Thursday, April 18, 2013

Precious bodily fluids honors William Stone

Bill Stone is another member of that dying breed of physician-scientists and master clinicians. He was a nephrology attending at the Nashville VA and Vanderbilt Hospital across the street when I was a medical student there. He had a superficial reputation for being a bit malignant but to those who knew him well he was a dedicated physician and teacher who cared greatly about the students and house staff. He was a walking encyclopedia of internal medicine. I was too intimidated to fully appreciate his teaching gifts.

Joel Topf at Precious Bodily Fluids has recently written a post in his honor which lists his 23 “rules of Stone” and mentions his research. Among many other things he discovered beta-2 microglobulin amyloidosis in hemodialysis patients.

Another of his research accomplishments impressed me as a med student. Back then IV penicillin G was used to treat a lot of serious infections. Every now and then patients with renal impairment would experience penicillin neurotoxicity and seize. Thus was born the notion that doses of pcn that were appropriate for normal renal function were “comparably massive” in patients with renal failure. Stone and one of the ID fellows got together, looked at the pharmacokinetics and worked out a method for “renal dosing” of pcn.

Of his 23 rules I like #18: “If an older doctor writes an axiom or a diagram on a piece of paper, ask if you can have it.” (Now some EBM apologists who decry experience and expertise as a basis for learning won't like this).

Sometimes I feel a little worn down by the legal and administrative baggage I face in practice. Reflecting on the legacy of the exemplars of internal medicine is therapy for me.

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