When Studies Fall Short and Textbooks Fail: A Thank You Letter to Three Masters of Eminence-Based Medicine

Dear Drs. Kenneth Prebil, Charles Williams, and Gary Goldberg,

Words can’t fully express how grateful I am for the profound influence you’ve had on my growth as a physician, as an anesthesiologist, and as a human being. When I left the structured environment of academic medicine for private practice twenty-three years ago, I had no idea how much I would learn from you.

Drs. Prebil and Williams, you both taught me what it truly means to care for surgical patients. Beyond the technical aspects of perioperative care, you showed me how to recognize subtle clinical changes, trust my instincts, and make tough decisions when patients didn’t follow the textbook approach or study outcome. Your years of experience and willingness to share your wisdom shaped my clinical judgment in ways that no amount of reading or formal education could have achieved. You are both masters of the evidence, but when evidence-based guidance was lacking, your experience and surgical expertise always got us through, and more importantly, our patients!

The countless hours we spent caring for patients together, the challenging cases we faced, and the informal teachings in the OR, ICU, or on the floor were invaluable. You taught me that medicine is as much an art as it is a science, and that experience-based decision-making often goes beyond what we learn from clinical trials and guidelines. Indeed, when evidence is lacking, we are forced to rely on our basic physiologic knowledge and clinical experience, and for a young anesthesiologist, your mentorship, experience, and mastery of surgery and perioperative care were more than I could have ever hoped for.

Dr. Goldberg, thank you so much for being such a great mentor in anesthesiology. Your calm and wise demeanor, combined with your incredible clinical skills, have been a huge inspiration to me. The knowledge and insights you’ve shared over the past two decades have not only made me a better doctor, but they’ve also helped countless other perioperative physicians, clinicians, techs, and nurses.

What makes you all so special is not just your medical expertise, but your willingness to share it. You’ve taught me (and many others) that true medical wisdom comes from years of patient care, careful observation, and the humility to learn from each patient encounter. The lessons you’ve shared continue to guide me in the work that I (and many others) do every day.

I hope you three know that your influence goes far beyond the many thousands of patients you directly cared for. It lives on through those of us who have been lucky enough to have been mentored by you, and through countless patients who have benefited from your wisdom, knowledge, experience, and surgical and perioperative skill. I am so very proud to be your colleague and friend. You three are incredible. Thank you for decades of friendship, and exemplary clinical teamwork.

I am so grateful for our lifelong friendship. I love you guys, and I miss you every day.

Joshua Bloomstone, MD, MSc, FASA