Q&A: Diagnosing a profession in pediatric ID

September 21, 2022

7 min learn

James H. Brien, DO, displays on greater than 30 years of presenting the favored quiz, What’s Your Analysis?


Healio Interview

Brien experiences no related monetary disclosures.

This yr, one of many displays at November’s Infectious Illnesses in Youngsters Symposium will mark the top of an period.

For the ultimate time, James H. Brien, DO, a lately retired pediatric infectious illness specialist at Baylor Scott & White McLane Youngsters’s Medical Heart and an Editorial Board Member of IDC and Healio Pediatrics, will current his last What’s Your Analysis? in-person quiz.


Though he’s stepping away from the assembly, Brien stated he’ll proceed to write down his monthly column of the same name, which has been operating for greater than 3 many years. He lately spoke with us relating to the trajectory of his profession, the work that goes into getting ready the difficult instances that he presents to readers and attendees, and concerning the academic impression of What’s Your Analysis?

Healio: Wright here had been you in your profession once you started What’s Your Analysis?

Brien: I’ve a long-standing curiosity in visible prognosis, starting in my third yr on the Texas School of Osteopathic Medication, which is now the College of North Texas Well being Science Heart (TCOM), after I was on a summer-long clerkship at Fitzsimons Military Medical Heart in Denver in 1975. The Military school there inspired medical pictures, and I invested in my first good digicam. This continued by way of my residency there and my years at Fort Hood that adopted. Then, on the primary day of my ID fellowship with James W. Bass, MD, MPH, at Tripler Military Medical Heart in Hawaii, Bass despatched me to the put up change to get a greater digicam, and he taught me extra strategies of medical pictures, from getting parental consent to snapping the image, to incorporating photos into lectures. As I gave increasingly lectures at greater conferences, I feel I caught the attention of Ted Eickhoff, MD, FIDSA, the unique medical editor of Infectious Disease News. Ted requested me to start writing a case-based visible prognosis column utilizing a thriller case in a multiple-choice format with a dialogue of the reply. Once I was a employees doctor at Brooke Military Medical Heart in San Antonio, Texas, I wrote my first column in IDN, printed within the November 1988 problem. Quickly afterward, Phil Brunell, MD, the unique Chief Medical Editor of IDC, requested me to write down the same column on this sister publication. My first case printed in IDC was within the April 1989 problem, about cat scratch illness. IDN would alternate an grownup case with a pediatric case each different month. The pediatric case would additionally seem in IDC. After a few years, I ran out of fine grownup materials, and my column finally stopped showing in IDN.

As of October 2022, I’ve printed 383 columns in IDC. The explanation the quantity is just not extra is because of some comparatively quick breaks in writing, starting with the primary Gulf Conflict in 1990 to 1991, after I was deployed with a fight assist hospital to Iraq. I additionally needed to cease after I was assigned to the Workplace of the Military Surgeon Normal throughout 1995 to 1997, after I solely printed a couple of columns between November 1995 to August 1997 as a result of calls for of the job and actions surrounding retiring from the Military and beginning a brand new job in Temple, Texas, at Scott & White Medical Heart. After settling in, I started writing the column once more in IDC, starting with the September 1997 problem, which has been uninterrupted for 25 years.

Healio: What’s it about pediatric infectious illnesses that intrigues you most?

Brien: What intrigues me most about infectious illnesses is the problem of constructing the right prognosis and discovering the trigger or organism accountable for the illness that’s making the kid sick. My long-standing motto is “remedy is straightforward, prognosis is tough.” On the danger of oversimplification, I might say that if the prognosis, it’s pretty straightforward to search out the newest suggestion for remedy and follow-up.

I’ve by no means tried to hide the truth that I’m not very brilliant. I struggled in school and practically gave up, opting to work within the Shell oil firm refinery in Deer Park, Texas, in 1969 to earn cash and get my head screwed on straight. Once I married my highschool girlfriend, Ellen, in 1970, she impressed me to return to varsity and get my diploma with a brand new sense of goal and end the arduous work of my chemistry diploma and get the premed requirement wanted to use to medical college, which I did for the 1972 TCOM coming into class. I didn’t get in that yr however made the alternate listing, which inspired me to attempt once more, and I efficiently enrolled in 1973. Once more, I struggled simply to be barely common. I did nicely on medical rotations, however the lecturers remained a battle. It was solely by way of my 4 months spent on pediatric electives at Fitzsimons Military Medical Heart that I used to be in a position to get chosen for this very aggressive residency.

All alongside the best way, I knew that differential prognosis was the best problem to me academically. Midway by way of my first yr, it practically precipitated me to drop out of pediatrics for one thing simpler. However, for some purpose, as a substitute of leaning away from it, I gravitated towards it. In the end, I integrated differential prognosis and medical pictures into this visible prognosis column. I’m nonetheless no brighter than I’ve ever been, simply higher organized.

Healio: Are you able to stroll us by way of your course of for getting ready instances for What’s Your Analysis?

Brien: I often begin by considering of any current sufferers, of whom we obtained photos that could be of curiosity to the readership. Additionally, I’ve a big file of unused instances that I regularly seek the advice of for concepts. I’ll often use the season of the yr for the problem to be printed and incorporate it right into a message of curiosity — immunizations, summer time security, back-to-school alerts or some “sizzling subject” within the information. I additionally obtain fairly a couple of instances from the readership, a lot of that are glorious candidates for the column. I’ll provide the doner of the case the chance to be a “visitor columnist,” and collectively we are going to write a few of the greatest columns we’ve printed.

After deciding on the case to make use of, I analysis the subject to attempt to be as present as attainable. Then I choose some diagnoses which may usually be within the differential to listing within the multiple-choice query in a “Board query” format, after which I write the dialogue.

Healio: Are you able to title two or three of your favourite instances, or maybe essentially the most difficult instances?

Brien: Counting the columns that I wrote for IDN, there have been simply over 400 columns written over the past 34 years. I’ve by no means given any thought to any columns or instances that I preferred the perfect. I simply hope to reduce grammatic and scientific errors. And I’ve made some bone-headed errors. One such case that stands out was that of a donated case of erythema migraines published in the June 2007 issue as Lyme disease. Shortly after it got here out, I used to be contacted by the main Lyme skilled, Eugene Shapiro, MD, at Yale College of Medication, informing me that for a few causes, we actually don’t see Lyme illness in Texas. What we had in that case was a special tick-born illness referred to as southern tick associated rash sickness. After additional evaluation, I spotted he was proper and printed a correction. And there have been quite a few lesser errors made alongside the best way. However again to the query of favorites: I actually can’t consider any. There have been many difficult instances used, often uncommon, once- or twice-in-a-career instances, like the case of ecthyma used in January 2020, or cutaneous myiasis within the December 1991 problem, to call a pair. They’re all fascinating or difficult, or I might not use them.

Probably the most gratifying instances I can recall weren’t infectious illness instances in any respect. Perhaps that’s what made them stand out. One was a 17-year-old male who had been seen a number of instances by totally different suppliers for mysterious signs, together with fatigue. Once I entered the room, I noticed what gave the impression to be a drained however healthy-appearing adolescent male with a darkish, nearly bronze-appearing pores and skin. My first response was to ask him to take his shirt off and lift his arms, revealing equally “tanned” axillae — the previous medical college maneuver to clue in Addison illness. After seeing his electrolytes, he was referred to my endocrine guide who confirmed the prognosis. For some purpose, this noninfectious illness case introduced me nice pleasure. Sadly, I didn’t get photos, so no column. The subsequent was a neonate with “ringworm” that turned out to have neonatal lupus. This case is also the one time the dad and mom refused to permit publication of the photographs, so once more, no column.

Healio: What would you like readers/attendees to remove from What’s Your Analysis?

Brien: For readers of the column and attendees of the assembly, I can solely hope that everybody will discover one thing that will likely be helpful to them of their on a regular basis apply to assist their sufferers. In any case, isn’t that why we learn and attend conferences?

Healio: What would you prefer to say to readers/attendees? Ground is open.

Brien: I wish to say thanks to your loyalty over these 3-plus many years of studying my columns and attending my slide exhibits on the conferences. I might maintain going if not for my faltering reminiscence. So, I select to maneuver on with as a lot grace as attainable and take a look at my hand at one thing a bit simpler. Nevertheless, I would really like you to do not forget that schooling is a lifelong pursuit. Simply once you assume you might be executed with the Krebs cycle out of your biochemistry course, you might discover the necessity to evaluation it once more years later. Such is the character of schooling. Whenever you retire from seeing sufferers, as I’ve now, you might select to pursue something however medical schooling, which is pretty pure. Nevertheless, after knowledgeable lifetime of exercising that intracranial muscle, I might encourage you to stay lively in some type of tutorial pursuit, whether or not it’s learning the pollination of orchids or the planetary orbits of the photo voltaic system — something to stimulate a long-standing ardour you will have, something to maintain you from placing your thoughts to relaxation, for it might certainly atrophy.

Editor’s be aware: Be part of Dr. Brien and different distinguished school members at this yr’s convention in New York Metropolis, Nov. 19-22. Go to https://www.healio.com/meeting/idcnewyork/home for extra info.


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