In this edition, Brady Stein, MD, talks about the overlap between teaching and practicing medicine, as well as passing down the tradition of hematology. Dr. Stein is assistant professor of medicine in the hematology/oncology division at Northwestern University’s Feinberg School of Medicine in Chicago, Illinois.
What was your first job?
My first job was as a golf caddy. As I am not a golf enthusiast, it was also my shortest. After that, I worked at a tennis club for many summers, which was a much better fit for me. I started by helping to maintain the courts, and eventually I worked in the pro shop and assisted with junior lessons.
During the summer, my brother and I were always at the tennis club – my mom was a lawyer, so she dropped us off early in the morning and we spent most of our days at the club, playing tennis and going to the pool. I think we got jobs there just by virtue of being around so much. There are worse ways to spend your summer!
What did you want to be when you grew up?
Honestly, it’s hard to imagine doing anything else. I knew from an early age that I would go into medicine. My father is a hematologist and I wanted to follow in his footsteps. Watching him provided me with an opportunity to see what the field of medicine was like – both the good and the bad. That’s probably the best type of exposure one could ask for.
I thought about becoming a teacher, but education is also a large part of what we do in academic medicine, whether teaching medical students, residents, and fellows, or trying to teach our patients, so it’s very satisfying.
I think my father might answer the same way. In looking back on his own career, if he could do things differently he might have gone into academic medicine because it offers a complement to patient care, which can be grueling.
Besides your father, is there anyone who had an effect on your decision to go into hematology?
There are many people who helped me decide to go into hematology, but it all started with my father, Robert Stein, MD. He’s a practicing hematologist and has been an active member of the American Society of Hematology (ASH) for more than three decades. He has attended every ASH annual meeting since the 1970s. When I was younger, we would joke that while some fathers take their sons to a baseball game, he took me to an ASH annual meeting.
He was – and still is – a strong influence on my career, offering advice whenever I need it. I remember when I started as an attending seven years ago, I would break off during hematology service rounds, find a hallway, call my dad, and ask him, “What would you do in this situation?” Then I’d go back to join the residents and tell them what he told me. We still talk about cases, and we almost always agree on what to do. It gives me a nice sense of validation, because it’s coming from a hematologist who’s been at this for four decades.
My decision to pursue academic medicine was based, in large part, on what I saw of my father’s experiences as a hematologist. But I’m also lucky to have other strong mentors in hematology. Many of those relationships started at Johns Hopkins University, where I did my residency and fellowship. These include Alison Moliterno, MD; Jerry Spivak, MD; Robert Brodsky, MD; Sophie Lanzkron, MD; and Michael Streiff, MD.
Dr. Brodsky, my fellowship director, designed a unique program in which I was fortunate to be the second participant. I wasn’t interested in solid tumor oncology, yet hematology and oncology were linked in one program – for people who wanted to concentrate on malignant hematology or medical oncology. I was delaying my decision about which path to follow post-residency because I wanted to focus solely on hematology and, luckily, he created that opportunity at Johns Hopkins. There are still few traditional non-malignant hematology programs across the country, which has definitely contributed to a shortage of people entering this field. We could certainly use more in the academic world.
I’ve been away from the institution for about seven years, yet all of them remain excellent mentors.
I am also fortunate to have supportive colleagues at Northwestern, including Anaa Zakarija MD; David Green, MD; Hau Kwaan, MD; Karlyn Martin, MD; Brandon McMahon, MD (now at University of Colorado); and John Crispino, PhD. These colleagues have provided a sounding board for discussing challenging cases, helped edit manuscripts, offered career guidance, and collaborated on research endeavors.
I’ve also had the privilege of receiving external mentoring. Ruben Mesa, MD, has shared many opportunities with me. I am very grateful for his support and guidance through my academic career. I didn’t train with him, and I only met him when we shared the podium at a patient advocacy meeting, but he’s been extraordinarily helpful.
Did these mentors offer any specific advice?
It is more of a case of leading by example. As we go through our training and as we develop our careers, it may not be specific statements or phrases that stick with us, but the day-to-day encounters and the smaller things that we, as mentees, remember.
I also try to emulate the characteristics I admire in mentors: enthusiasm about their careers and scientific discovery, perseverance, reliability, dependability, and – above all – dedication to patient care.
Great mentors are always willing to help and are generous with their time. All the mentors I mentioned share these characteristics.
On a typical day, what is your rose and what is your thorn?
I enjoy the parts of my days when I can find a little quiet time to do some academic work. It might be only a small chunk of time, but if I can polish a presentation or edit a manuscript written by a resident, then that means it was a good, satisfying day. I also get great satisfaction from being in the room with patients.
All physicians respect the privilege and intimacy of the patient encounter – that’s not what we complain about. The problem we have is that greater portions of our time are being taken over by indirect patient care – such as charting or securing prior authorizations and approvals and denials from insurance companies. This is not unique to me; everyone deals with the frustrations of paperwork and red tape.
In a larger sense, as physicians, we seem to be operating in an era when we have to justify our existence. Unfortunately, much of what we do in patient care (talking with patients and their families or consulting with or advising colleagues) is not included in measures of our productivity and relative value units. It can be discouraging to continually have to prove your worth, and walking out of the hospital feeling that weight is definitely the worst part of any day.
Navigating these barriers can also keep us from providing the best possible patient care. We might have a good idea for how to help a patient, but then we find out that the patient’s copay is enormous, and it represents a massive barrier to treatment. We want to spend time counseling patients and seeing them through illness, but there are other things that we must do to complement that work.
What do you like to do outside of work?
My wife and I have three kids, ages 10, 8, and 4. My wife is also a physician, so you can imagine our dinner conversations. My 8-year-old daughter already knows how to make a diagnosis of iron deficiency anemia, so I suppose I’m continuing the tradition my father set by exposing my kids to medicine early on.
Tennis is becoming a larger part of our family life, too. I play on a traveling team, and my kids also play on a United States Tennis Association traveling team. I played a lot of tennis growing up, but I’m probably enjoying it now more than ever because I’m getting to watch my kids grow and develop in the game.
Is there one thing people would be surprised to learn about you?
I think people would be surprised to learn that I’m a big Grateful Dead fan. I’ve been a fan since my brother took me to my first concert when I was 15 years old.
That concert was also the start of a really strong bond between us, and we’ve tried to continue that tradition by going to a Grateful Dead-related concert every year. We’ve seen many different parts of the country and many different formulations of the band. Along with tennis, it’s the most important hobby for me and a great outlet outside of work.
I am also a big Pittsburgh Steelers fan. This is probably upsetting to my Baltimore based–mentors and colleagues.
Who would be on your dream dinner party guest list, and what would you ask them?
At the risk of sounding less intellectual, I think it would be a pretty enjoyable dinner if Jerry Garcia or another member of the Grateful Dead was there. I think the Grateful Dead is an important part of American cultural history. I’m not sure what I would ask, though. I think I’d probably enjoy just listening to the many stories of experiences that members of the band have had over their 50-year career. I’ve been going to their concerts for the last 25 years, so it would be wonderful to thank them for the many great experiences.
Of course, there are many pioneers in the field of hematology who would be wonderful to have dinner with as well, but I have to give my honest answer.