Our Dialog Continues: Postscripts from Gene Stead's world of
students, friends and colleagues
The Internet connected Gene at his lake home with the world. He
quickly learned how to use Google to find information. He immediately
recognized that Google + the Internet were extensions of his memory and
a way for young learners to avoid the forgetting curve.
It is clear after a short 24 hours
that the Internet has enabled the Stead dialog to continue.
I have received several postscripts from you and decided that this would be
a useful continuation of our experiment. Send any comments to me,
and I shall add them to this page.
Frank Neelon: May 15, 2006
I am reading an interesting book entitled "How Doctors Think" by Katherine
Montgomery. She talks about how "misunderstanding the epistemology of
medicine -- how doctors know what they know -- has damging consequences for
patients, for the profession of medicine, and for physicians themseves."
This led me back to the eastead website to refresh my own mind about what I
had said epistemology in my little memoir about the man.
I think that Montgomery is right -- and that Stead's intuiting what she
explains at philosophical length explains at least in part what made him
such a remarkable and pervasive influence in our lives.
I also noticed that we have misprinted A E Housman's name. And, since we
give the allusion to the fact that the title was derived from a poem, it
wouldn't hurt to include the whole stanza from Housman:
The thoughts of others
Were light and fleeting,
Of lovers' meeting
Or luck of fame.
Mine were of trouble
And mine were steady,
So I was ready
When trouble came.
Goodwin Breinen Class of 43, Emory University School of Medicine:
I was a member of the first classes that Gene Stead taught at Emory. He was a
daunting character in those says, demanding and accepting nothing less than
total commitment to the patient and the intellectual task of understanding
disease. I was captivated by the dynamic approach to human physiology which
he innovated in our curriculum. My medical career was determined by his
example and I pursued clinical and basic research in my field of ophthalmology.
I became the Kirby Professor of Ophthalmology at New York University and
held the departmental chair for forty one years. I suspect the list of
academicians and professors who were motivated by Stead would fill a book and
would embrace every discipline of medicine. Paracelsus's doctrine that the
physician must study the patient rather than blindly following traditional
therapies was given complete realization in Eugene Stead's teaching and
practice. Goodwin Breinin MD class of 43, Emory University School of Medicine.
Frank Starmer: May 7, 2006, Singapore
A lot has happened since Gene's farewell almost a year ago. For me, I have
joined the faculty of the new Duke - National University of Singapore
Graduate Medical School where we are building the first Graduate Medical
School in this part of the world. The model will follow the Duke
model and will focus on team learning. As I was adding Goodwin Breinen's
comments about Gene's dynamic approach to human physiology I thought
about the Duke curriculum and the current format of the first year classes.
The first year starts with Molecules and Cells followed by the Normal Body
and then Body and Disease. Gene's view of the world, whether at home
or in the clinic was never compartmentalized and Goodwin's comments show
us that this was true in 1943. With the Duke NUS program here, Sandy Williams
has provided us a laboratory to follow Gene's lead and further integrate
learning with clinical practice.
Barry A. Cassidy:
I am one of the very many people whose lives were directly touched by
Dr. Eugene A. Stead Jr.. I graduated from the Duke PA Program in 1971 and
first met Dr. Stead in 1969 but really got to know him when we started the
Stead Society at Duke. In order to raise funds for the society I was
selling subscriptions to our monthly newsletter; it was a lot of money
then $5. Dr. Stead quickly paid the $5 and then proceeded to query me,
for the next hour, on my thoughts of the future of the PA Profession.
We kept in touch over the years; he helped me try and start a PA-JD program
at Duke, which never quite made it and it was Dr. Stead who most helped me
see that failure of some things is inevitable, but never a reason to not
keep trying. I went on to accomplish many things throughout my career
and I was honored when Dr. Stead agreed to come and speak at the first
class graduation of our PA Program in Arizona in 1999.
Shortly thereafter, my wife and I visited Dr. and Mrs. Stead at Honah Lee,
where we discussed issues about some PAs getting their medical degree with
Drs Harvey Estes, Bill Stead and Reginald Carter. I last saw Dr. Stead on
his birthday in 2003 when I was inducted into the Duke PA Program Hall of Fame.
While Dr. Stead would say he had no influence upon me, that it was just my
brain that decided to be open minded to changing, this opinion of his is one
of the only areas that I disagreed with him. His influence was so profound
on me that it literally changed the course of a young ex-military corpsman
and deputy sheriff's life forever. It was his positive, inquisitive and
challenging mindset that served as my life-long role model. So many times I
wondered how would Gene Stead approach this issue? He will forever be in
my heart and in my thoughts.
Herb Kaplan: House Staff 1955-1957
After now 75 years, no one scared me as much, and no one has affected my
life as much,( except my dear wife and parents ) as Dr. Stead.
Sure, I lost several nickels, but in return gained a Fort Knox worth of
wisdom from this wonderful man. In the course of a recent return to
medical school teaching, I found myself instinctively reciting many of
the pearls gathered a half century ago. (And this from one who has
trouble remembering what happened yesterday!) But this should be no
surprise since it was a rare day in my rheumatology practice when I did
not apply those gems to my care of patients. How many times did I make
the right decision by recalling," Herb, I learn just as much from
patients who don't do what I say as I do from patients who do what I
say." And I confess that there were times that when the remaining sting
in my ear of "What this patient needs is a doctor" gave me enough of a
pause to act as a "doctor", and not take the easy route in the care of a
patient. Who incidently, as a "sick person does not act in a rational
Even in retirement His slightly stern but yet with a hint of a smile
signed photo sits on my desk. Next to my grandchildren of course.
Carl Voyles, M.D.: To Dr. Stead's Housestaff / Faculty Colleagues / Students and PA's.
The phone rang a few days ago. Good news or bad? - One never knows.
Galen Wagner's voice from Durham: "Carl, did you know Dr. Stead died peacefully
at his home at Kerr Lake this past Sunday (June 12)?
"No! So sorry to hear that! I guess I thought he might go on for ever,"
Galen agreed, "As if he knew something we hadn't quite figured out."
Galen and I hope to have these and whatever we can add in published form by
October 30, when there will be celebration of his life at the
Med School reunion that week.
Suggest you crank into you search engine and review some of the
and add whatever comes to mind to your own. Don't worry about format or
spelling, we'll edit a published book of these will be a great tribute to
You can email your story (stories) to me at email@example.com or mail to me at
PO Box 2204, Anna Maria, FL 34216 (or to Galen at firstname.lastname@example.org).
I'll edit those I receive and forward to Galen, who has the publishing
I have spent almost the entire day re-reading the stories and letters on the Stead web-site and remembering. We had our annual Fellow dinner last night and Joe(Greenfield) informed us of his passing. I can't think of another person that has had a greater influence on so many people, especially when one considers the exponential influence he has had on all those he has touched, and all of those touched by them. Two of our children have continued the tradition, one of whom is in your midst at MUSC. Her name is Marcy Bolster and she is the Director of the Fellowship program in Rheumatology. No surprise, she was a Stead Scholar at Duke and has established a computerized database of Scleroderma patients at MUSC.
I am saddened at the passing of Dr. Stead.
His vision of a "physician assistant" has allowed me to fulfill a dream I have had since childhood (to practice medicine) that had been denied to me for most of my life.
In my parents' eyes, "girls aren't doctors"; so I became a speech pathologist, with a specialization in dysphagia. I worked in early intervention for 15 years, frustrated with my inability to medically serve my small patients.
I married a physician (oncology/hematology), birthed two beautiful girls. I would eagerly read my husband's copy of NEJM, JAMA, Mayo Clinic Proceedings--with passion! My love of medicine and caring for people would not die, even after all those years had passed.
Then I found out about the concept of physician assistant. My husband had remembered working with them while he was in training at Albany Medical Center. I applied to Hahnemann University. I was 40 years old, two kids (8 and 10 years). I didn't know how I would manage this decision.
It was everything I ever dreamed of. I fell in love hundreds of times with ideas presented to me. Hahneman stressed not only excellent medical care of the patient but also viewing them as a suffering human being--spending time listening. Two years later I completed a distance learning Masters' degree at University of Nebraska Medical Center. My thesis was "Mindfulness: Practicing the Heart of Medicine".
My subspecialty became (surprisingly) emergency medicine. I began to see the difference I could make to people in their darkest hours when I combined compassion with good medical care. I worked 4 years in Emed; then our ER was bought by a McMedicine corp. I moved on after that and worked as a hospitalist for 3 years with service patients. I love community medicine.
I have never been happier, more involved, or more rewarded then with my medical practice. I have completed two medical aid missions to Guatemala with a physician group called DOCARE. Last year, my husband and I visited Tibet and formed an impromptu medical clinic for two days. We saw over 100 people who had not seen a health practitioner in 40 years.
I am sorry to have "rambled". Dr. Stead changed my life. I will be grateful to him for the rest of my life for helping me realize my dream.
Here is a poem from Robert Frost's New Hampshire collection to express
my feelings about Gene's passing:
NOTHING GOLD CAN STAY
Nature's first green is gold,
Her hardest hue to hold.
Her early leaf's a flower;
But only so an hour.
Then leaf subsides to leaf.
So Eden sank to grief,
So dawn goes down to day.
Nothing gold can stay.
Lucy Barnhill, Ellen and Frank Starmer:
Gene was passionate about medical education and frustrated by
what he called the Medical Monopoly. He viewed the medical monopoly
as blocking training initiatives that departed from memory-intensive
just-in-case learning. He understood that learning
was use-dependent, requiring frequent exposure to the same
concept. He realized that repetitive exposure could arise not
only with repeated reading of book material,
but also within the daily practices of physicians, physician
associates and nurses. He also realized that forgetting followed
disuse of learned material and he characterized the loss of learned
material in terms of the forgetting curve. He saw no reason
why learning acquired through repetitive clinical experiences of
practicing PAs and nurse practitioners could not be
recognized as equivilant to that associated with traditional
MD training programs, thereby enabling some PAs and nurse
practitioners to make an
inexpensive transition to becoming an MD. Short visits to an accredited
medical school supplimented by Internet accessible courses
could make up for identified weaknesses and examinations.
His progressing age increased his
familiarity with the forgetting curve and, as he focused his attention
on the Internet and Google, he realized that the traditional
just-in-case learning paradigm would in time, be replaced by
just-in-time learning. He used the Internet + Google as an
extension of his biological memory. In reality, this was simply a extension
of his ideas that started the Duke Cardiology Data Bank 35 years earlier.
About a year ago, Gene sent to Ellen a xerox copy of an editorial
he had submitted to the New York Times. In it, he outlined the
medical monopoly problem and
asked that we add the text to his web page. One page was missing and
repeated searches at the lake failed to locate it. Consequently,
this paper never became web accessible. Yesterday, Ellen e-mailed
Gene's daughter, Lucy,
the first page of the paper and requested one last
look for the missing page.
Lucy replied last night with an e-mail:
"Oh Ellen - I hope you just like typing! Your efforts have not been
Having the article here, prompted me to go see if there was a backup of it
on my own computer. I found a version. I originally typed it in WordPro.
Here it is in RTF format and HTML formats. " Clearly, repetition
continues to have utility.
I have wrapped it in the Stead web page wrapper and added it to the
Mostly My Thoughts page, placing it at the top of the section
"Thoughts about Medical Education".
here to read it.
Tobin Lim: Tobin Lim is a recent medical school graduate and
works with Galen Wagner. Tobin visited Gene and discovered that
Gene knew that the world belonged to the young.
Here is Tobin's contribution.
World Series of Chess
This story is an excerpt from my personal memoirs while here at Duke, pertaining to my short lived experience with Dr. Eugene A. Stead during the summer of 2005. It has been adapted here since its entry into my memoirs in light of his recent passing.
I had arrived at Dr. Stead's house to discuss with him the importance of the Wallace Wade project. Shortly thereafter, I found myself asking him if he would like to play a game of chess, knowing that he had enjoyed playing several games or more in his past. He looked at me in a manner which I will not forget and asked me why I wanted to do such a thing. I informed him that I had read about his interest in the game and that I too, once, had a fair amount of interest as well.
What he didn't know was that at one point in my life, playing chess equated into making some spare change. Since spare change was always a nice thing to have, I became quite good at playing the game.
Without another word, he arose in his rigid state and left the room. He returned shortly and brought with him a chess board and some chess men. I've never seen a man as anxious as he was to play a game of chess since my last money making venture in college. I set the table to make ready for what I thought would be my most challenging game of chess to date.
I gave him the color choice of what he called the chess men in which he chose white and set the board accordingly. I guess I'm just used to referring to them as pieces. Perhaps it's a southern thing, or a generation thing. Regardless, I found it amusing in how the pieces were termed. In addition, the opportunity to make the first move was given to Dr. Stead, knowing quite well, the opponent who makes the first play usually wins the game. However, this was not the case. The game was over within an hour of playing, we exchanged some words over plays and he invited me back for another game, another day. I agreed and left.
The following week I informed Galen of my interaction with Dr. Stead and how we played a game of chess. He asked "well who won?" I told him that I had won without much competition and then proceeded to tell him that I was a bit disappointed because there is no glory in beating a 96 year old man in chess. Galen then replied that I should look at it this way; It's better than losing to a 96 year old man what if you would have lost? He most likely hasn't played a game of chess in a very, very long time. I would be willing to make you a bet. If this was, for instance, the world series of chess; the best out of seven, I'm certain he will have beat you. In fact, I'll make a nickel bet of it. I agreed and accepted his nickel bet. The next day I placed a nickel on some tape with a post-it-note stating "Stead vs. Lim, world series of chess".
A few weekends later I had returned to Honah-Lee to update Dr. Stead on the status of the Wallace Wade project. After a long conversation about Wallace Wade, I asked him if he was ready for yet another game of chess and without hesitation he told me to set the table. I made ready the table to play on and in came the chess men in all their untold glory.
This time Dr. Stead asked me my color choice and so I told him black. He informed me that most avid players chose white and that he would always opt for white himself and that I should do the same. I again extended him the opportunity in making the first play in which he refused. We decided on drawing for this right. I won the draw and made the first play in game two. After three short moves he had informed me that the move made was a foolish one and stated "I want to play an intelligent game and I think you ought to do the same. I will let you rethink the move you've just made". So, I took his advice and repositioned the chess piece in order to execute a more intellectual move. As the game continued to unfold, I had made yet another foolish play in which was duly noted by Dr. Stead in the same manner as before and gave me yet another chance to reconsider the decision regarding my move. I repositioned yet again, to execute a more suitable move. He was now playing at three to four moves ahead of me where as in the previous encounter, he had only played, at most, two moves in mind.
The conversation throughout the course of the game was quite pleasant. He had detailed me on how he came about taking a liking to the chess men. At one point, Dr. Stead had grown so fond of the game of chess that it consumed much of his leisure and academic time. He stated that he nearly flunked out of college because of how much time he invested in playing chess with a particular classmate. The game lasted an hour and forty seven minutes (doubling the last game) in which technically speaking, I had won the game by forfeit. He saw that I was ahead and felt he no longer could win so he looked up at me with a smile and said, "you win again".
Looking back through the retro scope on that day, I lost that second game the moment I had made first play. Dr. Stead was not playing Tobin Lim in a game of chess that day.
Dr Stead was in fact playing Dr. Stead, or himself. I was merely an object, an
"animated tool" on the other side of the chess board that carried out plays that he had already envisioned, anticipated and constructed in his mind. Though he may have forfeited on the game board, he defeated me in my own head. So you see, Galen was right and in turn, I too forfeited the nickel bet that was made. The nickel remains taped to the wall of a bookshelf that sits in Galen's office. Thank you Dr Stead, for the memorable conversations, insight, and chess games in our World Series playoff.
Jennifer Scott, BSN:
Through surfing the web, I found your Dr. Stead's site.
I'm sorry to hear of the passing of such a great man.
I am currently pursuing my Nurse Practitioner online at Florida State
University. I absolutely agree with Dr. Stead's ideas of teaching what is
necessary to take care of the patient instead of the "filler classes"
(Physics, Calculus etc..) that have nothing to do with medicine. Please
enlighten me if I mistook his meaning regarding such. I would have loved to
have found out his ideas about Nurse Practitioners and the changes in
their scopes of practice gravitating toward the medical ideology. Most
physicians are very threatened by NPs and feel that if we want to treat,
diagnose, and prescribe for our patients, that we should go to medical
school and become a "real doctor". I personally think that they have it
backwards. In order to be an effective physician, they should practice
nursing before going to medical school.
I happened across your website and had the pleasure of learning about
Dr. Stead. He sounds like a compassionate and innovative person.
I challenge those who study his life, methodology, and passions - to seek
truth and wisdom - and continue his work and further his vision.
With sympathy and prayers to all family and friends,
Harvey Fineberg, President, Institute of Medicine:
Among Gene Stead's many accomplishments, he was instrumental in the
founding of the Institute of Medicine of The National Academies.
Serving on the Board of Medicine, which pre-dated the Institute, he
helped to bring about IOM's establishment in 1970. As a charter IOM
member, he served on the first Executive and Membership Committees,
helping to shape the emerging organization. With two other members, he
devised the program for the first IOM Annual Meeting in November 1971 at
which "medical care as related to scientific research" was the key topic
of discussion. On behalf of the more than 1500 current members of the
Institute, I want to express our sincere appreciation for the legacy he
left us and to extend our condolences to the family.
Larry Dennis, MPAS, PA-C:
This is a photo of Dr. Stead when he last visited the East Carolina
University Department of Physician Assistant Studies in 2004. At that time
he presented the program with his collection of The Classics of Medicine
Library, a 22 volume set. He was on the editorial advisory board. On Dr.
Stead's lapel is a gold ECU lapel pin we gave him that day. He was a welcome
guest here, as I imagine he was nearly everywhere. He enthralled both the
faculty and the students with his humor and tales of his experiences. As a
PA of nearly 30 years, I viewed Dr. Stead as an icon, although in real life
when he visited with us he was just "Gene." We send our condolences, but we
will cherish our memories of this great but unpretentious man.
Bill Vaassen, PA-C:
Amazing afternoon with Dr. Stead at his compound at the lake. Dr. Stead was
reflective as we discussed building the Stead Center. His passing is a loss
for all Physician's Assistants in particular and for health care in
Chip Hedrick, MPAS, PA-C:
I will never forget sitting down with Dr. Stead on the couch in the lobby of
the Sheraton and just listening and occasionally sharing bits of my thirty
five years as a PA. A truly extraordinary experience.
Sir Winston Churchill epitomized what I feel about Dr. Steads death 'We
shall draw from the heart of suffering itself the means of inspiration and
Zach Smith, PA-S:
"It was an honor and a pleasure to meet Dr. Stead. I feel fortunate that the
WFU Class 2005-2006 was able to meet him before he passed."
The Duke University Physician Assistant Class of 2006 feels very fortunate
and honored to have met the father of our profession. We extend our deepest
condolences to the Stead Family.
Sarah Capps, PA-S
NCAPA Student Director:
The ECU PA students and staff were saddened to hear about Dr. Stead passing
away. The class had the pleasure of meeting the PA founding father last
fall. Dr. Stead had a lasting impression on us all. He left us with three
major ideas to remember as physician assistants.
First, he wanted us to always remember how those before us had to work hard
and persevere through many doubters to make the PA profession the
well-respected profession it is today. He spoke of many hardships he and
others had to overcome. He reminded us that we should all take an active
part in supporting and making our profession be the best it can be.
Secondly, he talked to us about the importance of keeping the patient's best
interest at heart. He stressed the importance of providing good patient
care. He emphasized that as healthcare providers, we really need to listen
to the patient's story in conjunction with taking a good history.
Lastly, he reminded us that it is impossible to know and remember everything
from our didactic courses. He said "if you don't know something you can look
it up." He reminded us all that providing good quality care is what the
physician assistant profession is all about.
Dr. Stead will be missed but never forgotten.
The Triangle Area Physician Assistants would like to express our sincere
gratitude to Dr. Eugene Stead for creating our exceptional profession. He
has touched the lives of all TAPA members in such a profound way. Dr. Stead
is already dearly missed and will never, ever be forgotten.
John F. Sallstrom, PA-C:
The sun warmed our shoulders as we walked together this past fall. He had
taken my arm to steady himself and I was overwhelmed with honor as this
wonderful gentleman and I strolled through the grounds of his home. I was in
the presence of Dr. Eugene Stead and I was humbled and grateful that I had
met the man whose vision had directed my life. He just smiled when I told
him how much he had meant to me and reiterated what he had said earlier in
the day: "Take care of the young".
As chair of the Endowment, I have had the privilege to be part of that
directive. Each year the NCAPA awards scholarships to second-year physician
assistant students at Duke, East Carolina, Methodist, and Wake Forest.
Applications have been received from these students and the selection
process is underway. These young men and women are highly motivated,
qualified, and the life-blood of our profession.
As I fondly reflect back to that afternoon with Dr. Stead, I remember his
hand on my arm. It seems now that I was not supporting him as much as his
hand was gently guiding, pushing me. I will always remember that warm fall
afternoon and a walk with a kind gentleman with extraordinary vision.