Pulse
The Human Touch
For 50 years, rheumatologist Gerald Mullin, M.D., has taken a high-touch, low-tech approach to practice. And patients love him for it.
Curmudgeon isn’t a word most people would associate with Gerald Mullin, M.D. Instead, they often describe the semi-retired rheumatologist as “soft-spoken,” “kind,” and “a gentleman.” Mullin, whom friends and colleagues used to teasingly call the “boy doctor,” exudes a youthfulness and vigor that belies his 70-plus years.
Yet Mullin knows some of his opinions on medicine might sound downright curmudgeonly. At a time when medicine has become increasingly reliant on diagnostic testing, expensive drugs, and high-tech devices, Mullin continues to preach a softer, gentler kind of doctoring that emphasizes communicating with patients and thorough physical exams.
“That was my idea of what a doctor was supposed to be,” Mullin says over coffee at a south Minneapolis ice cream shop. “He was supposed to listen, and then he was supposed to do a physical exam and make a diagnosis based on the physical exam and what the patient said.”
It’s a philosophy Mullin still practices in Guatemala, where he volunteers at a clinic run by the St. Paul-based nonprofit Common Hope.
“I’m all for science,” Mullin adds. “I’m always amazed at what people can do because they figured it out. But doctors have to be able to use the science and technology in a way that will allow them to understand human beings.” That means spending more time listening to patients and examining them before ordering expensive and often unnecessary tests. Too often, he says, patients would arrive in his office with test results in hand before a diagnosis had been made. “It’s a waste of money,” he says.
Mullin says a physical exam can reveal whether a patient is likely to have rheumatoid arthritis, lupus, osteoarthritis, or inflammation of the cartilage, or if the source of a problem is in the synovial membrane. “And you can find that out just by feeling it,” he adds.
During an exam, he gently probes for the source of the pain: Is it the joint, the muscles, or the tendons, or some combination of the three? He feels to see if there’s a thickening of the tendon and looks for signs of inflammation such as heat or redness.
“The clues are there,” he says. “You can define it more on the physical exam than you can by ordering laboratory tests.”
Problem Solver
As a student at the University of Minnesota Medical School in the mid-1950s, Mullin was initially interested in infectious diseases, but that interest changed during his internal medicine residency at Mayo Clinic. “I ran into these rheumatologists in Rochester who said, ‘Well, do a physical exam. Grab somebody’s wrist and squeeze it, turn it, feel it, and look at the skin, then [make] the diagnosis.’”
Their approach appealed to Mullin; but rheumatology wasn’t offered as a subspecialty in the 1960s, and there was no board exam for it until the 1970s, so Mullin completed his training in internal medicine. He became board- certified in rheumatology in the 1970s while in private practice.
After serving two years in the U.S. Army at a military hospital in Germany, Mullin returned to the United States and joined a downtown Minneapolis practice, where for nearly four decades he provided his style of high-touch care. “I really was interested in basic patient care,” he explains. “That was the best deal in medicine for me: understanding people and trying to work out their problems—helping them work them out was what it amounted to.” His long-time partner, William Hedrick, M.D., now retired, was an internist who specialized in oncology. They had an unusual combination of skills, says family physician Jon Hallberg, M.D., who joined the practice in 1995, the year Mullin and Hedrick sold it to Fairview. Hallberg stayed until Fairview closed the clinic at the end of 2000, a decision that prompted Mullin to retire.
Hallberg says Mullin’s approach to physical exams and his skill as a physician have had a big influence on his own practice. “If I’m a decent physician, I think a lot of that is due to Jerry Mullin,” he says. He notes that Mullin taught him how to do a musculoskeletal exam as well as the practical skill of giving painless joint injections, which he says amazes patients to this day. Hallberg also admired Mullin for less-tangible attributes. “There was just something that resonated in me from him. And I still don’t know what it was. It was a kindness and intelligence—a high-touch quality to medicine.”
Flip Flops and Cortisone
After his retirement, Mullin was haunted by the memory of his father, whose plans for retirement were derailed by Alzheimer’s disease and macular degeneration. So Mullen decided he should do something while he could and that was to spend more time in Guatemala.
Mullin first began volunteering two weeks a year with Common Hope in the mid-1990s. He and his wife, Margie, liked the country’s climate and the city of Antigua, where the organization is based. Mullin was also attracted to the organization’s family focused mission of providing education, health care, and nutrition to poor people.
Since retiring, Mullin volunteers part time about four months a year at Common Hope in Antigua, where he and his wife have since built a house. He works with the clinic’s staff to diagnose and treat patients with rheumatoid diseases and volunteers at Antigua’s charity hospital, Obras Socialis del Hermano Pedro.
Mullin has brought his low-tech approach as well as a focus on prevention to the clinic, says Tamalyn Gutierrez, Common Hope’s country director for Guatemala, sometimes pushing up against cultural norms in the process. One of his pet projects is to get women who work on their feet all day to wear tennis shoes instead of high heels or flip flops, Gutierrez says. “It’s a status symbol here to wear high heels.”
The high heels cause foot problems such as hammer toe, and they can cause injuries on Antigua’s cobblestone streets. Each year, Mullin sends tennis shoes to the clinic and then tries to cajole the clinic’s cleaning staff—many of whom are also patients—into wearing them. It’s a tough sell, Gutierrez adds. “I think by hitting at it every year, year after year, he’s making headway with certain people, helping them to see that their pain is often caused by things they can control, the way they carry things, the way they lift things.”
Mullin also works each year with the clinic’s arthritis patients, many of whom are women who wash clothes all day in cold water, helping them learn to manage their pain without relying on cortisone drugs, Gutierrez says. Armando Gutierrez, a Guatemalan physical therapist with whom Mullin has worked for the past nine years, tells of a 24-year-old mother of two, who had debilitating joint pain. In 2004, Mullin diagnosed her rheumatoid arthritis and began to wean her off the oral cortisone she was being treated with. The overuse of cortisone drugs is a common problem among patients in Guatemala, Mullin says. They are powerful and relatively inexpensive; but long-term use results in side effects such as diabetes, hypertension, osteoporosis, and muscle weakness. Mullin says disease-modifying drugs such as methotrexate, sulfasalazine, and antimalarial drugs are inexpensive and often effective, although patients must be carefully monitored when taking them. The newer biologic drugs that are popular in the United States are too expensive to use in Guatemala, he says. “We have to work harder at more basic methods to control tough diseases.”
Mullin’s low-budget, personalized approach seems to work. Each year, the young woman, whose rheumatoid arthritis he diagnosed five years ago, walks from her home in nearby San Juan del Obispo to the clinic in Antigua to greet Mullin with a warm embrace, Armando Gutierrez says. Half a century later and half a world away, Mullin is still providing treatment the way he always has, with a light touch and a kind heart.—J. Trout Lowen