DukeMed Alumni News
Summer 2008

A 'Blue Devil' of a Doctor
Reflections on Duke Medical Training—an Extraordinary Privilege

by Robert L. Murrah, Jr., T’79, MD’83, HS’83-’85, ’90

Duke University has been an integral part of my life since my arrival in Durham at age 17; the following 10 year span included a series of triumphs and failures that led to my personal and academic growth and established a foundation for the individual and physician I represent today. When applying to college, I knew little about Duke, the curriculum, the basketball, or the meteoric rise of the medical center. There was simply a transcendent confidence that Duke was the place for me.

I saw Duke for the first time upon my arrival at freshman college orientation and was absolutely awestruck by the regal gothic structures and beautiful campus. I had grown up around Atlanta in a small country town followed by high school at Culver Military Academy; needless to say, I had never seen anything quite like Duke. My early enthusiasm and exhilaration quickly gave way to the reality that I was no longer a big fish in a small pond; indeed, the entire freshman class was outstanding. The level of competition and discipline demanded for academic success was substantial.

After a freshman year of too much fraternity fun and social adventure, there was some doubt regarding the seriousness of my medical aspirations; this was particularly true since my early academic performance was mediocre. Medical school applications were soaring based upon the “golden” era of medical reimbursement; doctors seemed to be professionally gratified, tremendously respected, and financially well rewarded. Fortunately, my strong desire to participate in our profession eventually superseded the need for entertainment, and my academic success followed to a point where I was a good candidate for many medical schools.

There was only one medical school I wanted to attend, and that was Duke. In my mind, Harvard, Johns Hopkins, or the two medical schools where I was accepted were all second best. I was and remain absolutely passionate about the preeminence of Duke Medicine. Granted, this represents a somewhat subjective and emotional position; however, I could make many substantive arguments about the tangible and intangible, the seen and unseen aspects of our medical center that make Duke so special and set apart from any place else. One of Duke’s distinguishing features is the flexibility and willingness to support students and faculty pursuing their goals in an unconventional manner. Dean Davison established this priority from the outset, and for me, being somewhat of a nonconformist, this elasticity has been especially important.

As I was pressing my case for admission to Duke medical school, Dr. Ewald Busse (the Dean) summoned me to his office during the spring of my senior undergraduate year. It was a rather unusual meeting, and I am not sure either one of us knew exactly what the agenda should be. He had received some recommendations from high ranking university representatives supporting my candidacy, and my application was clearly a “hot potato.” Basically, I think he wanted to see if my zeal for Duke medical school was genuine or the frivolous fantasy of a college student prone to dressing in tights, cape, and mask. I remember he expressed particular concern about how I would fund my Duke medical education, and I spontaneously presented several solutions which were completely uncertain at the time; I was not deceitful intentionally, but I must confess my proposed financing schemes were somewhat “creative”.

In any event, I think I persuaded him that there was no obstacle, financial or otherwise, that would deter me from accepting an opportunity to pursue my dream of becoming a Duke medical student. Shortly after our meeting, I received a bulky envelope from the dean’s office notifying me of my admission, and the celebration was on! In fact, the celebration has continued up to this moment. Unfortunately, my medical school loans lasted almost this long; however, I have been reminded repeatedly by patients and peers regarding the value of a Duke medical degree – “PRICELESS!” I will always be grateful to those who supported my application, especially Dean Busse.

Many times each month, patients present in my office simply because they have learned that I received training at Duke University Medical Center. It has been fascinating to observe individuals from all socioeconomic strata demonstrating a level of consumer sophistication and preference for a physician who has received some portion of medical education through Duke. It is clear to me that there is a decided difference between the medical community generally and the way a Duke doctor approaches people and medical care. The Duke doctor typically understands that these two components are inseparable and is not simply treating a disease, but treating patients who happen to have disease. That may seem obvious to most; however, I can assure you that my experience in Florida over the years has convinced me that few physicians either have the natural instinct or the exemplary teachers and extraordinary training to help them understand this point. The Duke medical tradition is rich in the qualities of: exceptional caring, judgment, intellect, thoroughness, and astute clinical acumen. Dean Davison and the founding department chairmen effectively transported the Johns Hopkins template to Durham emphasizing humanitarian behavior and delivering the highest quality medical care; this has been provided much like the successful investment ad campaign, “one patient at a time”.

I find myself muttering on the wards while reviewing a chart in consultation occasionally observing glaring omissions and think “what this patient needs is a doctor.” I understand better what Dr. Stead meant; the quality of care from physicians today is variable. There is not the level of meticulous attention we have been taught by our Duke professors and colleagues. We live in a time when medicine no longer seems so glamorous and is under attack from many challengers; medical school applications have been substantially impacted, and the overall effect on the new physicians being produced is predictable. Multiple factors, including the mandated 80 hour maximum work week for trainees, seem to be translating into a “nine to five” mentality among young doctors entering the community. There is a greater preoccupation with lifestyle than life- saving. In other words, the level of commitment to our profession or to a given patient from physicians today is inconsistent. Just so we remain focused on proper priorities, I remind my staff frequently, “our office is not a mill, it is a ministry!”

During my training, I witnessed even the most highly regarded Duke physician-scientist readily accessible for clinical consultation and teaching or available for comforting and treating a patient in the midst of a demanding work and research schedule. The moment a patient was in need, the only thing that mattered was fully addressing that patient’s problem regardless how long it took. Unfortunately, the medical system has largely moved away from such an approach; yet Duke has remained steadfast. The Duke doctor is epitomized by a God-given ability and total commitment to: patients, excellence, service, learning, teaching, caring, high ideals, and making a difference in this world. Dean Davison said many times “dissatisfaction is our goal…dissatisfaction with the world as it is.” Dean Davison has successfully permeated and propagated that state of “dissatisfaction” among Duke doctors; for us, the status quo is not acceptable. Innovation for improvement is the imperative.

Ultimately, what has distinguished Duke has been the people who have invested their lives, talents, passion, and truly embodied that total commitment to improvement and personal excellence so effectively championed by Dean Davison, the founding faculty, and their mentors before them. The source of inspiration and role models we have inherited through the Duke tradition is unsurpassed. Sir William Osler, himself, has truly impacted each one of us through the lintage and leadership of his student, Dean Davison and his successors. Indeed, Osler assured Dean Davison that a great medical complex which would ultimately become Duke Medical Center could be built away from a bustling metropolis. He advised him to “look heavenward if you wish, but never to the horizon.” As a result, Duke has never measured herself so much by the standard of others as by the inherent potential and possibilities not yet imagined. The contributors are legendary: Davison, Hart, Carter, Shands, Baker, Stead, Sabiston, Arena, Woodall, Anlyan, Wyngaarden, Snyderman, Goldner, Kinney, and so many others who have each put their unique stamp on this very unique and special medical institution.

As I reflect on my career I can't imagine any other profession which would have been so ideally tailored for me; moreover, I am struck by the immense impact Duke continues to have on my deep sense of personal and professional gratification. From my freshman year of college until now, Duke has offered me the opportunities and tools to pursue my professional dreams and goals in ways no other university could have. I simply believe that Duke is the best, and I am so blessed to be a part of such a remarkable medical tradition.

The challenge for all of us Blue Devils, medical and otherwise, is to stay closely connected to Duke and channel our collective talent and passion for our great school into a meaningful future. We cannot be bystanders while others plot our beloved institution’s course; we need to be active participants supporting her progress. Never fearing change, we must be certain that innovation is thoughtfully built upon the principles that have made Duke great and distinguished among similar elite universities, despite her youth.

Like any true friend, Duke loves you back in proportion to the interest and passion you show her; let us all commit to being better lovers and keep this affair growing for generations to come.

Suggested Reading:
1. William G. Anlyan, M.D. METAMORPHOSES, Memoirs of a Life in Medicine. Duke University Press. Durham and London, 2004.
2. Jay M. Arena, M.D. and John McGovern, M.D. DAVISON OF DUKE, His Reminiscences. The Ovid Bell Press, Inc, Fulton Missouri. Copyright 1980, Duke University Medical Center.
3. James F. Gifford, Jr. THE EVOLUTION OF A MEDICAL CENTER, A History of Medicine at Duke University to 1941. Duke University Press. Durham, North Carolina, 1972.
4. Synderman RS, Rogers MC, Saito VY. THE ACADEMIC HEALTH CENTER AND HEALTHCARE REFORM. Proceedings of the Duke Private Sector Conference, 1994. Raven Press, NY, NY.

Murrah was the Blue Devil mascot 1977-1979, and past president of the Duke Medical Alumni Council. He has been named one of Central Florida’s top orthopedic surgeons by his medical peers every year since the inception of the “Top Doctor” survey by Orlando Magazine. He is also recognized in 2008 Edition “Guide to America’s Top Orthopaedists” published by the Consumer Research Council of America. He considers his greatest achievement and blessing to be his family: Lisa, Annie, Hamilton, Brad, Will.