September 01, 2011

By: SALLY KOCH KUBETIN

rhnews@elsevier.com

Here is something you may not know about Dr. Eric P. Gall: He was involved with patients with tiger bites and bat bites when he was an army physician in Vietnam. Yet, he received his Bronze Star for something that he describes with typical understatement: “Epidemiologic investigation of serious disease outbreaks in less than ideal circumstances.” Less than ideal circumstances is probably the mildest way to describe practicing medicine in a war zone where there are tigers roaming about.

After his basic training, Dr. Gall went through Preventive Medicine School at Fort Sam Houston before completing 6 months of training at Walter Reed Army Research Institute in Washington, D.C., taking the Global Medicine Course. With that under his belt, Dr. Gall shipped out for 13 months in Vietnam where he was assigned to be the Preventive Medicine Officer in the Division Surgeons Office at Headquarters Company for the 4th Infantry Division, about 20 kilometers from Pleiku. That air base came under frequent attack from the North Vietnamese Army during his stay there from 1969 to 1970.

Disease control was a challenge in that tropical setting. Much of Dr. Gall's time in country was spent either advising the commanding general and staff twice daily on issues related to a variety of communicable diseases or actually treating them.

Among those disease outbreaks were plague, venereal disease, hepatitis, and diarrheal disease. Other health problems he saw included malaria, shigella, salmonella, food poisoning, animal bites including those of snakes as well as the aforementioned tigers and bats, rabies, viral illnesses such as dengue and encephalitis as well as psychiatric disease. Some of his time was spent on drinking water safety. Under him was a team that was made up of an environmental health officer, a veterinarian, six preventive medicine technicians, and a medical service core officer.

But being the big-hearted man that he is, Dr. Gall also spent time treating children at the Tu Tam Catholic Orphanage in Pleiku, and he saw patients at a leprosarium n ear his firebase located in the Central Highlands near Pleiku. Having entered the U.S. Army under the Berry Plan which required 2 years of service from drafted physicians, Dr. Gall spent the remainder of his commitment as an internist at Valley Forge Army Hospital until his discharge.

Once he was again a civilian, Dr. Gall did the third year of his internal medicine residency at the University of Pennsylvania hospital, followed by a rheumatology fellowship there. Eventually, Dr Gall became professor of internal medicine at the University of Arizona, moving on to the Chicago Medical School of the Rosalind Franklin University of Medicine and Science, where he eventually became chairman of the department of medicine and chief of rheumatology.

Being an academic internist was all that Dr. Gall ever wanted to do.

“When I was 5 years old, I told my father, who was an academic pathologist, when he asked me what I wanted to do, that I wanted to be an academic hematologist. I had no idea what academic really meant or what a hematologist was. The only change I ever made was from hematology to rheumatology, which didn't exist in 1945. I made the change to rheumatology after I met [pioneering rheumatologist] Dr. Evelyn V. Hess during my internship at Cincinnati, when rheumatology was becoming a major specialty. I never wanted to be anything but a physician, in academics, in internal medicine. I never wanted anything else, I never had a fall-back plan,” Dr. Gall said in an interview.

And that's a good thing for all the fellows he trained over the years. Both while at the University of Arizona and at Chicago Medical School, Dr. Gall has trained rheumatology fellows and medicine residents. When asked to name his greatest achievement during the interview, Dr. Gall did not hesitate: “The pleasure and honor of teaching literally thousands of students, residents, and fellows and providing care to patients outweigh all the positions I have had and honors I have received. The former allowed me to do what I hope I do well.”

Asked to reflect on her training by Dr. Gall, Dr. Margaret M. Miller recalled: “During my fellowship [from 1978-1980], Eric taught me a simple, but often forgotten element of a rheumatology office visit. Rheumatology patients should change into an exam gown and a good physical examination should be performed.

“He is a master of the rheumatologic physical exam, and has taught scores of residents and fellows the art of the physical exam. I suspect many lives have been saved because of this,” said Dr. Miller, who is the Director of Infusion Services at the American Cancer Center at University Medical Center in Tucson.

Dr. Gall recalled that his first grant from the National Institutes of Health was to develop the steps for arthritis patients to conduct an exam on themselves and then teach these techniques to students and physicians. In consultation with rheumatologists, primary care physicians, allied health professionals, and orthopedists, Dr. Gall and his team developed a checklist of what should be on a complete musculoskeletal exam.

“We then trained bright patients in the techniques and what their abnormalities were on any given day. We made sure they were consistent and reliable and then we began teaching physical diagnosis using them. Later we helped other specialties such as neurology; cardiology, pulmonary, urology, etc., develop similar patient instructors.

“We tested this in large populations and were able to show that this technique worked better than the traditional way of teaching the physical exam. We later used this model to test trainees and doctors in the diagnosis of common musculoskeletal diseases. This also eventually was able to be implemented in 12 other prestigious rheumatic disease centers around the country. Through this research I became involved with the ARHP (the Association of Rheumatology Health Professionals, then the Arthritis Health Professionals Association) as they were interested in using this educational model at the time the ACR (American College of Rheumatology, formerly the American Rheumatology Association) was less interested in educational research than they are now. It led me to big league involvement with interdisciplinary activities and I remain active with them, the ACR, the Arthritis Foundation, and other educational societies,” he said.

“Eric is one of a kind … the best kind!” Dr. Miller enthused.

Another veteran of Dr. Gall's University of Arizona fellowship training, Dr. Karen S. Kolba, recalled Dr. Gall as one of the most memorable people in her life. “I have never known a harder worker. He was amazingly efficient with his time – except for the time spent on collecting all the various organizing notebooks, sticky notes, calendars, etc., ever created. There was never a gadget made that he didn't love, if he could stuff it into his pocket.

“He was – and is – unfailingly kind to his patients and students. His knowledge of internal medicine is vast and deep, which continues to amaze me – and he helped his trainees see the place of rheumatology in the vast galaxy of medical knowledge. I hope the students at the University of Arizona where he now teaches appreciate the time he shares with them,” said Dr. Kolba, who practices rheumatology in Santa Maria, Calif.

This brings one to the fact that Dr. Gall is known as the guy who flunked retirement. Since moving back to Tucson with the intention of easing up a bit, he finds himself acting director of the Arizona Arthritis Center, which he launched a few decades ago, and he is training rheumatology fellows again at the University of Arizona Medical Center.

How's this for summing up a career to date: “I have never regretted one moment of what I have done. The joys of rheumatology and my patients, the challenge of understanding our diseases and providing new knowledge, the privilege of teaching and interacting with the people I have taught, the chance to be active in universities, the academic centers, the communities I have been in and the organizations I belong to are more than payment for the time I have spent. I have never regretted one moment and never will,” said Dr. Gall.

The honors and awards bestowed on Dr. Gall are legion. The military ones alone, in addition to the Bronze Star he received in 1970, make a fine list: Vietnam Cross of Gallantry – Unit Citation 4th Infantry Division, 1970; Presidential Unit Citation 4th Infantry Division, 1970; National Defense Medal Vietnam Service and Campaign Medals, 1970; and the Army Commendation Medal, 1969.

Dr. Gall is a founding fellow of the American College of Rheumatology.

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