Physician Profile

Each month, the home page of the Resident’s Corner will feature a physician who is making great strides in his or her field both as an example and as a resource for residents If there is a physician that you would like to see on this web page, please feel free to send us a line at residents@anesthesiaweb.com.

By Giuditta Angelini, M.D.

Dr. Richard Rosenquist, director of Pain Medicine at the University of Iowa hospital, in Iowa City, Iowa, our first profile, is someone that made quite an impression on me.

At the University of Wisconsin, where I am doing my residency, it is no secret that pain management is an area that "needs growth". I have been saying this to prospective residents interviewing for anesthesiology positions for the past couple months. Unfortunately, I have to admit that the sincerity of my concern has been at times a bit dubious.

Many of my previous exposures have been with physicians for whom the Pain Clinic is among a number of different responsibilities. At times, the subspecialty of the physician (anesthesiology, neurology, internal medicine) has often dictated patient care more than the pathophysiology of the patient’s problem. Finally, most of these physicians are overwhelmed by the number of referrals from other physicians trying to avoid difficult patient contact. While I have had some good experiences, most of the time I have felt unfulfilled by what little affect my participation had on the course of a patient’s disease. In December, I went to the University of Iowa in Iowa City to do a rotation in their pain clinic. I now have a different opinion about the efficacy of a pain clinic.

Most of my experience in Iowa was shaped by Dr. Rosenquist. First of all, he makes me feel like I could never interview or examine the patient closely enough, and I never have exactly the right diagnosis. In fact, I often felt like I was letting him down. He admonished me often, "Don’t forget how to be a good doctor." He took great time and energy making sure the precise problem was isolated. I am board certified in internal medicine, and I was quite impressed with his abilities as a clinician. He would investigate thoroughly, discuss the different components of the differential diagnosis, and then expertly arrive at a single entity to explain the whole thing. He would conclude the entire interaction with the demonstration of incredible dexterity at placing his blocks.

Furthermore, describing his bedside manner as pleasant could not possibly accurately reflect his disposition with patients. I felt like he was sitting down for a little visit as I observed the way he chatted with each person. He would recall little details about each individual patient. During a presentation, he recounted a story from his fellowship training about a woman he had taken care of with complex regional pain syndrome (CPRS) secondary to a tibia/fibular fracture. She had avoided wearing anything that might reveal her lower extremities were different sizes; the calf suffering from CPRS was significantly more atrophied. After many treatments had failed, intermittent Bier blocks were starting to have some effect by the time he left for his first job as an attending. Months later his wife had a few questions about some lady sending him Christmas greetings with many pictures of her legs from all angles.

I think the most enlightening aspect of any physician is their viewpoint on the future of their own field. I thought pain ended eventually with an adjustment in the dose of narcotics. There is a cutting edge to this field regarding the pathophysiology and treatment modalities that I had no idea existed. Dr. Rosenquist opened my eyes to the multitude of possibilities that exist and are continuing to evolve. He also has tremendous plans for the future of his own Pain Clinic, where the chronic pain patients are seen in an outpatient facility. This facility is adjacent to a number of rooms where both acute and chronic pain procedures can be done just outside of the operating room.

Dr. Rosenquist mentioned a number of different staff that inspired him during his training. I would hope more residents are exposed to him over the years because I think he could supply a great deal of inspiration. I am already quite engrossed by the field of critical care, but I wonder if I might have grown more attached to the world of pain management had I been exposed to Dr. Rosenquist earlier.