The face of many

The face of many

Though Dr. George Karam deflects credit, he has touched lives across Louisiana through LSU's residency program at EKL.

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In a 10-by-10 room without windows, books crowd two shelves, mostly journals of medicine. One also observes an antique apothecary desk and photos of graduating classes in ornate frames hung around his small and neatly cramped office in one of the buildings Dr. George Karam playfully refers to as “two tin cans.”

Most know the tin cans as the Earl K. Long Medical Center, the home away from home for Karam, who oversees the LSU residency program.

Like any proud family man with wall space to spare, Karam has constant reminders of his wife, Mary, and their daughters Susan, Anne, Elizabeth and Claire. All four are grown and in college or beyond. The pictures are various points in their lives.

All those pictures, medical literature and even some other antiques, in the view of the current generation—audio and video cassette tapes—remind one that 23 years have blazed by at EKL as the LSU program has helped to rebuild the image of the proud old hospital on the north edge of Baton Rouge.

On the back wall, impossible to miss, two documents stand out prominently and best depict what Karam and the program he oversees have come to stand for since LSU's medical school relaunched a Baton Rouge-based residency program in 1990.

One is the Hippocratic Oath, solemly sworn by every doctor.

So far, so ordinary, right?

The other contains a quotation from European scientist and historian Jacob Bronowski that is to the same degree extraordinary: “It is important that students bring a certain ragamuffin, barefoot, irreverence to their studies. They are not here to worship what is known, but to question it.”

Karam might not have spoken those exact words in extraordinary medical career which continues to influence, and touch people all over Louisiana. But you don't have to search too far or long to find somebody who will tell you how succinctly the idea sums up the program Karam has been the face of over the last 23 years.

“When it comes to taking care of patients, we have to teach in black-and-white because that's what you can easily communicate,” says Dr. Dean Lauret, an assistant professor of clinical medicine and one of Karam's dozens of protégés.

“The realty is, when you take care of sick people at their bedside, the practice is in the gray. So you need to be able to clinically reason and problem solve, and that's where George absolutely excels. He teaches you how to think, and that helps doctors learn how to take care of people in the best way possible.”

The doctors who have learned from Karam are part of the LSU Internal Medicine Residency in Baton Rouge, which dates to 1990 when Karam was brought in from LSU School of Medicine in New Orleans, where he was a faculty member. The program at EKL has evolved into a model of consistency for producing successful physicians.

Mostly by design but also stemming from Karam's influence, an estimated 76% of the 164 graduates from LSU-IM-BR have stayed in Louisiana, a large portion of those in the Capital Region. That exceeds the estimated national percentage of doctors who practice within 100 miles of where they complete their education: 68% to 70%.

Karam, who grew up in Oakdale, a town of 8,000 in Allen Parish, doesn't camouflage his pride in the program's track record for keeping the brightest and best in a state where the phrase “brain drain” has become too commonplace.

Those numbers are especially impressive considering that EKL doesn't rate as an eye-catching option for medical students who have grown up in an age of rapidly evolving technology.

That external impression will change in the next year, when LSU-IMR-BR relocates to the Our Lady of the Lake Regional Medical Center facilities off Essen Lane.

Karam stresses the tin cans on Airline Highway played a key role in the journey.

“When we first started, it was a challenge to attract people based on our facilities and the salaries that are paid,” Karam said. “But I knew we had a chance to produce superb patient care and how you do that with limited resources is provide superb education so you can attract really bright people.”

Credit for the decision of many porgram graduates to reamain in the region may not go solely to Karam, but he is certainly a major factor.

Another Karam protégé and LSU-IMR-BR faculty member, Dr. Angie Johnson, grew up in Baton Rouge after her her father's military career resettled her family here.

Like Karam, Johnson went to LSU for undergraduate studies, but she eschewed the chance to spread her wings and attend higher-profile medical schools with top-shelf facilities.

Fourteen years after her first encounter with Karam, Johnson said she can't fathom having wound up anywhere else.

Karam turns the 'dysfunction' of the EKL building into strength. More...

“One of the things he's done so well is being that mentor—somebody who makes it comfortable to go to him and seek advice, whether it's about medicine or not,” Johnson says. “I can't say that students come only because of him, but I do think it's because of the environment we've created here that he's so important. People want to stay here or come back and continue that mission with him.”

It's not just the students-turned-doctors who have grown up with Karam who count him as a mentor and powerful influence. The new wave of doctors also recognize what Karam and the LSU-IMR-BR mean to their lives.

Daniel LaVie, a first-year resident at EKL, returned to Baton Rouge from the New Orleans campus. While there were plenty of reasons to stay at LSU, LaVie doesn't blink when he says Karam was at the top.

“From the first time you meet Dr. Karam, it's evident just how much he cares, not just about people who were in his program, but even about people in other programs and the students he was talking to,” LaVie says. “He talked to me about my career goals and offered to help in any way he could.

“He was a huge factor in my deciding to go to Baton Rouge for my residency. It's a tribute to him that the rest of the faculty has taken on the same way of doing things.”

That hasn't gone unnoticed.

Lauret proudly points out that for eight consecutive years, the graduating class from the LSU medical school in New Orleans has deemed LSU-IMR-BR as its outstanding department when it comes to clinical education and teaching.

Karam agrees, but don't expect him to view that distinction as a feather in his cap. Instead, he calls it the result of a team effort made by teachers and doctors who strive to hold onto that level of excellence.

As quickly as just about any member of the ever-growing Karam tree might be to sing his praises, he likely to shoot down any direct compliment. Instead, Karam points out that he is simply the “ringmaster of the circus and the talent is in the show,” reviving a quote from a 1993 Business Report story on the program in its early stages.

“This program has excelled because there have been a lot of good people who were willing to see a philosophy about medical education that they liked, and then they came and took a chance at being part of that environment,” Karam says. “What's come together now is something that has worked really well because of a lot of hard work and a commitment by a lot of people.”

While that is unquestionably true, the “ringleader” certainly deserves some credit.

To indicate what Karam means to LSU-IMR-BR, Lauret refers to the philosophy listed on the program's website: “Our program provides a relaxed educational atmosphere, understanding that to promote the learning process there must be opportunity for humor, casual interactions, self-reflection, and constructive criticism.”

“It's often a cliché when you hear people say they're very close, like a family at work; but here that's exactly the way it is,” Lauret says. “You don't think of this place as a job. Many people have interpersonal relationships.

“That all begins with him. It's hard to count how many people look at George as a second father. He establishes those kinds of relationships naturally with people. That spreads out to the faculty members and the chief residents and residents. He's told me before, the thing he's most proud of that he's done here is that he's established this atmosphere of mentorship and nurturing.”

Karam steers attention on his accomplishments to those who influenced him.

One was his maternal grandfather, Joe Mawad, whom Karam called a gentle man who considered it a privilege to live in the United States after emigrating here from Syria in 1910.

Growing up in Oakdale, Karam remembers that his grandpa's most common motto was “Be nice to the people.”

“That certainly has stayed with me all these years,” Karam says.

As Karam began his career journey, he learned from one of the South's legendary medical educators at the University of Alabama-Birmingham, Dr. Tinsley Harrison.

Harrison was often quoted around the UAB hospital halls and classrooms, even after his death in 1978, and one notion is still as fresh to Karam as when he first heard it.

“He would say, 'I'm not here to teach you facts. If I wanted you to learn facts, I would tell you to read my book,'” Karam says. “He always told his students 'I'm here to teach you how to think.' "

It's no coincidence that Lauret, Johnson and so many other LSU-IM-BR students and colleagues have heard almost the same line from Karam.

Those textbooks and medical journals lined up on his office shelves? Karam still relies on them and dog-ears the worn pages as much as ever.

There's more, nevertheless, to getting doctors ready for their careers than reading pages from a book.

“The questions never change. Just the answers change,” Karam says. “If you teach people the answers, then pretty soon the answers will be out of date, and they won't have anything. If, on the other hand, you can teach them a thought process, they will have that thought process for life. And as the answers change, they just rehang the new answer on the framework of a thought process that will allow them to give very good care.”

That concept lies at the heart of what LSU-IMR-BR has stood for since its inception, with Karam at the front of the line.

While Bronowski's quote proudly adorned on Karam's wall serves as a foundation for the residency program, another quote fits just as well: “Knowledge is an unending adventure at the edge of uncertainty.”

“It's not just the knowledge [Karam] shares, it's the way he teaches you to use it,” says Dr. Casey Carlisle, a third-year resident at EKL. “He wants you to be the continual learner, and that's what most physicians should be because medicine is constantly changing.”

Adds LaVie, “What's really important is to take that knowledge to the bedside. Dr. Karam teaches you how to approach patients from a very practical clinical standpoint, but the most important impact of the education you get here—the formation of the physician—is that it's so much more important to treat your patients as people and make sure they know you care about them.”

Karam embraces the ever-changing nature of medicine, but he says he also subscribes to Harrison's belief in the three roots of a “medical tree”:
• the science of medicine
• the art of medicine
• the priesthood of medicine

Science is self-explanatory, the art is based on bedside skills and Harrison considers the “priesthood” the roots of treatment.

“We want to create a situation where people learn to be great scientists and master the first and second roots, but at the same time come up with a way to incorporate that third root,” Karam says. “If you can make all those things happen together, it's a synergistic effect and that creates the most effective and compassionate patient care, which is what we strive to teach and provide.”

So far, for 23 years, so good.

Using sometimes unorthodox methods that revolve around having fun while finding fulfillment, LSU-IMR-BR has carved a niche and churned out an impressive group of doctors who have stayed close by to help the Capital Region as it has grown.

Karam's face lights up as he conveys a conversation with his Baton Rouge friend Dr. Ray Corona, who focuses on kidney health and kidney disease as a nephrologist.

“He told me 'You guys are the liberal arts of internal medicine in this state,'” Karam says. “That really hit home for me and told me we're doing something right.”

No argument from those who know Karam best.

Johnson says Karam deserves mention as one of the most influential medical educators in Louisiana history.

“So much that Baton Rouge doesn't realize that goes on out here,” she says. “The educational environment is so strong.

“The impact that he's had, not just on the Baton Rouge training program, but the School of Medicine in New Orleans—his impact on medical education in this state has been absolutely tremendous. There aren't a whole lot of people who have the kind of impact he has in Baton Rouge.”

And it took a fortuitous twist of fate to make sure that happened.

Karam recalls that once he finished a fellowship at UAB in 1983, his goal was to open a private practice specializing in infectious disease, at the time a fairly new specialty.

When that didn't pan out, he moved to New Orleans to teach at the LSU medical school.

“I thought, 'I'll just go to the teaching school and do that for a couple of years and get that out of my system,' ” Karam says, smiling. “I got there and found out it was a lot of fun and very rewarding. Things worked out pretty well.”

Karam, who recently turned 60, isn't in a hurry for the finish line of a spectacular medical career to come into view.

“I want to be here as long as I can make a contribution and as long it can be fun,” Karam says. “And when I say 'fun,' I mean finding enjoyment and meaning in the interactions with the people with whom you work and the patients you treat every day. That's fulfillment.”

To be clear, Karam also isn't completely satisfied with the program he is so much a part of, and by choice, never will be.

“Oh, it will always be a work in progress,” he says. “There's always room for refinement. We'll always search for ways to do things better. We're in a field where there is never going to be a completely finished product.”

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