Leaders in Medical Education

Grey's Anatomy Medical Advisor & Neurosurgeon, Dr. Allan Hamilton

Osmosis Team
Apr 24, 2014

After four months of scheduling we were incredibly fortunate to get an interview with the impressive Dr. Allan Hamilton, professor of neurosurgery at the University of Arizona and medical advisor to the popular Grey's Anatomy. He shared some unique insights on his professional career, why he values creativity in himself and medical students, and how to avoid burnout. Enjoy!

How did you decide on neurosurgery?

I actually decided to become a neurosurgeon before medical school. I loved working with my hands, and developed an appreciation and talent for fine motor skills early on. I used to build models of boats and even organs such as the heart, and tended to be a very visual learner. At some point in college I got a job in a lab where I was doing nephrectomies on rats. I loved doing these surgeries and then within the field of surgery decided that I wanted to do the hardest thing possible. So initially I came into neurosurgery from a very manual perspective, and later I became very interested in the relationship between the mind and the brain, which made my love for the field that much stronger.

Given that neurosurgery is a long and difficult path, even within the field of medicine, how did you stay the course during medical school?
It helps that I get into genuine flow states when working with my hands, so I was already committed to surgery. The idea that there was this discipline that required extreme focus was really appealing to me. The other thing was that I got to meet neurosurgeons and the more of them I met the more I admired them and realized I wanted to be among them. That’s one piece of advice for medical students I have: during every rotation you should try putting yourself in the shoes of the attendings and residents you’re working with. Ask yourself, “Can I really see myself being a cardiologist, dermatologist, surgeon, etc?” Then you further narrow it down by figuring out whom you are most comfortable with. For me those were neurosurgeons, whom I found to be extremely intellectual especially with how they deeply understood anatomy and the implications of it. I remember hoping that I could just measure up to them, and I’ll admit along the way I did meet some who tried discouraging me either through their words or their actions.

Fortunately I had a wonderful advisor, Dr. Daniel Federman, at Harvard, who later became the Dean there. He was wonderful and whenever I became discouraged he would continue inspiring and supporting me. He’d say, “Yes it’s a long training period, but this is what you were meant to do.” It helps to have a couple of advisors who can buck you up.

One other thing I’ll say on this point is that you never drift too far from your roots. That is, you cannot really change your inherent talents and gifts. I remember in the fourth grade for my science project I made an entire model of the human body with clay, and now decades later I’m still doing the same science project. Life becomes a set of recurring themes that revolve around your inherent strengths.

I’ve noticed the same with all of the neurosurgeons I’ve interacted with. Though I’m still undecided on specialty, it was the experience working with a child with hydrocephalus that made me want to go to medical school. Fast-forward 20 years and I’m doing research with Hopkins neurosurgeon and hydrocephalus-specialist Dr. Daniele Rigamonti. Our chair of neurosurgery at Hopkins, Dr. Henry Brem, is another example of a dedicated and supportive surgeon.
Neurosurgery is a tight community, which is another added benefit. I’m friends with both Daniele and Henry. An interesting story for you: on September 11, 2001 Henry and I were preparing to testify in front of Congress about why laws relating to Medicare regulations should be changed to fast-track new, efficacious medical technologies, particularly for brain tumors. We were lined up outside of the room and Henry was checking his phone - not as ubiquitous back then, mind you - and said, “Oh man, a plane just fell into the World Trade Center.” We both thought it was a private pilot and questioned what he was doing so close to Manhattan island. Within the next 20 minutes it became very clear that it was not a private pilot. The Congressional building started evacuation procedures and the air was filled with F18s, while smoke billowed out of the Pentagon. It was hard to get out of DC, but I found a way to the nearest hospital in Bethesda (the Naval Hospital) and reported there in case they needed surgeons. It was a surreal experience, for both Henry and me.

A quick realization that one has when looking at your CV is that you have many unique experiences and hobbies. Speaking of, how did you begin writing forGrey’s Anatomy?
This was one of those serendipitous opportunities that emerged from left field. As I mentioned, I am very visual and can take a set of 2D images and construct a 3D model in my head. I decided to pursue this area within neurosurgery and became fairly involved with designing and advising on 3D graphical displays and guided surgeries.

The team at Grey’s Anatomy contacted me because they were interested in special effects and needed help with a simulation for one of their episodes. We worked on that episode together and then they came back again, and again, for more consultation. Bit-by-bit they continued asking for my thoughts until finally they offered me a permanent role as their medical advisor.

Now I was an English major in college so I was already very interested in writing and had done quite a bit myself. I knew this would be a cool opportunity since I’d be working with professional creative writers and be able to contribute to their process in a meaningful way given my clinical background. I could draw on life experiences working with thousands of patients to come up with scenarios based on what they wanted to occur in the drama. For example, they would say, “We want a clinical scenario in which the physician doubts him- or herself, or they’re in too deep. What do you think?” That part flowed naturally, and I’ve been with them for eight seasons now.

How do you balance a medical career that requires such intense focus with all of the other things you do?
The nice part is that the things I do alongside neurosurgery are very creative. Surgery is very technical and not inherently the most creative thing you can do. One of my attendings used to admonish me, “Just don’t get creative!” You want surgeons to stick to a particular plan, while allowing for some flexibility so that they can deal with issues that arise. I would say that 70 percent of my time is spent on left-brained activities, such as neurosurgery, and 30 percent is spent on mostly right-brained creative work. I think they’re complementary skill-sets.

Now when I analyze what really makes medicine work, I realize that creativity and intuition play a huge role. I often tell my residents to think with their guts in addition to their brain, because oftentimes their guts are faster.

Besides gaining more experience, how do medical students develop intuition?
Intuition is a funny thing because most of us have it, but we tend to override it. We’re taught not to trust our intuition. I’ll give you an example. Go into a first grade classroom and ask the kids how many of them want to be artists. 75 percent will put their hands up. Now walk into a fifth grade classroom and when you ask the same question less than 10 percent will raise their hands. The system has managed to kill creativity and a belief in our inherent abilities. The trick in medicine is to go backwards and dismantle that. For you to be good doctors you have to be creative and willing to take risks by coming up with oddball answers. We do a lot in medical school to consolidate people into a specific culture and a vocabulary. If you think about it that’s what medical school is really about. “Learn this new language and act like us.” The people you really want are those who don’t act like us. Sure, we’re most comfortable with the people who are like us, but we’re going to get the farthest with the people who are not. Maverick thinkers tend to trust themselves a lot more than the opinions of others. One of the things we need to do is build into medical education this self-confidence.

That’s a great perspective. You may be interested to know that at Osmosis we’re developing an “Intuition Index” which we aim to share with our 10,000+ medical student users, that compares their accuracy and confidence metrics. For example, how often do they get questions right that they answer “No Clue” versus get questions wrong when they answer, “I’m Sure”?
That’s a very interesting piece of data. There are very few things that are 100% in medicine. I’d prefer a surgeon or physician who has some doubt in her heart as opposed to a bull-headed clinician. I want the 21st century physician to be a compassionate, tech-savvy problem-solver who can work in a team. We’re still training 20th century medical students, under the system set forth by Osler and Halsted. We need to place a larger premium on people with emotional and social intelligence, as well as intuition, as opposed to people who are really good at cramming and regurgitating information.

How would you improve medical education?
The first thing I’d do is shorten it. I’d have future clinicians graduating medical school or even residency in their early 20s, while their psychomotor skills are their peak. We need to create a lifelong learner, and we are able to select for that right out of high school, not college. Most pre-med students are so pegged on making sure their GPA and MCAT scores are high enough, but those have nothing to do with being a good clinician.

Do you have any advice for medical students who have heard the statistics about physician burnout?
Out of thousands of medical students, I’ve never met one who wasn’t genuinely interested in helping people. However, leap forward to residents about to graduate and you’ll often find incredibly disillusionment and sarcasm. The system and the hierarchy are turning people off to medicine; it’s not medicine itself. The reason that I still love going to work after 35 years is that I never feel like I’m not making a difference. It helps that your family is never going to want, you’ll always have a roof over your head, your kids can go to college, and you’ll be a respected member of society.

Another thing is that there’s not a personality or character trait that there isn’t room for in medicine. Whatever your skills are, there’s a niche for you. If you’re an introvert and bookworm, there’s a field for you. If you want to be a person who reads images from home, there’s a field for you. If you want to be an absolute exquisite machinist with the finest watch-making ability, there’s a field for you. If you want to be a humanist, there’s a field for you. I look at that and realize that I have to be proactive about letting my students and residents know that so they do not get discouraged or turned off. True, medicine is undergoing a lot of changes, but two facts remain: (1) The need for healthcare will not disappear, and (2) You’ll never feel like what you’re doing is not valuable.