Q&A with Robert J. Joynt, M.D., Ph.D.

A top neurologist and former dean discusses medicine, education and aging.

About two months before his death on April 13, 2012, Robert J. Joynt., M.D., Ph.D., Distinguished University Professor at the University of Rochester Medical Center and former dean of the School of Medicine and Dentistry, sat down for an interview with Rochester Medicine for an article in the magazine’s spring issue. Here is what he had to say.

You have not retired. What keeps you busy these days?

I work with first and third year medical students in Problem-based Learning sessions, presenting clinical problems to the class. I do professor’s round with residents and medical students to see patients. I enjoy it very much. I used to work in the clinic and hope to start back again at least part-time. I’m not ready yet to stop. I enjoy the camaraderie with the young people, the residents and the students and the staff. I’m still very interested in the new advances of neurology. Everyday there is something new in the field and that is very encouraging. If that is staying in the game, so far it has worked.

This year is the 60th anniversary of your graduation from medical school at the University of Iowa. That’s quite a span of medicine.

I’ve seen a lot of medicine, good and bad. We have a lot of new treatments today in neurology. When I began, neurology was a kind of no-man’s land. We didn’t have many good medications. We had antibiotics and the use of steroids had just been started. We had some drugs but they weren’t very effective. The major change came in the late 1960s and early 1970s with new imaging technology like the CT scan and then the MRI. These diagnostics gave us a way to scan the brain and see things we just could not see with radiographic techniques. You have to think these advances will continue.

The organization of medicine and the delivery of health care need to be looked at closely. We have fallen down in that. When politicians put together health care plans, the last ones they talk to are the physicians. The Canadians have done a much better job with health care. People say there are delays. There may be, but, at the same time, you have a stable system and you are not going to become destitute over your health care plan. That will happen more and more here unless we find a new way.

What about changes in medical education?

The medical students here are wonderful. The amount of learning has increased exponentially since I was a med student, particularly in genetics. Our med students come in pretty well-equipped. They take on these challenges very well . . . When I started medical school, there were few girls in my class. Now it’s about now 50-50 men and women. This change has softened health care in some ways. It’s been a very good influence on medicine in general.
It used to be that when you started medical school, you got a basic science education and then a good clinical education. There was very little mixing in. With our Double Helix curriculum, one is wrapped around the other. They are intertwined. Med students start right out with clinical problems. We introduce a clinical problem that illustrates some of the effects of damage or disease of the particular part of body they are learning about. They get to interview patients. We have a lot of instructions in interviewing. It is very important that students learn how to take a good history. To watch a good history-taker take a history and see what they get out of it is amazing. It is a technique that is all important in medicine. Once you get a good history, you are on your way to helping that patient.

Reducing the importance of grades in the first two years is another good development. We are taking pressure off the students. They come to us out of a maelstrom of competition for who has the best grades to get into medical school. It gives them a feeling of ease and camaraderie. They get to know each other and work together and listen to other ideas. It’s a great collegial atmosphere.

You started the first Alzheimer’s center in Rochester. What do you think of the state of Alzheimer’s research?

My early research was very basic, a neurophysiological project that investigated the way the brain releases vasopressin. But I also was interested in behavioral neurology, the way brain lesions affect behavior, language disorders and dementia. I was director of the Alzheimer’s center here until I became dean and could see I could not do justice to the research with the job of being dean. A lot of the Medical Center’s Alzheimer’s research started from that center’s research. Alzheimer’s has remained very stubborn. We have some symptomatic treatments that help for a while, but they do not get down to the core of the problem and what causes the disease. Hopefully, we will have more luck with stem cells, but we have not demonstrated much with the current treatments.

I would like to see all the diseases solved, but Alzheimer’s, in many ways, is the most devastating. The humanity of the person disappears before you. With other similar devastating diseases like stroke, which is more common than Alzheimer’s, we’ve made some progress. But Alzheimer’s continues to be very elusive. If you think of terms of finances—and you shouldn’t always think in terms of finance—Alzheimer’s creates such a huge health care cost to the country. Combine that with what it does to the emotional health of families, you see why we must figure out Alzheimer’s.

Are you concerned about tightening NIH research budgets?

If you neglect medical research, you’ve neglected one of the most important facets of our government. People around the world look to the United States for education, medical care and scientific discoveries. We educate many international students here and they have enhanced our medical entourage greatly by coming here.

How do you feel about getting older?

I start a little slower than I used to. I think the University of Rochester is just a wonderful place. Even though it has gotten bigger and bigger, it still is a place you can get your hands around. The students are friendly. There’s a good relationship between the faculty and students. It’s a good place to work. I’ve been fortunate to be able to stay around. I’m probably a provost’s nightmare because I’ve stayed so long.