By Elizabeth Kiem

For most doctors there is a seminal moment in which the medical mission is made clear: an inspiring patient who overcomes great odds, a miracle drug that grants quality of life to the terminally ill, or a case that is clearly beyond the reach of modern medicine but still within a physician’s daily rounds. For Brian Wispelwey, it was learning about a new deadly disease as a fourth-year medical student.

“AIDS slapped me in the face and woke me up to what it meant to be a physician,” said Wispelwey, a professor of internal medicine in the Division of Infectious Diseases and the founder and director of the University’s AIDS clinic. “We were all trained in a technological era, so there was this scientific optimism that we can cure all.”

When, in the late 1980s and early ’90s, many of those optimists were fleeing the AIDS clinics of New York and San Francisco in despair over the disease’s relentless death rate, Wispelwey was having his epiphany. As a resident at Harvard University’s Deaconess Hospital, he began to realize that a cure might not be in the cards. “We don’t cure much,” he said, “but we try to prolong life and improve its quality. When I realized we’re doing that, the goal became very different.”

Wispelwey chose to do a medical fellowship at U.Va. in 1986, when the infectious diseases program was considered among the best in the nation. But by 1988, when he was asked to stay on as a faculty member, it was clear that the demographics of Central Virginia barred the University from ever becoming a hotspot of AIDS research.

“I was told that it was academic suicide, because the numbers (of AIDS patients) were so small,” he recalled recently, “but that was my choice. I could have gone back to Boston – the place where you would be front and center and handling clinical trials. But the opportunity here was that I could emphasize the things I wanted to emphasize from the ground up. And that’s where I succeeded.”

Drawing from his earlier experience at Harvard where he was among doctors administering the first AZT trials, Wispelwey set up the Charlottesville area’s first AIDS clinic. In the 15 years since opening, the clinic has helped more than 500 patients and their families here and in Lynchburg with state-of-the-art care. In 1993, and again in ’96, U.S. News and World Report rated it among the best clinics in the country.

He also was the force behind a successful telemedicine program founded to provide long-distance care to AIDS patients in eight Virginia prisons. With his guidance, U.Va. joined a telemedicine consortium two years ago to provide consultations for the government of South Africa.

Professor Gerald Mandell, who was chief of infectious diseases until last November, saw Wispelwey as the perfect candidate to take over U.Va.’s fledgling AIDS program.

“We saw that he could function as a master clinician and teacher,” he said. “He clearly had the ability to learn with the patients, to be a compassionate provider and an outstanding teacher. And I must say, it’s proved to be a wonderful decision.”

Wispelwey’s latest endeavor is to direct a joint venture with the Medical Center’s organ transplant program for people with infectious diseases in need of liver or kidney transplants. Still in the final phases of development, it’s unclear how many hours this will add to Wispelwey’s calendar, already crowded with teaching hours, hospital rounds and consultative commitments to the hospital’s antimicrobial surveillance team.

Arranging his schedule to accommodate all these obligations is tricky, and a major worry for the 47-year-old Wispelwey, who sees his colleagues increasingly forced to abandon their low-earning academic pursuits for more lucrative medical initiatives.

“I have a genuine concern about how we’re going to pay for the commitment to teaching when everything else is being rewarded,” he said, as a prelude to a larger topic — the remuneration system of academic medical centers. “How do you (as a salaried faculty member) bring in money? Mostly by seeing patients, doing clinical activity or through research grants. The teaching allotment towards one salary is relatively small.”

The result, said Wispelwey, is a lack of incentive for Medical School professors to do what they were originally hired to do — teach.

Michael Rein, also a professor of infectious diseases, shares a secretary with Wispelwey, as well as some of his anxiety about the changing priorities of medical schools. “Two hours a week with a small group of students doesn’t pay as much as two hours in the cath lab or endoscopy suite,” Rein said.

But no one is complaining about the job Wispelwey has done in that regard. His efforts as an educator earned him the Medical School’s Dunglison Outstanding Teacher of the Year award from 1990 to 1993 — the same years he walked away with the University’s Attending Physician of the Year honor.

“We have a large faculty,” Rein said. “It’s totally not the case that by chance he would win that three years in a row.”

Jamison W. Chang is a fourth-year medical student who met Wispelwey while taking a required clinical medicine course two years ago. Last year, and again this year, he had the opportunity to work side-by-side with Wispelwey while doing an internal medicine clerkship. Chang says he has seen enough of Wispelwey to know that he will be the model for his own medical career.

“He clearly emphasizes to both his patients and those he teaches that there is a point at which modern medicine cannot change the course of illness,” Chang said. “It is at this point that he emphasizes the need to place the patient in control. … I discovered from him that physicians can do a greater service to their patients by honoring their wishes than by subjecting them to every test and treatment that modern medicine has.”

According to Andrew Darby, also a fourth-year medical student, one of the things that most distinguishes Wispelwey is the fact that he puts the education of students and residents first. “He is always striving to ensure that we approach clinical problems rationally,” Darby said, “and that we provide care that is not only optimal by current standards but also the best for each person.”

Last year his students nominated Wispelwey for the Humanism in Medical Education award. His candidacy was based on his strength as a mentor and provider of compassionate care. It is an honor that he holds above all the others, even the opportunity to be part of breakthrough research.

“I see myself as a translator,” Wispelwey said. “You get other people’s research, you translate it and bring it to the bedside and to the student. The thing I’d like to instill in my students, is a broader sense of mission.”