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.
Jules Cohen. George L. Engel, MD. JAMA. 2000;283(21):2857. doi:10.1001/jama.283.21.2857