Vagelos Receives First Master Clinician Award

Were it not for the shrinking of liberal arts faculties around the country in the late 1970s, the inaugural recipient of the Department of Medicine’s Master Clinician Award, Randall H. Vagelos, MD, might have stayed at Harvard for his PhD and embarked on a career teaching American history. Despite being raised in a household headed by an eminent biochemist, “every adult guest at our home was a biomedical scientist,” says Vagelos, “my fantasy was to become an academic historian, mostly based on being enthralled with the excitement a series of terrific high school teachers had shared with me for a life of teaching, writing, and learning about our national, historical origins.”

It was 1978 when Vagelos noticed that the History PhD candidates around him were abandoning the liberal arts in droves. He recalls that “everybody was moving abruptly towards professional schools – mostly business and law schools.  I felt that if these talented individuals were abandoning their life’s dreams, then far be it from me to be confident enough to think that I would be successful in this shrinking field. I decided to do the next best thing, which was go to medical school.”

The first hurdle was soliciting a letter of recommendation from his mentor, the pre-eminent American Revolution historian Professor Bernard Bailyn. “I hoped he was going to say, ‘what a terrible loss for our field of American history,’ but he slapped me on my back and instead said, ‘You know, I'd love to write a letter in support of you going to medical school!’”

Vagelos originally envisioned himself a primary care doctor in rural America, and applied to the National Health Service Corps, which at that time would pay medical school expenses in return for him practicing in an underserved area after graduation. When he arrived at Columbia for medical school, although the Health Service Corps had accepted him, neither the financial support for tuition nor funding for supplies and books were forthcoming. With the added threat of having to wear a military uniform as a member of the Corps, “I changed my career direction and never looked backwards. Most of what I've done since then has focused on much more specialized or advanced care related to working with advanced heart failure patients in and out of the Cardiac Care Unit at Stanford.”

Following medical school and residency at Columbia, Vagelos was attracted to cardiology and headed west for fellowship training. When visiting Stanford and asked what clinical problem most attracted him, “myocarditis” was his excited answer. This interest had been stimulated by a talk he was assigned to give to his co-residents on the pathophysiology of myocarditis, for which he had studied the field enough to gain some in-depth knowledge, but even more importantly had spent time speaking with a famous cardiac pathologist at Columbia, John Fenoglio. “I suspect the group at Stanford were impressed by my focus and enthusiasm – all quite recently acquired.  This experience has always reminded me of the unpredictable but valuable benefits of training in a stimulating environment.”

At the end of his general cardiology training at Stanford, Vagelos did a year of research in heart failure, working with Michael B. Fowler, MB, and John S. Schroeder, MD, both professors of medicine (cardiovascular). At the time, interventional cardiology was coming into its own and he was then offered the opportunity to be an interventional fellow the following year.

Explaining his reasoning for adding another year of fellowship: “I'd already seen where heart failure was going from the standpoint of pharmacologic strategies, so the opportunity to spend a year experiencing interventional cardiology, in which percutaneous rather than surgical revascularization techniques were being expanded and perfected, was hard to pass up. The perspective I gained from being in the cath lab doing procedures was likely a reason the new Chief of Cardiology, Victor Dzau, offered me the position of Medical Director of the Cardiac Care Unit.”

Vagelos did not focus on an interventional career, however. “The year I spent doing interventional cardiology allowed me an ongoing visceral connection with the interventional world that has given me an advantage in terms of understanding what's being done percutaneously for patients, and it also added insight into the risks and benefits of the same. Almost three years ago I stepped back from doing interventional procedures, though I do miss the focus and challenge of the cath lab environment.”

He is currently in his thirtieth year as head of the Cardiac Care Unit, which may have played a role in Eldrin Lewis, MD, MPH, professor of medicine (cardiovascular) and chief of cardiology, nominating him for the Master Clinician Award. In part his nomination read: “I would like to nominate Dr. Randall “Randy” Vagelos for the Department of Medicine Master Clinician Award.  Randy is an exceptional clinician. He has been the medical director of the CCU since 1991 and is very active with the heart failure and transplant program. He is always willing to help and is a go-to person for a wide range of clinical and critical care needs.”

In a similar vein, David Maron, MD, clinical professor of medicine (cardiovascular), wrote in his nominating letter: “Randy is the doctors’ doctor. His knowledge is encyclopedic, and his clinical judgment is impeccable based on years of experience caring for critically ill patients in the Coronary Care Unit. He is dogged in his pursuit of a diagnosis or a treatment plan that optimizes quality and quantity of life. He is the one I want to care for me when I am sick.”

I see this award as an acknowledgement of the terrific collegial and fraternal atmosphere here that allows all of us to be the best clinicians and teachers possible.

Despite so many years on the CCU, Vagelos most enjoys seeing these previously unstable and unwell patients after they have recovered from their acute episode. “Maybe the most satisfying aspect of longitudinal patient care,” he says, “has been to take care of someone really sick in the hospital, hopefully contribute in a positive way to their survival, and then be involved in their care from then on. I think that connection is, for me, putting together the best of both the Intensive Care Unit and outpatient clinic worlds.”

Given the hypothetical opportunity to take an all-expenses paid six-month sabbatical, where might Randall Vagelos go, and why?

“I would likely start with a prolonged travel experience with my wife and whichever of our four children were willing and able to join us! After returning, leaving some part of that six months for academic pursuits, my focus would be on one or both areas I see as disparate but potentially additive to my current areas of expertise. I recently spent a half-day rounding with Dr. Ann Weinacker and her ICU team, which really amplified my awareness of the many areas of intensive care medicine that have evolved since I branched off into cardiology, but would likely enhance what I have to offer to patients and trainees in our Cardiac Care Unit .

“At the other end of the health care spectrum, I would love to spend time with Dr. Euan Ashley, Director of the Stanford Center for Inherited Cardiovascular Disease, and his genetics group to learn more about why patients with a family history of cardiac failure – mechanical or electrical –  have developed similar problems, and what might be therapeutic targets to either stabilize or eliminate these vulnerabilities. I think that's really where cardiology – and health care – is moving in the area of precision medicine: that is, figuring out which people are vulnerable to various genetically-based cardiovascular challenges and what therapies are going to help them.”

Finally, what did he think when he received the call from an administrative assistant telling him he was the first-ever recipient of the Master Clinician Award?

“Wow, I hope this is not a mistake! Stanford Medical School is a great institution full of terrific clinician scientists with whom I've interacted for over 30 years. I see this award as an acknowledgement of the terrific collegial and fraternal atmosphere here that allows all of us to be the best clinicians and teachers possible. I am honored to represent our whole, terrific team!”