Hooked on Rheum with Andrew J. Laster, MD
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I have been told that I wanted to be a physician since I was a little kid, likely influenced by my maternal grandfather, Bernard Aschner, MD. He was a gynecologic surgeon and physiologist trained in Vienna and Berlin, who showed that the pituitary gland controls growth and sexual development by successfully performing transsphenoidal hypophysectomies in pups and comparing them to controls from the same litter. He later taught the surgical technique to the neurosurgeon Harvey Cushing, MD.
It was the mentors whom I was so fortunate to work with at Johns Hopkins while a medical student and house officer who hooked me on rheumatology. I initially thought I wanted to be a hematologist. While in medical school, I had the opportunity to work with C. Lockard Conley, MD, founder of the division of hematology. He had an interest in autoimmune diseases including idiopathic thrombocytopenic purpura, as well as autoimmune hemolytic anemia, and was the first to discover and describe the lupus anticoagulant. That really piqued my interest in the field of immunology.
Then it was the amazing confluence of clinicians at Hopkins in the 1970s that sealed the deal. In that place and time, there was Phil Tumulty, MD, author of The Effective Clinician; the geneticist and chair of the department of medicine was Victor McKusick, MD, who had a special interest in heritable disorders of connective tissue; and the rheumatology division itself was headed by Mary Betty Stevens, MD, FACP, FACR; with Frank Arnett, MD; Marc Hochberg, MD, MPH, MACP, MACR; Fred Wigley, MD; and John Reveille, MD.
Ultimately though, it was the challenge of caring for patients with complex, multisystem diseases that often unfolded over time that was so intriguing. Clues were yielded by a detailed history and meticulous exam. As others have noted, the rheumatologist is the Sherlock Holmes of internal medicine, called in when the diagnosis appears elusive.
Having been in practice now for 36 years, I have never regretted my decision to be a rheumatologist. I have come to appreciate the unique privilege of caring for patients, as well as their family, friends and neighbors, over many years and the trust imbued in that relationship.
Rheumatology continues to be an ever-evolving field — from the introduction of biologics more than 2 decades ago, to novel markers for diagnosis and measuring disease activity, to the potential of predicting response to drug therapy. Lately, the COVID-19 pandemic has further expanded our role to require knowledge of vaccines and how best to manage our immunosuppressive therapies around the time of vaccination.
It is a bright future and one that I hope I can continue to participate in for many years to come.
Andrew J. Laster, MD
President
Arthritis & Osteoporosis Consultants of the Carolinas