He spent five decades ‘folding socks’

After 50 years, Dr. Jim Bryan is retiring from UNC. And no one can replace him.

He spent five decades ‘folding socks’ click to enlarge Dr. James A. Bryan II will retire after 50 years at the UNC School of Medicine.

The moral center of internal medicine at UNC. A fierce patient advocate. The greatest influencer of medical education in North Carolina.

When James Bryan II, MD, MPH, professor of medicine and social medicine, hears some of the sentiments colleagues and former students use to describe him, he laughs them off.

“Oh, don’t puff me up, please.”

According to Bryan, he has simply been practicing medicine for the last 50 years the only way he knows how: by focusing on his patients and making sure they receive the best care possible. It sounds simple, but in today’s ever-evolving medical landscape, where beeping technology can trump listening, and specialists see patients more than generalists do, practicing medicine in this manner is a complicated feat.

“I believe my patients are my responsibility,” said Bryan. “They need a generalist to follow them through life, and that’s me. Having a primary care champion is the best medicine.”

And while Bryan delivers advice to medical students and colleagues in a folksy manner and preaches simplicity, his colleagues say that they have never encountered such a keen diagnostician, internist and patient advocate in their time at UNC.

“It’s not possible to replace a man like this,” said Thomas Miller, MD, section chief for Ambulatory Education and Practice. Miller, who was one of Bryan’s first students when he started an introduction to medicine course in the early 1970s, said that Bryan practiced and taught a patient-centered brand of medicine -- long before patient-centeredness was a buzzword in medical school curricula.

“Jim has an unconditional positive regard for his patients,” said Miller. “He did not have to take detailed notes because he always remembered everything about a patient’s illness, their family and friends, and their place in the community. That’s because he has a keen intellect and memory.”

Those superior mental skills, as well as an interest in medicine, came from his mother. Bryan spent the first nine years of his life in Japan, where his father was a Presbyterian missionary. His mother, whose father was a doctor, gave him biographies of David Livingston and Albert Schweitzer to read as soon as he knew how. The family left Japan right before World War II and returned to Alabama. In the early 1950s, Bryan came to North Carolina as an undergraduate at Davidson College.

“In those days the only respectable professions at Davidson were doctor, lawyer, military or clergy,” said Bryan, “and I enjoyed science.”

After medical school at the University of Pennsylvania and a fellowship in hematology, Bryan joined the organization that would later become the Centers for Disease Control as the country’s last Epidemic Intelligence Service Chief of the Polio Surveillance center. He came to UNC in 1964 as a research fellow and instructor to run the student clinic, attend on the medical wards and work in hematology clinic.

As hematology expanded with the treatment of solid tumors, treatment sometimes exceeded patient capacity.

He expanded his focus to general medicine, where he could care for patients throughout their lives. He began teaching medical students in their first year in the introduction to clinical medicine course, which he developed and taught for two decades. In 1974, he also shared in developing  Hospice in North Carolina, a passion he continues to this day, and soon had Hospice in every county in the state. On campus, he pioneered the Student Health Action Coalition (SHAC) as one of the group’s first advisors. He was recognized with dozens of teaching awards.

In recognition of his accomplishments, the School of Medicine’s Whitehead Society gives the James A. Bryan Award to students who improve the medical school community and better the educational experience of fellow medical students. The Department of Medicine’s Bryan Award is given to residents whose performances best embody the qualities of Bryan, including excellence in ambulatory general internal medicine, and altruism, positivity, exuberance, and a life-long commitment to learning and self-improvement.

“The most important thing for my students was hearing the stories of people in need,” said Bryan. “I tell them that being in clinic every day is like reading a novel. You have to hear the stories.”

One of the students who understood the message was Paul Chelminski, MD, MPH, associate professor in the Department of Medicine. Chelminski met Bryan as a medical student in 1994 and was inspired by Bryan’s way with patients. Later, as a resident under Bryan, Chelminski saw firsthand how Bryan managed to make each patient feel like the most important person in the room.

“He used to say to us in clinic, ‘You go give out the Gorillacillin [antibiotics], I’m going to do social work,’” said Chelminski. Bryan would make his rounds, nail clippers in his lab coat, ready to trim his patients’ toenails. 

Chelminski also saw Bryan perform house calls, something he has incorporated into his own practice, and comfort patients in their last moments. More than anything, Bryan makes patients confident in their ability to get better, and makes medical students confident in their ability to do better.

“He told me that I could do my first spinal tap, my first invasive procedure as a medical student,” said Chelminski, “and I believed him.” 

Tim Carey, MD, director of the Cecil G. Sheps Center for Health Services Research, met Bryan when he came to UNC in 1983. He learned how to navigate the world of academic medicine from Bryan, but he also learned to always be wary of anything that looked like bureaucracy getting between patients and their care.

“Jim is known for going to the mat for patients, making phone calls and writing letters,” said Carey.

Bryan’s colleagues note that his frustrations with medical organizations, insurance providers and administrators were always handled gracefully but with force.

Chelminski recalled that in the 1990s, when new Medicare charting systems required physicians to document an “onerous” amount, Bryan quietly filled out his charts in Latin.  He had asked the bureaucrat instructing the physician whether the verbiage had to be in English and he could not answer.

Health care reform now requires even more documentation and the implementation of completely new electronic medical record systems, meaning the learning curve for the changes will take some focus off of Bryan’s style of simple medicine. That’s a lot of change for someone who is reluctant to even wear a pager. However, Bryan insists he is no Luddite.

An artificial hip and a pacemaker keep him spry at 82, and he marvels at what he has seen medicine do in the last 50 years. He also credits a priceless assistant with making sure his patients could always reach him, even at home, where they would often call.

Bryan, who lives with his wife in Chapel Hill, has four children—three sons and a daughter. All of his children and nine grandchildren live in the region, and Bryan said he is looking forward to spending more time with family. 

Family time aside, Bryan certainly isn’t planning an idle retirement. He is very involved in community work, including the First Presbyterian church in Chapel Hill, the free Samaritan Health Center in Durham and the Chapel Hill homeless shelter. He also plans to continue his work with Hospice at UNC in a fundraising role. There is no question that his influence will be seen in North Carolina for decades to come.

“I would be willing to bet there’s nobody in the state that’s had a greater influence on the education of medical students than Jim,” said Miller. “He’s touched so many of them in a 50-year career, and touched them in such meaningful ways.

Chelminski summed up his mentor’s approach to the practice of medicine with a fond memory. He said a colleague saw Bryan going into clinic one day and asked him what he was doing. “I’m just going to fold socks,” Bryan said. Chelminski explained that this was Bryan’s way of explaining his work in patient care and medicine: It was the work of a servant—humble, necessary and of fundamental importance—it was done simply. 

The Department of Medicine cordially invites you to a retirement party to honor and celebrate Dr. Bryan. The event will be held at Alumni Hall, George Watts Hill Alumni Center, on March 21, from 5:30 - 7:30 p.m. The program will begin at 6 p.m. Heavy hors d'oeuvres will be served. Please RSVP by email no later than March 12. Click here to find out details and to view the event flyer. To learn how to donate to help fund the construction of a new UNC Hospice Inpatient Facility in Dr. Bryan's honor, visit http://bryanretirement.kintera.org/.