Ode to Burton ‘Bud’ Rose, MD – Renal and Urology News

Likemany of my colleagues, I was very saddened to hear of the passing of Dr BurtonBud Rose on April 24, 2020 at the age of 77 years. There were two importantsides of Dr Rose: First, he was well known in the nephrology community asan extremely modest, brilliant nephrologist who published 2 important textbookson nephrology. Second, and more importantly, he was the founder and editor ofUpToDate.

DrRose was born in Brooklyn NY in 1942.He attended Princeton University,where he majored in history. He then attended New York University School ofMedicine, where he also completed his residency and fellowship.Afterserving in the US Navy as a nephrologist, he moved to Wellesley, Massachusettsand began his academic career, with positions at the University of MassachusettsMedical School in Worcester, Massachusetts, and Brigham and Womens Hospitaland Harvard Medical School in Boston.

Dr Rose seems to have touched everynephrologist of my generation.I first came across his work Pathophysiologyof Renal Disease, when I was a student on the nephrology rotation at BaylorCollege of Medicine in Houston.This book, as well as Clinical Physiologyof Acid-Base and Electrolyte Disorders, provided me with my foundation andinterest in nephrology. Dr Rose was known for his clear style, and especiallyhis ability to express complex nephrologic concepts in a way that a student,resident, and fellow like myself could understand.

When I was a fellow, 2 of his articles werealso of great importance to me.New approach to disturbances in theplasma sodium concentration, published in the American Journal of Medicine (1986;81:1033-1040), still helps me tounderstand pathophysiologic changes that occur with hypernatremia.His Kidney International Nephrology Forum ondiuretics (Diuretics, Kidney International (1991;39:336-352) was also well-readby me and many of my colleagues.It was a great privilege to have afellows lunch with Dr Rose when he visited the University of Pennsylvania in1991. He was extremely approachable and charismatic.During lunch, hedescribed his idea for UpToDate. Several fellows at the dinner were quite enthusiastic,but others thought it was not such a great idea.

In 1992, Dr Rose started his flagshipUpToDate.Like many of my colleagues, I would see him at American Societyof Nephrology annual meeting in his at first very small booth. Nephrology wasthe first component of UpToDate, and I was fortunate to be an author of severaltopic cards.UpToDate was not successful just because it was the firstcomputer access program for medical doctors.There were several thingsthat Dr Rose did to make it special:Topic cards were directed to busypractitioners and provided expert advice; Topic cards were updated regularly,at least annually; UpToDate was established without industry funding or support,which must have been quite hard early on when there were few subscriptions andvery little income; and UpToDate has an international outreach program that hasdonated subscriptions to clinicians and organizations providing care to poor orunderserved populations.

You know the rest: There are now 25specialties covered in depth, with more than 7,100 authors and editors. Some1.9 million doctors and 38,500 institutional sites worldwide use UptoDate.Thereare more than 50 million topic views per month.The median time to obtaininformation needed during a search is a little over a minute.It isestimated that UpToDate changes physician practices one-third of the time. Whatan impact!

I consider Dr Rose to be the most influentialclinical educator in the history of medicine, with an unsurpassed impact onphysician education and patients lives. While we keep alive the memories ofgreat historical figures like Hippocrates, Galen, and Osler, their impactlessens over time as medicine changes. In contrast,Dr Rosesaccomplishments will live on and his impact will become even more substantialwith each passing day and each new click leading a clinician to learn more atUpToDate.

While (thanks to Dr Rose) I may not be able toeffectively teach students about medical conditions like deep venous thrombosisor Hashimotos thyroiditis because they get to UpToDate before me, I can tellthem the history of UpToDate and how a kind, modest, brilliant nephrologist wasresponsible for much of the learning that occurs in medicine today. I hope thatwe will all keep alive the memory of Dr Rose and that someday he will berecognized for his unparalleled contribution to medicine and patient care.

I encourage you to watch the following youtubevideo, in which Dr. Rose discussed the origins of UpToDate https://www.youtube.com/watch?v=k4nQWM6U298

Anthony J. Bleyer, MD, MS, is Professor of Internal Medicineat Wake Forest University School of Medicine in Winston-Salem, North Carolinaand a member of Renal & Urology News editorial advisory board.

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Ode to Burton 'Bud' Rose, MD - Renal and Urology News

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