Leaders in Medical Education

Interview with House M.D. Medical Advisor, Dr. Lisa Sanders

Osmosis Team
Apr 10, 2014

If you love House M.D. and those New York Times patient cases, then you can thank the subject of this week’s Osmosis Leaders series: Yale physician Dr. Lisa Sanders. Dr. Sanders began writing the Diagnosis column for the NYT in 2002 that, in part, inspired the creation of House M.D., where she served as one of three medical advisors.  We are fans of her work not only for their entertainment value, but also for their educational value since research shows that forming associations is one of the best ways to learn and retain information  - something Osmosis users know we put into practice. Dr. Sanders took time out of her busy schedule to speak with us about her background, career, and medical education in general.

You began your professional career as a journalist. Can you describe what appealed to you about that profession? 

I’m sort of a nontraditional doctor, since I began medical school after a 12-year career in television news. Journalism had been interesting to me from an early age, and fortunately was not that difficult to get into. It’s completely based on the assumption that regular people looking at complicated things can report back to other regular people. Like many others I got into television journalism completely by accident, but found it to be a great fit because it exposed me to so many new concepts and people. I found myself increasingly attracted to the medical stories we were covering.

Is that what made you decide to go into medicine?

In part, yes. Medicine had always fascinated me, and I correctly suspected that if I delved even deeper I would grow even more interested. It also helped that I had become tired of traveling all of the time through my career in journalism, so was looking for something a little more stable.

Had you considered applying to medical school in college? 

No, I personally would have never applied to medical school at that time. While I was always good at math and science, the amount of uncertainty did not appeal to me in college. We’re just at the beginning of this fabulous science. I’m glad that I took the nontraditional route since it has certainly informed what I’m working on within the field.

Once you were in medical school how did you decide to pursue internal medicine? 

On my first day of clerkship during my third year of medical school I went to a meeting called “Resident Report.” It was a regular gathering of residents and eminent attendings sitting around a table, discussing and solving diagnostic dilemmas. It was fascinating. The case that day was of a woman with lupus nephritis. While listening to her presentation and symptoms, history and lab findings, I thought to myself, “Oh my goodness, this is a Sherlock Holmes story!” After that it was clear to me that I would go into Internal Medicine.

That is not to say that I didn’t keep an open mind. I had dalliances with other specialties and strongly considered urology because I loved the mix of clinical office-based medicine and the operating room. I also thought I could contribute something to the field since most of the physicians are male. However, at the time the path was a bit too long for my taste. I would have to do three years of general surgery followed by three years of urology. I also had the most toxic resident during my surgery rotation and, like many medical students, assumed that this was not an exception but rather the rule.

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Isn’t that an interesting aspect of medical education? That our future careers may be influenced by one or two people we work with? 

Definitely, how we pick our specialties can be so random. What if the chief resident at the Resident Report had picked a bad case or a dull presentation? Would I have still decided to go into Internal Medicine?

Speaking of careers, you’ve been writing for the New York Times since 2002 in addition to consulting for House M.D. Has this helped you keep things interesting and avoid burnout?

I love having a variety of activities, because it keeps things fun. However I don’t think that’s what prevents burnout. I don't think that many doctors really consider what it is about their job that they enjoy so rather than pursuing a career that is personally fulfilling they go for external validations of their choices – stuff like prestige and money. Believe it or not, those things can't really bring satisfaction over the long run. Real joy, real pleasure comes from pursuing what's interesting to you and doing what you enjoy. That's not stressed nearly enough in medicine and that causes burn out.

How did you start writing for the NYT and advising for House M.D.

My husband, who is a writer, is incredibly social and often hosts dinner parties at our home. Since we both came from a background in journalism, a large proportion of our friends are not physicians. I found myself explaining the most fascinating cases to our guests, and having to craft the narrative so they understood how cool the profession is. One of the guests at these gatherings, a brilliant writer, was particularly interested in these cases and happened to be an editor for the New York Times. He asked whether the stories I was discussing could be turned into a regular column, which is how my “Think Like A Doctor” column came to be.

House M.D. was in-part based on my column, so it was natural to become an adviser to the show. Both opportunities arose not by design, but rather by doing what I loved. That’s advice I regularly give to my trainees.

That’s great advice. Do you currently teach medical students? 

Yes, I am a clinical tutor at the Yale School and Medicine and help teach history-taking and physical exam skills to medical students. Most of the students I work with are at the residency level however.

I wonder if any students are afraid to shadow you given that you in-part inspired House M.D. and probably ask the most difficult questions, right?

Haha, I don’t “pimp” students; instead, I leave that to the surgeons. I don’t think that pimping is the best way to teach someone. Though we learn more from our mistakes than our successes, possibly because the burn of shame, you don’t have to make someone feel bad for them to learn and retain information.

How you describe learning things, by making associations and providing context, that’s the way to learn things. The people who are most likely to make the correct diagnosis did not necessarily go to the best medical school or become chief resident, rather they were the ones who had seen a similar presentation before. It often comes down to pattern recognition.

Speaking of pattern recognition, what do you think about clinical decision support tools, such as IBM’s Watson?

There are many tools that use the vast memory of computers to support diagnosis. Isabel is a current one. Everything I’ve heard about Watson seems like it’s going to be more of the same. They are great tools because they can remind you of less common entities that you might not have thought about and that’s really important. The problem with all these tools is that they depend on human minds to document their observations. We are awful at that. We are collecting data with our eyes, ears, noses that give us an impression, a gestalt. If we were thoughtful and really took the time to identify the data that gave us the impression we might be able to help the diagnostic software even more - but we don’t. Maybe we can’t. Maybe it takes too much time. Some day we will have the equivalent of the Star Trek tri-corder - a computer that can get data directly from the patient’s body and that will be real diagnostic software. Until then, these are giant and extremely effective search engines.

You’ve also published two books. I can guess how your book on medical mysteries and the art of diagnosis originated, but can you discuss how your first book on dieting came about?

It actually started before the Diagnosis column, when I was doing research with a professor. She was studying the low-carb diet, which I admittedly had very little interest in. Nutrition did not appeal to me, which goes to show how mistaken I was back then since it is so important to medicine. In any case, I decided to work with her on this research project and we wound up publishing in JAMA. The literature review fell to me, so I found myself poring over dozens of articles to see if they fit the criteria for inclusion in a meta-analysis. I found myself armed with all of this original research which I decided to distill for the general public through the Perfect Fit Diet book.

If you could change one thing about medical education, what would it be?

I would broaden the admissions criteria for students who want to go to medical school. We usually ask our applicants to bring with them a background in science and math. You will see exactly how valuable this background is when you start doctoring - in whatever specialty you choose. I think we lose out on good doctors by making students with a liberal arts background the rarity, the oddball. At Yale they keep 10% of the class slots for oddballs like me. Is that really the ratio that makes the most sense?