"The Doctor's Art" is a weekly podcast that explores what makes medicine meaningful, featuring profiles and stories from clinicians, patients, educators, leaders, and others working in healthcare. Listen and subscribe on Apple, Spotify, Amazon, Google, Stitcher, and Podchaser.
The National Academy of Medicine (NAM) is an independent organization that provides expert evidence-based guidance on issues of health, biomedical science, and health policy. Election to the NAM is considered one of the highest honors in the fields of health and medicine, recognizing individuals who have shown exceptional professional achievement and commitment to service.
In this episode, Henry Bair and Tyler Johnson, MD, are joined by Victor Dzau, MD, who has been president of the NAM since 2014. He previously served as president of the Duke University Health System, chairman of medicine at Brigham and Women's Hospital of Harvard Medical School, and chairman of medicine at Stanford Health Care. As a leading scholar in cardiovascular medicine, his pioneering research laid the foundation for the development of blood pressure medications widely used today.
Over the course of their conversation, Dzau discusses his challenging upbringing as a refugee of the Chinese Civil War, describes his dedication to health equity and global health, explores the work of the NAM, and passionately shares why clinicians should be more involved in public discourse.
In this episode, you will hear about:
- 2:27 How growing up as a refugee of the Chinese Civil War shaped Dzau's path and practice as a physician
- 7:06 How Dzau became a physician-scientist
- 11:03 The circumstances that led Dzau to take on issues of global health
- 13:05 Reflections on how Dzau stays in touch with the deeper meaning of medicine
- 17:41 A discussion of the values Dzau holds in his various roles
- 20:04 The difficulties Dzau faced during his education and career and how he recovered from burnout
- 28:36 A description of the purpose and mission of the NAM
- 32:26 How new members are elected to the NAM
- 36:25 A survey of the current issues the NAM focuses on and how Dzau thinks about the political dimensions of his work
- 41:25 The need for medical professionals to better communicate scientific facts with the broader public
- 45:32 Advice to early-career clinicians on leadership
Following is a partial transcript (note errors are possible):
Dzau: Yeah, so I was born in China and at a young age, 5, my family and I fled China, I guess literally as refugees, to go to Hong Kong because of communism. And so my early memories, this would be post-Second World War, and also, being myself, a refugee, I observed a lot of suffering.
And even our early days in Hong Kong, where we lived in a single room with no bathroom, no kitchen, but our neighbors had even more suffering because we live close to a hillside and there were many people who are squatters who literally have houses made of cardboard and others, and you can imagine when it catch fire, etc. And then, of course, no really running water except one pipe, one tap for the whole kind of so-called village. So, you know, seeing illness commonly -- my family had tuberculosis. My grandparents died of tuberculosis.
And seeing this suffering really made me think about doing something about this and therefore becoming a physician. So that's the starting point of how I became very interested in being a doctor.
Johnson: Can I just ask you, Dr. Dzau, I grew up in, I openly acknowledge, much more comfortable circumstances. My family was not ever wealthy or close by the standards of the neighborhood where I lived. But we always had a house and clothes to wear and food to eat and all the rest of it. And it really wasn't until I visited Mexico when I was 19 years old and actually lived there for a few years, that I became acquainted with the degree of grinding poverty that you're describing.
I'm just curious, though, that kind of poverty is so foreign to so many people who probably are listening to the podcast. I'm wondering if you could just reflect for a minute on how does the fact that that's where your roots are, that that's what your life was like for however many years starting out, how does that continue to shape the way that you see the world and the way that you practice medicine now?
Dzau: Tyler, I appreciate what you said and the fact that that experience will change you in a way and had an indelible impression on you. But, you know, we don't have to go that far to Mexico or to post-World War II or whatever. In our country, we have lots of poverty.
And, as you know, being a physician, caring for the patients, I know that many people really struggle and have lots of suffering. I think what we need to do a lot more, particularly for our students and others, is to have them really go into community and see how people live and where they live, etc.
You know, we have such an idealized situation. Sometimes you watch television and certainly the way I live, you live in others, but lots of people are struggling. I mean, we all know that in any city there are neighborhoods. I live in Durham, North Carolina, and I see poverty. And during COVID, you see a lot more. For example, students have no broadband. They couldn't even do classes. And my friends and I and many others got together to raise money to get computers, old computers, and create hotspots for people to do this. So it happens every day. We know that in a single city at different zip codes, life expectancy can be as much as 15 years' difference.
But let's not forget the rural areas. I bet you a lot of people have not visited them. If you grew up in the city and you have to go in rural areas -- I live in North Carolina -- you see there's poverty. So I think there's a need everywhere. But I thank you for raising that question.
I have written, for example, in Lancet, about academic medicine, the fact that I think all students should be exposed to communities and looking at real equity issues before they even learn how to stethoscope, because I thought the stethoscope is a tool, but I think it's our values that makes a huge difference. And I'm so glad you mentioned it because obviously you have the right values.
Bair: Dr. Dzau, thank you for bringing that up. And we certainly know you've been involved in many initiatives addressing the needs of marginalized communities. But before all of this, before the healthcare leadership, you attained great achievements as a physician-scientist in cardiovascular medicine and vascular biology. Your work significantly shaped our modern understanding of how blood vessels are regulated and laid the foundation for the development of lifesaving blood pressure medications now used everywhere. Can you tell us more about your path from physician to physician-scientist and what your research was about?
Dzau: Well, so I said earlier I wanted to be a doctor and it took me to Canada and McGill to study medicine. So when I started studying medicine, as would be the classical academic medicine classrooms, learning about physiology and learning how to examine patients. Of course, the science of medicine became very interesting to me. I still remember my cardiovascular physiology course, I said, "Oh my, this is how it works." And guess what? This is what happens when you have aortic stenosis or cardiac dilatation. So it became very obvious that science was the basis for, in fact, the understanding of medicine and the practice of medicine.
So I became very intrigued by research and, of course, by that time I was really interested in going to United States. So I end up, as you know, at the Brigham and Women's Hospital and Mass General, and I had lots of role models who were doing research and taking care of patients, and their research translated into the management of patients. For example, Dr. Eugene Braunwald, my mentor, he's kind of the godfather of cardiology, wrote the book "The Heart" [Braunwald's Heart Disease]. I mean, he taught me many things about how pathophysiology leads to disease and how you can intervene. His work relates to reperfusion after coronary occlusion, right, which is what we practice every day.
So I became very interested in research and so I combine a career of physician-scientist, as you say, and I still am a physician-scientist because I believe science and research are going to help us bring better care, better diagnoses to our patients.
For the full transcript, visit The Doctor's Art.
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