Dr. Ted Eytan: Family Medicine Physician and Director at the Permanente Federation

Ted Eytan - Kaiser Permanente Center for Total HealthDr. Ted Eytan is a Family Medicine physician and a Director at Kaiser Permanente for the Permanente Federation. His work is based at the Kaiser Permanente Center for Total Health. In this interview, we chatted about the importance of telling people what you’re looking for in a career, why living in the right city makes a huge difference in your life and in your career, and how Kaiser Permanente is working to catalyze innovation in healthcare with their Center for Total Health. Read his eponymous blog here.

Where did you go to med school? What interested you about medicine?

I’m from Arizona and I went to the University of Arizona Medical School. I wanted to be a family doctor at the beginning and I wanted to be one when I finished medical school, so during my medical school years, I wanted to see how versatile my career could be. I took a year between my third and fourth years and went to UC Berkley to get an MPH. It was the perfect time in my career to discover the world of public health. After that, I graduated medical school, did my residency in Family Medicine, and then I went into fellowship at the University of Washington for two years.

What kind of fellowship did you do?

I did the Robert Wood Johnson Clinical Scholars program. The cool thing about that is that you don’t have to be any kind of speciality. So I can use it to work with people who have trained in different ways. I did it in Seattle which I don’t think is a site anymore but the Robert Wood Johnson Foundation is amazing.  They have the best thinkers, access to the best people. They taught me leadership and how to work in the community.

Why did you want to become a doctor in the first place?

You know it’s funny that you say that because just yesterday, a colleague of mine asked about my fellowship personal statement. So I pulled out my personal statement from my fellowship 12 years ago out. I read it and realized I’m actually doing now what I wrote about.  I wrote that I wanted to be solving problems for patients and communities. When I think about what I am doing now, I am a family doctor and I help solve society’s health problems in America.

What did you do after the fellowship?

I did the fellowship and got my first job. My first job was very non-traditional.  A lot of people who did my kind of fellowship stayed back in the university to do research.  I got a job in IT. I was really interested in doctors working with patients online so I worked at a non profit health system, Group Health Cooperative of Washington State. I was one of the first doctors hired in that kind of role so I had to make up work for me and for them. We did a lot of great work together. I was there for 8 years.

How did you know that a job like that would be available to you after fellowship?

I didn’t. This is what happens in life – I just called someone who was working on a project and I asked if there was anything available there that I might be interested in. She talked to someone, who talked to someone. Eventually they got back to me that there was something available and we got together to see if it was a fit.

We all go through medical school, and it’s a lot of training and a lot of work. When you are all done, you wonder who is going to hire you. It’s hard because it doesn’t always work out the way you want it to and sometimes people are not banging down the door to find you.  What I would suggest is: you just have to keep letting people know this is what I am interested in. You may tell 100 people and one person will get back to you with what might be your dream job.

Also, treat every person you work with as someone who could potentially help get you to that next step in your life.  You just never know. We have all known people who didn’t treat us the way we wanted to be treated. But always remember, all of the people you work with and no matter what level they are at, they could actually make your career. They could make it wonderful.  So treat everyone with compassion, it will definitely come back to you.

Can you talk a little bit more about what you did at this first job, for 8 years?

For 8 years was this exciting idea that no one had thought of before. It was all about patients emailing their doctor. No one thought it could be done and no one thought it would work. My job was to help 800 doctors in a non-profit health system get up to speed on email technology with their patients. It was basically making our health system more accessible to people online.

On a daily basis, what kind of work were you doing? Were you applying your clinical knowledge and how developers would be building the technology? How did your healthcare training help you in this job?

I thought they are going to want my clinical expertise and make sure everything is accurate. But it turned out that one of the most important things a doctor can do is lead change.  For many people, changing the way you do things can be hard. It turns out one of the best things about doctors is that they listen to other doctors.

At the beginning they were sending me to all the medical enters and I was speaking to the doctors. The doctors were really excited about the future, the prospect of emailing patients and communicating with technology.  I remember saying to my bosses, are you sure this is what you want me to be doing? It’s really fun but I want to make sure this is valuable to the company. They said this is very valuable, keep doing it.  I didn’t realize until six months later that it really did make a difference.

What did you do after 8 years at the Group Health Cooperative of Washington State?

My position eventually became the Medical Director of Informatics. I was doing more than talking then, I was helping set direction. The clinician part was important, but the judgment part was more important. It helped to know what the doctors needed to be successful.  After this job, I took a year off again. I did a sabbatical in Washington D.C. around understanding the use of health records for underserved people for a year. Then, I got the job that I have now, with Kaiser Permanente.

How did they find you or how did you find them?

I had gone through leadership training through Kaiser Permanente when I was at the Group Health Cooperative and I met with the CEO of the company I am in now. He brought me in and we talked. It looked like a good fit so he hired me.

You make it sound so easy.

I think you need to believe that it will always work out. The right opportunity will come to you. There was a year during which I didn’t have a job. I had a great job that I left and I wanted to live in Washington D.C. I just said you know what, I am going to find something once I get there, and it’s going to be great.

Was there a reason that you were you looking to do something different after Group Health Cooperative? Why did you decide to change jobs?

It was literally the best job in the world, no question about it.  I wanted to live in Washington D.C. I didn’t move for a person or for money. I moved because the cities are so different. When people come to me and they say I am looking for a job, the first question I ask is: where do you want to live? The world is not flat, where you live has a huge impact on everything in your life.  The people you see in the morning, where you walk down the street, it’s everything. I think it’s important to not have the best job but live in a great city than not to have both.  For me, where you live is the most important thing.

You’re right, the right city makes a huge difference.

It’s not just about how easy it is to live, it’s the kind of people who live there. If you are an innovative person and you really like to do things on your own, then California is great.  If you are social and want to work with big groups of people, and you want to be near the center of government, then D.C. is great. If you are not here, then you can’t simulate it.  You can’t simulate it by being in Chicago.

It’s very true, that is very good advice.  Speaking of Washington D.C., can you talk a little bit about what the Center For Total Health is?

The Kaiser Permanente Center for Total Health is in Washington D.C, and it is relatively unique in healthcare.  It’s a place to talk about health. People from all over the world and all over the country can come here and have conversations and interact with high-tech displays and devices. People can get inspired about health as something greater than just healthcare or medical care.

What the mission of the center? Who is the center for?

The center is for people who are trying to change health and healthcare. There are not a lot of places for you to go and just have a conversation about your ideas, your innovations, to share innovation, to learn innovation, to meet people not like you. Often healthcare can be very onto itself; it doesn’t really interact with other industries that we can teach and learn from.  It’s high tech but it’s a very neutral environment. Our large video touch panel is one of the biggest in the world.

Do you guys change the display on the large panel on a monthly basis or does that just stay with one exhibit? How does that work?

Well it’s extremely interactive so it’s hard to actually get through all of it in one run. It’s very technically complicated so that one hasn’t changed for a year.  We are also adding some augmented reality to one of the rooms.

So would the center be more geared towards providers and healthcare professional than medical students?

There are also community leaders, national leaders, business leaders. There is a lot more to changing healthcare than doctors and nurses who want to improve the health of Americans. Large employers want their workforces to be healthy and this is a place for them to come learn about what we are doing and what are the best innovations. They’re not medical professionals but we can bring that exposure to them.

How did you get involved with this?

I work for the medical groups of Kaiser Permanente. There are 9 of them across the country when you include Group Health Physicians. My organization supports them and helps them to succeed. This facility was opened up about a year and a half ago and so there was an opportunity. The thing about Kaiser Permanente that makes it so great is that it is run by physicians and non-physicians together in partnership.  So in the name, Kaiser Permanente, Kaiser is the business side of healthcare and the health plan. They finance the care;.  Permanente are the physicians. Everything is in partnership; our medical offices are run by physicians and non physicians or business leaders and medical leaders together.  We complement each other and that’s why we are successful.

Can you tell me a little bit about your job as the Physician Director of the Center for Total Health? What do you do on an average day?

This is a facility almost like a medical office. I have a partner who is the Executive Director and we plan the operation of the facility..  We are like ambassadors. There are 17,000 doctors here at Kaiser Permanente, so we help bring those doctors’ work forward.  All 17,000 physicians are doing amazing things; they are all doing new things every day. Our mission is to find those things and bring them to other people so they can learn.

Do you have speakers come into the center? What sort of events do you put on?

Yes we do. Last week we did corporate recess for an hour, where we learn play in the work environment..  We have large events with speakers, we have code-a-thons where people come and write apps.  We have small discussions with bloggers. Basically anything that anyone is interested in to learn about health, we will do. What we don’t do very well is PowerPoint slides. We are trying to create a no PowerPoint zone. It’s very cool because in the way the space is laid out, it’s hard to do PowerPoint.  People want to learn by talking to each other. We network them to each other and we network them to Kaiser Permanente and we network them to the rest of healthcare.

It sounds like it is a commutation hub. Is there anything else like this in the world? I don’t think I have heard of anything like this before.

There are other centers like it. We have a sibling center in Oakland, California called the Garfield Center, which is online.  UPMC in Pittsburgh has a Center for Connected Medicine.  The Center for Connected Care, which is a little bit similar to ours.  So there is a few of them.

Just to finish up, I want to mention how much I like your open-minded statements about medical school. Because you’re right, most people don’t quite see the medical world like that, about exploring the variety of opportunities that can come to you should you be looking for them. 

They should. If people have those questions, they should find a mentor. Also, explore different areas. I went to public health school and found this other pathway that was so exciting to me. Once you see that it can happen, everything falls into place from that.

Dr. Geeta Nayyar: Rheumatologist and CMIO of AT&T

DrN_0183Dr. Geeta Nayyar is the Chief Medical Information Officer (CMIO) for AT&T, where she works to guide the AT&T ForHealth portfolio strategy. She has been named one of the “Top 25 Minority Healthcare Executives” by Modern Healthcare and one of Fierce Healthcare’s “Top 8 Women to watch for in Healthcare,” among many other accolades. Dr. Nayyar also holds memberships and committee appointments in the American College of Rheumatology and the Association of Medical Directors of Information Systems.  Read her top Health IT blog.

 

 

 

 

 

 

Can you tell me a little bit about your background? Where did you go to school and what did you major in?

 I got into medical school at 17, straight from high school. I went to the six-year medical program at the University of Miami Then I did my internal medicine residency at George Washington University  (GW) in Washington D.C. and stayed on to do my rheumatology fellowship. While I was a fellow, I did an MBA at GW.

When I was in the six-year medical program, I tried to do as many non-medical things as possible. I majored in biology but I minored in political science and English. I tried to have a well-rounded experience. I ended up in D.C. because I worked there during college. I did an internship with the American College of Preventative Medicine. Back in the day, I worked on items like the smoking cessation policy and the McCain bill. I loved it. I loved D.C. – it is an amazing city where a lot of the direction of what was happening in healthcare was starting. I was really drawn to the policy but also the business, because policy is ultimately affected by economics and what is feasible from a revenue vantage point.

I was drawn to MD-MBAs, MD-JDs, MD-MPHs. I found people within my past who were doing different things. I’d spend time with them and ask them for career advice. But I never found a clear path. I was also very active in different organizations like AMSA and AMA. I gravitated towards organizations that were doing things outside of academics.

What made you want to pursue healthcare from a business perspective?

It was very much by happenstance. When I started medical school at 17, I wasn’t aspiring to become the CMIO of AT&T, that was nowhere in my vision of where I would go. I always wanted to do something a little bit different with my clinical background, but I just was not sure how to get there.

Coming from a medical family and in my own practice, I always felt like there were these external factors that affected the doctor-patient relationship, whether it was policy makers, the legal team, hospital administrators. There were always people external to the practice of medicine that influenced how doctors practice. I felt that this was very backwards. How could an attorney or a policy maker understand what we do in day-to -day practice?

When did you apply for business school? Why did you choose to apply?

At the end of my fellowship, I thought, ‘How am I actually going to do something to impact the practice of medicine from outside?’ There was so much going on with all the changes in the past 5-10 years. So I decided to pursue an MBA, and would take my beeper to class. Again, I did night classes. If I got paged out, I would walk out of the lecture.

The GW MBA program was very cooperative; they were thrilled to have a physician. The professors were terrific. They never took it personally if I walked out of a lecture that it was any reflection on their lecture.

After my fellowship, I took a job with a company called APCO Worldwide, a communications firm. While I was doing the MBA and working at GW and APCO, we were going through our electronic medical record (EMR) implementation. I think because I was doing the MBA, I understood revenues, accounts receivable, etc. I was thinking about what all those things meant and how they affected how we practice. And I thought this EMR could really improve efficiencies and the quality, and make the lives of doctors and patients easier.  I became the physician champion within our department and helped craft rheumatology templates and made the EMR work better for the doctors. I helped with the training and worked with my peers to make that happen. I had a lot of fun doing it. It was gratifying to see this change happen while I was there and practicing. We went through this whole paradigm shift while I was there.

When I took the job with AT&T, part of the reason was to move closer to my family in Florida. I heard they were starting a healthcare practice and they needed a physician’s perspective on the work that they were doing.

I’ve been the CMIO for a little over a year now and I’ve really enjoyed working for AT&T because it’s a company with so much breadth and scalability. There’s a lot of opportunity to make an impact on the industry in a significant way. It’s been great because my role is a new role, so it’s been fun to craft it and shape it.

There’s been an incredible will internally within the company in terms of the commitment they have made in healthcare. I have a nurse on my team, we have other people from the industry from the provider side, the patient side — you name it. As a company, we’re very invested in healthcare and I feel fortunate to be part of that. We have quite a number of customers – Indiana Health Information Exchange, one of the largest health information exchanges (HIE) in the country is using our HIE solution. Texas Health Resources is doing a pilot study that looks promising. We completed four pilots with 600 individuals who basically said we love the mobile health tools; we feel engaged and feel they are making an impact on our diabetes. It’s just been fun.

What is your daily schedule like? How many days do you practice clinically? Amount of time spent at AT&T?

I still have my faculty position at GW and I’m starting my practice at Florida International University down here. They have a brand new medical school and a brand new ambulatory care center. I’ll do about two clinics a month and continue my role with AT&T.

It’s hard, but I’ve always done it so I don’t know any different. I did it when I was with APCO and with Vangent.

And it’s because of the technology I can. Whether I’m traveling, even if I’m not physically on site at the clinic, I’m able to look at my patient’s chart, give them a call, and set up to bring them back to the office. I’m not sure how I would do it in a paper-based world. It’s fortunate that both GW and FIU have EMRs and believe in technology as a way to better connect doctors and their patients.  It’s not easy; I wouldn’t be completely honest if I said it’s no big deal. But AT&T has been great in saying, ‘We want you to practice and stay relevant.’

How did you feel about doing your MBA? Have you felt that what you have learned in business school has been applicable? Did you feel that it was a good supplement to your medical training for the role you play today?

For me, it was well worthwhile. If nothing (else), it gave me a different way of thinking. After medical school, our creativity is almost completely stifled because you’re forced to think more as a scientist, as a medical person. It’s a completely different way of thinking than in business school.

In business school, there was more encouragement to be creative and entrepreneurial. It also helped me to understand the language of business. I do think of myself as a creative person; however, after 10 years of training in medicine, I think that part of my brain may have been completely shut down. I think business school kind of opened that up again. How do we think about this problem differently and how would we solve it? So in those ways it was useful.

If I were to go back, and in today’s present environment with all the resources available, I think I would try to get more experience as opposed to formal education. Like the internship I did on the Hill with the American College of Preventative Medicine If Health IT vendors were looking for a medical student or a resident, I would look for opportunities like that, or opportunities to shadow a CMIO at a company.

In today’s modern world with Twitter, blogs, and LinkedIn, there are so many different ways to connect with people outside of medicine. I don’t know if I would need to go to business school. You could learn the terms online. But I think it depends on the person; if you’re that proactive, you’ll go out there and teach yourself.

I think the advice I would give someone is that you have to know yourself. If you’re the kind of person who is creative, entrepreneurial and will put in the time to educate yourself, you can definitely do it without a MBA. If I spent two years getting experience, that would have been great. At the time I was into my career, I didn’t know how to connect the dots and the MBA really helped me connect the dots in a way that I had been trying to do throughout my formal medical education. So in that way it really helped me.

What were some of your other influences on your career path?

I found mentors; people who were instrumental in helping me make the transition. It’s really about mentoring and networking. It’s all about having mentors who spend time with you and are willing to help you out. Many mentors have helped me to get where I am.  They’ve been really instrumental in helping to give me feedback and continue to be. We talk all the time and they’ve always been very supportive. Now, many AT&T executives have been instrumental in saying this is where we want to help you. I think networking and mentoring are important.

In medical school, time is so precious. For a savvy doc in training, there are ways to reach people that weren’t there when I was a fourth-year medical student. Now there are different ways to do it. There are more and more companies, businesses, policy makers saying we need clinicians who can think outside the box. It’s a different landscape than it was before.

Atul Gawande wrote an article in the New Yorker called “Cowboys and Pit Crews” and in it, he stated that “medicine’s complexity has exceeded our individual capabilities as doctors” because we now have tens of thousands of diagnoses, more than six thousand drugs, and four thousand medical and surgical procedures. How do you feel about this? And how can technology help?

I agree with that wholeheartedly. One of the things that has really struck me is that clinical medicine is all about cutting edge technology. We’re always looking for the cure to cancer, HIV, or a way of doing noninvasive surgeries. What’s ironic is that you have surgeons doing robotics and laparoscopic surgery, where they’re able to go inside the body without penetrating the body cavity, and then they turn around and write up the whole case on paper.

They should just attach the Da Vinci to a Twitter.

Right. I think Atul is spot-on in saying that the delivery has definitely changed. There are technologies available that weren’t before – the ideas of mobile health, remote patient monitoring, the ability to take the office visit outside the four walls of the office. Things are definitely changing. I think that’s where companies like AT&T have their value proposition.

The reality is that doctors who are just starting now, they’re thinking about where they’re going to practice. Are they going to go to a hospital system who doesn’t embrace EMR? These are the issues that physicians are going to have to decide because they are now part of your practice decisions. This is part of the future and now I have to think about this when I choose where to work.

With your experience in HIT, what do you think is the most important change that the healthcare system needs to undergo in order to streamline their practice?

I really think it’s about shifting the paradigm from the traditional office and hospital setting and meeting the patient where they are, in their home or community. The reality is that healthcare today is not experienced in the physician’s office and hospital, but patients experience their diseases most of the time outside of the hospital. Being able to give insightful clinical data points to patients and providers in their homes and community will be important.

The industry is going towards a place where our current model of care is not economically sustainable, nor sustainable from a healthcare outcomes standpoint. The quality of care we deliver is a traditional model that is poor and very expensive. Companies like AT&T and others in the industry are now offering solutions that help integrate points of care that are not yet integrated today. If you, as “Doctor A’, want to do what ‘Doctor B’ or ‘Hospital A’ has done with your patient, (technology) let us help you make this connection points happen so you can get to the business of practicing medicine better and faster.

What can medical students do to adjust to the changing practice of medicine?

In medical education, it’s about building the car as you’re driving it. I think it’s happening. From working with residents and fellows, I see that they always bring their smartphones and tablets. They tell me about apps, like the stethoscope app that’s out there. One of my residents showed me that.

The doctors of your generation get technology and they use it. It’s almost going to be natural when you start fully practicing. When you start residency or fellowship, you’ll realize how inefficient your day can be. The way you use technology for other things, even things that have nothing to do with healthcare, will make you realize – if I could just do this thing on my smartphone or tablet, if I could just send my patient a secure text message, it would be so much more efficient.

Dr. Bridget Duffy: CEO of Experia Health, former CXO of the Cleveland Clinic

Dr. M. Bridget Duffy, a thought leader in the patient centered model of healthcare, previously served as the first Chief Experience Officer (CXO) of the Cleveland Clinic, the first senior position of its kind in healthcare, and is presently the CEO of ExperiaHealth, a leading resource for hospitals seeking to humanize the patient experience. After graduating from medical school at  the University of Minnesota, she completed her internal medicine residency at Abbott Northwestern Hospital in Minneapolis, where she created and served as Medical Director for one of the first hospitalist services in the country. Dr. Duffy also previously served as Medical Director of Medtronic, Inc.

Can you tell me a little bit about your background? How did you decide you wanted to go to medical school?

I didn’t know what I wanted to do at all at 18 as I started college. My father is a periodontist and I worked in his office so I had some sense of healthcare. But what caused me to have great passion was about being of service to the underserved. My father on every family holiday break would take us to work at different underserved populations here in the U.S. and abroad – from the Pine Ridge Indian Reservation to Mexico, El Salvador, Nicaragua.

That’s wonderful.

I had a sense early on of wanting to give voice to people who didn’t have a voice. My father would be of service through his skills as a clinician. So that had some appeal. After undergrad, I didn’t go to school for several years. I worked with a migrant population in Colorado through a public health program. I got my training as a dental hygienist thinking I would go to dental school. However, I felt that without the credentials, I didn’t have control over my practice or my destiny. I didn’t like reporting into somebody. I knew that early on. I liked creating my own path.

I applied to medical school because I wanted to do more than teeth, I wanted to care for whole human beings. I entered medical school and worked as a dental hygienist to pay my way through medical school, along with my parents’ support. The biggest deviation came during the last month of my residency, where I knew in my soul that I was not a 9 to 5 physician. I met a man who altered the course of my life: Earl Bakken who invented the pacemaker and founded this little company called Medtronic (world’s largest medical technology company). Because he wrote a paper and I picked up the phone and I called him. I told him I just read your paper, I’m trying to figure out what to do with my life. I know I’m not a mainstream physician and I want to make a difference in the world. And that’s the value of having mentors, they can alter the course of your life.

I’ve been on a journey now for 20 years to help organizations humanize the way we deliver medical technology. Here I went through all those years of training thinking that I would just become a regular doctor. And I did it when everyone else thought I was nuts, so that was the other hard part.

What happened after you met Earl Bakken?

He and I stayed on this journey together. We created the American Institute for Health and Healing that he helped fund. We sought and found people in the nation who were innovating around patient centered model of care.

Typical doctors in the academic setting would say that what I was doing was not real medicine. I remember this one time that I was called to be interviewed and she said why have you left medicine? And I said I haven’t, I’m just working from a different platform to catalyze change in healthcare, it’s so broken. Now, however, one of the most important priorities in healthcare today is focusing on the patient experience. Reimbursement is tied to it. Had I listened to the naysayers at the time and had I not had mentors around who helped support me and propped me up on days that I felt dejected, I would have quit. I wouldn’t have trusted my gut or my instincts and I’m glad I did.

Initially I didn’t leave clinical medicine all together. For a while I did this while practicing clinically and seeing patients. I helped build one the first hospitalist programs in the county. And on the side, I would work with Earl.

I do think it helps to do some clinical medicine to walk in the shoes and gain credibility. Also to feed your soul. Because part of what you love about being a doctor is the ability to have a human to human connection and a relationship with someone who desperately needs a guide.

Someone who is completely vulnerable to you.

Exactly. You meet people when they are completely vulnerable and really sick and they need a partner or guide on their journey. After I left clinical medicine, I get my clinical fix from the volunteer work I do. So if you decide not to have a full time practice, I think there are things you can still do to touch patients again. I love the work I’ve done in India through Children’s HeartLink. There’s work locally in Sonoma where I can contribute. For me it’s about being of service. I like to spend some time reflecting what am I here to do and how can I make a difference in a bigger way than one to one individuals. so i like the work I am doing on a national scale but there is nothing more rewarding and enriching than on an one to one basis.

There’s a lot of things that detract, but there’s no more sacred work than being a doctor. The best credential is that it lets you do anything in the world with it. It’s probably the best career ever. I feel so privileged that I was able to do it and use it in a way to give back in different capacities.

Can you talk a little bit about your work as the first CXO of the Cleveland Clinic? How did they decide they needed a CXO? What kind of work did you do with them?

It really came through my years of work with Earl Bakken. I had visited the Cleveland Clinic 7 years earlier and it was one of the centers that Earl and I did not fund. I had met the newly appointed CEO and did not think that his values were aligned with mine. Years later, he called me and said that he now understand what you do, can you come and meet me? There was an openness there and there was also a pressure that their scores were going to be publicly reported. They were later to the game than some others, but there was interest and they said we need some designated leadership. I rarely embed in organizations to do it but I agreed to do that while keeping my home in the SF area.

I helped them build an infrastructure to continuously listen to the voice of the patients and the physicians to create a better environment that delivered better outcomes. Before I went there i was helping organizations improve the experience.

How do you build an infrastructure that helps physicians listen to the patients more?

There are business techniques and methodologies that you can deploy to build an operating infrastructure that does more than focus on efficiency and cost reduction. The whole nation in healthcare is just focusing on being more efficient and delivering better care at a lower cost. There are people on my team who are trained in lean six sigma and that sort of work being done in other industries to create highly reliable, high quality organizations.

There’s a way to go in and map the gaps in efficiencies. So we’ve created a proprietary way to map the gaps in the human experience of care.  We find out what’s missing in the human perspective and put those things back in so that they can be hardwired as ‘always’ events rather than ‘never’ events. In healthcare we typically focus on taking things out and working faster and producing higher quality. We are missing putting some things back in that patients care about. For example, upon checking into the emergency room or before getting surgery that day, instead of just asking do you have a living will or what’s the copay to your insurance, perhaps saying what are you most afraid of or most concerned about today? What do you need on your discharge to help you with your healing? What could help reduce stress fatigue and anxiety while living with Parkinson Diseaes? And then give them tools to live a more full life.

That’s the discipline. We train people within the organization to do it and to do it more proactively. We’re very reactive in healthcare and  often just look at complaint data. We help organizations put a methodology in place to map the gaps.

I wonder if the fact that physicians have a regimen down and are concerned more about being cost efficient might have to do with the fact that the financial skeleton of healthcare is based on fee per service. I wonder how much that affects how physicians treat their patents. 

I think all physicians and nurses enter it with the right intentions but all the paperwork and hassle create this burnout. It’s burnout doctors and nurses who have to check their souls at the door. It’s not intentional. But the reimbursement is incentivized the wrong way. That’s why there’s no prevention done in this country and they’re reimbursed for procedures versus these other things. Often physicians view what you and I are talking about as soft or fluff or unimportant. But I help organizations is equate it as important to work as quality and safety.

If you have really highly engaged employees, you’ll have better patient satisfaction and you usually have better financial results and quality and safety. Every other industry in business has demonstrated that.

Since you’ve gone on this journey and utilized your medical degree in a different way, what other ways do you foresee a medical degree in a nonclincal setting?

Oh I just think limitless. You name the industry. I think every industry, non profit and for profit, could tap into somebody with a medical background. I think it’s ripe for technology. There’s a lll kinds of things for technology and social media that can more intimately listen t othe patient and family voice. Tools that can connect remotely at home to monitor patients. To pharma, biotech, devices, to corporate wellness, prevention, etc.

Do you have any advice for medical students who are interested in your field? How can they get involved?

Yes. Pick up the phone and if you read something about someone have the chutzpah to call them. Ask them if you can shadow them for a day or a week. Ask to participate. Spend time walking in the shoes of the people you admire. Have the courage to pick up the phone and call. That’s what I’ve done my whole life. When people say no it’s full or we’re not taking anyone, I don’t take no for an answer (politely of course).

I would write down what your gifts are – I’d figure out what you most love to do with your life., what your strengths your gifts are, the type of people with whom you like to work, the type of environment in which you like to work and then I’d create a list of people doing things in other industries for which you have awe or admire.

And then I would cold call them or stalk them (haha) until they allow you to come do something with them. We never turn anyone down. We just had a Berkeley MD PhD come do one of his electives with us [at Experia] for a month.

Just be really creative with how you structure your electives. Just say hey, I wanna go spend a month with Experia Health and learn the methodologies to bring experienced mapping into healthcare. Tell your advisor you want to do that. I would structure it into your education.  Find a cool way to expand your mind and your knowledge and skill set while you’re in medical school. And just create every opportunity to connect with people you see doing something cool and making a difference. Go attend conferences, meetings, or workshops with people who are pushing the envelope in an industry outside the medicine and look how what you do can apply to that.

I think you just motivated me to call this doctor I’ve been meaning to call. 

The other thing I would do is – and I used to do this – after I met someone and I loved what you were doing, I would ask them for three names of people that they thought would help me further the work I am doing. Surround yourself with really good people who can alter your course. I had a huge deviation. The key is to stay out of your way and don’t block anything the universe sends you that might allow you to do something incredible with your life.

Here’s a wonderful video of Dr. Duffy from the Gel Conference in 2008 where she demonstrates the theory and practice of patient-centered care:

Dr. Lawrence Bass: Plastic Surgeon and Technology Innovator

Speaking with Dr. Lawrence Bass was like listening to the sound of science and business fusing into one.  A graduate of Columbia’s College of Physicians and Surgeons, Dr. Bass is a nationally recognized innovator of advanced technologies in aesthetic plastic surgery and a practicing plastic surgeon in Manhattan with over 90 scientific publications in journals such as Plastic & Reconstructive Surgery, Annals of Plastic Surgery and Lasers in Surgery and Medicine. Read below to hear about how a physician can transition into business and what opportunities lie ahead for scientist/entrepreneurs. Also, we talk briefly about diamond knives.

When did you start doing research? How did you find opportunities in the medical device field?

I started doing research as an undergraduate. Having already done a year of general chemistry before college, I began taking organic chemistry as a freshman. Second semester of organic chemistry, my organic chemistry lab professor was doing x-ray crystallography research. He was a particularly engaging lecturer, and I enjoyed working with him, so I asked if I could work in his lab. For the rest of college, I did research with him. X-Ray crystallography is used to determine the  3-dimensional structure of various molecules that you might be interested in because they are possible new antibiotics, anti-tumor, or other useful medical compounds. First, you crystallize the substance and then shoot x-rays through it and observe the behavior of the rays to determine the chemical structure and the 3-D conformation. Crystallography will tell you which enantiomer (left or right conformation) the compound has; often one enantiomer is biologically active while the other is not. Once you have determined which one is active, and have worked to determine the structure, you try to find a way to synthesize it to produce a potential pharmaceutical. So you’re using physics to solve a chemistry problem to work on biological problems. It is a very productive merging of the three fields.

While I was in college, I also did research at New York Blood Center in immuno-hematology a couple of summers. Then, in my first two years of medical school, I did research with one of the cardiac surgeons at Columbia-Presbyterian Medical  Center writing software for 2 and 3 dimensional ultrasonagraphy.

I was eating lunch in the physicians lounge in the Surgical Intensive Care Unit one Saturday, early in my surgical internship, with one of the general surgery professors. He was telling me about one of his new lasers he thought could be used for removing adenomatous polyps during colonscopy. The problem he was having was with the sessile polyps. One strategy was to vaporize the polyp from the top down, take a little bit, little bit, and hopefully stop before reaching the wall of the colon.  However, he was having some issues with dependability. Lasers are used in medicine for coagulation, vaporization or cutting.  Above the vaporization threshold, the reality is that you produce  some vaporization and some coagulation; some lasers give a little bit of vaporization with a lot of coagulation, some give a little coagulation and a lot of vaporization. His new laser had a shallower depth of penetration (older ones were 3mm and this one was 285 microns) so he hoped it would avoid penetrating the colon wall during polyp removal. At the time, I was doing microsurgery research, and as I was listening to him talk, I started thinking about the possibility of using the coagulation component for welding tissues instead of using sutures because the penetration depth was just right for blood vessels. So I asked him if I could use it to weld rat arteries together. He said, sure, why not, you can fool around with it. So I ended up working in his laser lab.

We began looking at various applications for the laser, including vaporization of  atherosclerotic plaques in coronary arteries. That’s how I started working in the medical device arena and medical product development, since the laser was not yet an FDA approved device; it was still experimental and a company was trying to develop it for clinical use. It was my first real exposure to FDA applications, animal experimentation, human clinical trials and some of the commercial issues associated with creating medical devices and products.

What are some of the commercial issues?

The first issue is FDA approval. The approval process varies greatly depending on what the product is, but devices generally follow one of two paths for approval. Either they follow the path of 510-K, where the device company will go to FDA and assert that their product is substantially equivalent in effect and application to an existing product that’s already approved. Otherwise the company will have to apply for a pre-market approval (PMA) application, which will require them to develop more background data on the product or device. They will need to conduct background studies on the biological effects and safety of the product, design and conduct animal studies, examine and statistically analyze results and data from any clinical use abroad, and then formulate multiple phases of clinical testing. This will usually include an initial patient safety trial with a few patients, followed by a dose safety study with a larger base of patients, and finally a phase III clinical trial that will demonstrate safety and efficacy in a sizeable cohort of patients. This final trial is called a pivotal trial because it is the deciding point for FDA approval, and it is usually a multi-center, randomized, and blinded clinical trial.

There are some strategies you can employ to help you structure your plan for FDA approval. For example, if you are coming up with a new antacid, you can look at how the last antacid released on the market did their clinical studies. Then you have to make sure the FDA has not changed or raised their standards in some way. If you decide to do something innovative that no one has done before, you will have more difficulty validating your data with the FDA. You have to define a whole new set of criteria, both objective and subjective, that you will use to evaluate your study. It’s a much harder process for the commercial entity and the clinicians, as well as the government regulators. Obviously the FDA doesn’t want to block something that may be tremendously useful, like a new anti-cancer drug, but they also can’t let everything out on good wishes. You really need to have solid data and it often requires a lot of time and effort to figure out the best way to quantify, measure, and collect this data in the best and most informative way possible.

Sometimes your best option is to meet directly with the FDA, just to sit and put your heads together and decide how to do the assay or how to get the most meaningful results or data by structuring the clinical trial in the most effective way possible. The worst thing to do is to move through an entire clinical trial that costs tens of millions of dollars and have a bunch of useless data as your end point. Everybody is trying earnestly. It’s not really a fight between the sponsor and the FDA; it’s more a matter of effective communication.

There’s another interesting point here and it takes me back to the professor that I first started working with on laser research. We were involved in some start-up activities through product and company development. We said, “We’re doctors, we work really hard, we’re as smart as anybody, we can really do everything. We can be the business manager, the fundraiser, the marketer, the engineer, the medical researcher, we can do it all.”

Theoretically we probably were smart enough to learn each job, but in reality, it takes a lot of time and effort to learn each component of the start-up business. You don’t have the expertise, prima facie, to do all of it. You’re much better off getting people who are experts in those respective areas and slicing up the pie and sharing the company. It took us a while to learn that.

However, there’s always a risk in hiring others, because if you bring the wrong people you can tank a project. I’ve seen a number of products, that were great medical devices or treatments, die, not because they didn’t work, but because of how the company development played out.

What do you do in terms of your corporate work?

I do a lot of different things. I do a small amount of laboratory research which is usually at NYU, although sometimes in outside corporate venues. I’m currently on the clinical faculty at NYU. I also do clinical academic research – I write and teach to report clinical experiences or advances in techniques and outcomes. Because I do a fair amount of lecturing and teaching about new techniques and new devices in plastic surgery, some device companies seek me out to help them in developing educational programs for doctors and also to help them in various different ways in developing new products and getting them approved.

In the current structure of FDA clearance, if the FDA feels a new device or treatment is novel enough that it will require provider education to be used effectively, the FDA can compel a company to provide some kind of education in the form of a webinar, online course, or a nation-wide lecture tour with a standardized slide deck. Companies will pull together 50 experts from around the country to develop the educational materials to teach doctors about the new technique.

Earlier in product development, I often help pick clinical applications or focus areas where they will be most useful. For example, say you have a new device for cutting and sealing – will it be most useful in endoscopic surgery or neurosurgery or vein harvest for coronary artery bypass?

So it’s not just plastic surgery.

Right.  Plastic surgeons are basically biomaterials specialists.  We borrow almost every body tissue to rebuild some damaged function elsewhere in the body.  We understand about tendon, bone, muscle, nerve, fascia, fat; all of these tissues are routinely used or handled by the plastic surgeon.

I work with a company to help improve the function or point out the deficiencies or limitations of an existing device that they will need to overcome. Sometimes they will have me use the device in an animal lab, or if it’s ready, in the clinical setting, just by brainstorming and trouble shooting. Sometimes it’s me inventing a new device or they’ll come with a problem “we want a way to do this” and we’ll think through a number of options. Sometimes it’s looking at intellectual property and figuring out a way for a new company to provide a product or device in an existing area without infringing on another company’s patent. Sometimes I’m hired to look at a patent held by one device company, and determine if their patent is being infringed by another company or device. If yes, then I’ll serve as an expert witness in their patent litigation case.

I have also gone on behalf of companies to speak with the FDA during their approval process or while trying to formulate the structure of a particular study. Most medical device and pharmaceutical companies have a regulatory department whose personnel understand how to work with the FDA, so they need clinical expertise and input from someone who also understands the regulatory side – how FDA regulations work and how they make decisions and what conditions they are bound by because they have to follow specific rules. You need to propose something that is workable for FDA. The same holds true with patent infringement. You need to understand enough about patents and enough about patent law to give useful advice and information. You’re mostly there for clinical knowledge but you need to know how to best interface with the legal and corporate parties involved.

The same thing is true with product development. It is a classic refrain from doctors: “Well this would be a great product and it would really help us if we had this.” And they don’t understand why it’s not being made. But it’s not being made because it’s not commercially viable. It would never be approvable from an FDA regulatory standpoint, or it would never be profitable enough to pay back the development costs so the company making it would eventually end up going bankrupt. And that’s not productive because if the company’s bankrupt the product’s not going to be there for the patients. It must be done in a way that allows the company to pay back venture capitalist investments or, if it’s a bigger company, research and development costs. If not, the company won’t be around long enough to develop more wonderful new things. So you have to develop and pick specific application areas such that the product has the potential to be fiscally viable and allow the company making it to survive. Not every product is going to be a billion dollar a year market – not every product is a Botox.

What additional value does the medical degree have that might not be immediately obvious?

There are a lot of people who have studied on the PhD level and maybe even worked for many years in a research lab. They have studied the biological basic science that we studied in medical school. In fact, they have a much more in depth exposure than we have in our survey medical school courses. However, that is basic science. Doctors are basically applied scientists, just like engineers. There’s physics and then there’s engineering physics, which is an applied science. Medicine is applied science in the biological arena. That’s very important because the big buzzword right now is translational research. Translational research is moving from the lab into the clinic, getting it out there.  The basic idea is making it useful and integrated into clinical care. It’s very hard for a basic scientist to do that. It is hard for a basic scientist to understand what clinical needs are, and how clinical practice is performed. And doctors have the ability to understand that.

If you’re selling a product your customer doesn’t need, then you’re not going to have a lot of sales. If you’re selling a product there is a tremendous need for, he’s probably going to buy a lot and pay a high price. And it’s very important to identify that, particularly considering the tremendous expense of developing new devices and new products, especially pharmaceuticals and biologicals.  Just in round numbers, device approvals can run tens of millions of dollars in development costs and drug approvals can run a couple of hundred million to half a billion dollars.  You need to be pretty clear that there is a need for what you are creating, and that it fits in with the current evolution of the specialty it is intended for, as well as look at multiple specialties it could be applied to in a multidisciplinary way. Sometimes that is something that can be challenge for a doctor since everyone is so clinically specialized these days. You have to be able to figure out if it will good in general surgery or in ob/gyn surgery. Everybody’s got his own set of problems so having a broad understanding and a good generalist medical education is tremendously valuable.

However, the trend is currently going away from that. It is towards this very specialized training, which makes it extraordinarily hard to cultivate a broad range of general medical knowledge. But there is a need for generalists in the sense of bridging all specialty divides and being able to advise a company: your first application should be urology, not gynecology, etc. That is the kind of knowledge that doctors can provide, which is very hard for anyone else to be able to do.

What are the other aspects of your career that you’ve been involved with as a result of having the M.D.?

Because of the medical product development work I’ve done, I’ve been introduced to a number of venture capitalists, entrepreneurs who work with start-up companies, engineers. In some cases, it’s allowed me to play more of a business role or a medical advisory role than a medical doctor role. 

How does one go about finding these opportunities?

It’s hard to innovate on schedule. But all you can do is keep your eyes open, be a curious person, be creative and inventive and analytical. And when you least expect it, you will run into something. You will run into people like the professor I met in the lunch room who first introduced me to laser research. If you want to be involved in something, you just have to keep your eyes and ears open.

 Any last words?

To a large extent, doctors have, understandably, not been highly business savvy. I think the only way we’re going to defend ourselves is being smarter on the business side and being engaged in the process of how healthcare is administered. We have no business training, we have no time, and we’re trained to heal the patient. But the problem is, if the system collapses financially, we’re not going to be healing a whole lot of patients. We can’t kill the goose that lays the golden egg. We need to have a healthy healthcare system so we can continue to help our patients.

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“One of the very few silver linings about me getting sick is that Reed’s [his son] gotten to spend a lot of time studying with some very good doctors… I think the biggest innovations of the twenty-first century will be the intersection of biology and technology. A new era is beginning, just like the digital one when I was his age.” –Steve Jobs (from his biography, Steve Jobs)

NextGen: Health Conference March 29-30, 2012 in NYC

Hi guys,

I was recently alerted about this great conference called NextGen: Health (http://nextgenhealth.com/) showcasing healthcare and medical leaders from The Mayo Clinic, Harvard, MIT Media Lab, IBM Watson Project, Columbia, StartUp Health Hall of Innovation, a Mobile Health Summit. Additionally, there will be three NYTimes bestselling authors and expected guests from Mayo, RWJF, Pfizer, GSK, Athena, IBM, NYCHBL, Aetna, plus investors, inventors, CXO’s and more. It will not only be a great learning experience from the myriad of informative 18 minute lectures (in the style of the TED) and startup demos but also a wonderful networking opportunity. See the flyer below for full details:

For the first 12 medical students who contact me, you can get a huge student discount. Email me at ehp2001@caa.columbia.edu if you are interested in attending!

Dr. Randi Hutter Epstein: Medical Journalist and Author

      

Dr. Epstein is the author of “Get Me Out,” a medical journalist who has written for  The New York Times, The Washington Post, The Daily Telegraph, and adjunct professor at The Graduate School of Journalism at Columbia University. She is also the managing editor of the Yale Journal for Humanities in Medicine and a part-time lecturer in the department of the history of medicine at Yale University School of Medicine. She earned her B.S. from The University of Pennsylvania, a M.S. from Columbia University Graduate School of Journalism, and an M.D. from Yale University School of Medicine.

Read more of Dr. Epstein’s work on her Psychology Today blog and on her website.

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Can you tell me a little bit about your background? Where did you go to school and what did you major in?

I went to University of Pennsylvania originally thinking I wanted to be an architect. But I became a history and sociology of science major which I chose because it’s the most liberal arts-y of the liberal arts majors. I had no idea what I wanted to do and I thought it would let me dabble in anything. I knew I liked to write, I knew I liked science. When I did a semester abroad in London, and we were assigned an advisor, my advisor in London was a journalist by coincidence and she asked me if I had ever considered journalism. So that’s when I started thinking about journalism.

I come from a family of doctors – my dad’s a pathologist, my brother’s a surgeon – so medicine was always there. It was always there in my thinking that I didn’t want to do it. But knowing in the back of my mind that I liked all the health stuff and I might change my mind, I took the premed requirements. I had already taken physics and calculus for architecture. But I still wasn’t sure.

At the end of college, I applied to both medical school and Columbia’s journalism school. I also had a summer internship at The New York Times which was basically filing things for people in the science news department. It was great because I got to see that and I thought what they did was really exciting. I did write one piece, it was one paragraph.

And you got to publish it? That’s so exciting!

Yeah, I had a paragraph; it didn’t have my byline. They used to do something called Science Watch and it was literally 1 or 2 paragraphs that I wrote. And they completely rewrote it. But my mother had it on her refrigerator for years.

So I applied to Columbia Journalism school and medical school. When I went on my medical school interviews, I was really honest and said I don’t think I’m ever going to practice. Because I really didn’t know and I thought if they rejected me across the board, then it’s fate.

Columbia was going to let me do a joint program with the journalism school. But I also got into Yale – they have no tests at Yale and the guy interviewing me told me that Columbia medical school had the most class hours of all the medical schools. After I was accepted, I decided I would go to journalism school first but Yale didn’t have a deferral policy. Looking back maybe this was riskier than I thought but I just said no to Yale medical school and decided to reapply the next year. I guess times were different then, or maybe I was stupider – it just didn’t dawn on me that I could get rejected the 2nd time around and that there was going to be a different pool of applicants. Had I not gotten into journalism school and I got into medical school, then I’d have to make a decision.

So at this point you were thinking you wanted to be a medical journalist.

Well I didn’t know. I took one science writing class but mainly I didn’t focus on medical writing. I wrote my thesis on theatre, which was good advice from the people in the journalism school. They said while you’re here, broaden your outlook because you might find it’s not medicine you want to write about. But I did, I liked writing about science the most. To me, what I like about medical writing compared to other kinds of journalism, you’re really informing people.

Medicine is one of those things that applies to everyone. No matter who you are, it’s going to affect you one point or somebody close to you.

Yeah, exactly. And as someone doing it, the learning curve is huge. After a while, certain stories, if you’re covering the same beat, you’re doing it over and over and over. But if you’re covering a new drug, or a new technique, or some changing thing in healthcare, I’m in school all the time. I like that about it.

I reapplied to Yale medical school and got in again. Some of the people in journalism school told me that I shouldn’t go to medical school because you’ll just learn on the job in 5-10 years. But by that time, I could have someone spoon feed me the information.

So I went to medical school and I’m really glad I wen. There were times when I thought maybe I’ll practice. I loved pathology. If there were more hours in the day, maybe I could practice medicine and write. But I knew that I wanted a life, I knew eventually I’d have kids, and I wanted to write things that required research. There are a lot of doctors who write about their patients that day or their reflections on what they did. But I didn’t want to write about my reflections, I wanted to investigate things and research the historical, which is time consuming.

So when I graduated, my husband and I moved to London and that’s when I got the job at the Associated Press. It was great because I was covering hard news medicine – learning to write fast, getting to meet a lot of people in terms of science and reporting.  I really liked it a lot, and I did it for 5 years. I freelanced on the side. But I started thinking that I wanted to do books, to dig deeper into something. I kept toying with ideas but I didn’t really get into the book until way after we moved back here. It was one of those things when you keep saying, I’d really like to write a book. At a certain point you have to say, so just do it. I like to write about the history and culture of medicine; it’s not that I have this childbirth thing.

The reason I got into it is because I’m really fascinated with the grey zone of medicine, where there’s not hard core science – here’s a blood test, you have this, here’s the exact correct treatment. That is like 1% of medicine. The rest of it is this art of medicine where, well, you’re not exactly sure so let’s give this a try. And from the patient’s perspective, they have notions of, my friend did this or my mother always did this. So it’s this on-going dialogue between doctor and patient. And the thing with childbirth, this is even more true because the patient isn’t sick. They don’t even have to go to you in the first place. So there’s another kind of tension. So I was very interested in the doctor-patient relationships and how they’ve evolved, how it’s changed, and whether it has changed. So that’s how the book came along. I loved the research – the science of it – what we know about sperm, eggs, and making humans. It’s, you know, making humans.

How long did the research take you for the book?

I dabbled in the research for years but when I finally wrote the proposal and got a contract, I had 2 years from start to finish to write. So for 2 years, it was a full time job. The research takes a long time. There can be weeks when I’m interviewing people or going through archives. Then it takes me a whiel to figure out what the storyline is. And the little bit of time is the writing part.

How did you get an agent and do the proposal?

I just started talking to people who were writers and editors and asking for names. Then I was sending things off. Really just started. As a journalist, I felt like I was switching careers because the book business is so different from journalism. So I had to start talking to people. I chatted with some agents until I found one that I liked. After I worked with my agent who I really like a lot, I realized why people get agents. She was able to help me shape my proposal and she knew people in publishing houses. She kind of knew which editors I’d work best with.

She’s your navigator.

And she still is. Also she’ll fight for me. I’m not a salesperson so it’s not something I’d want to do. She read my contract. Then basically I was focused on the book for several years and freelancing a bit.

 

Can you tell me a little bit about your work in academia?

At Columbia, I’m an adjunct in the journalism school. I don’t teach a course there but I’m a thesis advisor. I have a student who is doing her masters thesis, which is a big magazine piece on a medical topic. A lot of students haven’t written long form so I help her through the process.

At Yale, I’m a lecturer in the history of medicine department in the medical school. And I teach a writing seminar for the medical students there. It’s very light because medical students have a lot going on. It’s analyzing medical writing, talking about some of their pieces. It’s an extra light elective, there’s no grading or anything.

As someone who chose to pursue something outside of the medicine after medical school, do you think most doctors have a certain kind of mindset? Just because of the way that medicine is, it’s very factual. Do you think people with a big picture kind of perspective would have a more difficult time being doctors?

That’s a good question. I think it depends on the medical school. We didn’t have any multiple choice exams for the first 2 years at Yale. The Yale system allows you to talk about bigger issues and bigger pictures. So I think in some ways it depends on the school. When I went from medical school to the Associated Press what I had trouble with, which is cultural, is that in medical school you’re always taught, rightly so, that nothing is definite. You’re never going to say to someone – yes, we know this will happen in 1 month. It’s always this finding suggests. Everything is might be. But you don’t write wishy washy news articles. If it’s suggestive then don’t write about it.

You’re supposed to deliver the truth.

Right. And you’re pushed to say yes or no. So it forces you to think in a different way. And in some ways I think it’s good.  This is why I like teaching medical writing to medical students even if they never pursue journalism; because I think it helps you understand how your patients want you to talk to them. If you say to someone that the latest studies found that 58% of people with your illness have a 5 year survival rate, that means nothing. They want to know, am I going to feel good or not?

What do you think someone who is not a traditional thinker who is in medical school can pursue aside from being a doctor?

I think the world is wide open to you, I really do. People say, if you don’t know what you want to do with your life, go to law school. And it opens up all these opportunities and it’s accepted. It’s okay even if you don’t practice law because you learn all these skills. I’m not an expert and I didn’t do residency but I do think going to medical school gives you more analytical skills. While you’re immersed in it you just think you’re learning facts about specific disease. But it gives you incredible opportunities to have this front row seat with people who are facing major issues and learning how to deal and making decisions about it. And seeing how medicine plays out in the trenches. Which I think if you go into healthcare policy or consulting or writing, it helps to have been on the wards, to see how it really plays out. It makes you more sensitive to what happens between doctors and patients. For people who have never been on wards, they can be overly critical of doctors. And I’m not saying all doctors are nice and kind. But for the most part doctors are there to make you feel better. I think in terms of making decisions it helps. I don’t feel that I’ve left the field of medicine, I’m fascinated with medicine, I love the field of medicine.

How is your average day?

It really varies. I have an office up in New Haven, which is an hour and half from my house. My average day will being with some work in the morning and then I’ll bike up to the train station at 125th Street. I get a ton of work done on the train. If there’s any background reading I will do that on the train. Sometimes I’ll do a bit of writing. Once I get to Yale I’m either teaching a bit or I’ll have a meeting. Now that I’m just starting my proposal for my book project, I’ve been working on my proposal. Except when I’m home, I have four kids. I find when I’m at home, I get flooded with texts from my kids. So I do it piecemeal. But the beauty of writing is that I can make it up at night. I really try to work my schedule around my kids.

Do you have any advice for medical students who want to go into journalism or writing?

A lot of them have been approaching me and asking me how they should start. I guess you just have to start. I got my masters at Columbia because I had no background at all and I don’t think everyone has to do a whole masters degree with medical school. If you don’t think you understand the whole process, it might not be a bad idea to take a course. The other thing is just contact these doctor blog sites. In some ways it’s harder to free lance – the pay is terrible, but you can get something published. I also encourage students – if you’re really interested in medical writing in terms of learning a topic, seeing what the issue is and writing about it – just start contacting editors, start writing, come up with ideas. It’s really slow but keep pursuing it, it’s not easy. You’ll get rejections. It’s not like medical school where you do your homework and then you get to the next level. When you enter more of a creative field it’s hard. You might write something and someone will reject it. But if someone gives you valid advice, you might want to rewrite it and show it to someone else. Keep pursuing it.

Being honest with yourself is much better than going through it and burying yourself in it. That came across for me when I did this panel at Yale – people were telling me I’m in my second year and I’m sort of having doubts but it’s too late now because I’ve wanted to be a doctor since I was like 10 years old.

 

Is it too late or are you just scared?

Right. And I don’t think it’s ever too late.