In 1962, Louis R. Caplan, valedictorian, summa cum laude graduate, and future world-class stroke authority was advised that, if he wanted to make a living in neurology, he would have to add psychiatry to his practice.
“There were few neurologists in those days,” he says. “I was the second to join the faculty at Beth Israel Hospital in Boston in 1970, and there were many who questioned why it was necessary to have two neurologists on staff. “Today, there are 55!”
Caplan, who is board certified in medicine as well as psychiatry/neurology, is professor of neurology at Harvard Medical School and senior neurologist at Beth Israel. He was feted by his alma mater recently with a full-day symposium and banquet commemorating a career that prompted the department of neurology to name the new Louis R. Caplan Stroke Service in his honor. His path to this celebratory event led from internship and residency in medicine at Boston City Hospital to a residency in neurology at Harvard, and a fellowship in cerebrovascular disease at the Massachusetts General Hospital.
William Weiner, MD, chair of the department of neurology, has been a colleague and friend of Caplan’s for many years. “Even beyond his stature as an eminent alum and internationally regarded stroke expert, Dr. Caplan has made enormous contributions to our field through his training of young doctors,” Weiner says. “He continues to challenge them to explore the complexities of our field, and to think for themselves, rather than being swept up with the tide.”
Considered by many to be the world’s leading authority on stroke treatment (a distinction he quickly dismisses), Caplan says he loves teaching, but his methods are of the unconventional variety. “My own bias is that didactic teaching is less important than mentoring with residents, taking them with me on rounds, and talking about cases,” he says.
His writing and global activities alone are convincing evidence of teaching excellence well above the norm. He is the author or editor of 35 books, more than 600 articles and chapters in medical journals and books, and he has trained 60 stroke fellows, including 28 international fellows. He has been on the editorial boards of 29 medical journals, has delivered 35 named lectureships, among them the 2000 Thomas Willis Lecture for the American Heart Association. In addition, he is an honorary member of the German, Australian and Hong Kong Neurological Societies and the Korean Stroke Society.
Almost from the beginning, the young Caplan was interested in stroke, then primarily treated by internists. He saw the specialty as the merger of his own two disciplines—neurology and internal medicine, and he debated, in his mind, who should be caring for stroke patients. At the time, there wasn’t much that could be done for these patients. Stroke was considered a disease of the elderly. Past a certain age, people with serious degenerative illness had strokes and died.
“At that time, we couldn’t see the brain. There were no CTs or MRIs,” he says. “All we could do was x-ray the skull. Now we have technology to rapidly and safely study stroke patients. We can perform accurate vascular studies. We know more about blood and coagulation, and much more about the heart using echocardiography. There are many more people recording information on stroke through stroke registries that deal with sub types of the disease, how they present, and all the clinical findings related to brain function. But all that has evolved over the past 30 years.”
So what does a physician who has dedicated his work to attacking stroke do in the total absence of therapy guidelines and technology? One might suggest building a stroke registry except that there was little in the way of computer technology in 1970, and virtually no finite history of stroke to feed into one. Nevertheless, that’s what Caplan did. He came up with the idea and co-developed the Harvard Cooperative Stroke Registry, which ultimately became the first medical registry for any disease.
“I connected with a statistician at MIT who knew as much about medicine as I knew about computers,” Caplan says “We had to start with ballpark figures. Working obsessively to design the program, we collected information on almost 800 patients over a number of years. When we submitted our findings to the New England Journal of Medicine, it was disappointing to receive their reply arguing that no one understood computers, and that computers would never have a place in medicine.”
Fortunately, the National Institutes of Health had a different vision on computers in medicine. They stepped in and sponsored what became the National Stroke Data Bank.
Caplan is a man who clearly enjoys what he does, especially consulting on complex cases. He has been called to consult on strokes incurred by world leaders and the famous in almost every walk of life. When Ariel Sharon had a stroke, it was Caplan who was involved long distance in all the decisions regarding his care.
Asked what were the primary building blocks to his global success, Caplan credits being trained by giants a the University of Maryland, as well as at Harvard. Beyond that he reckons it was hard work and a lot of luck that guided his career. Those who know him well have another slant to his success story, however. They claim he is more than a superlative clinician with a worldwide patient roster.
Barney J. Stern, MD, professor of neurology and director of the clinical stroke program, says, “As a doctor and as a person, Louis Caplan has had a strong influence on many of us in neurology because of his advocacy for excellence and dedication to patient care.”
As for Caplan, he tells young people today that medicine is still the best career, and neurology the best discipline. “I believe neurology provides the most intellectual stimulation, and the best opportunity to help patients,” he says. “Stroke happens quickly, and it devastates people. A doctor who knows the field can do enormous good. What more could any physician want?”
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