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June 7, 2000

George L. Engel, MD

JAMA. 2000;283(21):2857. doi:10.1001/jama.283.21.2857

Few of us in medicine have the creativity, vision, or persuasiveness to have a transforming influence on the fundamental ways in which we think about health and illness and frame our approach to the care of patients. George Libman Engel was such a person, and our profession is poorer for his passing, which we mourn.

Engel's early life experience undoubtedly influenced his professional career interests significantly. He, his parents, and his brothers grew up in the home of his uncle, Emanuel Libman (of Libman-Sacks endocarditis), distinguished pathologist and internist at Mount Sinai Hospital in New York City. A superb clinician and keen observer of patients ("he could smell typhoid fever on a ward"—George Engel's words), Uncle Manny, of whom Engel spoke and wrote often, surely had a profound effect on George, his twin brother Frank, and their older brother Lewis. Frank went on to become a distinguished internist/endocrinologist at Duke and Lewis a distinguished biochemist at Harvard.

George Engel attended Dartmouth College and graduated from the Johns Hopkins Medical School in 1938. He then served a 2½-year rotating internship at Mount Sinai before going on to the then Peter Bent Brigham Hospital in Boston for fellowship training.

Engel's first article, published in 1935, dealt with organic phosphorous compounds in muscle. Many of his other early articles also were principally biomedical in their orientation. One suspects, however, that the early influence of Libman and Engel's own growing interest in the science of clinical observation, led him quite naturally to come under the influence in his later training years of several clinical masters and patient-centered mentors who had a broad view of human biology. Special among these were Soma Weiss and John Romano, with whom Engel worked when he was a postresidency fellow at the Brigham. Both were important to Engel's growing concern with the interaction of psychological and biological forces in health and illness.

Engel accompanied Romano when the latter was recruited to become chair of psychiatry at Cincinnati. In 1946, Romano was recruited to the chair of psychiatry at Rochester and he asked Engel to accompany him so that they could pursue together their common cross-disciplinary objectives for medical education and patient care. They chose Rochester because of the collegiality of the faculty and because they perceived it to be a school with "freely permeable" departmental barriers—as Romano put it. Both characteristics, they felt, would make the institution hospitable to their interdisciplinary way of thinking. The support of Dean Whipple, Wallace Fenn (chair of physiology), and William McCann (chair of medicine) was key to their decision to come to Rochester and their ultimate success in achieving their goals.

Rather than educating psychiatrists, they focused on the education of medical students, introducing them to what Engel later called the "biopsychosocial model," described in his seminal article in Science in 1977. The objective was to give students and ultimately others an appreciation of the interaction among biological, psychological/behavioral, and social forces in maintaining health and influencing the onset and course of illness. Engel also emphasized the influence of the physician himself/herself, as a person, in helping the patient remain well, and in the healing process. He also stressed to other faculty that the manner in which we treated our students would influence how they treated their patients. It took time, but ultimately belief in the validity of the model became accepted at Rochester and then widely in the United States and abroad.

Engel was increasingly given a national and international platform to talk about his ideas, as an invited speaker and visiting professor at many institutions. His more than 300 publications embraced the fields of psychosomatic medicine, internal medicine, neurology, and psychiatry, an expression of his capacity to bridge multiple disciplines. Engel has had an enormous impact worldwide on our understanding of human disease, on the education of health professionals, and on humane patient care.

Engel's leadership role in professional societies and the many awards and honors he received are too numerous to mention here, but one that he especially treasured was his selection in 1997 by the Association of American Medical Colleges for the AOA Distinguished Teacher Award.

Dr Engel died suddenly of cardiac failure on November 26, 1999, at his home in Rochester, NY. He was predeceased by his beloved wife of more than 60 years, Evelyn, who died in 1998. He is survived by his son Peter (Albany, NY), his wife Anna, and their children Julie and Eric; and by his daughter Betty (San Diego, Calif) and her husband Michael.