Princeton Review: Rewriting the Rules

He’s written the textbooks; he’s lectured across the world and is a recognized leader in the complex field of rheumatology. But Dr. John J. Cush, repeatedly named nationally as one of the “best doctors” in his specialty, says his 25-year career thrived because he rewrote the rules every step of the way, beginning with his choice of medical school.

Dr. Cush was initially attracted to medicine at age 15 when several close family members fell ill. His first hand observations led him to determine that he could contribute to the field of medicine by combining his natural bend to science with his own well-honed communication skills. That’s when he broke the first “rule” and decided to attend medical school at St. George’s University in Grenada, West Indies, as a member of the second class.

Dr. Cush attributes much of his subsequent career focus to the St. George’s University philosophy now embodied in its anthem: “Think Beyond.” “St. George’s was all about potential and possibility and not about subscribing to a predetermined expectation.”

Racheting It Up

During his years at the University, Dr. Cush originally zeroed in on primary care as his future. He believed his strongest contributions to medicine could come in the area of patient communication. “I saw what I didn’t like – people who were the medical professionals were always intelligent, but not always able to communicate. And I decided it’s not always about writing an order for a bedpan – it’s about talking to the wife, maybe the cousin, maybe the next door neighbor as well to make sure that people are OK with the plan proposed for them,” Dr. Cush explains. “And that’s what I thought my niche would be – communicating to patients, developing my skills, helping the greatest number of people I could.”

But, somewhere during his second year of residency, Dr. Cush’s attention was caught by the intricate specialty of rheumatology, his curiosity triggered by a mysterious patient case.

“I was working with a 23-year-old woman from New York who was admitted with complex medical problems that none of my medical colleagues could seem to decipher. She had fevers; we thought maybe it was a serious infection. But ultimately, it was the rheumatologists who knew what to do and she was diagnosed with a form of juvenile arthritis ­ Still’s Disease.”

Dr. Cush explains that during the residency training years, young physicians come into contact with many specialists and “they impact you. But these guys [the rheumatologists] were like Butch Cassidy and the Sundance Kid – and I thought, ‘Who WERE those guys and why do they know something the rest of us don’t?’”

He was aware of the common perception that rheumatology meant treating “little old ladies.” Yet, Dr. Cush’s St. George’s education had taught him “to reject ‘truths’ and make my own truths.” So he dove in head first, training in the field, mounting research, and attaining leadership positions in The National Arthritis Foundation and the American College of Rheumatology.

Rewriting the Field

Now, as Chief of the Division of Rheumatology and Clinical Immunology and Medical Director of the Arthritis Center of Presbyterian Hospital of Dallas, he continually researches new therapies, treats new patients, noting wryly that of the ten patients he saw on one recent day, “three were in their twenties, one was a nine-year-old, one was 50, and two were in their 60s.” Definitely not a disease confined to little old ladies.

To battle arthritis in all its forms, Dr. Cush has spent his career at the forefront of research into enabling patients to lead happy lives in the face of chronic illness. He has investigated new biologic medicines that carry fewer negative effects in treatment than the earlier steroid therapies. And, he remains devoted to communication, though far beyond the levels he first imagined.

Beyond his one-on-one involvement in helping his patients cope with long-term chronic illness, and his teaching duties as Clinical Professor of Internal Medicine at the Texas Southwestern Medical School, Dr. Cush has published over 100 works in the field, including co-authoring the leading textbook. He serves on the editorial board of Bone and Joint and as well as on the Arthritis Advisory Committee for the Food and Drug Administration.

Despite his great involvement in rheumatology, and his non-stop responsibilities to patients, students, and the broader medical community, Dr. Cush has not forgotten the institution that encouraged him – he is a member of St. George’s University’s Board of Trustees and Chairman of the Academic Board.

John Cush, MD, says “St. George’s encouraged me by putting pressure on me to meet a new expectation for myself. I learned to carve my own path to success.” Not breaking the rules – rewriting them for a leading role in clinical and academic medicine.

Published on 05/19/2005