Pulling Back the Curtain: Joseph R. Mikhael, MD, MEd 

Associate dean at Mayo School of Graduate Medical Education, deputy director of education at Mayo Clinic Cancer Center

What was your first job?

My first job was as a camp counselor, and this actually turned out to be a great job because it was where I met my wife. We were directors of the camp – she directed the girls’ program, I directed the boys’ program – and ultimately became friends. So, I guess I’m a little partial to that first job.

When did you decide to pursue medicine as a career? How did you find yourself interested in hematology?

I come from a family of doctors: my mother, father, and older brother were all physicians. I used to joke that I was going to become a lawyer instead so that I could protect them. Eventually I came around to medicine when I experienced it for myself. I saw both the clinical side and the “thinking” side: taking care of patients and being able to answer interesting scientific questions.

Did you ever see yourself in a career other than medicine?

The practical answer is that, had I not gone to medical school, I would probably be involved in economics of some sort. In college, I took many economics courses and did well in them. When one of my professors asked me to his office to discuss my future in economics, I felt bad informing him that I was going to medical school.

At the back of my mind, though, I have always thought it would be fun to be a crisis negotiator. I like challenging situations; I love communicating effectively with people; I love trying to be calm in very challenging circumstances. If I weren’t in hematology, I’d probably be in some kind of challenging environment like that – whether on Wall Street or talking someone down off the ledge.

In a typical day, what is your “rose” and what is your “thorn?”

The “rosiest” part of my day is perhaps when I’m leaving for work, backing my car out of the garage, and I see my two beautiful daughters, ages seven and nine, doing what we call the “Goodbye, Daddy” dance. Sometimes it’s a simple goodbye wave, and sometimes it’s just a funny dance. My 7-year-old, Katie, in particular, makes sure that she’s up when I’m leaving. That’s how I start my day, and that’s a fantastic, beautifully colored rose.

Sadly, there are probably many “thorns,” from the emails that I don’t get to answer that day, to the bad news I might have to give patients. In my world, multiple myeloma, there have been great strides in patient care, but it is still difficult to break bad news to patients. Personally, my approach is to get very close to my patients – I want to know their names, the names of their pets, their hobbies, and what makes them tick. I always say, “I don’t treat myeloma; I treat people.” Having to talk with patients about relapse, palliative care, or hospice care is definitely a thorn. In one respect, getting to be that close to people is a privilege of my profession, but it is tragic when we lose them.

What strategies do you use to maintain a healthy work/life balance?

I travel extensively – this year, I’ll fly 200,000 miles – so I have developed ways to maximize my time at home. First off, I am an obsessive planner, and I will not accept any invitation to travel or to speak until I review it with my wife. We are very careful with our calendars.

I am also very regimented in my schedule. For example, I go to the gym before work every morning. This helps clear my head, and, when I’m more physically active, I feel like I can contribute more in the day. Thirdly, I do absolutely everything in my power to be home for dinner. I live about 10 – 15 minutes away from my office, and one of the blessings of that short commute is that I can leave my office at 6:15 p.m. and still be home for dinner at 6:30 p.m. That is my objective every night, and I think that consistency is helpful for my children.

As much as we love our jobs, we have to remember that there is much more to life than work. My life outside of medicine is what defines me as a person. Having that sort of attitude helps me keep the work/life balance in check.

What is the best advice you have ever received?

When I was in Canada, I helped run a wellness program for trainees, and the psychiatrist in that program, who treated physicians and medical students exclusively, had a great piece of advice: “There is only one place in the world where you are indispensable, and that’s at home. Someone else can write your paper; someone else can see your patients; someone else can give your talk. No one else can be to your family what you are.” I really try to live that out.

Who were some role models in your life and throughout your career?

My parents taught me one of the greatest lessons in life: generosity. My parents gave and gave and gave – even if they didn’t have much. They were wonderful Christian people who loved their families and their church. I remember always having people visiting at the house when I was younger, so I saw that my parents were willing to share what they had with other people. They came from a culture in Egypt where they had little, yet when they came to North America, they worked extremely hard and did well financially. That background, I think, made them more than willing to share their blessings with others.

My dad was a tremendous role model, both in how he cared for his family and how he cared for his patients as a physician. When I was accepted to medical school, he took me aside and said, “I’m not going to give you lots of advice, but I am going to tell you one thing: you need to treat nurses as professionals, because they are.” That made me realize how important it is to practice the team approach in medicine. When I went to the hospital with him when I was a young child, I would sit at the nurses’ station while he did his rounds and I could see firsthand the respect he had for nurses and allied health staff, as well as the respect they had for him.

Mentorship has always been very important to me, and I think I owe my success to having good mentors throughout my career. During my internal medicine training, Jeff Turnbull, MD, really had an impact on me. He held many leadership positions, including president of the Canadian Medical Association, and I would attribute this to his unique way of bringing people together. I worked with Dr. Turnbull when we were developing a homeless clinic at Ottawa and his volunteerism and compassion for those with less was exemplary.

Armand Keating, MD, was a huge part of my move to Toronto and developing my career. He also urged me to get involved with ASH, and I have been involved in the Society ever since – beginning with the Trainee Council. Dr. Keating and I still communicate, which is a relationship I try to emulate with my own mentees. Every eight weeks or so, I schedule a 30-minute teleconference with about 10 of my mentees to keep in touch and to see how things are going personally and professionally. It definitely takes a lot of time, but if mentorship is done right, it is going to take time.

On a fun note, I have a pseudo-mentor in Sanjay Gupta, MD – as I love medicine and media, I wonder someday if I could play a role that bridges medicine and television!

What accomplishment are you most proud of in your career? Any disappointments?

I am honored to have an award in my name in Canada, the Joseph Mikhael CAIR Award for Medical Education. I value this deeply because I have always wanted to elevate the level of education. Some people may view education as an “easier” path to success, so to speak, but there is a depth to it.

We have all had disappointments in our careers, and I will be the first to admit that I have failings, but I think our perception of these disappointments changes with time. For instance, when I was part of the Multiple Myeloma and Bone Marrow Transplant Program in Toronto, I was devastated when the program shrunk. Initially, I thought this was a closed door, but it turned out to be just a closed window. Shrinking back there led to opportunities at Mayo Clinic, and I think my career has flourished here in a way that it would not have in Toronto. Changing countries and moving to a place where we had no family was a challenge, but looking back at it now, it was a remarkable open door, and I am very, very thankful for how it worked out.

What questions do you ask in an interview?

In medicine, I think we sometimes become so focused on the CV and the academic record that we lose sight of the fact that we’re recruiting a person, not a hematologist. When I am interviewing someone, I like to ask the candidate, “Tell me about who you are – not about what you do.” This helps me get a better sense of who I am hiring. Some people start listing their professional accomplishments, but I try to steer them away from that. It’s easy to Google someone’s CV, but there are things that we can only reveal to people by ourselves, and that’s what I’m interested in knowing.

I remember once being interviewed by a rather staunch man who clearly had not had his morning cup of coffee yet. He asked me, in a very Spanish Inquisition-type way, “Well, young man, what is it that you are going to be able to bring to this program?” Instead of the typical answer, I looked at him and said, “I bring a life outside of medicine, sir.”

That answer completely surprised him and changed the whole tone of the interview. I listed all the things I did outside of medicine – sports, social activities, volunteering – and said, “These are the things that make me an outstanding candidate, and are going to make me a better doctor.”

What do you like to do in your off hours?

I am an avid runner and a frequent traveler. When I do travel, I don’t spend much time at each destination, so I always say, “You can explore just about anywhere with two hours and a good pair of running shoes.” I love to see new things and to see how different cities are built. Like many of us, I also really enjoy speaking – in medicine, obviously, but I also do some speaking on a religious basis, as well. I really enjoy the opportunity to convey concepts and ideas to people in a didactic format.

Just for fun, what superpower would you have – and why?

I wish I could have teleportation. With all my travel, I would love to be able to get to two places almost at the same time. That would make life a lot easier, for sure.

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