The Art, and Heart, Of Teaching - Dr. Raj Dasgupta, Associate Professor at the Keck School of Medicine of USC

Shiv Gaglani: Hi, I'm Shiv Gaglani, and today on Raise the Line, I'm happy to welcome Dr. Raj Dasgupta, an award-winning medical educator who has become a force in the field using various mediums and wearing multiple hats. Dr. Dasgupta is quadruple board certified in pulmonary, critical care, sleep, and internal medicine and maintains a clinical practice while also serving as an associate professor at the Keck School of Medicine at the University of Southern California, where for six consecutive years he has received the Faculty Teaching Award. 

His educational work includes partnering with our parent company, Elsevier, to publish the clinical and basic science book series, Morning Report: Beyond the Pearls and Case Reports: Beyond the Pearls. He has also taught USMLE Step 1, 2, 3, and Internal Medicine board review around the world for the past twenty years. 

Dr. Raj has a regular presence in the media, appearing on various platforms and TV shows such as Chasing the Cure, The Doctors, CNN, ABC News, and Inside Edition. On top of all that, he also hosts three podcasts: The Dr. Raj Podcast, Beyond the Pearls, and MedPrep2Go.

I'd like to thank Jim Merritt, our colleague at Elsevier, for making the introduction to Dr. Raj. So, thanks very much for taking the time to be with us today.

Dr. Raj Dasgupta: Hey, thanks Shiv. This is a treat. You know, usually I'm interviewing others. I'm trying to get into the mode...trying to feel being the interviewee again. So I'm excited.

Shiv: Yeah, me too. I've heard so many good things about you. Even when I was in med school the first time around, I'd heard about you, but finally we're getting the chance to connect. 

As regular listeners to the podcast know, we always like to ask our guests to, in their own words, describe their medical journey. What got you excited about medicine, and then ultimately, how'd you decide to get quadruple board certified?

Dr. Dasgupta: Well, you know, it really all comes down to my background. So, you can't really see me, but when most people look at me, they're like, “Well, he's brown, his name is Raj, he's got to be Indian!” You know what I mean? But the truth is that I'm two races put together and if anyone ever looks at my picture, they'll never guess what my second race is. But it's actually...my mom is amazing. She is a former RN. She is, you know, not too tall. She loves going to church. She's Filipino! So, I'm half Indian and half Filipino. Because of this powerhouse of Asian in me, well, what happens is, we kind of are pushed, shoved, directed into that, ‘hey, maybe I should be a doctor and the healthcare profession is the way to go.’ And I love my folks, you know? So, initially I thought, well, that's what you're supposed to do. 

But then I'll tell you one thing is that during my journey I did some training in New York and during that time -- I don't have to date myself but it was actually during 9/11 and I was fortunate and unfortunate that I was there -- but you know, it was so heartbreaking to be a medical student and not really do the things I wanted to do when tragedy hit. That was really one of the motivations for me to really just go through my training the best I can and really looking forward to really helping people. That was a big change there. 

After I became an internal medicine doctor -- because I just love internal medicine -- I really decided that, hey, you know, I just kind of wanted to focus on a few things because I think that as you're in the hospital, it's very easy to say the word ‘consult, consult’ and I think that I really enjoyed my critical care rotation. I really enjoyed putting lines and putting tubes in people -- in a nice way, not a mean way -- and critical care is usually peanut butter and jelly with pulmonary. So, I did pulmonary critical care and I would have been done there until I realized that when we talk about good health Shiv, it's diet, it's exercise...but sleep is a huge part of that If we both live to ninety years, we sleep a third of our lives, which is thirty years. That's kind of a lot. So, it made sense to do sleep. 

And that's how I became certified in all this because, you know, we work so hard to be internists. I just didn't want it to go away, so I kept my certification. So, yeah, I'm super proud. Maybe not as proud as my mom and dad, but I am quadruple board certified and I just love doing what I do.

Shiv: That's incredible and that's evident from your delivery style, which I'm getting the pleasure to experience personally right now, but I've heard you on podcasts before. I can see why you get faculty teaching awards. I always like to joke that one of the privileges of having running Osmosis is I've gotten to meet many wonderful medical educators over the past decade and if I could pick an all-star team of them, we probably would have never started Osmosis because medical school would have been so fun and engaging that we wouldn't have had to start, you know, building flipped classroom videos and stuff like that and you'd obviously be in that in that cast of people.

We're definitely going to go into sleep and your work there, but let's first start off with your educational work because you’ve won teaching awards and you published these books with Elsevier. Tell us a bit about what got you engaged as a medical educator.

Dr. Dasgupta: Sure. For many people out there when they hear USMLE Step 1, they still get a little chill. That's the first huge test that you have to take since college and it was so overwhelming when I took it. It wasn't pass/fail like it is now and that was a huge part of getting the residency you wanted. I remember that I did take a review course and it was wonderful and there were instructors that were just amazing, and I always felt like despite how amazing they are, I wanted to do things that if only he or she kind of made it a little more entertaining, a little more fun, gave this acronym or just kind of incorporated different parts to make it engaging and educational at the same time, it would have been above and beyond. I really had this desire to kind of combine personality, be engaging, and teaching all into one. I really wanted to teach. 

That's why I ended up teaching Step 1 and that led to Step 2 and Step 3 and I never wanted to let it go. 

If I think about who do I love teaching the most? I love everyone. I do. I do. I love teaching foreign medical graduates and I love stories. My father-in-law, God rest his soul, he was a cardiologist from Iran. My wife's Iranian. And, you know, when he came to the United States, he had to do all his Steps again. I remember he told me the story that when he had to redo his Step 1, he would have to listen to lectures through a tape recorder over headphones. There were no like CDs and DVDs and all these things. It just makes me tear up. So, I really enjoy teaching foreign medical graduates and especially Step 1, 2 and 3. 

That led eventually to thinking that beyond just talk, talk, talk, which I love doing, I really wanted to have some books, and Elsevier is awesome. They had so much faith in me. Jim Merritt is my boy. I love him. He has always gone to bat for me and I made my first book, which is Medicine Morning Report: Beyond the Pearls. No one sees this, but I made this hand motion and it was really successful. Jim decided to say, “Hey, let's do it across all the Steps too, you know, a series on OB-GYN and Peds.” That whole series became great.  So, now I'm doing my basic science series. We already came up with a pathology book. I'm working on immuno and micro and it's just awesome. 

And then the last person I'll give kudos to -- who you know and you interviewed -- is Dr. Ted O'Connell. He got me into podcasting. He's like, “Raj, you talk so much. Why don't you do podcasts?” I got to do all these cool podcasts because of him. That's how I kind of incorporate all my teaching and stuff.

Shiv: That's fantastic. Two comments I'll make on that. Well, definitely Jim Merritt is wonderful. And actually, I met him a decade ago when we were first starting Osmosis and the fact that he, as well as a few other people at Elsevier, were still at the company a decade later when Elsevier decided to acquire us was a huge reason why we felt comfortable. I thought that if they can retain people like Jim, Elyse O’Grady, Madelene Hyde -- there's a whole bunch of them -- I was like, “This is a good place with people who are really passionate and committed to what they're doing.” And obviously, being able to work with faculty like yourself and Ted and a few others who are just wonderful.

So, you mentioned the other pieces. I love the focus on international medical graduates. You know, they work so hard. They're so committed. Many of them wind up taking minimum wage jobs while they're studying...working at McDonald's or something while they're trying to pass the tests. Many of them they have to check their ego. They were cardiothoracic surgeons in Africa, and they have to start from literally Step 1, Step 2. My father immigrated from India to Namibia to South Africa to then Florida and due to a variety of health reasons, he wound up not taking the Steps in the US. But he was such an experienced physician. 

Frankly, this physician shortage we keep hearing about... the fact that we don't make it easier for foreign medical graduates is, I think, a travesty, though there's a counter argument about brain drain for their countries, which I fully understand. I mean, I was just in London for a couple of weeks, and even the UK is having issues with brain drain because all these doctors or med students want to leave and go to places where they're paid more, or treated better, at least.

So, anyways, there's a lot to unpack there. I'm curious, you mentioned when you took Step 1, it was not pass/fail. Step 1 is now pass/fail, any commentary? And then more than that, I'm sure you've been following the AI developments where GPT-4 passes that one even better than 80% of med students or whatever it may be, and GPT-5 will probably be like 99.9%. 

What are your thoughts on these tests, the importance of these tests? And how should we be adjusting medical education in the age of AI?

Dr. Dasgupta: Oh, my God, so many good questions. Number one, as I'm getting older I'm seeing how medicine in general has changed. When I was a med student -- and oh, my God, I can't believe I just said that...I promised everyone I'll never say ‘when I was’ -- but it was all about a little more Socratic way of teaching. I remember my critical care doctor would say, “Hey, Raj, so why don't you explain what the Swan-Ganz catheter does?” I think that the skin is not as thick as it used to be and I think that that's a good thing and a bad thing. To be a good teacher, Shiv, you have to change your style with the times and who your audience is and I definitely changed quite a bit for the better. 

I think I have to credit my wife. She's like, “Raj, if you want to survive in this teaching business, well, you may have to put that Socratic method in your back pocket and understand that, hey, there are other ways to get your point across.” I think, you know, it's always good to have good advice. My wife is actually a doctor and she's the smartest, I tell you, rheumatologist. 

So, when it comes to Step 2, I feel like it's all about people's health, and depression is a huge thing. I mean, it's a real, real, real disorder. But I think that if you really, really, really want to take that stress away from med students, you would make Step 2 pass or fail. It's like, you're just taking one Step and now made another thing very numerical. Maybe I'm a little biased because I mentioned about the foreign medical graduates, but just makes it harder for them to get the residency they want because of the fact that one of the things that really separated them is how amazingly high their scores are sometimes and now they're focusing on different things, which is not wrong, but research, good letters of recommendation. I tell you, if you just come from a foreign country, it's hard to get that letter of rec and get that research in there. So, you know, I don't think there'll ever be a right answer, but those are things that jump out at me

As far as AI is concerned, some of my besties here at USC are radiologists because they're always teaching me how to read those CT chests. I'll still mess up a chest X-ray now and then, so they're always putting me in my place. But a lot of AI is affecting radiology because, you know, this is the classic way where if you have a program that sees a pulmonary embolism or whatever abnormality you're talking about, they would just kind of read it. But what are you taking away from there is the clinical behind it, you know? I mean, when you talk about what patient, what's the pretest probability, why did they do that, did you just have a procedure? 

I think that there's so many limitations when you talk about AI that it does scare me sometimes. I mean, I think that it's something that will always be getting modified and being incorporated. I'm sure there's going to be a role. But really just by the name, it takes away the human factor that really is ingrained in trying to be a good teacher and trying to be a good clinician.

So, like with anything, my answer is we have to roll with the punches and adjust our personalities and adjust our teaching style because it's not going away. But I'm not ready to just put all the cards in that deck.

Shiv: Yeah, that's a very nuanced answer and I appreciate how flexible and open minded you have been with your teaching style and certainly in the next couple of years it will be very interesting to see how the national boards reacts to all this stuff and how the schools react to it. I'm sure as an educator, I think it's the best of times and maybe the worst of times, too, because students are often asking what's the point of all this stuff when, you know, in five, ten years, AI will be making all the diagnoses for me, potentially.

Dr. Dasgupta: Scary, but yes.

Shiv: So, let's go back to your sleep research and sleep interest. We've had some guests on the Raise the Line podcast who've also highlighted the importance of sleep. Most notably, we've had Arianna Huffington on who's been a huge proponent. 

Dr. Dasgupta: Oh!

Shiv: Yeah. And Matt Walker, we have not had on yet, but obviously his great Why We Sleep book helped popularize it. Tell us about sleep. Like, you know, I know a lot from personal experience of pulling all-nighters in college and in med school and obviously residents do even more of that. What is your overall assessment of where we are with sleep medicine? And do you have any recommendations for medical schools or residency programs as it pertains to how they train students and residents with sleep issues?

Dr. Dasgupta: Sure. I would say that when we talk about the pillars of health -- I kind of mentioned it already -- I think that having the right weight, having the right diet, getting that exercise, you know, sleep is a big part of that and sleep affects every single organ in the body. Many people, unfortunately, have insomnia. Many people, unfortunately, have sleep deprivation. I just want to bring up a teaching point that everyone thinks insomnia and sleep deprivation are the same thing, and they're not. You know what I mean? They may have a common symptom, common signs, but remember that when you have insomnia, that means that when you have the chance to sleep, you can't. You have trouble initiating it, maintaining it. But when you are sleep deprived, it's like what you said, sometimes it's purposely done. You’ve got that all-nighter. I think we are changing the way we think. Sometimes in the olden days, we used to wear sleep deprivation like this big badge of courage right here. We would have phrases like, “You know what, Shiv, you could sleep when you're dead.” You know, “The early bird gets the worm.” We are changing that. I look at you as kind of like an entrepreneur, and I’m sure you know that you just can't not sleep and be an entrepreneur. It just doesn't happen that way. 

Right now, who am I fighting with? I'm fighting a lot with social media. Not literally. I mean, not a fistfight, but people watch TikTok, people watch Instagram and there are a lot of little sleep tips they give you on there. Sometimes the first thing I have to do is debunk those because people do listen to them. For example, mouth taping was a huge thing for a while. It was taping their mouth. There's something called sleep rotting, where they encourage you sleeping in bed for extremely long periods of time. Right now I think that it's important to realize that when you do give information out on the web or on a post that you want to make sure it's accurate. You want to make sure it's evidence based. So, I think that's a big thing. 

But, you know, when it comes to what is my favorite clinical thing to evaluate, to talk about, to teach, it's narcolepsy. You're going to say, “Why, Dr. Raj?” And I'm going to say I always love these David and Goliath stories. I'm always an advocate for diseases that are underdiagnosed and misdiagnosed and misunderstood. I really feel narcolepsy is one of those.

If I'm wearing my pulmonary hat, my jam is something called sarcoidosis and I'm so fortunate to run a sarcoid clinic here at USC. And yeah, it really is something that I'm very passionate about because my wife's a rheumatologist so I love seeing connective tissue diseases that have lung manifestations. I hate saying the word ‘love’ because these are sick people and I don't want to make it seem that it's nice to have it. But, you know, scleroderma, lupus, RA, dermatome, polymyositis...definitely almost all rheum diseases will give you lung involvement. So, me and my wife team up/ That's not all we talk about -- we are a very fun couple -- but we do tend to talk about that and we team up. So, those are the things that interest me as a clinician.

Shiv: Wow, that's awesome. I didn't know about the sarcoid background, actually. One of the things I'm not sure if Jim's gotten across to you or you've seen, is we've been focused this past year on what we call the Year of the Zebra, which is a way to educate more health providers and patients about rare conditions. We've worked with the National Organization for Rare Disorders and several other patient advocacy groups for many years and it sounds like you have a soft spot in your heart for patients who maybe go and get bounced around the medical system for quite a few years before they get their diagnosis or they get the diagnosis and we still don't really understand what's happening to them because these are very complicated.

Dr. Dasgupta: Yeah. And just on the research side and having treatments, you know, it's not like we're treating hyperlipidemia and hypertension when you have clinical trials or pharmaceutically-driven or huge trials. When you have a rare disease, it's hard to get funding for these trials. That's why there's very few FDA approved medications for some of these disorders. So, it's hard. Whether I'm talking about narcolepsy or sarcoid or scleroderma, you know, getting the diagnosis is just the first part. Even after the diagnosis, it's horrible. So, yes, I think we're on the same page, Shiv. I mean, those are things that we both want to be advocates for.

Shiv: Absolutely. I'm curious...you're an award-winning teacher and educator of medical students and foreign medical graduates. I'd love for you to be able to comment a bit on how do you teach your patients and how do you yourself learn? I'm always curious how great educators and teachers learn themselves.

Dr. Dasgupta: One of my favorite things that I always pride myself in is the way I act on your podcast, the way I talk, my expressions...that's me. That's not like fake Raj putting on his little media voice and his media personality. I always really try to be that. I think that obviously you have to read the room and what disease and what state and what are we talking about, but I always try to be, you know, myself and try to talk to patients the way I want them to talk to my dad, my mom and anyone that I love. 

So far, it's worked really well being myself. And yes, I probably smile more times than not in the room, even if it's something that's not happy to talk about, because I really feel that -- especially when you are working in a cancer center or with diseases that have really poor outcomes -- there is a lot of sadness that surrounds patients to begin with and if you could just show a little bit of happiness when it's appropriate, it really goes a long way. So, being myself is always the most important. 

As far as learning, I always tell my students in a very nice way that the party never ends when it comes to taking tests and educating. You know, what's harder than when you're a student is when you are married and have kids -- I have three amazing kids -- and studying for the boards. So, you've got to be creative and you've got to know where to combine things. I really feel that whether I'm doing a workout on my little elliptical or whether I just have downtime using my phone, it’s good to do small feedings of the mind. 

Not to stroke Osmosis’ ego -- you guys are awesome, that's what you do well -- I go to YouTube and get some free Osmosis stuff, something entertaining. I kind of like that approach and I think that's where you have to be creative. So, that's how I always try to keep up to date.

And obviously, that's why I never give up the teaching, because I hope practice makes perfect. The more you teach, the more you retain. Every time I teach, someone asks a question. I'm like, “Wow, I really don't know that.” It's OK to say I don't know. I say it all the time. And that adds to my medical knowledge.

Shiv: I love that. I love being authentic and one of our core values is ‘spreading joy.’ There's so many things that people can perseverate on that are unhappy. Being a joyful person -- forget just being in the health care system, but just out in the world -- being that person who smiles at other people or makes eye contact is rare. It's a rarity. Being able to provide that to somebody, it's contagious. There's a wonderful quote I like to share, “A candle can light a thousand other candles and its brightness won't be diminished in the process.” Right? That's what a smile is.

Buddha, I think, said that supposedly. 

But in any case, we always like to get a sense of what our guests like to do outside of medicine. I'd love to know what your hobbies are? What have you learned that's totally random? Like, are you into medieval French war history? What are you interested in and what are you learning outside of healthcare and medicine? 

Dr. Dasgupta: I'm going to probably embarrass myself now. I would say there are two things that I'm very passionate about. The first thing is going to be sports and that's mainly because of my dad. I just want to say this...my dad right now, he's eighty and he’s got Alzheimer's. It stinks. It's the worst thing in the whole world. Let me just tell everyone that Alzheimer's is not just a disease of ‘I forget stuff.’ It affects a lot of your body and motor function. But, you know, I love him so much. When, he was ‘all that’ -- and he's still all that -- he got me into basketball and he's a huge Lakers fan. But I grew up in the age of Michael Jordan, so we weren't friends for a while. But then when Kobe was Kobe and he won all these championships, we were buddy- buddy back then. 

So, my favorite athlete, I'm going to tell everyone, is Michael Jordan. And just like how you busted out one of your favorite phrases, one of the Michael Jordan phrases that I always, always, always love to mention is -- I'm going to say it wrong -- but he likes to always brag that he missed a bunch of shots. He missed tons of shots and because he failed so many times in these shots, it made him who he is today and that really is how I feel. I don't mind making mistakes. I don't mind doing things wrong and I tell that to my students. I don't care if you fail the exam. I don't wish it. But, hey, take that and that's going to make you a better person. 

The other thing that no one really knows too much about me is I'm a big sci-fi geek. I mean, super dorky geek. I grew up with the ‘holy trilogy’ known as Star Wars. So, don't quiz me on like the new Rebels this and this comic book, but let's talk about the movies. I'll take anyone on a one-to-one competition of the original trilogy knowledge. And if you ever get a chance to see my old bedroom, I have like figures in the package, didn’t take them out. So, that's how you can get on my good side. Talk to me about Star Wars. Talk to me about like some old Chicago Bulls or NBA basketball. That's my favorite thing to talk about.

Shiv: Oh, that's fantastic! I love that! And thanks for sharing that about your dad. You know, being in our thirties, forties, fifties and your parents aging and you have young kids seems like a really challenging thing to balance with everything else going on. But you seem to wear it well.

I do want to ask you about strategies for coping with burnout or moral injury, because you're one of these people that you meet that clearly exudes passion for what you do -- and that's probably cultivated some and some is probably genetic or natural -- but I don't get that from many clinicians I interact with day to day. I think it's the minority...maybe ten percent, if that. And again, it affects their quality of life. It affects the students they train. You know, we left med school to start a medical education company because medical education sucks so bad. 

So, how do you maintain your positivity and joyfulness or purpose? And have you been burned out or had this moral injury? If so, what are the strategies for coming up out of it?

Dr. Dasgupta: Oh, that's great. You know, I think that whoever says they've never been burnt out, maybe kind of slided on the fibbing side a little bit. Everyone did, especially during Covid times being a critical care doctor. It's been really tough, you know? I'm always honest and I'm Raj, but of course when I'm wearing my work hat and I have a med student, a resident or a fellow with me, I want to be a role model. I'm not saying hide it, but, you know, I don't want to make that define who I am. 

It's very easy to be burnt out when you're married and have kids and you have responsibilities. You have a dad who has Alzheimer's. And don't cry, Shiv -- this is not a bad thing -- but my middle child, Aiden...my little tiger's got autism. So, you know, I love him to death. He's such a fighter and he's going to improve. But, life is full of challenges and I think that if we just let those kind of take advantage of us... it's easy to go down that rabbit hole. It's easy to say, put me on Zoloft, give me some Xanax every day. It's easy to cry when you're not around, you know. 

But what I think is my cornerstone is that I have my wife to talk to. We relate to each other really, really well. I always kind of communicate as much as I can. Having the right mentors is good. Sometimes it's not easy, you know, but you need to have the right mentors in your life. So for me, I love talking to other parents who have autistic kids. They really understand. For me, I love talking to other family members who have patients with some sort of dementia. They understand. 

So, I think the answer is, Shiv, for anyone listening, you have to talk. Don't keep it bottled up inside. Find the right people. You can't go forward and be successful in life putting your baggage or sadness as the first thing people see in you. I want people to meet me as the happy Raj. Even if I'm having kind of a rough day, I don't keep it bottled up inside. I just need to talk more about it when I'm not at work, you know? 

The last thing I'll tell everyone about this is that's why it's so important to pick the career you want to get into --that’s not to say that even if you pick the right one, you won't get burnt out -- but I feel in my heart the chance of getting burnt out is much, much less. I know I picked the right career and I'm really happy where I am now. I am surrounded by positivity. Jim Merritt, Ted O'Connell, my wife, my parents...you know, you just surround yourself with good people. 

Shiv: Wow. Wow. I really love all those strategies. I do want to take a tangent. If you let me take this tangent for a minute, I'll come back to it and connect the dots. 

When I was going through med school the first time around -- 2011 to 2013 at Hopkins -- I was also getting burnt out and I was also like, wow, this system can really beat out the joy of learning medicine or treating patients. It was something we heard about all the time and obviously it gets worse in practice or residency for sure. I've had friends and family who've left medical careers because of that burnout. 

So, one thing we did right around the time we were starting Osmosis was we launched this thing called the Patient Promise, which essentially was based on research coming out of the Hopkins Bloomberg School of Public Health. The research indicated that clinicians who practice what they teach -- the ones who care about their sleep, they want to exercise, the ones who eat well, the ones who don't smoke and don’t engage in all of these avoidable risk factors -- tend to be not only healthier and happier, but they tend to be more believable or credible with their patients.

It's like if you catch your pulmonologist smoking, but they're telling you not to smoke, it’s a kind of hypocritical, right? It's kind of like the tagline we were sharing. These are obviously individual point solutions and a lot of moral injury or burnout is systemic in nature -- so I don't want to confuse the two -- but I think the tide is turning because of two things that we've been really focusing on on this podcast. 

So, obviously, your personal health behaviors, your sleep patterns, having a good community of friends, family, mentors, spending time with them -- all the things you mentioned, I one hundred percent agree. I'm excited about AI for reducing the burden of clinical documentation and improving workflows, maybe even streamlining medical education so that you don't have to memorize as much as you tend to memorize and whatever. So, I think it could be a tool for improving burnout or moral injury. 

But the second thing we're covering a lot on this podcast -- and one of the main reasons I've gone back to med school at Hopkins where a lot of this research has started or restarted from -- is psychedelics and anything that helps provide clinicians or anybody really that sense of purpose or connectivity that maybe they lost along the way or maybe they never really had. You and me get it. We're both brown. Our parents said, “Go to med school, be a doctor.’ But did you ever stop and be, like, am I self-aware? That's really what I want to be able to do. 

So, it’s a long-winded way of asking you if you have any thoughts on that. You can feel free to double down on that one again, or psychedelics. 

Dr. Dasgupta: Oh, wow. You know, I would definitely say that I would go the way of the AI. It's nice that we're thinking that it has so many applications and, you know, when you were first mentioning it to me, I'm thinking of it from just the clinician standpoint. Like already in medicine when someone comes in -- whether it's going to be heart failure or COPD exacerbation -- there's always kind of like a checklist of things that we do. One of the things that I hope to ingrain in my wonderful residents, students and fellows is always ask the question why? It's so easy to say you check off a loop diuretic, you check off a nitrate, you check off checking a brain natriuretic peptide in the chest X-ray, but you always have to say why. I hope that AI doesn't take away from that. But when you're talking about help for burnout, I hope it does go to the things that really bog down a lot of clinicians, which is documenting, which is writing the appropriate note, which is going to be billing. Then I like it.  

I'm really not a big fan of medications and the reason why I say that is my wife, a rheumatologist, gives a lot of toxic meds out -- methotrexate and imuran and cellcept and tocilizumab, you name it. The TNF inhibitors. She feels that the majority of her patients don't want to be on lifelong meds. I feel the same thing being a pulmonologist and sleep doctor and talking about sleep aids. So anything that takes patients away from being on

medications and focuses on other ways, hey, you don't have to twist my arm, Shiv. I'm on board.

Shiv: I agree with you for sure on that. The one thing I will push back on with regard to psychedelics is that a lot of these therapies are not necessarily about long-term usage. There are one- or two-time interventions that have lasting effects.

Dr. Dasgupta: Oh, OK.

Shiv: Yeah. Yeah. So, like MDMA phase three clinical trials for PTSD show that one or two interventions can lead to six months or even a year of lasting reduction in PTSD symptoms. I agree with you, in general, to avoid medication. But where possible and where it is kind of life changing...if someone doesn't have 10,000 hours of therapy in them or if there's a way to get them streamlined faster or at least more open-minded, which I think is the root of a lot of it. Like, why do people smoke? You know this better than me because you've treated so many

people. I'm sure you have the manifestations of smoking for decades. It's they're masking something else. It isn't necessarily smoking. It's a coping mechanism for stress or for something else. Same with alcohol. Same with opiates. A lot of these things have the biological addiction, but they also have the underlying psychological issues and if we're able to change people's minds -- make them more open-minded because they become they join an AA program, they surround themselves with positive influences or because they read the right book at the right time or because they take psilocybin at the right time with a therapist -- I think all these things could be valuable as well.

Dr. Dasgupta: 100 percent agree. We're on board on the same page. I like that.

Shiv: Awesome. Well, I want to be respectful of your time, so I just had two last questions for you. 

Dr. Dasgupta: Fire away. Fire away.

Shiv: What advice do you give to faculty who want to become better teachers or anybody who wants to become a better teacher? And then second part, what advice would you give to our audience about approaching their careers in healthcare?

Dr. Dasgupta: Oh, my God. So, you know, when it comes to faculty, remember, all of us are in different stages of life and of what we want to accomplish. I always want to be respectful because there's our faculty I still look up to even though I’m forty-eight. And I know, Shiv, you're going to say, “Raj, you look great!” I feel it, you know. 

Shiv: But you do look great!

Dr. Dasgupta: But, I love having mentors, so I try to actually learn from their experience. You know what I mean? I think that everyone has something to contribute in one way or another. So, I think the hardest part when you get older is having to deal with people like me and having to deal with the new health care system and new documentations and new everything. I always try to put myself in their shoes. 

For younger faculty that join on, I think we all play fairly well in the sandbox together, but they tend to be a little more aggressive. I see myself in them where they want to get this teaching award and that teaching award. And sometimes maybe they may, you know, do things that I hope I could mentor them in a way and say, “You know what? I screwed up on this. Don't do that.” 

But I think the best thing to do when you're in a hospital -- and you didn't ask that -- for any faculty is I go out of my way to be super nice to literally everyone...whether you're the person who is nice enough to help with the parking, whether you're the person that works at Dunkin Donuts, whether the person who checks to see I'm wearing my mask in the lobby. It pays off to be nice to everyone. When I go to work and everyone gives me knuckles and we do the exploding knuckles, it just pays off. So, that's my advice to everyone is that, you know, it's not just always focusing on your faculties, the other doctors. It really is everyone else that makes your work experience nice.

And what is my advice for people going into medicine? I think the hardest thing to believe is people feel that they can have everything. You know, I could have the research, I could have the money, I could have the teaching. And why wouldn't you feel that way when you're younger and you feel like, hey, I have the special formula that no one else has. But the truth is -- I feel like I'm Debbie Downer here -- as you get older you realize how the people who gave me that advice really knew what they're talking about. 

You do have to make some sacrifices to really do the things you want, which means that the hardest part to know when you're younger is what makes you happy? And making you happy doesn't mean is it OB-GYN or surgery or medicine? I'm sure that's part of it. But is it going to be time with your family? Is it going to be the money factor? Is it being in the community? Is it not writing notes and being more of someone who does inpatient medicine? It's hard to know these things because everything has pluses and minuses. Being in a university setting like I’m in now is great and I love it, but hey, there is some downside to it. 

So, you know, I think that it just really comes down to finding the right mentors, asking the right questions and really believing in the advice that you get, because I know we only want to hear the advice that we want to hear. I could tell you out of experience that it really does make a difference of knowing what you want up front, because the older you get, it's really hard to change your future in the sense that sometimes changing your future means moving, buying a new house, moving to a different state and doing a different specialty. So, up front, really put a lot of thought into what you want to do in the future.

Shiv: Mm-hmm. I really love that. I hope our audience pays close attention to that advice. It's timeless. So, is there anything else you wish I asked you that I haven't got an opportunity to yet? 

Dr. Dasgupta: You know what? I just love doing this, Shiv. I mean, I knew it was going to be pretty easy going. I've always loved your hairstyle, you know, we're both bald.

Shiv: Yeah, we have the same barber!

Dr. Dasgupta: Yeah, exactly. But, I would say for everyone out there, I really hope I get to meet anyone who's listening to this. And yes, you'll find out that I'm just smiling and nice. And if you get a chance -- I'm not trying to plug anything  -- but check out my Dr Raj Podcast. I love it. It really means a lot to me to be the host there. A couple of the cool guests I got on the podcast... God bless his soul, Bob Saget was on there. How did he go on your podcast? You know, it's not a secret. His sister died of the lung manifestations of scleroderma, and he was so nice to just come on and raise awareness. So, that was a real special episode. And I’ve got to throw this out there: my boy Shiv is going to be on my podcast that we're going to record right after this. So ,check that out, too.

Shiv: That is amazing. Well, Dr. Raj, it has been a total pleasure. Again, I heard really good things from Jim and others about you and finally having you on the podcast has been a real, real pleasure. I hope our audience has enjoyed this as much as I have. 

I'd like to thank you for taking the time to be with us and more importantly, for the work that you've done over the past several decades to take care of your patients and educate tons of clinicians who in turn have treated thousands or tens of thousands of patients. So, thank you again.

Dr. Dasgupta: Oh, you're super welcome.

Shiv: And with that, I'm Shiv Gaglani. Thank you to our audience for checking out today's show and remember to do your part to raise the line and strengthen the healthcare system. We're all in this together. Take care.