David Yang
Rice University
Houston (29.7° N, 95.3° W)

featuring Pierre Elias, Cardiology Fellow, Columbia University Medical Center, New York (40.7° N, 74.0° W)

Pierre Elias is a cardiology fellow at Columbia University. He completed his residency training at New York-Presbyterian Hospital/Columbia University, his MD training at Duke University School of Medicine, and his BA at Rice University. Along with practicing cardiology and seeing patients, Pierre conducts research in health informatics in order to make better use of existing healthcare data, and he works with the New York-Presbyterian information center and venture capital groups to improve technologies in the hospital.

When I was preparing for this interview, I had expected to talk with Pierre mostly about informatics and cardiology, two areas that were new to me. The interview, however, introduced me to a new mindset of approaching college and life afterwards. Pierre first discussed how students in college tend to strive for clearly set paths that have prestige associated with them (e.g., medical school, law school, or consulting) that all other students also seem to be striving for. I was impressed to see that another way to approach college and post-graduate plans is to figure out what problems I am interested in working on, and everything will follow afterwards. The problems I work on can change over time, but passionless work is to be avoided at all times. After the interview, I thought about the involvements I am engaged in and if they were issues that I was passionate about. I think that is a good self-assessment to take every now and then to make sure I am not just doing what others are doing in order to “fit in.”

Another part of the interview that impressed me was the role of data in medicine. We live in a world that is becoming increasingly reliant on data and information that is generated faster than we can process and digest. In any field I go into, there is the potential for enhancement with learning programming and data analysis skills.

After the interview, I was inspired to follow my interests wherever they may take me, and in order to do this, it is important to be exposed to issues and perspectives that can spark interest and passion. This can occur by reading new things on the internet, attending conferences, or even just emailing someone who works in a field that is interesting to you. I hope to take the lessons I’ve learned from this interview with me after I graduate college, when routes may become less structured as I decide on how to spend my life on something meaningful to me.

Highlights from the interview

I am a junior. I am a chemistry major, and I know I am interested in healthcare, but I am very open to whatever capacity that I can be working.  Healthcare is a huge field so I want to explore the different aspects of it.

So, you like science. You want to help people, and you are trying to figure out if you should go to med school, because everyone is going to either end up in grad school or law school, med school or being a consultant after college. And going to med school is kind of a logical and prestigious thing to do, so you are trying to figure out that is the right thing to do. Does that sound right?

I am eighty percent sure I am going to med school but basically you are correct, to know for sure that this is the path for me.

My goal is to try to knock that certainty down like fifty percent by the end of the interview.

Oh cool!  That’s good.

I think Rice takes in these really smart people, and it shows them these paths, and does a great job training them, but at the end of the day I always felt like there is this overemphasis on—I don’t even know if it is coming from Rice or students or what—these kind of very clearly set paths, like, I am going to go to grad school or law school. And there is a lot of comfort in that. The problem is, that is not how the real world works.  There are ten professions you see on TV, but there are a thousand different jobs you are not even exposed to. The truth of the matter is, if you are going to graduate from Rice, and do well at Rice, you are never going to go hungry again. So it is easy to feel like you have to go down these paths.  But oftentimes, the most interesting jobs are the ones that you never hear about.  

Medicine is this super oversaturated field. Even if you want to make healthcare better in this country, there is a question of—is going to medical school the best way or the only way to do it. In my undergrad years I was definitely underexposed to some of the other opportunities that are out there. I want you to feel like, okay, I settled on going to medical school, but at least I knew three other things that I could do that weren’t going to medical school that would be a great opportunity.

Do you at all regret going to medical school, or are you perfectly happy with your decision?

I don’t regret it, but I think the reason I don’t regret it is multifactorial. One, I chose where I went to medical school because of the opportunity afforded. I went to Duke for medical school, which has a really unique program. The traditional medical school is two years at the books, two years in the hospital. What Duke did is they took these first two years and they made it one year. It is very jam-packed, an accelerated program. It is eleven months of preclinical, which is just brutal. Then your second year is in the hospital, and then your third year you are off. So, basically, you learn the books, you go to the hospital for a year, and then you are off—free to do whatever you want for a year. That was an incredible opportunity. Trying to decide where to go when that was offered to me, I was like, I want that because I want to explore a bunch of other stuff. I was choosing between Duke and UCSF for med school and ended up splitting the difference because I went to Duke for med school and out to UCSF to do my research.

Nice!

[To decide what to do during my free year] I would talk to people about what I should do, and one person in a phone call told me to talk to this other person, and that person said I should talk to a third person, and then the third person was Bob Wachter. I never heard of him before. It turns out he is a really big deal in his field. I had a couple of conversation with him. He said, “Why don’t you come out and work with me?” After two phone calls I moved my life to San Francisco. I had this incredible time at UCSF, and I also had this incredible opportunity to work at a tech company, first as an intern, then as a data scientist. I liked medical school. After I worked full time at a Silicon Valley startup, I decided, you know what, I do want to still practice medicine and came back to it.  

Medicine is far from perfect. The process is long and frustrating. There are days when I am extremely annoyed by it, but I think the reason I don’t regret going to medical school is I went for something that gave me opportunity to explore other things. I am going to ultimately find a way to find a hybrid of all the different things I did and want to do. I think I would regret it if I never had the opportunity to leave, and try something else, and figure things out for myself. That flexibility is really, really important. 

Awesome. So would your advice to undergrads be to basically explore as much as possible?

My advice, when I talk with people who are trying to figure out the next step, particularly if they feel like it is a big next step, is expose yourself to problems. Real problems. And really see what it is like to be in the day-of-life of different people. I think the more you expose yourself to problems, once you find a problem that matters to you, the rest becomes so much easier. You worry less about posturing and think, oh, should I go to medical school or grad school because it is prestigious, or looks good, or should I go to this place because that looks good…Yada yada yada…You just say, this is the problem that matters to me and in order to fix that problem, I need to have these skills. How do I get to a place that is going to give me those skills? And you realize that all of these things, whether it is medical school or taking a job right after college, oftentimes what you are given is a very broad, boilerplate version of something, which is less than impressive. You know, it is so broad that it is hard to feel like you are becoming an expert in anything. It is going to be really hard to decide what are you really dedicating yourself to. You have to say sooner or later that this is the stuff I am going to learn and this is what I am good at. That is incredibly difficult when you are given a ton of options, but if you know what it is that you are trying to achieve—particularly if you know the problem that you want to be a part of fixing, your understanding what your value is, and you have a framework around how you make your decision—that, in the long run, is a lot better. When you look back, you will say, “I made those choices. It wasn’t because I thought this was the best thing, or I thought it would look like the best thing. I made that choice because I trying to fix something in the world, and this appeared to be the best way I could move forward.” I think prospectively; it is helpful because it helps provide some architecture to decide how you are going to make decisions.  

How did you come to know the problem you wanted to fix, the problem you were interested in? 

Problems I have worked on have definitely changed over time, but for me it really came from that exposure of my time in the hospital. I thought healthcare was interesting. Okay, med school seems like an okay place to go. And then I didn’t really like my preclinical time very much, but I don’t think really anyone does. It is just a ton of information being shoved into your head as fast as possible. Then I got to the hospital, and I liked seeing patients, but for me it was looking at the way—how it works.

Basically, every day in a hospital, life and death decisions are being made. The people who are working the hardest, like residents in the hospital, have to overcome insurmountable logistical problems. You will watch someone who is working eighty hours a week trying to take the best care of super sick people, then spend thirty minutes on the phone trying to make sense of a project after that. I looked at this mismatch and thought, this is insane. Or you pull out your phone, and you get to use these incredible technological apps on your phone that work seamlessly and then you have this piece of crap ten- to fifteen-year-old software at the hospital to make life and death decisions. So, for me, it was really about—why is the technology that we use in healthcare so bad compared to the technology we use in the other parts of our life, even though the stakes are so high. That is what, for the last eight to ten years, I have been totally fixated on. I can’t accept the way things are around that. You know, I have been working on these problems, and thought about these problems, and work with the best people in the country around this stuff, and still, every day, I am mad about the quality of technology that we have in healthcare. It is something that pisses me off every single day. If it is going to be something you dedicate your life to, or at least dedicate your career to, you should be really passionate about it. This just became clear to me that this was something that I was really passionate about. 

When did you first envision yourself as a physician, clinical researcher, or a cardiologist?

That is a good question. I was interested in medicine in high school. When I went to college, I was taking pre-med classes, but I was also a sociology major. It wasn’t until junior year I thought I may give medical school a try. For me, the way I made that decision at the time— if I try to look at everything bad about being a doctor, and if I am okay with everything bad about being a doctor. Every job has perks, but the downside is we undervalue…I think if I convince myself that I was okay with all the things that were negative about being a doctor, then I knew I could be especially happy in the area. I really had no idea that I wanted to be a cardiologist until I started practicing medicine.

Did you have someone who acted as a mentor to cultivate interests?

I had tons of mentors. One of the big things I learned is that there is no such thing as having a single mentor who answers all the questions. Frankly, mentors can give you really good advice in one area and really bad advice in another. Over time, you have to learn.

Most people don’t know for certain what job they want to have, and also a lot of times the job that is going to be perfect for them does not exist yet. It is going to be a hybrid of different things. It is really hard to meet someone and say, “I want your exact job.” And even if you do meet someone like that, you don’t really know how they got there. It changes. I think that is the advice I would give about mentorship, have multiple mentors and don’t necessarily assume everything you hear is going to be right. Get different opinions and think for yourself to figure out what is it that feels right, what is it that doesn’t feel right. And then make your own decision.  

There is no point in asking people where do they think they are going to be in five years. There is so much that is going to happen between now and then that that answer is going to change. We [all need to understand] that people’s careers are representations of them doing good work around companies and being presented to you as opportunity—and moving left and right through this opportunity, and that is completely okay for yourself. You have to look at your local environment and work on something that matters to you and realize you are going to float through the river of opportunities that are made for you. That is how most people’s careers are and that makes it less stressful.

You mentioned that in your undergrad that you majored in sociology. Why did you choose to do that, since it is a nontraditional pre-med major? Do you use that major in your day-to-day work life at all?

I think I ended up being sociology major because during orientation week I met a really nice girl. She told me that she was taking a sociology class. She was pre-med, and she seemed to have more sense to pick out classes than I did, so I ended up taking that class with her. I ended up gravitating toward sociology partially because I like the subject matter and partially because it offered me flexibility to take all sorts of classes, which I enjoyed. I could be pre-med, I could be sociology, and I could still explore other interests. That was one of the other benefits of being a sociology major.

I would say sociology changed the way I look at the world. To recognize that when you interact with someone else, a lot of how that interaction is going to go was already dictated before you opened your mouth. There are all of these social contracts that we live with that determines most of how things are going to go between you and I. And understanding how much is dictated by the way these are constructed is, I think, very profound, and it could make you super empathic. You may take care of a patient who is extremely difficult to take care of, and he is yelling at you and can be making all these mistakes with their personal health, and extremely health destructive. You can be very frustrated, and it can be very easy to entirely blame that person. Or you can recognize this person grew up with a life very different than your own. The opportunities were very different. You can start to understand maybe part of the blame belongs to him and maybe part of the blame belongs to society. Starting to understand that this person had a much higher chance of ending up here just because of the life they were given when growing up. And the way the society is structured. You get to understand the gravity, trying to make society better, as well as to understand that not all things are determined by, first of all, effort.

Can you give a brief overview of the kinds of projects you are working on? Why do you think your field is important for both physicians and the public to know about and care about?

There are three major things I work in. I am a cardiology fellow, which means I practice cardiology and see patients at Columbia, and basically do all things cardiology-related, whether it is noninvasive cardiology, taking patients to the CATH lab, or cardiac infection care. So that is one part of what I do. Seeing patients, learning about cardiology, practicing cardiology, and getting to delve into all the things we do taking care of people who have cardiology problems. So that is one part. Then there is another part, which is research, particularly around health informatics. I am very interested in how do we make better use of healthcare data that exists. We are at a very interesting inflection point where we greatly increased the amount of data, simple data, that is available anytime, but we still don’t know how to use it. Data is information, information is knowledge, and knowledge is wisdom. We are at a point where we greatly increased the amount of data that is being generated, but we are still very far away from turning that into information or knowledge so they can be used in the field. So, how do you unlock that puzzle? That is a big part of what I work on. I am very interested in the ways we can make technology automatically work for us. Machine learning—specifically machine sensors, so things like machine vision—to better automatically interpret images and get better interpretation of clinical imagery like echocardiograms. So that is one part that I work on, pure research side. 

And then there is another part which is the more practical side, which is we know we need to do a better job providing high quality care at a low cost in this country. We have a very inefficient, very expensive healthcare system. There are a lot of companies that are working on that. So how do you work with a technology startup company that has great technological expertise help solve these problems. I work with the NewYork-Presbyterian information center and venture capital group—and to help find companies that we think are doing important technological work in healthcare and bring their technology to the hospital and employ that technology in the hospital, trying to improve the clinical care that we provide. Working on some of those technological solutions and figuring out how do you actually take a grand high idea and make it work where the rubber meets the road. You know, how do you deal with potential problems taking new technology and making it work in a highly complex, highly variable, and highly risky situation.  

For research, you talked about using machine learning, dealing with data, and working with tech startups—how did you receive the training to get you to this point? Was that what you did in your third year off from medical school?

That is a good question.  I would say a huge portion of what I need to know in order to do that work would not be found anywhere in a traditional medical curriculum. And that is not necessarily the fault of medical schools. Medical school is supposed to train and prepare you to be a doctor. And I say that to get to that point it is very optimal. Very likely you will end up doing more than one thing in life, from a professional standpoint, and that training may not necessarily be from professional schools, grad school or undergrad. A lot of learning comes from on the job or finding it yourself. The way to figure out what it is you need to learn is to find a problem that matters to you, to understand how you are going to approach this problem. 

What started for me was understanding the problems I wanted to work on and going to people smarter than me and saying, “This is important to me,” to see if they say “Yes, that is an important idea, and that is a good thing to work on.” And then say, “What is it that you don’t know and you need to know?” So it would be things like recognizing that you need access to the data, you need to understand the way the data is structured. For example, Epic has one of the largest electronic health records in the world. So they sent me to the headquarters for Epic, and I spent two weeks there learning about the way the data is structured and getting certification of data. And then I would start with little projects, and work my way up, and start to learn about how do I actually do data science, how do I learn how to do extraction of front load, how do I actually understand the data. And when you are actually given a problem, and you need to answer that problem, you learn at a much more exciting and engaging pace because you have a very clear reason to learn something. And you need to learn it right, so it gives you an excuse to delve more. A lot of it was: I have a problem, I need to answer that problem with the resources that would help, and then I went about trying to answer that problem.

I also expose myself to different experiences. I kept looking out for different opportunities, and kept putting my hand up, and kept trying to do good work, and kept asking for more.  I can give you an experience where I did something nontraditional, but it worked out incredibly well. There are three major TED conferences each year. They are TED, TED Global, and TED Med. I loved TED talks when I was an undergrad. I learned more about TED Med, and I called to see if they had scholarships. They were offering colleges to just basically—to those who go to TED Meds. I filled out the college application saying I would like to come to it. This is what I am doing. This is why I am so excited about this. And I would literally like babysit your kids, please I would love to have the opportunity to come to this conference. I was lucky enough to get the scholarship, and I got to go to TED Med at Johns Hopkins. It was a great experience. I talked to every single person I could. And I made a first connection. After that, they said, “We need help. We get a thousand applications for speakers at TED Med every year. We need help vetting for this, would you be able to do that?” I said I would love to do that. I got to select the next speaker for TED Med and they liked how I did that so I got to vet speakers. They sent me to TED Meds for two more years in a row. I went to TED Med three years in a row. I was studying speakers, I met bunch of the speakers, and I was nominating speakers. The startup that I ended up working at was through meeting someone at TED Med.  

What advice would you give students who are still looking for problems that they are still interested in? I think you mentioned that you have to push yourself out there to expose yourself to various issues.  Is there any practical advice that you would give to a college student that is still trying to find what they are interested in?

First is, you don’t have to find the perfect answer. You just have to find the answer that is going to work for now. Everything is about durations. Start with what you know you are interested in, or think you are interested in, and just go and start talking to people. Professors’ office hours, look at the TED talks you like on the internet, read about it often, and just go where the problems are and try to understand what is an important problem that needs to be worked on. And then be convinced that this is something that is worth your time, and it is exciting. So start with that. Conferences, professors, just interesting things via internet. There are so many ways to start to find problems. And really think about these problems and try to understand them. Engage with people about them, say things like okay, I do think this is important, I do think this is unsolved, and I want to work on it.

There are times when you end up working on things people are not going to support, and it ends up being very, very important. Probably the poster child for that is E.O. Wilson. He basically discovered pheromones. But he always thought it was an important problem. And so you should work on a problem that you think is worthy of your life, because you are going to be dead in something like 960 months. It is not a lot of time that you get. You only get one go at it. You should only be working on stuff that is worthy of your life. And that means working on a problem that is going to take a generation to find it. So you should absolutely look at all these problems and really— this is big, this is something that is going to define the way we live our lives. This is something that is just so incredibly important. It has to be important to you. It is okay if it is not important to others, but it has to be important to you. So talk with a bunch of people, get yourself out there, find a generation-defining problem, and then start asking yourself, “In order to answer this problem, what do I need to do?” And then you are off to the races. I have always preferred that to the equivalent about…should I be a consultant, does that pay well, should I live where I want to live, does it look interesting, should I go to McKinsey or Bain, McKinsey could do this for me…all of that stuff is how you end up in a career with a lot of accolades and a lot of…it is really figuring out how do you solve a problem that matters to you. 

(Interview excerpts have been lightly edited for clarity and readability and approved by the interviewee.)