JAMES H. BURNETT III, jburnett@MiamiHerald.com
PUBLICATION: Miami Herald, The (FL)
DATE: April 24, 2007
EDITION: F1TL
Page: E10
He pokes and prods, furrows his brow and stares into space. He squeezes hands and shoulders, bestows pats and hugs. He urges his patients to talk about themselves and the events and pressures affecting their lives, about the spat that alienated a sister, the money troubles, the philandering spouse, the son's auto accident. And he listens, smiling and nodding, ears and eyes sponging up every gesture and detail. Then he probes for more delicate nuances, automatically singing along to a rhythm most people never hear, to the syncopated Phht phht phht, click-click-whoosh of a heart murmur, the Whoosh, whoosh, ssssst! of fluid in the chest or the Flub de-lub, whoosh! Flub de-lub, whoosh! of a slightly leaky valve.
Dr. Michael A. Chizner plays the guitar, but at work his instrument is the stethoscope, "the most underappreciated tool in cardiology." With eyes, ears, hands and vocal cords tuned, Chizner is a maestro, a one-man band performing and interpreting the crescendos and decrescendos, the hums and gallops of what used to be called the music of the heart.
"A hundred years ago, medical doctors didn't have ECGs or CAT-scan machines," says Chizner, director of the Heart Center for Excellence at Broward General Hospital. So aided by stethoscopes, they developed a system of diagnostic melodies.
"Most doctors my age and older are familiar with it," says Chizner, 57.
"Many don't use it anymore, because of technology. But younger medical students these days? They don't know it at all. And when technology fails, they will need to know how to detect heart problems with their ears and with their hands. They need to learn the music," need, he says, to know not just how the heart works but also how it fits within the body and the context of their patients' lives.
About a decade ago Chizner, a good-humored man who from some angles resembles Steve Martin and from others John Inman from Are You Being Served?, began a campaign to resurrect this traditional hands-before-scans approach. His textbook, Clinical Cardiology Made Ridiculously Simple (MedMaster, $34.95 in paper), with its goofy cartoons and CD of Chizner performing heart-music sound effects, is now standard reading in a dozen medical schools and treatment facilities, including Georgetown University School of Medicine and the Mayo Clinic.
"It sounds like it would be a given," says Dr. Stephen Scheidt, professor of Clinical Medicine and director of the Cardiology Training Program at New York Presbyterian Hospital-Weill Cornell Medical Center in New York City, who has trained with Chizner in the past and whose students read Chizner's book. "But many young doctors and young students today have been practically raised on computers and diagnostic machines. Half of them wouldn't know what to listen for. Dr. Chizner may just revolutionize how we treat the heart in this country, by bringing back the methods our forefathers relied on. . . . If our current and next generations of doctors are going to successfully treat the heart, they're going to have to pay attention to Michael Chizner and start thinking like him, too."
Ten years ago Linda Gruccio of Pompano Beach was a 25-year-old fitness buff who had lived with a heart murmur since she was 7. One day, just home from work, she suddenly couldn't climb the stairs. Specialists recommended surgery, but after several second-opinion consultations, Gruccio met Chizner, who asked her to tell him everything about herself.
"So I told him I had just lost my job and was going through a divorce," Gruccio remembers. Then Chizner took out his stethoscope and sang along with Gruccio's heart. 'He said, 'You don't need surgery. . . . You need stress management.' "
Because most heart problems manifest before patients turn 30, and almost half of first heart attacks occur before the age of 65, "You'd better know who you're dealing with," Chizner says, "and what they're dealing with before you put them under the knife or tell them they don't need surgery."
Gruccio's previous doctors just "didn't understand what they were hearing from her heart. You can't just listen. You have to understand what the heart is saying. Hers said" -- eyes clamped tight in concentration -- "lub, lub, lub, de-lub," the sound of Gruccio's mostly healthy but of late agitated heart.
Chizner's hardly anti-technology. He uses some of the best in his clinic. "Doctors, young and old, need to use a full set of tools," Chizner says. "And that includes the ability to connect closely with patients and a complete understanding of how the heart fits -- not just works, but fits in conjunction with the rest of our body and the other elements of our lives."
Chizner's fascination with heart music began more than 40 years ago when he was growing up in New York City.
"I was just inspired on two fronts by my uncle, my mother's brother, who worked his way through medical school playing concert piano," he says. "His musical skills were amazing, and this was during the Depression. My mother told me that he'd make house calls to . . . people he knew had no money to pay him, and after the visit he would leave money with them. So that was the first indication I got that doctors could care and could be friends to their patients."
By the time he was 10, Chizner had decided to follow his uncle's footsteps.
At Georgetown University Medical School, he met his mentor, Dr. W. Proctor Harvey, then head of cardiology and an avid proponent of classical medicine, famous for his "five-finger" approach to diagnosis: patient history (thumb); physical exam (forefinger); electrocardiogram (middle finger), X-ray (ring finger), lab tests (pinky). Says Chizner, "His expertise emphasized the human connection."
De-lub, schwep, de-lub, schwep, schwep!
Rose Marie Barnett, of Fort Lauderdale, remembers that song. She had been diagnosed with end-stage cardiomyopathy, a condition in which the heart muscle becomes inflamed and then severely weakened.
"I don't mean to sound melodramatic," says Barnett, 77, "but my doctors told me 30 years ago to get my affairs in order." Barnett's son insisted she visit his childhood pal, Chizner. That was 25 years ago.
"She arrived on a Tuesday, filled with fluids," Chizner remembers. "Her neck veins were standing up. Her muscle mass was gone, atrophied." He says he was near tears when he reached for Barnett's hand, but he noticed something: Her grip was strong. Too strong.
"She didn't have the type of alternating pulse that is common to cardiomyopathy," he says. "She shouldn't have been able to hold on so tight."
Chizner whipped out his stethoscope. "If you're a musician, you know what I mean by sound alteration. Her heart was singing a healthy Lub tub, lub tub. . . . Her heart should have been making what is called an S3 gallop. It literally sounds like a galloping horse -- tuddle up, tuddle up, tuddle up."
Chizner diagnosed Barnett with constrictive pericarditis, meaning the sack that encases the heart was squeezing so tightly the heart couldn't perform. After a computer test confirmed the diagnosis, he and a surgical team spent 14 hours scraping away the scar tissue that was choking Barnett's heart. Days later, Barnett walked out of the hospital.
"Medicine is an extremely inexact affair," says Dr. Ron Epstein, of Rochester University's Department of Family Medicine and a proponent of that school's acclaimed biopsychosocial model of patient diagnosis, which teaches consideration of psychological and societal influences on patients.
"It is somewhat art and somewhat science. The point is you need every critical factor you can bring to bear to treat patients well. If you're just relying on technology, it's like operating with one hand tied behind your back. . . . I don't want to romanticize the past. The good old days were not really that good. . . . The question is how do you make judicious use of the exam and patient interaction and the technology."
How do you make the beat go on?
Stephen Scheidt recalls the Chizner he knew at Cornell as a "remarkable song writer" who performed at Christmas shows. "I still remember him singing and dancing Blame It on the Carcinoma, a song he wrote about making diagnostic excuses. It was funny, comic relief. He had that touch even then. It's no wonder he understands what the heart means." stunning on every phone.
