Leaders in Medical Education

Dr. Shantanu Nundy, The Human Diagnosis Project

Thasin Jaigirdar
Published on Jul 14, 2015. Updated on Invalid date.

Dr. Nundy’s career spans public health, academia, and technology. Previously, he founded a medical clinic in rural India and served as a consultant to the World Health Organization (WHO). Dr. Nundy has conducted research at Harvard Medical School, Johns Hopkins, and the Centers for Disease Control and Prevention (CDC), and published peer-reviewed articles in Health Affairs, Academic Medicine, and the Journal of Medical Internet Research. Prior to Human Dx, Shantanu was Managing Director for Clinical Innovation at Evolent Health, a population health management company, and co-founded mHealth Solutions, a mobile messaging startup for patients with chronic illness.

Shantanu received his B.S. from MIT, an M.D. with Alpha Omega Alpha distinction from the Johns Hopkins University School of Medicine, and an M.B.A. from the University of Chicago Booth School of Business. He trained in internal medicine at the University of Chicago Medical Center where he also completed an Agency for Healthcare Research and Quality (AHRQ) research fellowship and served as a principal investigator.

To find more information about the Human Diagnosis Project, what he current works on, check out https://www.humandx.org/

How did you first become interested in medicine? Medical education?
I am one of those I-wanted-to-be-a-doctor-since-I-was-a-kid people. As a child, I was always in and out of the doctor’s office and thought “hey, I want to help people too.” That being said, I had no clue what doctors actually did. I grew up in a family of people who do development work (World Bank, NGOs, etc.). When I got to college, I went to my family’s school in India to teach English but immediately was drawn to our students’ health care needs instead. Over the next three years, I ended up starting a small free clinic and that experience cemented my desire to go into medicine.

Over the years, my focus is broadened from clinical medicine to global health. We have over a billion people today without any access to health care. To address that, we are going to need to reimagine health care. The challenge is clear: how do we make the highest quality health care newly available to hundreds of millions of people? Changing medical education must be part of the solution.

Can you share your background on how you got to where you are right now?
Before medical school, I started doing research in medical malpractice, from an economics perspective. That introduced to the Institute of Medicine’s “To Err is Human” report. As someone who wanted to be a doctor since I was a kid to help people, I was shocked to learn that doctors sometimes hurt patients more than they help. In medical school, I got involved with patient safety efforts to reduce bloodstream-related catheter infections in the ICU and improve teamwork in the OR. Affecting immediate change in health care practice was exhilarating. From patient safety I went into health care quality to health systems and finally to population health.

Along the way, I became more and more of an “accidental technologist.” Health care is incredibly local; fix a problem here and you’ve fixed a problem here. Everyone deserves the best available health care, and technology is the best tool available to drive global scale.

How did you come up with the idea for the HumanDx Project? What are your goals for the initiative within 1 year? Five years?
The Human Diagnosis Project started over two years ago. I only joined the team recently. But I have been thinking about the problem Human Dx is trying to solve for a long time.

When I was a medical student, I saw a patient no one could diagnose. She was a 30-year-old marine stationed in South East Asia, who was in an excellent health until a year earlier when she developed recurrent, nightly fevers that left her disabled. Over the next twelve months, she went from hospital to hospital without a diagnosis, starting with the local naval clinic, then the regional base, then Germany, then Walter Reed, and finally Johns Hopkins Hospital where I was a student. On the last day of her hospitalization, just as she was about to be discharged, a retired infectious disease physician barged into her room and diagnosed her in fifteen minutes. Within a few months, she was back to her usual health.

The case left me stunned. Somebody, somewhere knew how to help this patient. Yet despite access to many of the world’s top medical institutions, it was only by luck and happenstance that she finally got better.

This patient’s dilemma is not unique. To nearly every person on Earth, the well-being of oneself and one’s loved ones is the most important concern. And yet, the most essential question of human well-being is still very difficult to answer: when someone has a health problem, what steps should he or she take to get better? The Human Diagnosis Project intends to answer that question for current and future generations.

Within 1 year, we aim to build the largest open project in medicine, with over 10,000 physicians and medical students contributing to the Project. Within 5 years, we aim to scale to over 100,000 contributors from the medical, scientific, and patient communities. Our mission to is empower anyone, anywhere, with the world’s collective medical insight.

What are 2-3 changes you would like to see in the current medical education system? Healthcare system?
Repeated, rapid cycles of practice, feedback, and reinforcement are key components of learning. Sports training is a useful analog -- the best athletes practice drills daily, often for hours a day, and monitor their performance rigorously -- but the same can be said for many other professions, including musicians, chefs, and public speakers.

In medicine, we call seeing patients every day “practice”. But we aren’t practicing if we aren’t getting feedback and improving — we are just performing. None of us can hope to be the Michael Phelps, Yo-Yo Ma, or Grant Achatz of medicine that our patients deserve us to be without real practice.

Human Dx builds on the science of learning by enabling physicians and students to quickly test and get feedback on their clinical reasoning skills. This is done by both by receiving input on their own cases as well as giving input on other contributors' cases to compare their thinking with physicians and students from around the world.

What I’d like to see is that rigorous practice and pursuit of excellence in clinical reasoning, diagnosis, and management becomes a core part of the physician experience- I want in 10 years for us to look back at today with the same surprise as we would to hear that a professional athlete never trained.

Do you have any final thoughts regarding the medical profession as a whole?
Medicine is tough. Often it feels we’ve given everything we have and then some. We’re drained.

But paradoxically, it’s by serving others that we find the energy to do more, in our professional and personal lives. Mother Teresa said, “Love is Service. The Fruit of Service is Peace.”

My hope is that for physicians and medical students contributing to Human Dx is their 10 minutes a day to be a part of a something greater than themselves, to share their insights with humankind, to build a resource for current and future generations- and in doing so, renew the reasons that brought them to medicine in the first place and find joy in clinical practice.