Pulling Back the Curtain: Brian G. M. Durie, MD

Brian G. M. Durie, MD
Attending physician at the Cedars-Sinai Medical Center, Los Angeles, California; Chairman of the International Myeloma Foundation; Chairman of the International Myeloma Working Group

In this edition, Brian G. M. Durie, MD, shares how his father’s battle with tuberculosis led to his interest in medicine, and how his decision to focus in myeloma happened almost at random.

In Sound Bites, hear more from our interview with Dr. Durie, including the party trick he learned during microscope work in medical school: recognizing patients from their blood!

Where did you grow up?

I grew up in North Berwick, Scotland – a small town just outside of Edinburgh. At the time, it was a fishing village with a population of fewer than 2,000 people.

I have two sisters – one older and one younger. Our father worked at the local railway station, and our mother worked as a nanny. We certainly were not a wealthy family, which is one of the reasons I started working at a young age. Around 10 years old, I had a job at the local butcher shop, making deliveries around town on my bicycle. I also delivered newspapers on the side. I was a busy kid.

Dr. Durie at a cooking class in Italy.

When did you become interested in medicine?

As it turned out, it was sort of a family thing. My father developed tuberculosis when I was young, and he was quite ill during my childhood. Because of that, I had a lot of contact with doctors; they would make regular house calls to visit him during his last two or three years [of his life]. Seeing how well they took care of him and  getting to know the doctors on a personal level gave me the idea to pursue medicine.

When my father passed away, I was just starting high school and thinking about medicine as a career. In Scotland, you’re able to go directly from high school to medical school. I was fortunate that I received a full scholarship to medical school.

What led you to focus in hematology?

During my medical school training, I became fascinated with the microscope. I enjoyed the fact that you could distinguish different diseases by looking carefully at the cells, blood, and ultimately bone marrow. I loved looking at blood cells through the microscope, and that’s definitely why I selected blood diseases as my area of interest.

How did you come to focus in myeloma?

Almost immediately after I graduated medical school, I moved from Scotland to the United States to start my hematology fellowship at the Mayo Clinic in Rochester, Minnesota. Because I was a foreign graduate, I was randomly assigned a mentor, and, luckily, my mentor was Robert Kyle, MD.

Many readers are probably familiar with Dr. Kyle as a myeloma expert and a stamp collector, but a fun fact that not many people may know is that he also led a Boy Scout troop in Rochester for many years, which is something I participated in in North Berwick. We formed an immediate connection, and Dr. Kyle quickly realized that I could help his troop members earn their higher-level merit badges – like the international badge, travel badge, and others. I became a regular teacher at the Rochester Boy Scout troop meetings for a while.

We also bonded over stamp collecting. I’ve collected them since I was a child, organizing them carefully in my stamp album, and now I have a rather large collection; however, I haven’t co-authored a series of essays about the stamps like Dr. Kyle.

Aside from our shared interests, working with Dr. Kyle prompted me to  pursue myeloma. This interest only deepened when I joined the University of Arizona to work with Sydney Salmon, MD, with whom I eventually co-developed the Durie-Salmon Staging System.

Dr. Durie (center) and his wife, Susie Novis Durie (second from the right, in the black jacket), with one of his youngest patients, her parents, and her significant other. She was diagnosed with myeloma at 17, and is now in her late 30s.

What do you view as your greatest career accomplishment?

It would be the establishment of the International Myeloma Working Group – the research division of the International Myeloma Foundation. A key research project of the group is the Black Swan Research Initiative, which seeks a cure for myeloma. This collaborative effort has brought together international experts in myeloma, and, from these efforts, we have launched joint research projects, developed guidelines, and furthered the discussion about myeloma research.

What advice would you pass on to early-career hematologists?

Pick a specialty and stick with it. Each subspecialty has become so large and truly specialized that you need to become an expert to survive these days. It’s important to identify what you like to work on and create your niche.

Also, you need to identify with the disease – not necessarily with the treatments, which are changing so frequently.

In my case, I became interested in myeloma almost at random, but it has become such a clear path for me. And, at the time, myeloma was a small field. It was not an area with much research interest: There was a lack of knowledge about the biology of the disease and treatment options were limited. It was a challenging field to pursue, but it suited me.

How do you think hematology and medicine have changed since you started your career?

It’s night and day. One of the biggest changes is the loss of the individual doctor-patient relationship. Patients used to come to see you, and then you would be their doctor; if they went to the hospital, you would still be their doctor, taking care of them throughout their life with the disease.

Now, if patients go to the hospital, hospitalists treat them. And when they come back to your clinic, one of the other doctors on your team might see them. Caring for patients has changed from individual personal contact to more of a team effort among members of the clinical practice, nursing, and hospital teams.

The traditional doctor-patient relationship has all but evaporated, and I miss that patient contact. I still have patients I’ve taken care of for many years. Recently, a patient and I commemorated the 20th anniversary of her myeloma diagnosis. She reminded me that when she was diagnosed we talked about a life expectancy of three to four years. It was a sad time for her and her husband, but we started her on one of the available treatments, and I told her that new treatments were being developed. And now, it’s amazing that treatment options have expanded to the point where we can celebrate 20-year anniversaries of diagnoses.

The whole financial structure of health care has changed, as well. Medicine used to be a lucrative business – particularly for surgeons – and a good, not-too-stressful career. But now, you need to see at least 12 patients a day to maintain your practice, and all the money earned goes into keeping the practice running; then, you’re salaried and a company comes along and buys your practice. You also have to wonder whether all the patients who come in to see you will be able to afford the treatments you prescribe.

The stresses of filling out endless forms, checking on finances, and waiting for reimbursement add up – not to mention the [frustrations associated with the] electronic medical record system. The shift from a hands-on, caring, personalized situation to a more stressful, complicated business has prompted a number of my colleagues to move out of practice.

This paperwork and administrative burden also tie into one of my biggest pet peeves: When people send you an email and expect you to answer it right away, or when you get the follow-up email saying, “I sent you that message at 10:21; it’s 10:23 now – where’s my answer?”

“It’s important to identify what you like to work on and create your niche.”

What do you enjoy doing in your off hours – if you have any?

These days, I love to travel and visit new places. Traveling also gives me a chance to read.

I also love music, so I’ve started collecting vinyl records again. I used to have many more, but my original collection seems to have disappeared in some of my travels. I’m slowly building up a new one.

What type of music do you collect?

It’s a mixture of classical and more diverse music: I have Mozart’s Horn Concertos next to Joni Mitchell, the Beatles, and Supertramp. I live in a neighborhood of Los Angeles – the Hollywood Hills – that is associated with a lot of musical history. Joni Mitchell lived in a house just above ours, and many of the musicians in this era lived and worked in nearby Laurel Canyon.

Are there any hobbies you’d like to get back to?

What I do in the off hours has changed a bit over the years. I was practically born on a golf course, so I played golf from a young age. I used to play a lot of racquet sports – tennis, table tennis, squash, and racquetball, and I even played table tennis for the university league in Scotland. I don’t have much time for those now, but I will play the occasional round of golf.

I have two children, a son and a daughter who are in their early 30s now and have young families. I have two granddaughters, but I don’t get to see them often because we all work and travel so much.

Did either of your children go into medicine?

Indirectly, yes. My daughter works for the International Myeloma Foundation in the meeting planning division. My son is a lawyer, but when he was in school he had a difficult time deciding between medicine and law. However, through watching me, he witnessed some of the changes in medicine that I was dealing with – he saw me filling in forms, coming home later, and all these things that turned him off to that idea. He is in medical law, though; he works with medical groups and hospital acquisitions.

What person from history, dead or alive, would you like to have dinner with? And what would you ask that person?

One aspect of science has always fascinated me: the connection between physics and life. I am very interested in the work of physicist Erwin Schrödinger, who developed the thought experiment Schrödinger’s cat. He also wrote a book, What Is Life?, in which he proposed that life – even the spiritual component – could be explained completely through physical and chemical principles. I think it would be cool to chat with him.