reinforces that one is part of the mission and strengthens commitment to it; lack of knowledge makes for distance. What has stayed the same begins with the exquisite privilege and responsibility of the physician—this is unlike any other profession and all of us at the hospital, whatever our roles, are fortunate to be part of that responsibility, whether carrying it out directly or supporting those who do. What else stays the same is the continuing unfolding of biomedical knowledge. It is always a better time to become enmeshed in the understanding of medicine, whether when Vesalius began uncovering human anatomy, when our researchers today come across new insights in molecular genetics, or what tomorrow’s research will reveal.
A: My mother died from breast cancer when she was 34 and I was 7. My memory of her leaves a lot to be desired. I’d spend that day with her. Q: You and your wife, Adrienne, have been married more than 50 years, which is simply wonderful. What was your most memorable anniversary? A: It’s coming on to 60 now, but I would call our 50th a highlight. The family gathered for a long weekend at Cliff House in Ogunquit. Relaxing and recalling together, sharing in sight and sound of the crashing sea on its rocky coast, and enjoying some fine restaurants made for a very special time. Q: If you were to make a time capsule for the BIDMC community to open in the next 100 years, what would you put inside? A: I’d digitize the entire content of our archives, now combined and curated. It’s a history that would help explain why the BIDMC of 2116 remains a gratifying place to work, leading the way in patient care, medical education, research, and service to the community. All images courtesy of the The Ruth and David Freiman Archives. |
