Editor’s note: Dr. Bhagyashree Barlingay wrote this appreciation of Scottsdale Dr. Edward Perlstein, who is retiring.
Great men who do great work in science are happy men, their happiness derived primarily from their work.
Dr. Edward Perlstein belongs in this category.
Over the last two decades I have known him, whenever I had asked him “Are you working today?” he would smile and say people like us don’t work or do a job but are having fun.
That is the answer to today’s burning problem of physician burn out.
Working hard was the mantra given to him by his father, a pharmacist in Philadelphia who never took a vacation. This virtue helped him spend hours together pouring over books, taking detailed history, listening to the heart sounds at a patient’s bedside at the New Jersey College of Medicine from 1965 to 1969.
He was trained not to order a test to make a diagnosis but to confirm the diagnosis; he was trained to reach a diagnosis before leaving patient’s bedside; he was trained to think analytically.
During his Internship, residency and fellowship at Temple University in Philadelphia, he was part of history, performing the first coronary angiogram. It is still done the way he performed it in the 70s.
Although he was well trained in academic medicine and cardiology, Dr. Perlstein took the path of clinical cardiology after paying his dues as an assistant clinical professor at Temple.
He literally won the hearts of the people when he joined Tricity Cardiology consultants in 1982 with Dr. Mark Stern. The group attracted scholars and grew in leaps and bounds. Currently, Tricity Cardiology has a roster of 300,000 patients and 220 employees.
The Tricity empire grew with this young cardiologist whose foundation was built on strong convictions – never tell a lie, work hard and live by example.
We do not learn solely from textbooks but learn from our patients, nurses, colleagues and especially from our senior colleagues like Dr. Perlstein.
They accumulated treasures of experience and knowledge. They are the ones who can guide us in our own quest of sanity and stability in the face of mounting demands of the trade.
Medicine became more mechanized, and when I asked Dr. Perlstein what he thought of these changes, he said:
“Mechanization has changed cardiology care dramatically. It made my 50 years of career go by in seconds. I have used the first ECHO machine at Temple University, though I still use my golden stethoscope to listen to the heart sounds.
“I was part of the team doing one of the first procedures at Temple University such as the cardiac angiogram, thrombolytic therapy, open-heart surgery, etc. But the best part of training was growing up with highly intelligent people such as Dr. Harvey Proctor, who taught authentic bedside cardiac examination. I was very fortunate to have Dr. Sol Sherry as my mentor.
“One has to know the place of machines in patient care. The machines will never replace a clinician. We are teaching our medical students directly or indirectly to depend on the data collected by these machines.
“Essentially, they are being trained to treat population; not an individual. Nowadays, computers rule our lives. We spend more time with EMR than with our patients.”
I asked how he maintains the patient-doctor relationship.
“It’s a contract, a contract that ‘I will take care of you as your doctor as long as possible.’" Adding:
“That’s why I am having trouble retiring. I have about 35,000 patients to say goodbye to – not easy.
“I have never fired a patient from my practice however difficult he or she might have been. My philosophy is to take care of the patient with the best interest of the patient at heart and the patients can perceive that sincerity and will stick with you and try to comply.”
What are the common jokes he uses in his day-to-day practice?
“Many doctors are isolated from their patients. I tell them about my personal life. We talk about my funny socks - my socks are a point of ongoing discussion with my chronic patients and breaks the ice with the new patients. Humor is the best glue to keep your patients with you.
“I know some of my patients on a personal level. They have become friends with me and my family. I have given my cell phone number to many patients. Not a single patient has misused it ever. A doctor has to cherish this bond with his/her patients. I never enter the room with a serious face. I always have a friendly countenance.”
In other words, laughter truly is the best medicine, although he stressed he gives straightforward advice on medical problems.
“I never impose my will upon them but use my sense of humor to convey the message assertively,” he explained.
“I loved what I did,” he replied. “I worked very hard but the intensity never bothered me. Most likely, because I could diffuse my tension during exercise. My mountain biking was my salvation.”
He also had another diversion – a love of architecture.
“I had a contractor’s license and built homes. And I continued my clinical work. I never stopped.
“I think the new generation is facing multiple challenges: Seeing more patients in a shorter period of time, having financial burdens, the dangling sword of lawsuits, handcuffed because they cannot change the price structure.
“Law limits the usual business model. Though I am an independent practitioner, I feel that I am working for the government.”
Dr. Perlstein also is an ace at smoking-cessation discussions.
“I tell them they are going to make me richer,” he joked. Adding, “I have personal experience of quitting smoking. I know the pain of it. What patients need is not only a nicotine patch but something to substitute for cigarettes. So, I tell them to pick up a toothpick instead of a cigarette to mitigate the desire, the craving. And I have the conversation at every visit.”
It’s the same where obesity.
“One patient hated me for discussing his weight at every visit,” he recalled. “He came back to me several years later and thanked me because he had lost more than a hundred pounds by then. One has to go beyond the prejudices and work with people. Compassion comes from within. It cannot be taught.”
"How we deliver our care is art," added the man who has treated 35,000 patients in his 45-year career.
“My patient is my canvas. My patients' well-being is the final artwork and my reward.”