Keating retires

Master clinician and gifted teacher and mentor to pediatric residents ends 44-year career

Dean Larry J. Shapiro, MD, left, congratulates James P. Keating, MD.
Robert Boston

Dean Larry J. Shapiro, MD, left, congratulates James P. Keating, MD.

BY John Twombly/SLCH

In an interview prior to the 40th anniversary of his career at Washington University School of Medicine and St. Louis Children’s Hospital, James P. Keating, MD, the W. McKim Marriott Professor of Pediatrics, was asked why he established the Diagnostic Center for Children. He replied, “I felt I had some knowledge, I saw that a need existed, and I wanted to be useful.”

That simple statement sums up the traits that guided Keating’s extraordinary career and influenced hundreds of physicians and countless patients and their families.

Possessed of an encyclopedic knowledge of medicine, Keating passed on his wisdom using a Socratic style of teaching that continually tested what residents did — and did not — know about a problem through increasingly probing questions.

His vigilance for caring for children led to his recognizing the need to establish three groundbreaking pediatric clinical programs, as well as conducting research that often changed the trajectory of patient care.

And his desire to be useful meant he became a trusted mentor and colleague always ready to listen, offer advice and tackle difficult situations with Pit Bull tenacity.

“Throughout his career, Jim has been in a unique position to be a role model for physicians in training because he possesses two talents that are rarely found in one person,” says Alan L. Schwartz, PhD, MD, the Harriet B. Spoehrer Professor and chairman of the department of pediatrics at Washington University School of Medicine and pediatrician-in-chief at St. Louis Children's Hospital. “He is an outstanding clinician with an incredibly comprehensive knowledge of medicine, and he has a native instinct about how individual patients think about their symptoms and respond to their disease. Combining those talents with education — something he cherishes because it was so formative in his own life and development — was a magnificent fit for Jim and those he taught.

Filling needs

In 1968, Keating was recruited as chief resident by the late Philip Dodge, MD, then pediatrician-in-chief at St. Louis Children's Hospital and chair of the department of pediatrics at Washington University School of Medicine. What he thought would be a one-year assignment became the start of a stellar career at Children’s Hospital and the School of Medicine.

Dodge’s mission was to rebuild the school's department of pediatrics, and Keating proved to be one of the pillars of that reconstruction. He became director of the pediatric residency program in 1969, a position he held until 2002.

Matching Keating’s dedication to teaching residents were his efforts in meeting the needs of patients.

“Jim was one of the longest-serving, most successful residency directors in the history of pediatrics — not just here, but in the entire history of the specialty,” says Schwartz. “Taking on the responsibility for the minute-to-minute learning for up to 60 residents at a time can be all-consuming emotionally and physically. Jim has enormous resilience and was always up to the challenge.”

His former residents are proof of the profound influence Keating has had on pediatrics. Many have gone on to senior leadership positions at major academic medical centers or have established successful private practices in communities throughout the country. To honor their mentor, in 1998 residents established and funded the James P. Keating, MD, Outstanding Resident Award, an honor that recognizes pediatric residency physicians who embody the attributes for which Keating is known — excellence in patient care, teaching and community spirit.

“Jim’s teaching style was always demanding, thoughtful and thorough,” says Katie Plax, MD, director of the division of diagnostic and adolescent medicine. “He never minded when people said they didn’t know. But he really didn’t like it when people couldn’t admit that — he’s a straight shooter who doesn’t tolerate deception well.”

Keating saw his responsibility as one of drawing bright, eager residents into a life that involved important but hard work.

“It’s a matter of building community, of establishing a bond of trust and shared values and goals,” he explains. “There are times people deserve praise, and that should be given in a dignified, sincere way. There are times when tears are appropriate, because a lot goes on in our lives as doctors of children that deserve tears. But there also are instances when we need to examine what is happening to get at the truth of a situation.”

He admits, chuckling, “Of course, there were times when I drove people to tears without really understanding why they had that reaction.”

Matching Keating’s dedication to teaching residents were his efforts in meeting the needs of patients. He established the pediatric gastroenterology and nutrition division in the department of pediatrics in 1971 and served as its division chief until 1992. Keating is now known as one of the field’s founders, and many standard approaches to patient care worldwide originated from his work.

He also was an early proponent of pediatric intensive care. He organized the first PICU west of the Mississippi and was its director from 1980 to 1992. Today, team members of St. Louis Children's Hospital 42-bed PICU are known worldwide for their care of critically ill children.

And Keating pioneered the concept of pediatric diagnostic medicine, founding the division in 1992 and serving as its director until his retirement.

“Jim loves to solve mysteries, and the Diagnostic Center was the perfect fit for his vast medical knowledge and curiosity,” says Andrew White, MD, SLCH director of pediatric rheumatology who has succeeded Keating as director of the center. “There was never any doubt that these patients would benefit from his determination to find the answers that would improve their health.”

Being useful

Keating’s desire to “be useful” was demonstrated as much in day-to-day interactions with residents and colleagues as it was in his major achievements over the years.

“As one of Jim’s residents, I admired his brilliance and was inspired by his determination to provide the best possible care to patients,” says White. “As a faculty member, I knew that if I asked him a question, he would dig into it until there was no stone left unturned in helping find an answer. He always was a fantastic resource and a great inspiration.”

Plax uses the example of Keating’s identification of water intoxication in babies as an example of how physicians can influence patient care by continually questioning what they see in their individual practices.

Summarizing Keating’s legacy is a difficult task, and in fact probably would be defined differently by each person with whom he came in contact.

“Rather than just accepting that water intoxication occurred in some babies, Jim paid attention. He identified that more of these babies were seen at the end of the month and that it was happening to babies whose mothers were enrolled in the Women, Infants and Children’s supplemental food program,” she says. “As always, Jim wanted to know why this was happening, what evidence was out there about the causes, and should we be changing our thinking in regard to these events. He took the same approach with making sure breastfed babies received vitamin D to avoid rickets. These were practical discoveries that affected the care of a lot of children.”

Summarizing Keating’s legacy is a difficult task, and in fact probably would be defined differently by each person with whom he came in contact. For Keating, however, his teaching clearly was his crowning achievement.

“Everything was intertwined, of course, but the core for me always was the pediatric residents,” says Keating. “Instilling the desire to do the very best for patients and the community was a wonderful reward.”

As one of Keating’s former residents, White agrees. “Jim’s legacy is all the residents who have gone out throughout the country having experienced his encouragement, intellectual curiosity and dedication,” he says. “These people are passing along what they learned from Jim to yet another generation of doctors, who will pass the knowledge on to those they teach. His influence will not soon diminish, and our profession is all the better for that.”


Keating and his wife, Susan, are planning a move to Raleigh, N.C., to be close to their daughter, Amy, the editor of a business journal. (Their son, Tom, is a sergeant in the U.S. Army’s Special Forces headquartered at Fort Lewis in Tacoma, Wash.) After a lifetime of achievement, Keating’s goals for retirement are modest so far. Reading (he just re-read Samuel Eliot Morison’s 15-volume naval history of World War II) and bird watching are at the top of the list.

“I’ve had a good 75 years, and I doubt that I’ll be bored in retirement,” he says. “I am looking forward to having my published papers bound.”

Flipping through those files, he smiles and says, “The most recent publication was in March, which was kind of fun — still publishing a few things in my 70s.”

To keep in touch with Dr. Keating, you can reach him at

Excerpted from BJC Today

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