Q&A with Jules Cohen

An alumnus and faculty member discusses Romano, Engel and the rewards of teaching.

Jules Cohen, M.D. (BA ’53, M ’57), celebrated his 80th birthday last year. His career as a cardiologist, researcher, medical educator and administrator spans more than 50 years. Cohen joined the University of Rochester School of Medicine and Dentistry faculty as an instructor in the Department of Medicine in 1963. He was promoted to assistant professor in 1966, associate professor in 1969 and professor in 1973. From 1963 until 1976, his work in cardiology included clinical care of patients, teaching of medical students, residents, and cardiology fellows, and research into the pathogenesis of cardiac hypertrophy and, with Marshall Lichtman, M.D., studies of oxygen transport. He continued all of these activities at the Medical Center after moving in 1976 to Rochester General Hospital as chief of medicine, and then director of medical services as well. In 1982, he returned to the School as senior associate dean for medical education and continued in that position for 15 years. Cohen is a professor of medicine and cardiology.  A member of the Alumni Council, he is co-author with Stephanie Brown Clark, M.D., Ph.D., associate professor medical humanities, of Paul Yu Remembered and of John Romano and George Engel: Their Lives and Work

When you look back to your days as a medical student, who stands out as a teacher or mentor?

George Engel, John Romano, Wallace Fenn and Paul Yu. What made them good teachers was their capacity for clarity, their capacity for making you think, and their making it quite clear that they were interested in you as you personally. There were many other teachers who also were inspirational, but I would pick these four out of the crowd.

Are the traits you saw in those four the most important in a medical school faculty?

When I was in the dean’s office, we asked this same question of alumni from various decades. When we asked those alumni from the 1930s and early 1940s what was important about their medical school experience, they said the collegiality of the institution and the personal attention given by faculty members to students as students. When we interviewed people from the late 1940s, 1950s, 1960s and 1970s, without exception, the first words out of their mouths were Romano and Engel. They became close to and influenced a lot of students. Their ideas are still alive today. They were the fathers of the biopsychosocial model and their ideas might be even more relevant today than they were 50 years ago because there are now so many forces in medicine forcing physicians to think about the technological aspects of illness as opposed to the human dimension.

What are the biggest challenges today in medical education?

The biggest challenges in medical education are no different than when I was a student: the sheer mass of what students have to grapple with and the array of psychosocial forces influencing health. They are inundating. The Medical Center itself also is huge compared to what it was. And that has an influence. I remember when some of the building of the 1950s and 1960s was going up, George Whipple telling us the story that George Eastman said to him when the place was first finished: “Well George, you’re never going to have to add another brick to this place.” He got that one wrong.

Were you always interested in becoming a cardiologist?

Yes, from the beginning, I wanted to be a cardiologist. But I spent some summers as a student researcher with George Engel. There were about eight or 10 of us from a couple different classes. I remember our meeting in Engel’s office every Friday afternoon to report on our frustrations as well as our accomplishments. He was a great director of our efforts. The first summer, we were studying the influence of psychological variables on gastric secretion in a four-year-old black girl who had swallowed lye and had developed esophageal atresia as a result. The study grew out of Engel’s earlier famous work with Monica, the infant born with esophageal obstruction. The last year, Stan Friedman and I had an interesting project. We studied the influence of psychological factors on the immune response. We studied the response to cholera and plague vaccine to which patients had not been previously exposed. We studied depressed patients, schizophrenic patients, normal patients and even our classmates. We found that the immune response was depressed in depressed patients.

Was it difficult writing your book about Romano and Engel?

It was a very long and laborious five-year process. Our oldest son knew we were even struggling to come up with a title for the book. He called me one day and suggested we call it “This Damn Book.” This past year, the provost had a reception for faculty who had published a book during 2010. We each were asked to say a few words and I told about my son’s suggestion. The provost later whispered in my ear: “We’ve all written that book.”

Are you working on another book?

Not another book. We’re doing a long paper on the ongoing evolution of Romano’s and Engel’s influence in medical school programs since their deaths. I’m writing it with Diane Morse (an assistant professor of psychiatry and medicine), who was Engel’s last liaison fellow, and Kathy Johnson, who was my administrative secretary when I was in the dean’s office and is a burned-out high school English teacher and a great writer.

And you continue with other work too?

I come to the Medical Center every day and I work. I do an occasional cardiology consult. I’m doing a lot of teaching. I’m teaching a first-year problem-based learning group, which I’ve done for the last several years. I do that all first semester and I teach the third-year internal medicine clerkship in the spring. I love teaching. I make a lot of good friends that way. I have a group of eight or nine students who started out as a problem-based learning group several years ago. They stay in touch with me. I learned about connecting with such a group from John Romano, who had similarly devoted students who stayed connected to him for several years.

To order Dr. Cohen’s book on John Romano and George Engel, e-mail Amy Gregory at Amy_Gregory@urmc.rochester.edu