As a young attending physician, Al Mulley '70 helped a family to decide whether to perform a tracheotomy on their elderly relative with end-stage lung disease. At first, Mulley said, he tried to approach the problem quantitatively, but as he watched the family grapple with the choice, he realized they were far more concerned about quality of life than probability of survival. In the years since, Mulley has dedicated his career to ensuring that the medical decision-making process is a collaboration between health care professionals and informed families.
Mulley a member of the Board of Trustees since 2004 will leave the Board to become director of the newly created Dartmouth Center for Health Care Delivery Science.
Mulley currently serves as chief of the General Medicine Division and director of the Medical Practices Evaluation Center at Massachusetts General Hospital, where he has worked for the past 35 years. He is also an associate professor of medicine and health policy at Harvard Medical School.
Karen Sepucha '93, who said she joined the MGH and Harvard staff largely to work with Mulley, called him "a pioneer in the field of quality of care."
"He's in a sense revolutionized the way people are thinking about decision-making," she said. "He's one of the few people who could really make some significant, measurable improvements in the quality of health care."
Mulley entered Dartmouth in 1966, the year after Medicare was passed, and was "pre-med by default," he said in an interview with The Dartmouth. As a first-generation college student his parents had seventh- and eighth-grade educations, respectively he said he simply did not know what other options were available.
During his junior year, Mulley said he was asked to join a student-faculty steering committee to design the College's first human biology course. At the committee's first meeting, biology professor emeritus William Ballard '28 brought six copies of a recently published paper titled "The Tragedy of the Commons," which discussed the problems faced by those managing common pool resources. Mulley said he was immediately interested in how these issues affect the medical community.
"I thought there was this tension between allocating resources for the health care populations which was big news back then, because we had just passed Medicare and providing personal medical care to individuals," he said.
Upon graduating from Dartmouth, Mulley knew he wanted to go to medical school, but only at an institution that would also allow him to study economics, he said. In 1970, he enrolled in both Harvard Medical School and the Kennedy School of Government as one of only three students receiving both an MD and a degree in public policy, he said.
Mulley began working at MGH in 1975, but has remained involved with Dartmouth faculty and the College throughout his career, he said.
Mulley's colleagues have lauded him for his ability to make connections between different fields.
"I think where most of us mere mortals have to push ourselves to think outside the box, [Mulley] would have to push himself to think inside the box," Michael Barry, one of Mulley's colleagues at MGH, said. "It's really quite remarkable. Big vision is his gift, and it sounds like he's a perfect match for this new center."
Barry serves as the director of the Foundation for Informed Medical Decision Making, a nonprofit co-founded by Mulley.
The impetus for the foundation came in 1982, when Dartmouth Medical School professor Jack Wennberg the future founder of The Dartmouth Institute for Health Policy and Clinical Practice published a paper describing practice variation for 10 surgical procedures in the United States.
"I read that paper, and I said, This distinction between probabilities and utilities driving decisions is really important,' so I came up and introduced myself to him," Mulley said.
In 1989, Mulley and Wennberg created the FIMDM to ensure that patients have access to information they need to take a role in determining their own medical treatment, according to Barry.
Mulley is the editor of the first and most widely distributed textbook about primary care medicine, in addition to being a dedicated fan of the Boston Red Sox and rowing, Barry said.
In addition to his time as a College trustee, Mulley became an overseer at the Dartmouth Medical School 12 years ago, he said. He has also served as a trustee for Dartmouth-Hitchcock Medical Center, although he will step down from both positions to join the Center.
Mulley's daughter Kate graduated from the College in 2005, and his son Alex graduated from the Tuck School of Business in 2008. Mulley called Hanover his "second home" and the "perfect" place to move. Although Mulley has spent most of his career in Boston, "if he cuts himself shaving, he bleeds Dartmouth green, not Harvard crimson," Barry said.
Mulley said he is excited to "roll up [his] sleeves" in his new position at the Center, where he will begin work Nov. 15. The Center which was created in May with a $35 million anonymous donation will offer courses related to health care to undergraduates and introduce a master's degree program through Tuck and TDI.
"Because of the strengths already existing at Dartmouth, this center has the resources to facilitate new innovative partnership that will find ways to make health care more efficient," Mulley said.
The Center hopes to begin offering master's degree courses in July 2011 to a class of 50 students, according to Mulley, who said he hopes to expand the program in the following years. The governments of the United States, the United Kingdom and China are all looking to Dartmouth to develop innovative new ideas related to health care delivery, Mulley said.
Harvard also recently announced plans to open a primary care research center following a $30 million donation, The Dartmouth reported previously.
Christopher Coley, who worked with Mulley at MGH, called him a "big-picture innovator" who will be a "great addition" to Dartmouth.
"He comes from a very solid clinical background and maintains, through his contacts, that front-line perspective for what this will mean for the actual primary care physician," Coley said.
Mulley was the chairman of the Presidential Search Committee that selected College President Jim Yong Kim.
"He has just been a sensational trustee and a sensational partner for me to work with on the presidential search and on other projects that we've worked on as trustees," Trustee Ed Haldeman '70 said.
Staff writer Angie Yang contributed reporting to this article.
