Doctor Stories: Dr Richard Wolfe

Meet Dr Richard Wolfe, one of the medical specialists who contributes to the knowledge within Dem Dx.

Why did you choose medicine as a career?

That is simple: I was brainwashed by my grandfather who was a GP in NY, who trained in the era of pre specialities.

I remember as a 4 – 5 year old boy sitting in his clinic watching him see patients, including all physical examinations and history taking. It was the most wonderful thing I ever saw. So, from a very early age I had a completely romantic, not well founded, reason for becoming a physician. But that intrigue and fascination with medicine never wavered. Over my career I have also  been very much  influenced by love of teaching, and throughout my career the more I knew more I enjoyed it.

What do you enjoy about it?

Fundamentally, I was attracted to the art of diagnosis first and foremost. I have always been fascinated by the pathophysiology, and interested in infectious diseases – the Sherlock Holmes approach to clinical medicine – Arthur Canon Doyle transposed what he learned as a doctor into detective novels. The working through evidence and clues, the attention to detail, the formulation of hypotheses; that whole approach is particularly exciting and challenging.

The second aspect that has always appealed to me, I discovered in medical school. It is the scary but exciting power to actually resuscitate and save people. You have to think very quickly and just a few actions can make a huge difference. It’s about being alert, maximising and utilising all your skill and talent in a very short period of time. When it is successful, it is the most rewarding feeling that I can imagine.

How did you come about selecting your speciality?

There was one particular event that sent me on the path towards ED: when I was a med student in France, the intern supervising me was called away and I received a call from the nursing home attached to the facility saying a patient was not doing well. I was a med student still very wet behind the ears but I could tell she looked critical ill, hypotensive and raised RR – feeling her pulse she was in VT.

There were no defibrillators in those days and I wouldn’t have been confident using them anyway. I ran her back to the main emergency hospital shouting for help, set her up with oxygen and grabbed an anaesthetist. We administered amiodarone, which at the time was a really new drug – she returned to sinus rhythm and we saved her life.

It showed me that rather than panicking or hating the stress of the situation, I felt exhilarated and I also happened to be quite effective in those situations.

There was no real ED in France at that time so I moved to Denmark to do residency training in critical care anaesthetic. (I was learning Danish at that point as my wife was Danish) My uncle was a leading figure in Emergency Medicine and he urged me to come to Denver to see how it was done in the US. I wasn’t thinking of leaving Europe for the long term but thought it would be fun to go for a bit.

What is a memorable moment in your career?

One of my most memorable experiences early on was a morning case presentation meeting, which involved a clinician presenting in front of the whole clinical group, being grilled by senior physicians, and having to explain their thinking and having their decisions challenged.

The first case that I went to, happened to be the head of the department, who had made a clinical mistake. He went through what he had learned from the exercise, how the protocols would be changed, all supported by a full literary review. I was particularly struck by the intellectual honesty, the use of evidence and the didactic approach to decision making. To have such a forum where everyone is comfortable voicing opinions, was intellectual love at first sight and was a real driver for me wanting to stay.