Dr. Clay Block is a professor of medicine in the division of nephrology with interests in clinical reasoning and the relationship/tension between the provision of health care and the administrative and economic constraints placed on providers. As this month’s featured physician in the department of medicine, he explains his return to UNC, how he chose his speciality and shares some of the best advice he’s ever received.
What brought you to UNC Medical Center?
My return to UNC is something of a homecoming. My wife and I trained here in the early 90s. I had the privilege to “grow up” with many of the members of the department of medicine and division of nephrology, including Drs. Hladik (Jerry), Nachman, Detwiler, Kshirsagar and Denu-Ciocca, under the wing of Dr. Colindres, Dr. Falk and others. Over the past few years I began to interact more with Jerry who was kind enough to include me in some educational projects with the American Society of Nephrology. Ultimately, this led to an invitation to return to my roots and work directly with him and the brilliant group of nephrologists, clinicians, scientists and staff who have assembled here. Although I was very happy in my life and position at Dartmouth and the Veteran’s Administration in Northern New England, this was an offer I could not refuse.
Where are you from?
I was raised in Northern California (Napa) and spent my whole life in that region before foraying to UNC for my internship.
Did you always want to be a doctor?
I dabbled in college with physics and engineering but ended up gravitating to biology and ultimately to medicine. I didn’t apply to medical school until after I had graduated from college and wasn’t sure about it until I started. Then, I loved it.
How did you choose your specialty?My dad was a nephrologist (and would have fit in beautifully here). He worked extremely hard, every day, every week, but enjoyed every minute of it. It sounds cliché, but he could work all day and night. The only things he ever complained about were administrative; never the clinical work. This left me with an appreciation for nephrology. And although I enjoyed all of my rotations with great mentors in all fields, from coagulation to the ICU to GI, etc., it was the personalities of nephrology that sold me. The section was like a family and my closest friends from residency felt the same way. The variety of clinical challenges and the complexity of renal physiology were also very appealing.
What do you find most rewarding about your work?
It is hard to pick out something most rewarding as it changes every day. Many days I am inspired by the cutting-edge work of my colleagues and their experience and insight. I admire the resiliency of many of our patients. I love the opportunity to see patients with learners who are much smarter than me. I think I learn something new every day, or at the least, discover something that I should know more about.
What are some of the new developments in your field of specialty?
One of the criticisms of nephrology has been the lack of a real innovation since the advent of dialysis. However, I think we are on the verge of revolutionary technologies that will change the lives of our patients for the better, such as the miniaturization of dialysis equipment. I think the major development that we are undergoing now is a real commitment to providing care that focuses on patient goals and experience rather than those of the system. In some ways, it’s a shame that this has to be a development and hasn’t always been the way, but dialysis has long been controlled by “pay for performance” structures that have resulted in too many “one-size fits all” strategies. Personalized medicine can refer to picking drugs and therapies based on a particular patient’s unique genetic and environmental parameters, but it can also mean better adapting conventional care to a patient’s circumstances. Another area of innovation is in the preventative phase of care, with earlier recognition and better management of conditions that may predispose patients to kidney failure.
Is there a particular achievement (professional or personal) that has been most gratifying to you?
I have been very lucky to have had the opportunity to work in a wide variety of situations over my career. Although I’ve spent the bulk of my time in an academic practice, I’ve also worked in other models and systems including private practice, HMOs, and the VA, as well as brief forays into international work. I think this variety provides perspective that makes me a better teacher and clinician. I am grateful to have this breadth of experience. I also want to say how honored I am that Jerry and the others had the confidence in me to bring me back.
What is the best advice you’ve ever received?
I can think of many things but three come to the top: My father said something to the effect: “Always do everything that is in the best interest of your patient and never do anything that isn’t.” I think these are words to live by as a physician. Another piece of advice, and I don’t remember who exactly said this, goes something like: “if someone disagrees with you, your first thought should be ‘maybe he/she’s right.’” Finally, I would be remiss not to paraphrase Dr. Blythe who said “always take a history.” Many others have said it too, but never as eloquently and with as much wit as Dr. Blythe.
If you weren’t a physician, what would you like to be doing?
I think I might be an archaeologist.
What hobbies do you enjoy?
I play soccer every chance I get, though my knees and back are more and more rickety. I enjoy fly fishing, though I remain a mediocre fisherman at best despite years of effort. I love to travel and hope one day to learn how to take decent picture.
Do you have a favorite quote or life motto?
I like everything by Yogi Berra including: “When you arrive at a fork in the road, take it.”