Think about how important it is to be compelling as a physician. The first thing you need to do with patients is establish trust. And part of that depends on how compelling you are when you speak. You have to take all those years of medical training and experience, listen to your patient, and then communicate a plan they agree to follow. This applies to situations outside of direct patient care as well. For example, let’s say you’re advocating for new equipment in your hospital - if you’re compelling when you deliver your argument, you’re probably more likely to win the day. Or let’s say you have to guide the public during a pandemic like our guest Dr. Gupta did - your ability to inspire trust and shape public health depends in large part on how compelling you are when you communicate.
With every guest on Good Medicine, I’m always struck by the incredible people we have in the medical field. As I learned about Sanjay, I immediately understood why my parents always referenced him as the guy I should emulate while growing up. In addition to being a neurosurgeon, he’s a White House Fellow alum, an author, a podcaster, a researcher, and of course a nationally renowned medical journalist. To become the trusted voice of medicine is no small feat, and I was excited to learn how he did it.
Sanjay’s story
The first thing I’ll say about Sanjay is that he’s thoughtful and present in a way that's both unexpected and refreshing. He speaks in paragraphs, and not sentences which I think reflects both his earned wisdom over his diverse career experiences as well as his keen observational skills. This ability was reflected in the first question I asked him about how his upbringing and South Asian heritage influenced him throughout his career. He almost immediately mentioned two distinctive factors in his childhood - being the son of immigrants and living in Novi, Michigan, population roughly 6,000. When he was growing up, it was “all about assimilation.”
As a fellow first generation South Asian kid, I viscerally related to this, as I grew up in Scranton, PA which in many ways is similar to Michigan. For me, fitting in was at the most basic level about survival as much as it was about belonging. But assimilation comes with a certain cost sometimes when it requires subordinating your own life experiences and heritage. It can feel constraining. Sanjay, too, wrestled with this tension telling me that “later in life, college timeframe, I started to understand the value of being distinctive as opposed to assimilating.” One example he shared related to his name; at one point, he was asked whether he would consider changing his name to make him more “accessible.” This question was raised by the way not in 1950 but 2000! But he remarked “I absolutely did not want to do that. I had understood my identity.” He was proud of what made him nuanced and unique. Now, that’s compelling.
On his Career
I was curious if his role today was at all presaged by his early days in Michigan. Sanjay mentioned he loved sports and music, but in no way was he a public figure in his school. He offered that his career choices were not planned but incremental. In his 20s, he became really interested in health policy as a medical student and started writing about it as a resident in neurosurgery. That experience writing and publishing allowed him to be a successful applicant to the White House Fellows program under President Clinton. There, he did a lot of work on health care, speech writing, and domestic policy guidance and he learned about “how to communicate messages in ways other than scientific journals.” This experience got him thinking about a career in journalism where he could educate the public about these issues. But it wasn't until a few years later that he was approached about being a medical correspondent on CNN shortly after landing a job at Emory as a staff neurosurgeon. When this opportunity presented itself, he initially thought he’d be talking about healthcare policy on Sunday morning shows. But Three and a half weeks after he started in 2001, 9/11 happened and he was called on to cover the defining story of this century. Since then, he’s covered just about every conflict, natural disaster and outbreak anywhere in the world for the last 23 years.
On being compelling
I, of course, really wanted to know the secrets to Dr. Gupta’s success. He’s a compelling storyteller, and Good Medicine readers might remember our missive on the importance of storytelling in medicine. His first advice: Remember the simple, narrative structure of a story. “There’s a beginning, there’s a middle, and there’s an end.” While its “almost pedantic to say, people forget that.” George Stephanopolous says something similar. “Tell them what you’re going to tell them, tell them, and then tell them what you told them.” I love these frameworks, because they are so instructively simple.
He also said he practices a lot. Storytelling is “ a little bit of performance…[for example], just how you inflect a word may totally change the meaning of the story. And [as the speaker] you know the meaning of the story, but if you didn't inflect properly, the audience may not quite get it…[As far as practice,] I have three teenage daughters. They're not always willing participants, but they're hearing my stories.” I loved this anecdote. Even for someone who does this everyday at a world class level, practicing his art is top of mind. Also as important: Coaching. As Atul Gawande famously wrote about many years ago, coaching is an essential ingredient towards achieving peak performance and Sanjay has had plenty of that as well.
Not surprisingly, he’s also an avid reader. “Sitting on my desk at any given time, I have several books I’m always reading.” You may not realize this but so much of what Sanjay does onscreen is unscripted. That means when people ask him questions, he may need to improvise. Some folks react to this kind of situation with evasion, but Sanjay doesn’t if you notice. He can consistently give thoughtful answers, and I think that’s a hallmark of being well-read and prepared. And by the way, I’d say these qualities are also essential for success as a neurosurgeon.
He also said that success in medicine and media have some shared traits. “People often look at medicine and media as sort of these disparate careers, but I think there's actually a lot of connective tissue between the two….I think for me, when you're talking to a patient, probably everything changes. You may slow down your speech a little bit. You may use a certain word choice because you really want them to understand what you're saying. And even your tone of how you're speaking may change. And I think it's the same in television. If I'm being asked a question, I really want the person to understand what I'm saying. I'm not trying to sound smart. I'm trying to sound understandable.”
On the influence of neurosurgery on his journalism career
When I asked him what influence neurosurgery has had in his life, he mentioned the ability to work hard. I agree that this aspect of neurosurgical training is uniquely distinctive - That singular focus on taking care of patients while growing your technical skills as a neurosurgeon just simply requires endless hours in the hospital. When he first started as a journalist, he told a story of how someone told him “you’re going to have work three hours on this thing” in a kind of despairing way. But here he leaned on his neurosurgical training. “I think we are trained to work really hard and be very patient and not give up on things too easily…It’s hard work and deep learning…And I think those things translate well when you’re chasing a big story.”
On being a central figure during Covid
For a science communicator like Sanjay, I was fascinated to know how he approached the Covid era. Science and public health guidance were changing in real time. Uncertainty was pervasive. How do you communicate the best available, but unclear science with a tense public? And how do you do this in a way that inspires trust?
Sanjay’s response was singular: a commitment to transparency. He would start each segment with “here’s what we know and here's what we don't know.” Some of this he opined was borrowed from medicine. “When you're talking to patients, we don't tend to speak in absolutes because as doctors, you're very acutely aware of the fact that we live in a probabilistic world…I think that's just part of our DNA… as physicians to be very comfortable in that space of uncertainty, or if not totally comfortable, at least to embrace it, to understand that it is there.”
Sanjay also understood that his viewers wanted to know what they could do. Here again, he pointed to the analogy in medicine. “Every patient visit that you have probably ends with some version of the same question, which is what would you do?” So he ended each segment by telling everyone how he would personally act upon the evolving information. The act of advice in those uncertain times was probably a soothing balm for many, much as it is in a doctor's office.
On will our response to the next pandemic be better?
“I'd love to say yes to that question... I don't know.” Sanjay referenced the Spanish flu of 1918 where about a “quarter of the population were not willing to abide by basic public health practices.” Fast forward to now and we still have a significant percentage of the population that are also skeptical of public health guidance either because they are “chaos creators” or because they “have legitimate concerns about their health or the health of their loved ones.” Sanjay also said that this group of people “is almost necessary…Because I do think it's how we evolve scientifically… by being challenged. I think that's how we move forward.”
On differences from the 1918 Spanish Flu
I naively thought that disinformation by politicians had reached a unique crescendo during the pandemic. But Sanjay politely corrected me saying “even back then(in 1918), there were people who were questioning the veracity of this really being a pandemic and spreading disinformation…I think what has changed is how quickly that type of information can get out there(i.e social media) and then start to just make a home for itself in various places.”
Which of course led me to a recurrent question on Good Medicine: How can truth tellers have more impact? How do the good folks win? Sanjay responded that “this idea that having a voice outside the intramural structure of the hospital is important. There’s a lot of noise out there and it crowds out what are some very sensible, credible voices. However you can get out there, the information should be as easy and accessible as some of the misinformation and disinformation out there.” Said differently, your voice as a physician is important, distinctive and should be shared. But as Sanjay has demonstrated throughout his career, being effective requires communication that is both compelling and accessible.
He went on to tell me about a troubling trend that predated even the pandemic. “I remember talking to Dr. Fauci during the pandemic about a survey that showed the public perceived physicians and scientists as arrogant…that’s not good!” His solution: Be humble. “ Presenting things with humility is really important..and ironically, saying that you don’t know something is actually a fantastic way to build trust because people don't expect you to know everything…simply acknowledge what you know and what you don't know and do it with humility.”
Finally, He also offered an approach that he finds resonates with virtually all the people he encounters: the scientific method. The scientific process is the “greatest story of science and it’s fascinating for people.” The inherent sleuthing involved in chasing the unknown invites people into the magic of discovery in a way that disinformation artists just can’t match.
On longevity
I was keen to probe Sanjay’s mind on this topic. One thing that’s important to realize is Sanjay goes deep into the data. For example, for his docuseries WEED, he spent 18 months researching the topic and speaking with experts before airing the special. And in that process, he changed his mind affirmatively that cannabis had a role to play in medicine for conditions like refractory epilepsy and pain. So I was curious to hear his take on the explosive interest in extending healthspan, especially given the growth in digital health clinics that prescribe medications(ie rapamycin) and supplements to that end.
“We're not a very healthy country in the United States. As you know, 40% of the country is obese. So the idea that you have people who are starting to seek out things that can increase their health span… I think that is fundamentally a good thing. Regarding some wellness clinics that prescribe unproven remedies, he said that “whether it be things like cannabis, when there's not a lot of data, you will get some charlatans who start to fill the void with outlandish claims. And I think that blackens the eye of very legitimate researchers out there(like Nir Barzilai) who are focused on this research.”
He added “I do ask myself existentially sometimes to what end? My dad just turned 80 years old. He's doing well. He's had some health challenges, but what are we really trying to accomplish here? Is it to get everyone to live to 100? And what are all the various things that come with more years on the planet?”
Somewhat tangentially, I then asked him about his longevity routine. He didn't mention any supplements! He did mention resistance training which he’s done more of as he’s gotten older. But then he said something which I think doesn't get nearly enough attention. “ I have really good friends. I've got friends of mine that have been friends for 40 years. I think that’s the longevity cheat.” He’s right on that by the way. One of the key factors in the McCance Brain Institute Brain Health Score is the strength of your social relationships. Though under some controversy these days, this was also a takeaway in the Blue Zones work by Dan Buettner. And finally, our current Surgeon General Vivek Murthy has written public health guidance stressing the importance of social connection.
As I reflected on my conversation with Sanjay, I was struck by the transformative power of science communication. With compelling, clear, and compassionate messaging, Sanjay has earned the public trust and guided countless millions in their own health journeys. With the epidemic of misinformation out there, though, we in medicine have an essential role to play in public health as well. Good news though - we’re starting to see more and more doctors share their voice in the public sphere. For example, everyday I’m privileged to see our incredible doctors at Roon combat misinformation and empower communities with trustworthy knowledge. With Sanjay as an emblematic example, they’re all showing us how impactful this work can be.
Quick hits
Favorite operating room music
Goo-Goo Dolls.
(to my friends who grew up in the 90s in my hometown of Scranton, PA - i’m sure you loved that)
Most impactful mentor
Julian Hoff, former Chair of Neurosurgery at the University of Michigan where Sanjay did his residency.
“This guy was a remarkable neurosurgeon… he was just a remarkable human being. And I think I modeled my life after him in many ways, the way that he thought about his family, how he thought about his community…how he fashioned his career.”
An impactful behind-the-scenes moment
“ When you're covering natural disasters and things like that, most of the things are behind the scenes. You experience a hundred percent of something and one percent of that makes it on camera. So seeing how people behave when they've gone from having a perfectly wonderful day to the worst day of their lives in an instant….those are some of the really powerful behind the scenes moments. “
On the lessons he’s taken from world leaders
“I've interviewed everyone, presidents from several countries, the Pope, Dalai Lama, top athletes, musicians and surgeons, people who are at the very top of what they do. I think the lesson is that none of them were born that way. But they all worked hard. The ones who are the true greats…none of them were born that way. It was all hard work. And I think the adage that Kennedy said in his speech… We do these things not because they are easy, but because they are hard…For them, the joy is in the challenge. That's probably the lesson.”
Musical instrument he learned growing up
Accordion. He’s versatile in both polka and Bollywood favorites.
If you had one thing to fix in healthcare, what would it be?
“The system of food. I think most of our chronic disease is a result of how we nourish ourselves so poorly. I see Food and Healthcare being inextricably linked.”
Most memorable Experience from Being a White House Fellow?
“Travel with the first lady(Hillary Clinton) staying up all night working on a speech with her. And then watching her deliver it the next day. It was a surreal experience.”
Book Recommendation
Siddhartha by Herman Hesse
What do you want your legacy to be?
“A fantastic and exemplary father.”
—
Dr. Rohan Ramakrishna is a Professor of Neurosurgery at Weill Cornell Medicine and one of the founders of Roon.
