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The Challenge of Extending Continued Education on PANLAR

By : Estefanía Fajardo
Periodista científica de Global Rheumatology by PANLAR.



17 September, 2020

https://doi.org/10.46856/grp.25.e026

"The new PANLAR president, Carlos Lozada, talks about his history with medicine and academics, as well as the challenges and stated objectives to strengthen research in the Americas. "

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Born in San Juan, Puerto Rico. His father was an accountant that worked for a multinational medical products company, Carlos Manuel Lozada Serrano, his mother, Marlene Milagros Rodriguez Gonzalez, was a social worker. “Here you may find the commitment to the community and service”.  

His maternal grandfather was a doctor and was one of the most important influences in choosing his career. His name was Jose Rodriguez Pastor. “He was from a small town in the central mountain range of Puerto Rico, Cayey, to the United States. He came to study medicine while working in different Jobs and studying at the same time. This without being to return to Puerto Rico until he finished his studies. I grew up hearing the stories of him working as a doctor, treating tuberculosis because he was a pulmonary medicine doctor. His story as a Hispanic doctor trained in the United States at the beginning of the 20th century was my inspiration.” 

He also remembers writing a diary during his student days. “I grew up with the story of the influenza pandemic that he had told me about, it happened when he was a student. It was an inspiration in terms of choosing a career and dedicating myself to service, especially to societies like the Colegio Americano and PANLAR”. 

The words to bring his grandfather to the present are not few. In his memoirs, he was also one of the founders of the Children’s Hospital in Puerto Rico, “he always taught me that service had to have a very high value. It is important not only to have your career, but to use it to try to help society and to improve the community”, he said. 

Of the group of friends who accompanied him throughout his childhood there are still four doctors with whom he is still in contact. “I grew up with a group of friends in San Juan who also shared and interest in medicine”. He summarizes it as “a very happy childhood” just a few meters from the beach. 

He moved to the University of Pennsylvania, and then went to medical school at the University of Puerto Rico, where he met his wife. He got married after he finished his studies. After this, he studied internal medicine at Cornell University in New York.   

Following his interest for being of service to his community, in 1994 he came to work at the University of Miami as his first job. He was looking for a public hospital, and that was the Jackson Memorial, there he was able to combine his passion for teaching. Later on, he was named director of the rheumatology program, and he has been in this position from 1996 to date. “My interest was clinical and also to direct the rheumatology training and education program”, he says.  

“Since the 90s I have been running the training center and we graduate two rheumatologists every year. All with different nationalities”. He considers this to be another of his great pleasures, to train Hispanic people who have served the continent.   

At first his interest was directed towards osteoarthritis. He has continued with this interest over the years in terms of clinical aspects and its management. He has published a lot of papers in this area as well as chapters regarding the diagnosis and management of the disease. “That has been my original area of interest, but over the years I have also had an interest for the management of inflammatory arthritis”, he adds. 

 

INTEREST FOR RHEUMATOLOGY

Lozada explains that rheumatology is usually interesting because it allows you to understand the functioning of the immune system in health and in disease. All the interest in immunology is fundamental. “Another aspect, which is also my case, is that there are mentors who guide, for me, it was Richard Furie”, he points out, acknowledging his learning through the relationship with patients, research, and, always behind everything, the calling for service.  

In this field, he points out, you have a lifelong relationship with the patient. It is not a specialty that allows you to see a patient for a week or for a short time, the hope is that you will be able to help the patient improve his/her life, and that doctor-patient relationship will last a long time. This was precisely what appealed to him the most.  

In short: interest in science and contact with someone who is an example and the long-term relationship with the patient. “We help them, and they sometimes help us”. 

To build that relationship requires a process that establishes challenges as time goes by. He ensures that many decades ago the doctor had more time. In the modern world everything is faster. 

“It is fundamental to try to give full attention to that patient that comes to visit us, to make them feel that we are really listening to what they have to say. it is important for them not only to tell us their symptoms but to also share how they feel, how they have affected their quality of life and their families. Rheumatology is a specialty that requires time in order to do it well, time to devote to the patient, to pay attention to what they are saying. Only by listening to what they say you may even be able to figure out what they have without even doing a physical exam. The medical history and what the patient says are the most important things”, he says.  

In every encounter there are learning opportunities, in every consult a lesson learned. This also happens in every class or lesson to his students. “Patients have taught me their perseverance, their optimism. They surprise you with the capacity that human beings have to overcome obstacles and live successful lives, giving what they can, seeking to overcome obstacles and give the best to others. The human capacity to be humane, to help one another, to confront the challenges that life gives us”.  

The students, he adds, give the lesson of being humble. “We always want to learn from them, they have the right questions, to investigate beyond what one thought one already knew. That is rejuvenating, having contact with medical students, residents, and those studying rheumatology”. 

“The fact that things are always changing in medicine, implies that we are learning more, there are new ways of seeing and investigating problems. That is fundamental for what we do in associations such as PANLAR and the American College of Rheumatology. Trying to support young researchers to have successful careers, keep them asking these questions and keep challenging us. Medicine cannot be static; it must continue to evolve and face new challenges like the one we have had this year”, he explains.  

 

PANLAR

His arrival at the presidency of PANLAR implies challenges, and as he states, some are anticipated, but others are not. “At PANLAR we have the goal of trying to continue improving in several aspects: one is to be an increasingly important provider of educational and training materials for rheumatologists at all stages of their careers”. 

He also explains that now the congress is being held annually, “we are also having more virtual educational activities the rest of the year”, he adds.  

But there is something else on this list. Leading PANLAR he now seeks to reach every corner of the continent. “In that, the unexpected thing which is what the pandemic has been for us, there has been a small positive side and that is that our ability to use technology has improved a lot. The whole thing of making virtual visits, meetings and consults already existed, but there was a certain resistance towards it, as human beings we like to see each other face-to-face, to share. But we have advanced years in these past few months in terms of doing virtual educational programs, meetings, and the hope of spreading knowledge effectively”, he says. 

The other thing PANLAR has been trying to do, with great success also and with the expectation of doing it more firmly, is to support research throughout the Americas. “We have the research unit that we hope to solidify and beyond that is in a position to support initiatives to support researchers, especially young researchers”. 

“As a professor, I also have an additional goal and that is to see how we can influence the education in rheumatology residents across the continent, to see how we can offer resources in this area in terms of solidifying rheumatology. That has been an interest of mine for many years with the goal of having more people trained in rheumatology”, he says. 

 

THE APPROPRIATION OF TECHNOLOGY

We are in a situation that no one wanted in terms of the fact that we are all living a pandemic in the world, but, Lozada says, in the midst of all this we can highlight a positive aspect: the accelerated development of technology. In his words, “It can now be used in a way that if this situation had not occurred it would have happened in a few years from now”. 

“Now we are able to use this to educate and to see our patients, there were months in 2020 that in my case we were seeing patients 100% on telemedicine, now we are returning to the medical center and personal visits. This is something that will remain to some degree, having certain hours available for the patients that may be seen through telemedicine”, he points out. 

This helps provide education to patients, but also in terms of seeing patients, “of those who live far from the urban centers where us rheumatologists tend to concentrate, those patients now have the hope of a better chance of seeing doctors without having to travel hours and hours every time they have an appointment”. 

 

PERSONAL LIFE

“It has always been a good exchange”, he says, acknowledging that medicine reigns at his home. His wife, Janet Sariego Rivera is a Physiatrist, which is why, he assures, they are in related specialties.  

“Having conversations with her has certainly made me appreciate the fact that the care for our patients is a multidisciplinary task. We can do an excellent job as rheumatologists, but if we don’t have a good relationship with the rest of the healthcare team, which would include orthopedics, physiatrists, and other related professionals, we are not offering the patient to our fullest. Having a multidisciplinary team when possible helps us and our patients to get the best out of each specialty”, he says. 

He has two sons, Carlos Antonio Lozada and Jose Manuel Lozada. Carlos is studying psychology, “It’s not medicine per se, but it’s related”. The youngest, Jose Manuel, is studying Biology. Following this, he adds, amidst laughter, “they are just getting started.”.  

In addition to medicine and his calling to serve and teach others, he has a rather large interest in history. He reveals that what he reads for leisure has to do with it, American, European, Latin American, the book he is always reading is always about that subject. 

“In terms of sport what I always played most to distract myself was basketball, it was never the main thing I did, but I did play it often as well as a little tennis. In Puerto Rico you have to play baseball, there’s no way you can’t, so as a child I did. I love being a spectator, we go to basketball games, soccer games also. Besides, I have developed a taste for soccer, which I didn’t see much of while growing up in Puerto Rico”, he says. 

He has clear goals. On a personal level it is to see his children grow and be by their side to share this experience with them, in the professional side he has a challenge with PANLAR: “To see it grow in terms of what he can do in education and support for research, these are the two things we will focus on. to grow the organization, so that we can have more resources to offer the continent”, he assures. 

In addition to this, as the director of the rheumatology division of the Medical Center of the University of Miami, he also seeks to foster the growth of research and training of rheumatologists and it is precisely in this position that he received the “Distinguished Fellowship Program Director Award” by the American College of Rheumatology a few weeks ago.  

“These will be years with many challenges and goals ahead, both in the division and in PANLAR”, he says. 

“Now you have made it difficult for me”, he replied with laughter after being asked what his personal mantra and motivation is when it comes to starting new challenges. “I tend to persevere in terms that even if things look difficult and don’t work out, you examine, modify and try again. I am quite persistent, if the goal is worth it, and of course PANLARs goals are very important”, he states. 

He adds that he also tries to listen to everyone and tries to incorporate the important notions they propose, seeking to create a strategy or plan that can support everyone in the group.  

This is how a new challenge begins. A desire for PANLAR to grow and educate, to support the researchers and also to be a continental reference. Everything under the parameter of being self-demanding, teamwork, and different strategies. A challenge led by that grandson who grew up with stories about a grandfather dedicated to serving others and who over the years seeks to continue that legacy.   

 

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