Shvetali Thatte
Case Western Reserve University
Cleveland (41.4° N, 81.6° W)

featuring Harrison Nguyen, Dermatology Resident, Emory University School of Medicine, Atlanta (33.7° N, 84.3° W)

In life, you should be in no rush. Sometimes, it’s easy to get caught up in the whirlwind of life, with the next step always coming before you’ve even put your first foot down. This is a reminder to explore all your options, to take the chances you might never have thought of, and to let yourself enjoy the journey instead of sprinting and missing the details just to get to the finish line first.

My conversation with Dr. Harrison Nguyen, a dermatology resident at Emory University School of Medicine, reminded me that every experience we have ultimately gives us a new skill set that will pay dividends in the future.

Dr. Harrison Nguyen began his journey to medicine when he was accepted to the BS/MD program at Rice University/Baylor College of Medicine. However, Dr. Nguyen’s journey was not limited to medicine; he also pursued research abroad, expanded his cultural horizons, explored the world of football in his undergraduate years, and pursued an MBA at Yale University between his third and fourth years of medical school.

Each summer during his undergraduate years, Dr. Nguyen committed himself to finding a new opportunity that would allow him to explore a different intersection of medicine, research, and service. From studying the healthcare system in Norway to conducting public health research in Vietnam and Greece, Dr. Nguyen had a plethora of cultural insights that he now sees himself applying as a practicing physician.

Dr. Nguyen was always certain that he wanted to be a doctor, and as he grew up, he found a natural love for science, the human body, and helping others. In his undergraduate years, he researched a virus that plays a role in 80% of aggressive skin cancer cases. From his laboratory experiences, his drive towards dermatology arose, and today, he continues his journey as a dermatology resident and the leader of the Health Policy Research Group for the American Academy of Dermatology.

As a future physician, I was curious about how Dr. Nguyen believes the medical field is changing, and he brought up a relevant conversation about physician burnout. Even before COVID-19 hit, many physicians were finding themselves exhausted with the patient load, combined with the increased paperwork from electronic medical records, but the pandemic has further exacerbated their concerns with the number of patients increasing and physicians being caught in difficult situations.

In his opinion, the most important way to prevent burnout, at any age or stage in your career in medicine, is to remind yourself why you chose medicine. Recognize why a career in medicine makes you happy, and make sure that you are constantly feeling that joy. Each individual has their own reasons for going into medicine, but as long as you stick to your own reasons and embrace them, you’ll find that medicine is a very rewarding career.

There’s no doubt that the use of technology in medicine has also grown in recent years. I sometimes worry that technology will replace healthcare professionals; however, Dr. Nguyen reminds us that no matter how many algorithms or robots are created to assist doctors, the foundation of medicine lies in humanity. The new tools can augment the physicians’ skills when caring for their patients, but they will not replace healthcare professionals. Medicine is an art and a science, and if you take the art of human connection away, you can no longer reap the same benefits.

Our discussion on the humanity of medicine was an excellent segue for me to ask Dr. Nguyen about a personal initiative that I have started this summer. The early part of my summer allowed me to read books that explored the intersection of culture and medicine, including Black Man in a White Coat and Racism in Healthcare: Alive and Well. After reading these books, I spoke to various physicians, medical students, and other healthcare professionals about their personal opinion on culture in medicine.

Based on these insights, my friends and I recently submitted a proposal to the Association of American Medical Colleges (AAMC) and various undergraduate institutions. We are asking for the AAMC to make cultural competency a pre-med course requisite, and we are asking individual undergraduate institutions to begin offering cultural competency courses at the undergraduate level. Our literature review, the proposals we’ve submitted, and our petition can be found at this link. 

On this topic, Dr. Nguyen’s comments were very encouraging:

“As a physician practicing in a multicultural hub, I see first-hand the powerful impact that cultural competence can have on understanding a patient’s disease experience and on partnering with patients to devise an optimal treatment plan.  Data have consistently shown that cultural gaps can drive significant health inequity and worse clinical outcomes, and I believe that it is of utmost importance for trainees at all levels to receive robust training in cultural competence.”

I feel very fortunate to have had such a multi-dimensional conversation with Dr. Nguyen, and I certainly have many takeaways that I will carry with me as I begin my own journey to medicine.

The theme that resonated most with me from our conversation was that there is no timeline for your life or your career. You determine what you do every day, every month, and every year, and the more passionately you pursue goals, the happier you will be. You can never connect the dots going forward, only backward. So, do what fulfills your passion now, and you’ll find a use for it in the future, maybe in a totally unexpected way.

Highlights from the interview

Could you talk about how your background prepared you for your career?

I grew up in Detroit as the only child of immigrant parents who came from Vietnam and started from the very bottom. I mention this because it is very much a guiding force in my life. I had a strict upbringing. My parents had always dreamed of themselves of being physicians, but they weren’t able to be doctors because of their own life challenges. In my earliest memories, I wanted to be a doctor without really understanding what that meant. But, as I started to get older, I noticed a natural affinity to science and knowing more about how the human body works. In high school, I applied to 13 colleges and eight combined medical programs and chose Rice University and Baylor College of Medicine because of my family and Rice being located in the largest Medical Center in the world. I knew I wanted to be a doctor, I knew I had guaranteed acceptance to medical school, but I didn’t know what to really do with myself. I started doing research as a freshman in college in the laboratory of a well-known investigative dermatologist specializing in oncogenesis. Just six months prior to my matriculation, an important paper was published in Science showing that Merkel Cell Carcinoma, a rare but very aggressive type of skin cancer, was caused by a virus in 80% of cases. So, I started doing research on this virus and growing my experience over the years. As I started to build my own reputation as a researcher, my mentor got me involved in clinical research as a consultant.

In college, I  wanted to see the world because growing up, I didn’t have that experience. So, every summer, I would try to take an internship abroad that integrated my interests in medicine and research & service. After the summer of my freshman year, I did public health research in Vietnam. After my sophomore year, I did research in Greece, and the after my junior year, I met Ipek Martinez. She was a great sponsor and supported my proposal to study the healthcare system in Norway. Norway’s healthcare system is radically different from ours. They have a socialized healthcare system where everyone has healthcare provided to them, and they have great outcomes for the most part. So, I wanted to understand more about this, and I spent my junior year abroad in Norway. It was a very formative experience for me as I started to see different drivers of health.

As I started to prepare for medical school, having that experience in Norway and also working with pharmaceutical companies in a more advisory consulting capacity, I began to think about pursuing supplemental education and training to my medical degree. So, I took the GMAT prior to starting medical school. I wanted to do an MBA between my third and fourth years in medical school. Baylor had a combined MD/MBA program with Rice, but I wanted to see something new and expand my network beyond Rice. I went to Yale University to get an MBA and MPH between my third and fourth years in medical school. Taking the time off from medicine to focus completely on building a skill set in finance, economics, and strategy in operations was really special. I also focused on health policy at Yale School of Public Health. I developed a skill set in statistics to apply it to concepts in medicine and business. I wanted to do this in a global context. So, I began doing consulting work for an Israeli pharmaceutical company.

Business school brings together folks from all different walks of life, different backgrounds, different paths. My path was considered relatively unique, but I was able to learn so much from my classmates from the nonprofit sector and the finance sector, and those who had worked in Teach for America. It opened my mind to the problems in the world and different approaches to solving them. It allowed me to study problems in other sectors and industries and apply them to my areas of interest in healthcare. During that time, I also worked as a consultant for the Food and Drug Administration. I worked in developing regulations for the cosmetic industry and that led to more work through the American Academy of Dermatology, which is the main professional organization that represents dermatologists. I was interested in the evolving landscape of health policy and how it impacts dermatology. So, I started and am now leading the Health Policy Research Group for the American Academy of Dermatology.

After Yale, I came back for my fourth year in medical school, applied for residency, and ultimately chose to go to Emory University in Atlanta, which is adjacent to the Centers for Disease Control and Prevention and close to the American Cancer Society. I saw this opportunity to advance collaboration. Most interesting problems and solutions happen at the intersections between fields, between industries, between researchers and collaborators from different perspectives. I think of myself as sitting at the intersection of dermatology, health policy, and innovation, trying to design and advocate for regulations that support safe and effective innovation in dermatology. I’m currently a second-year dermatology resident; I have two more years of dermatology residency, and then I intend to do a fellowship in dermatologic surgery. Moving forward, I intend to focus on advancing initiatives in health policy and innovation from the perspective of a dermatologist.

What do you think about medicine becoming a field of mixed feelings lately? 

It’s no secret that there’s a lot of burned-out people in medicine. I don’t have a solution myself, but personally, something that I remind myself is that, we have the great privilege of being able to take care of patients. They put their lives and their family’s lives in our hands. There’s no other opportunity like that. You should remind yourself on a regular basis why you went to medicine and what motivates you. If you recognize that you are more motivated by money, for example, acknowledge that, that’s not a bad thing. In medical school, people will discourage you from talking about lifestyle and money. That’s such a shame because although it may not be particularly relevant in medical school, these are important factors in your future happiness and so I encourage you early on to recognize your preferences, your tendencies, and your desires and then to make decisions based on what you want without concern for what other people think.

On the first day of medical school, I said I wanted to be a dermatologist. I stumbled on that field for the wrong reasons. This burned-out doctor had told me that he wished he had gone to dermatology just for the lifestyle and the money. As I came into it, I realized that dermatology has a great impact on our patients’ quality of life. We don’t save lives as other doctors do. But, patients will take their dermatology medications before they take their heart failure or diabetes medications. Data show that skin diseases have a significant impact on a patient’s quality of life. So, I feel like I am making a difference every day. Don’t let other people’s narratives shape your own. Gather as many opinions as you can, and then reflect and acknowledge your own characteristics and desires, and ultimately make the decision that is in your own best interests.

What would you recommend students in terms of navigating research opportunities, ways to build up their resume for medical school applications?

You should be in no rush because every opportunity you have early on to advance your career, to build more skill sets will pay dividends in the future. You only go through college once. Your opportunity to take different classes may not come again in the future. You will never have the opportunity to be around so many individuals and opportunities of diverse nature. So, as much as you have to focus on checking the boxes and jumping through the hoops of getting into medical school, push yourself to do things that you otherwise will never have the opportunity to do.

Broaden your horizon and recognize that college is a very special time with where you have free rein to be whoever and explore whatever you want. Once you get to the medical school, those opportunities dissipate, you’re told what to do and you have to go through a very structured path. That’s even more so the case in residency.

From when you started medical school and your residency to the present day, how has the field of medicine changed overall?

One of the most salient changes that I have noticed is the increasing integration of technology into our workflow. In dermatology, we rely on the tools of telemedicine to be able to care for our patients in the times of COVID-19. This is an example of technology being more integrated not to replace physicians but to assist physicians in caring for patients. I expect that to continue to grow.

We can use tools such as machine learning on a regular basis to make informed decisions on management. In dermatology, there are algorithms that are being developed to guide the physicians to decide whether a pigmented lesion is benign or malignant. Some physicians are resistant to these changes. They’re worried that technology will replace their role, but medicine at its core is grounded in humanity. I don’t ever see a world in medicine where physicians or healthcare providers are replaced, but rather where tools are developed to augment our skills in caring for our patients.

Do you think we will go back to face-to-face appointments or people will still opt to stay for telemedicine as a preference?

We’re finding that telemedicine offers many benefits in different scenarios. I think telemedicine is here to stay. The COVID-19 pandemic has accelerated and catalyzed the changes required to be able to implement and operate telemedicine services. For example, for Accutane follow up, we usually need to see patients every month in person to run labs and ask questions, but that’s something very conducive to telemedicine visits. Telemedicine is a great platform for following up with patients who are doing well on treatments. It has also expanded access to patients who live far from a hospital and allowed us to connect with them more easily.

This is a question that’s not pertaining to the reflection that I will write but I wanted to ask your opinion. We put together a cultural competency petition to the Association of American Medical Colleges (AAMC) and individual undergraduate institutions to begin offering a cultural competency course for pre-meds and make that course a pre-med requisite. Could you share your thoughts on this initiative and the importance of cultural competency in medicine in general?

That is an extremely important initiative. I applaud you for having that insight. I couldn’t speak more highly of the importance of cultural competence and caring for patients, and being able to recognize different walks of life, connect with your patients, and understand the different drivers of health disparities. As a physician practicing in a multicultural hub, I see first-hand the powerful impact that cultural competence can have on understanding a patient’s disease experience and on partnering with patients to devise an optimal treatment plan.  Data have consistently shown that cultural gaps can drive significant health inequity and worse clinical outcomes, and I believe that it is of utmost importance for trainees at all levels to receive robust training in cultural competence as early in undergrad and in the pre-med program. We as residents are now integrating this more formally into our curriculum. The Accreditation Council for Graduate Medical Education (ACGME) is starting to develop initiatives to formalize this. Let me give you a few examples from dermatology. We see different types of hair loss disorders, one of which is a type of scarring called cicatricial hair loss that is common in African American patients. The skill to understand cultural haircare practices and integrate that into our counseling and patient management is truly night and day. When I use the terminology that our patients are familiar with, their eyes light up because they realize that their physician understands them. There are some cultures who have faced a lot of adversity in the past and have developed some skepticism to physicians who are not from the same background; so, to be able to understand where they’re coming from, their desires, their preferences, makes a huge impact on the outcomes.

Interview excerpts have been lightly edited for clarity and readability and approved by the interviewee. This article only aims to share personal opinions and learnings and does not constitute the interviewee’s current or former employer(s)’ position on any of the topics discussed.