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BIDMC's Clinical Crossroads Reaches A Milestone

JAMA series celebrates 15 years and 150 cases

In the mid 90s, Tom Delbanco, MD of Beth Israel Deaconess Medical Center and Steven Schroeder, MD, then President of the Robert Wood Johnson Foundation, had the germ of an idea - they envisioned a medical grand rounds discussion involving a patient and doctor at a "crossroads" in a medical care decision. Supported initially by the Foundation, the Clinical Crossroads series was born as a collaboration between BIDMC and the Journal of the American Medical Association (JAMA). Delbanco thought the series would last only a few months, but it has become, as he says, "a widely read feature that seems to get better and better." The series is now celebrating a significant milestone, 15 years and 150 cases.



"It's unusual these days to really focus on a patient and learn from him or her in an academic journal," said Delbanco, Koplow-Tullis Professor of Medicine at Harvard Medical School, and the founding director of General Medicine and Primary Care at BIDMC. Involving patients, who discuss their issues in a taped interview and often attend the conference, allows the series to delve into not only the medical aspects of each case, but also the ethical, psychosocial and economic concerns that are often intertwined. "Clinical Crossroads involves a real live patient facing a real live dilemma and asking for help from an expert to figure out what to do, so that's what's exciting about it for me, that's what's apparently exciting for the audience, and that's why it's had such longevity."

Over the years, the series has explored the medical gamut from back pain, to brain tumors, to depression, always involving a patient and an expert discussant from around the world, often from right here at BIDMC. "It gives our faculty a chance to shine because this article goes to literally hundreds of thousands of doctors here and abroad. It's translated into many different languages, goes far and wide, and we're proud of it and we've had a heck of a good time putting it together," Delbanco said with a smile.

Nadine Tung, MD, Medical Oncologist, Hematology and Oncology also smiled when she recalled bumping into Delbanco in the elevator shortly after being invited to be a discussant. "Tom said something to the effect of congratulations and condolences. He warned that it would be one of the most challenging tasks I would undertake, but also one of the most rewarding, and he was right on both accounts." Tung's is the 150th case to be examined for the Clinical Crossroad series.

The authors of the articles undergo intense peer review. They are critiqued by a team of doctors at BIDMC who oversee the series and then by the editors at JAMA. "The review process is rigorous and the JAMA editors are wonderful," said Tung. "No matter how complete or clear you think the manuscript is, they raise questions that you might not have thought of and the modifications requested greatly improve the manuscript. Their involvement was very valuable. I am not aware of any other series in which every aspect of a particular topic and clinical decision is examined from so many angles."

After many years, Delbanco has passed the Clinical Crossroads reins to equally capable hands. "I'm the old man, but we have a wonderful team of doctors here, led by Risa Burns, who are leading the charge now," he said. "It's a big responsibility to do it well, and she and her colleagues are doing a spectacular job."

Burns, a primary care doctor at BIDMC's Healthcare Associates has tapped a talented team of physician editors to help her continue the series. "I'm thrilled to have taken over from Tom and I'm appreciative of the ongoing financial support from the Department of Medicine and from the hospital," said Burns. "We're working closely with JAMA and continue to explore novel ways to bring Clinical Crossroads to the larger physician community."

Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School, and currently ranks third in National Institutes of Health funding among independent hospitals nationwide. BIDMC is clinically affiliated with the Joslin Diabetes Center and is a research partner of Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. For more information, visit www.bidmc.org.