Career Goals and Objectives:  Scientific Biography
 
My goal is to become a consultant, application developer and independent research scientist applying problem solving technologies to make a difference in the lives of patients and clinicians who get involved with their plight. With more than a decade as sole proprietor of a clinical practice of veterinary medicine, I have the experiences which compel and define my contribution to relieve some part of the stress for the compassionate health care provider. I have an iconoclastic reputation in the pursuit of solutions to the problems of both patients and providers. In a world of exponentially accumulating technologies, I see the need for people who would be connectivists, uniting developments from diverse disciplines to solve real problems.
 
I began my professional career as a veterinarian in a mixed practice in the islands off south Florida after training which included the domains of exotic pets and marine mammals (specialty intramural tracts and AquaVet, Woods Hole, Mass. 1979). Early career developments resulted in my developing the concept of House-call veterinary practice for small animals in Tallahassee, Florida. Not only did this architecture better suit my desires to attend the needs of my clients and patients on their own terms, it afforded my freedom to maintain a higher standard of continuing education. My first professional diversion from routine small animal and exotics practice was in the domain of human-animal bond research. I provided literature review and volunteer training as founding consultant to a local pet-facilitated therapy program. Awareness of the dynamics involved in the intimate quadrants of the human life wherein we endear our pets and they us, has sensitized me to people as individuals whose stories are global as far as they see. Ever since those days, it has become increasingly difficult to recommend any course of action which is not substantiated with authoritative evidence. Veterinarians are often regarded as priests--consultants on the care of these non-human creatures that are, for many people, custodians of our self-worth. The honor and privilege that people entrust to these care consultants deserves more than mere humble opinion.
 
Thus prompted to have a better answer when asked for my services, and not being surprised when feeble answers begot feeble interest in remuneration, I found myself attracted by the promise of exploding computer and information technologies. I found myself wondering why engineers had so many problem-solving techniques that enabled their professional standards of safety and certainty. Why are these techniques not used more in application to medical problem solving? So, my next professional expansion became the pursuit of a master’s degree in industrial engineering. What I learned not only supported my suspicions that there were untapped potentials, but began the clarification of what others have done—where they have succeeded or failed. At the same time, it became evident that a discipline new to me, called “medical informatics”, was the perfect domain to unite my clinical experience and motivation with the new training in industrial engineering and my growing experience with computer science. The expansion of my career was made possible by the flexibility of my house-call veterinary practice. I had by now developed a paperless medical record system that traveled with me from house to house on a laptop computer (along with the works of others: computer aided diagnostic programs, multiple formularies, and conference proceedings with searchable text). My training in industrial engineering and a thesis on process simulation instilled an appreciation for statistical validation and the complexities of variance. On the more personal side, it not only substantiated my appreciation for diversity but also raised my hopes for dealing with the diversity represented by individuals of society. At the same time, my expectations grew that clinicians for all species would have an interest in what I was pursuing. Sensitive to the stress placed upon clinicians to provide answers in the face of adversity under an impossible burden of knowledge maintenance, I seek to engender tools that manage that expanding knowledge in more accessible, productive and objectively reliable ways.
 
As I emerged into a more national and international awareness of medical and veterinary informatics, I was particularly attracted to the work of Steve Pauker and those at the New England Medical Center’s Division of Medical Decision Making. My introduction to their work in Medical Decision Analysis was at an annual meeting of the Society for Medical Decision Making (1989). Successful candidacy for a fellowship in the Harvard/MIT/New-England-Medical-Center medical informatics training program has granted me the opportunity to pursue that interest while pursuing a doctoral degree in computer science. In so doing I have been impressed with the 20 year history of Medical Decision Analysis techniques and its scarce appearance in everyday practice of medicine. Additionally, I have of course been deeply influenced by my studies under Peter Szolovits in the Clinical Decision Making Group of MIT. Such exposure to the background of knowledge engineering applied to medicine is everything I could hope for. It has thus far been an intense training in the experience of those with similar ambitions for clinical problem solving with emerging information technologies.
 
This training has endorsed my aspirations to keep the patient in the decision making loop of medicine. I entered this training, sacrificing my veterinary practice, in hopes that I could impact patient outcomes. Thus far, it has been re-tooling my knowledge with the idioms, paradigms and techniques of knowledge engineering and artificial intelligence in medicine. I have also had an opportunity to visit distant discipline of economic utility theory and expand my exposure to psychology under the conviction that the values of the individual matter and can be addressed systematically in a way that fosters better communication and understanding between patients and their physicians. Realizing the ambitious nature of this goal, I am convinced of the need to complete the Ph.D.  in computer science at MIT to groom my exacting skills as an objective scientist and as a credential to support the credibility of my proposals. Having virtually completed the didactic portion of that goal in computer science subjects, I now have formulated a proposed method for achieving better communication and understanding.
 
The training as a fellow at Harvard/MIT Health Sciences and Technology has also provided exposure to the Boston medical research community. Very recently it has introduced me to Klemens Meyer, MD Ph.D. and the plight of the renal failure patient. I am not naive to the pathophysiology and treatment of renal failure, but the specifics of the trade-offs in their decision making has attracted my attention as a fertile soil to develop specific implementation of my intended problem solving applications. This introduction has freshened my contact with the plight of the clinician asked to recommend the strategy for dealing with degenerating conditions with dignity and respect. Dr. Meyer has illuminated the ways in which dialysis was conceived for a population entirely different from what is currently seen, that of an older population complicated with comorbidities which confound the trade-offs and issues of treatment. The plight of the clinical nephrologist can easily be seen as one in need of any light my research accomplishments can shed.
 
In short, the dialysis patient provides a specific problem to address with my goal to bring problem solving technologies to bare in the lives of patients and diagnosticians who get involved with their plight. This goal is served appropriately by the Mentored Career Award Program. It provides the opportunity to complete the Ph.D. not attainable in the time I have had to date as a postdoctoral fellow and to complete my preparation for a lifetime of connecting empirically sound technologies with personal outcomes of first renal failure patients and hopefully other patients as well.