User login
Hepatologist finds purpose as health equity advocate for LGBTQI+
Sonali Paul, MD, once thought she was an anomaly in the world of medicine. “As I was going through training, I didn’t think others like me existed, a gay South Asian transplant hepatologist. I certainly didn’t have mentors that looked like me. I didn’t have anyone to look up to,” she said.
Fighting to promote health care equity in the LGBTQI+ population has been a cornerstone of her career. As cofounder and an executive board member of Rainbows in Gastro, a sexual and gender minorities affinity group that builds community among LGBTQI+ medical trainees and physicians in gastroenterology, Dr. Paul often goes into the community to promote open discussions about health equity in sexual and gender minority populations.
“Our mission is CHARM: community, healing, advocacy, research, and mentorship,” said Dr. Paul, a transplant hepatologist with the University of Chicago Medicine with a specific niche within fatty liver disease and obesity medicine. She serves as an associate program director for the Internal Medicine Residency Program specifically for diversity, equity, and inclusion.
In 2022 she received the University of Chicago’s Department of Medicine Diversity Award.
Rainbows in Gastro has shown trainees they can be open about their sexual orientation and gender identity without fear of retribution. “I’ve had medical students and residents come to me and say they were going to go into endocrine or some other field because they thought it was more gay friendly, until they saw our group and the work we’re doing,” Dr. Paul said.
In an interview, she talks more about her two key passions: reducing disparities and promoting health equity.
Q: You presented “Embrace the Rainbow: Creating Inclusive LGBTQ+ Spaces in Medicine” at the University of Chicago Medicine Grand Rounds. What were some of the key takeaways of that presentation?
Dr. Paul: One is education. Knowing the history of the LGBT community and how marginalization and discrimination affects the individual coming into that clinic is important. Having little things like pronoun badges or a rainbow flag, having nondiscrimination policies that include sexual orientation, gender identity that are displayed in the clinics, are very small things that seem almost trivial to some people. But I can tell you for myself, it matters if I walk into a door and there’s a rainbow flag there. I feel immediately safer.
Q: What are your hopes and aspirations for the field of GI moving forward?
Dr. Paul: I didn’t learn about social determinants of health in medical school, but more and more I think we’re starting to pivot and really look at those things. I hope GI and hepatology continues to do that.
For me, it’s looking at everything through a health disparities lens, seeing the health disparities across communities and finding solutions to mitigate them. How do we get people access to transplant for all our patients, and really examining the social determinants of health in the health care we provide?
Q: Your clinical focus has been on nonalcoholic fatty liver disease. Can you tell me how you got interested in that area of medicine?
Dr. Paul: There’s been a name change for the disease itself. It’s now metabolic dysfunction-associated steatotic liver disease (MASLD). I got interested from an obesity medicine perspective. I thought the liver pathology was interesting but I wanted to approach it from a different kind of perspective and not just focus on the liver, but also the metabolic factors.
I practice from that kind of lens: Looking at a lot of the metabolic comorbidities that happen with fatty liver disease to help patients with weight loss.
Q: What do you think about the new weight loss drugs?
Dr. Paul: I think they’re very effective. They’re obviously very popular. Weight loss is a really hard thing and I think they are really changing the game. A newer one that was just approved, tirzepatide (Zepbound, Lilly) resulted in up to 20% body weight loss. I think if there’s a medicine that we can give to avoid surgery for some people, I think that’s great. I think what is quite disheartening is insurance access to the medications.
Q: Is there any type of research you’re doing in this area right now?
Dr. Paul: I’m interested in the changes in fatty liver with gender-affirming hormone therapy with estrogen and testosterone, an area that’s never been studied.
Q: Describe how you would spend a free Saturday afternoon.
Dr. Paul: With my wife, my 9-year-old son, and two dogs. One of our favorite places to go is the Lincoln Park Zoo. We go there, especially over the summer, sometimes every week just to walk around. And, my son loves animals. Or, play with our dogs.
LIGHTNING ROUND
What is your favorite junk food?
Doritos
What is your favorite holiday?
Thanksgiving
Is there a book that you reread often?
“Interpreter of Maladies” by Jhumpa Lahiri
What is your favorite movie genre?
Comedy
Are you an introvert or extrovert?
Somewhere in the middle.
Sonali Paul, MD, once thought she was an anomaly in the world of medicine. “As I was going through training, I didn’t think others like me existed, a gay South Asian transplant hepatologist. I certainly didn’t have mentors that looked like me. I didn’t have anyone to look up to,” she said.
Fighting to promote health care equity in the LGBTQI+ population has been a cornerstone of her career. As cofounder and an executive board member of Rainbows in Gastro, a sexual and gender minorities affinity group that builds community among LGBTQI+ medical trainees and physicians in gastroenterology, Dr. Paul often goes into the community to promote open discussions about health equity in sexual and gender minority populations.
“Our mission is CHARM: community, healing, advocacy, research, and mentorship,” said Dr. Paul, a transplant hepatologist with the University of Chicago Medicine with a specific niche within fatty liver disease and obesity medicine. She serves as an associate program director for the Internal Medicine Residency Program specifically for diversity, equity, and inclusion.
In 2022 she received the University of Chicago’s Department of Medicine Diversity Award.
Rainbows in Gastro has shown trainees they can be open about their sexual orientation and gender identity without fear of retribution. “I’ve had medical students and residents come to me and say they were going to go into endocrine or some other field because they thought it was more gay friendly, until they saw our group and the work we’re doing,” Dr. Paul said.
In an interview, she talks more about her two key passions: reducing disparities and promoting health equity.
Q: You presented “Embrace the Rainbow: Creating Inclusive LGBTQ+ Spaces in Medicine” at the University of Chicago Medicine Grand Rounds. What were some of the key takeaways of that presentation?
Dr. Paul: One is education. Knowing the history of the LGBT community and how marginalization and discrimination affects the individual coming into that clinic is important. Having little things like pronoun badges or a rainbow flag, having nondiscrimination policies that include sexual orientation, gender identity that are displayed in the clinics, are very small things that seem almost trivial to some people. But I can tell you for myself, it matters if I walk into a door and there’s a rainbow flag there. I feel immediately safer.
Q: What are your hopes and aspirations for the field of GI moving forward?
Dr. Paul: I didn’t learn about social determinants of health in medical school, but more and more I think we’re starting to pivot and really look at those things. I hope GI and hepatology continues to do that.
For me, it’s looking at everything through a health disparities lens, seeing the health disparities across communities and finding solutions to mitigate them. How do we get people access to transplant for all our patients, and really examining the social determinants of health in the health care we provide?
Q: Your clinical focus has been on nonalcoholic fatty liver disease. Can you tell me how you got interested in that area of medicine?
Dr. Paul: There’s been a name change for the disease itself. It’s now metabolic dysfunction-associated steatotic liver disease (MASLD). I got interested from an obesity medicine perspective. I thought the liver pathology was interesting but I wanted to approach it from a different kind of perspective and not just focus on the liver, but also the metabolic factors.
I practice from that kind of lens: Looking at a lot of the metabolic comorbidities that happen with fatty liver disease to help patients with weight loss.
Q: What do you think about the new weight loss drugs?
Dr. Paul: I think they’re very effective. They’re obviously very popular. Weight loss is a really hard thing and I think they are really changing the game. A newer one that was just approved, tirzepatide (Zepbound, Lilly) resulted in up to 20% body weight loss. I think if there’s a medicine that we can give to avoid surgery for some people, I think that’s great. I think what is quite disheartening is insurance access to the medications.
Q: Is there any type of research you’re doing in this area right now?
Dr. Paul: I’m interested in the changes in fatty liver with gender-affirming hormone therapy with estrogen and testosterone, an area that’s never been studied.
Q: Describe how you would spend a free Saturday afternoon.
Dr. Paul: With my wife, my 9-year-old son, and two dogs. One of our favorite places to go is the Lincoln Park Zoo. We go there, especially over the summer, sometimes every week just to walk around. And, my son loves animals. Or, play with our dogs.
LIGHTNING ROUND
What is your favorite junk food?
Doritos
What is your favorite holiday?
Thanksgiving
Is there a book that you reread often?
“Interpreter of Maladies” by Jhumpa Lahiri
What is your favorite movie genre?
Comedy
Are you an introvert or extrovert?
Somewhere in the middle.
Sonali Paul, MD, once thought she was an anomaly in the world of medicine. “As I was going through training, I didn’t think others like me existed, a gay South Asian transplant hepatologist. I certainly didn’t have mentors that looked like me. I didn’t have anyone to look up to,” she said.
Fighting to promote health care equity in the LGBTQI+ population has been a cornerstone of her career. As cofounder and an executive board member of Rainbows in Gastro, a sexual and gender minorities affinity group that builds community among LGBTQI+ medical trainees and physicians in gastroenterology, Dr. Paul often goes into the community to promote open discussions about health equity in sexual and gender minority populations.
“Our mission is CHARM: community, healing, advocacy, research, and mentorship,” said Dr. Paul, a transplant hepatologist with the University of Chicago Medicine with a specific niche within fatty liver disease and obesity medicine. She serves as an associate program director for the Internal Medicine Residency Program specifically for diversity, equity, and inclusion.
In 2022 she received the University of Chicago’s Department of Medicine Diversity Award.
Rainbows in Gastro has shown trainees they can be open about their sexual orientation and gender identity without fear of retribution. “I’ve had medical students and residents come to me and say they were going to go into endocrine or some other field because they thought it was more gay friendly, until they saw our group and the work we’re doing,” Dr. Paul said.
In an interview, she talks more about her two key passions: reducing disparities and promoting health equity.
Q: You presented “Embrace the Rainbow: Creating Inclusive LGBTQ+ Spaces in Medicine” at the University of Chicago Medicine Grand Rounds. What were some of the key takeaways of that presentation?
Dr. Paul: One is education. Knowing the history of the LGBT community and how marginalization and discrimination affects the individual coming into that clinic is important. Having little things like pronoun badges or a rainbow flag, having nondiscrimination policies that include sexual orientation, gender identity that are displayed in the clinics, are very small things that seem almost trivial to some people. But I can tell you for myself, it matters if I walk into a door and there’s a rainbow flag there. I feel immediately safer.
Q: What are your hopes and aspirations for the field of GI moving forward?
Dr. Paul: I didn’t learn about social determinants of health in medical school, but more and more I think we’re starting to pivot and really look at those things. I hope GI and hepatology continues to do that.
For me, it’s looking at everything through a health disparities lens, seeing the health disparities across communities and finding solutions to mitigate them. How do we get people access to transplant for all our patients, and really examining the social determinants of health in the health care we provide?
Q: Your clinical focus has been on nonalcoholic fatty liver disease. Can you tell me how you got interested in that area of medicine?
Dr. Paul: There’s been a name change for the disease itself. It’s now metabolic dysfunction-associated steatotic liver disease (MASLD). I got interested from an obesity medicine perspective. I thought the liver pathology was interesting but I wanted to approach it from a different kind of perspective and not just focus on the liver, but also the metabolic factors.
I practice from that kind of lens: Looking at a lot of the metabolic comorbidities that happen with fatty liver disease to help patients with weight loss.
Q: What do you think about the new weight loss drugs?
Dr. Paul: I think they’re very effective. They’re obviously very popular. Weight loss is a really hard thing and I think they are really changing the game. A newer one that was just approved, tirzepatide (Zepbound, Lilly) resulted in up to 20% body weight loss. I think if there’s a medicine that we can give to avoid surgery for some people, I think that’s great. I think what is quite disheartening is insurance access to the medications.
Q: Is there any type of research you’re doing in this area right now?
Dr. Paul: I’m interested in the changes in fatty liver with gender-affirming hormone therapy with estrogen and testosterone, an area that’s never been studied.
Q: Describe how you would spend a free Saturday afternoon.
Dr. Paul: With my wife, my 9-year-old son, and two dogs. One of our favorite places to go is the Lincoln Park Zoo. We go there, especially over the summer, sometimes every week just to walk around. And, my son loves animals. Or, play with our dogs.
LIGHTNING ROUND
What is your favorite junk food?
Doritos
What is your favorite holiday?
Thanksgiving
Is there a book that you reread often?
“Interpreter of Maladies” by Jhumpa Lahiri
What is your favorite movie genre?
Comedy
Are you an introvert or extrovert?
Somewhere in the middle.
Narrative medicine: Physician advocacy on the ground
In 2021, when Eric Esrailian, MD, MPH, was awarded the Benemerenti Medal from Pope Francis for his humanitarian work, he recognized other people worldwide who save lives daily – but without recognition. They’re motivated for “the right reasons. To be clear, I do not deserve this honor. It is honestly overwhelming and humbling,” he said in 2021 when news of the award reached him in Los Angeles where he holds the Lincy Foundation Chair in Clinical Gastroenterology at the University of California, Los Angeles. He also serves as chief of the Vatche and Tamar Manoukian Division of Digestive Diseases, and director of the Melvin and Bren Simon Digestive Diseases Center.
Dr. Esrailian, the son of Armenian immigrants, says that humanitarian work has been ingrained in him since childhood. His great-grandparents were Armenian genocide survivors and their struggles have never left him. He’s devoted his life not only to medicine, but to documenting the history of the Armenian genocide and leading, or supporting, efforts to resolve humanitarian crises in Armenia and around the world. Earlier this year, he, with Kim Kardashian and singer/actor Cher, published op-eds that addressed a humanitarian crisis building as a result of Azerbaijan’s blockade of the Lachin corridor – which is the only road that links Armenia to the ethnic Armenian–populated sections of Nagorno-Karabakh. In September, Armenia and Azerbaijan reached a tentative agreement to end the blockade, but more needs to be done, he says. Tragedies continue to unfold, and he is redoubling his efforts to bring more attention to this humanitarian crisis, he said.
The first film was “The Promise,” a historical war drama set in the Ottoman Empire and released in 2016. In 2017, he and partners released “Intent to Destroy: Death, Denial, & Depiction,” a documentary about the Armenian genocide. The documentary received an Emmy nomination for Outstanding Historical Documentary. And, in 2020, he produced “Francesco,” a film about Pope Francis that documented his pilgrimage to Armenia in 2016.
“The Promise” had such an impact on viewers that in 2017 Dr. Esrailian and the UCLA School of Law created The Promise Institute for Human Rights as a center of human rights education, research, and advocacy. In 2019, Dr. Esrailian and UCLA followed up with The Promise Armenian Institute as a place for academic research and teaching of Armenian studies, language, and culture. “The impact from building these two institutes has been transformational, and they will be part of UCLA forever,” he said.
His philanthropic efforts connecting health, human rights, education, and the arts has had an impact worldwide. One person can make a difference, Dr. Esrailian said: “I’ve learned along the way that an individual can have more of an impact than ever imagined, but you have to dream big and never give up.”
In this interview, he tells us more about his work.
Q: Not many doctors wear hats in medicine and filmmaking. Describe your journey as a filmmaker.
Dr. Esrailian: I’ve always been interested in storytelling. I was an English minor at Berkeley. My late mentor, Kirk Kerkorian, a legendary philanthropist, businessman, and entrepreneur, pushed me to take storytelling and do something that would potentially help secure Armenian Genocide recognition by the United States. Because of genocide denialists and geopolitical pressure, he felt the United States government was reluctant to recognize the Armenian Genocide. He thought having some visual materials for educational and outreach efforts would be transformational, and as it turns out, they were.
If you talk to any advocacy organization that tried for years to get Armenian Genocide recognition, they’d say that both films, “The Promise” (a feature film) and “Intent to Destroy” (a documentary), and the social impact media campaign we launched around them, were influential in moving the needle with legislators in the United States who, 3 years after “The Promise” was released, recognized the genocide. This was followed by the Library of Congress in 2020 and President Biden’s executive branch in 2021.
Q: What has been your most rewarding accomplishment?
Dr. Esrailian: Giving a voice to people who don’t have a voice is something that I’m proud of. Sometimes, it’s questionable what impact it may have because we still see atrocities committed all over the world. In September, Azerbaijan completed an ethnic cleansing campaign of Armenians from a region called Artsakh, officially the Republic of Nagorno-Karabakh.
Despite having so many relationships with powerful people in government and in high-profile media, and despite our documentaries, op-eds, and interactions with influential leaders on a regular basis, it always feels like it’s not enough. Obviously, the perpetrators are still able to abuse human rights and conduct these campaigns. Nevertheless, I don’t think we should be deterred. Allowing human rights violations to occur with impunity only emboldens perpetrators even more. It takes a long time to bring people to justice through international courts, but it does happen – eventually. That’s something I’m going to continue to work on.
Q: What should be the role of physicians in supporting human rights?
Dr. Esrailian: Physicians and health care providers play an important role in human rights. If you look back throughout history, whether it’s the International Committee of the Red Cross, or Doctors Without Borders, or other organizations, physicians and health care professionals are often on the front lines, helping people. Unfortunately, physicians have also been part of human rights violations, like the Holocaust or other genocides. But I do think that in this day and age, with the reputation that physicians have, we can be policy advocates and upstanders in addition to taking care of patients. Telling our stories to the world is important so that people know what’s actually happening on the ground.
Lightning round
Do you prefer texting or talking?
Talking
How many cups of coffee do you drink each day?
Two
What was the last movie you watched?
Mission Impossible
If you weren’t a gastroenterologist, what would you be?
Entrepreneur
Who inspires you?
My family
In 2021, when Eric Esrailian, MD, MPH, was awarded the Benemerenti Medal from Pope Francis for his humanitarian work, he recognized other people worldwide who save lives daily – but without recognition. They’re motivated for “the right reasons. To be clear, I do not deserve this honor. It is honestly overwhelming and humbling,” he said in 2021 when news of the award reached him in Los Angeles where he holds the Lincy Foundation Chair in Clinical Gastroenterology at the University of California, Los Angeles. He also serves as chief of the Vatche and Tamar Manoukian Division of Digestive Diseases, and director of the Melvin and Bren Simon Digestive Diseases Center.
Dr. Esrailian, the son of Armenian immigrants, says that humanitarian work has been ingrained in him since childhood. His great-grandparents were Armenian genocide survivors and their struggles have never left him. He’s devoted his life not only to medicine, but to documenting the history of the Armenian genocide and leading, or supporting, efforts to resolve humanitarian crises in Armenia and around the world. Earlier this year, he, with Kim Kardashian and singer/actor Cher, published op-eds that addressed a humanitarian crisis building as a result of Azerbaijan’s blockade of the Lachin corridor – which is the only road that links Armenia to the ethnic Armenian–populated sections of Nagorno-Karabakh. In September, Armenia and Azerbaijan reached a tentative agreement to end the blockade, but more needs to be done, he says. Tragedies continue to unfold, and he is redoubling his efforts to bring more attention to this humanitarian crisis, he said.
The first film was “The Promise,” a historical war drama set in the Ottoman Empire and released in 2016. In 2017, he and partners released “Intent to Destroy: Death, Denial, & Depiction,” a documentary about the Armenian genocide. The documentary received an Emmy nomination for Outstanding Historical Documentary. And, in 2020, he produced “Francesco,” a film about Pope Francis that documented his pilgrimage to Armenia in 2016.
“The Promise” had such an impact on viewers that in 2017 Dr. Esrailian and the UCLA School of Law created The Promise Institute for Human Rights as a center of human rights education, research, and advocacy. In 2019, Dr. Esrailian and UCLA followed up with The Promise Armenian Institute as a place for academic research and teaching of Armenian studies, language, and culture. “The impact from building these two institutes has been transformational, and they will be part of UCLA forever,” he said.
His philanthropic efforts connecting health, human rights, education, and the arts has had an impact worldwide. One person can make a difference, Dr. Esrailian said: “I’ve learned along the way that an individual can have more of an impact than ever imagined, but you have to dream big and never give up.”
In this interview, he tells us more about his work.
Q: Not many doctors wear hats in medicine and filmmaking. Describe your journey as a filmmaker.
Dr. Esrailian: I’ve always been interested in storytelling. I was an English minor at Berkeley. My late mentor, Kirk Kerkorian, a legendary philanthropist, businessman, and entrepreneur, pushed me to take storytelling and do something that would potentially help secure Armenian Genocide recognition by the United States. Because of genocide denialists and geopolitical pressure, he felt the United States government was reluctant to recognize the Armenian Genocide. He thought having some visual materials for educational and outreach efforts would be transformational, and as it turns out, they were.
If you talk to any advocacy organization that tried for years to get Armenian Genocide recognition, they’d say that both films, “The Promise” (a feature film) and “Intent to Destroy” (a documentary), and the social impact media campaign we launched around them, were influential in moving the needle with legislators in the United States who, 3 years after “The Promise” was released, recognized the genocide. This was followed by the Library of Congress in 2020 and President Biden’s executive branch in 2021.
Q: What has been your most rewarding accomplishment?
Dr. Esrailian: Giving a voice to people who don’t have a voice is something that I’m proud of. Sometimes, it’s questionable what impact it may have because we still see atrocities committed all over the world. In September, Azerbaijan completed an ethnic cleansing campaign of Armenians from a region called Artsakh, officially the Republic of Nagorno-Karabakh.
Despite having so many relationships with powerful people in government and in high-profile media, and despite our documentaries, op-eds, and interactions with influential leaders on a regular basis, it always feels like it’s not enough. Obviously, the perpetrators are still able to abuse human rights and conduct these campaigns. Nevertheless, I don’t think we should be deterred. Allowing human rights violations to occur with impunity only emboldens perpetrators even more. It takes a long time to bring people to justice through international courts, but it does happen – eventually. That’s something I’m going to continue to work on.
Q: What should be the role of physicians in supporting human rights?
Dr. Esrailian: Physicians and health care providers play an important role in human rights. If you look back throughout history, whether it’s the International Committee of the Red Cross, or Doctors Without Borders, or other organizations, physicians and health care professionals are often on the front lines, helping people. Unfortunately, physicians have also been part of human rights violations, like the Holocaust or other genocides. But I do think that in this day and age, with the reputation that physicians have, we can be policy advocates and upstanders in addition to taking care of patients. Telling our stories to the world is important so that people know what’s actually happening on the ground.
Lightning round
Do you prefer texting or talking?
Talking
How many cups of coffee do you drink each day?
Two
What was the last movie you watched?
Mission Impossible
If you weren’t a gastroenterologist, what would you be?
Entrepreneur
Who inspires you?
My family
In 2021, when Eric Esrailian, MD, MPH, was awarded the Benemerenti Medal from Pope Francis for his humanitarian work, he recognized other people worldwide who save lives daily – but without recognition. They’re motivated for “the right reasons. To be clear, I do not deserve this honor. It is honestly overwhelming and humbling,” he said in 2021 when news of the award reached him in Los Angeles where he holds the Lincy Foundation Chair in Clinical Gastroenterology at the University of California, Los Angeles. He also serves as chief of the Vatche and Tamar Manoukian Division of Digestive Diseases, and director of the Melvin and Bren Simon Digestive Diseases Center.
Dr. Esrailian, the son of Armenian immigrants, says that humanitarian work has been ingrained in him since childhood. His great-grandparents were Armenian genocide survivors and their struggles have never left him. He’s devoted his life not only to medicine, but to documenting the history of the Armenian genocide and leading, or supporting, efforts to resolve humanitarian crises in Armenia and around the world. Earlier this year, he, with Kim Kardashian and singer/actor Cher, published op-eds that addressed a humanitarian crisis building as a result of Azerbaijan’s blockade of the Lachin corridor – which is the only road that links Armenia to the ethnic Armenian–populated sections of Nagorno-Karabakh. In September, Armenia and Azerbaijan reached a tentative agreement to end the blockade, but more needs to be done, he says. Tragedies continue to unfold, and he is redoubling his efforts to bring more attention to this humanitarian crisis, he said.
The first film was “The Promise,” a historical war drama set in the Ottoman Empire and released in 2016. In 2017, he and partners released “Intent to Destroy: Death, Denial, & Depiction,” a documentary about the Armenian genocide. The documentary received an Emmy nomination for Outstanding Historical Documentary. And, in 2020, he produced “Francesco,” a film about Pope Francis that documented his pilgrimage to Armenia in 2016.
“The Promise” had such an impact on viewers that in 2017 Dr. Esrailian and the UCLA School of Law created The Promise Institute for Human Rights as a center of human rights education, research, and advocacy. In 2019, Dr. Esrailian and UCLA followed up with The Promise Armenian Institute as a place for academic research and teaching of Armenian studies, language, and culture. “The impact from building these two institutes has been transformational, and they will be part of UCLA forever,” he said.
His philanthropic efforts connecting health, human rights, education, and the arts has had an impact worldwide. One person can make a difference, Dr. Esrailian said: “I’ve learned along the way that an individual can have more of an impact than ever imagined, but you have to dream big and never give up.”
In this interview, he tells us more about his work.
Q: Not many doctors wear hats in medicine and filmmaking. Describe your journey as a filmmaker.
Dr. Esrailian: I’ve always been interested in storytelling. I was an English minor at Berkeley. My late mentor, Kirk Kerkorian, a legendary philanthropist, businessman, and entrepreneur, pushed me to take storytelling and do something that would potentially help secure Armenian Genocide recognition by the United States. Because of genocide denialists and geopolitical pressure, he felt the United States government was reluctant to recognize the Armenian Genocide. He thought having some visual materials for educational and outreach efforts would be transformational, and as it turns out, they were.
If you talk to any advocacy organization that tried for years to get Armenian Genocide recognition, they’d say that both films, “The Promise” (a feature film) and “Intent to Destroy” (a documentary), and the social impact media campaign we launched around them, were influential in moving the needle with legislators in the United States who, 3 years after “The Promise” was released, recognized the genocide. This was followed by the Library of Congress in 2020 and President Biden’s executive branch in 2021.
Q: What has been your most rewarding accomplishment?
Dr. Esrailian: Giving a voice to people who don’t have a voice is something that I’m proud of. Sometimes, it’s questionable what impact it may have because we still see atrocities committed all over the world. In September, Azerbaijan completed an ethnic cleansing campaign of Armenians from a region called Artsakh, officially the Republic of Nagorno-Karabakh.
Despite having so many relationships with powerful people in government and in high-profile media, and despite our documentaries, op-eds, and interactions with influential leaders on a regular basis, it always feels like it’s not enough. Obviously, the perpetrators are still able to abuse human rights and conduct these campaigns. Nevertheless, I don’t think we should be deterred. Allowing human rights violations to occur with impunity only emboldens perpetrators even more. It takes a long time to bring people to justice through international courts, but it does happen – eventually. That’s something I’m going to continue to work on.
Q: What should be the role of physicians in supporting human rights?
Dr. Esrailian: Physicians and health care providers play an important role in human rights. If you look back throughout history, whether it’s the International Committee of the Red Cross, or Doctors Without Borders, or other organizations, physicians and health care professionals are often on the front lines, helping people. Unfortunately, physicians have also been part of human rights violations, like the Holocaust or other genocides. But I do think that in this day and age, with the reputation that physicians have, we can be policy advocates and upstanders in addition to taking care of patients. Telling our stories to the world is important so that people know what’s actually happening on the ground.
Lightning round
Do you prefer texting or talking?
Talking
How many cups of coffee do you drink each day?
Two
What was the last movie you watched?
Mission Impossible
If you weren’t a gastroenterologist, what would you be?
Entrepreneur
Who inspires you?
My family
Advancing personalized medicine in IBD
Gastroenterologists have more treatments at their disposal today than ever before, particularly in the last decade. “We have had tremendous advances in many areas of understanding contributors to disease,” said Dr. Melia, an assistant professor of medicine at Johns Hopkins Medicine in Baltimore who specializes in inflammatory bowel disease (IBD). But the hurdle is in translating the science to clinical care that is individualized to each patient based on condition and stage of the condition.
“That still remains a bit of a dream,” she said. Much of her career has been devoted to chasing down a particular genetic variant that contributes to IBD, with the goal of reaching more precise treatments for patients.
In an interview, she shared how she entered this line of work, and what her research has revealed about Crohn’s disease, manganese, and a common genetic variant known as ZIP8.
Q: Your expertise is in inflammatory bowel disease and manganese deficiency. Why did you choose these two areas as your focus in GI?
Dr. Melia: In talking to many patients with IBD, I was always struck by the questions around nutritional factors related to disease. As a fellow, I was embedded in a lab that focused on genetics of IBD. A micronutrient transporter, ZIP8, has a mutation in it that increases the risk of Crohn’s disease.
I’ve dedicated the last 8 years to understanding how this mutation can increase risk. It initially started out as a project focused on zinc, because that’s what the transporter was thought to regulate. However, it’s evolved as we’ve learned more about it, underscoring the importance of manganese, another micronutrient that we derive from food.
We have established that having this mutation changes how the body handles manganese and affects downstream processes that involve manganese. What I’m doing now is trying to connect those dots on why those processes are important in Crohn’s disease and whether we can target them for treatment.
Q: How does manganese deficiency lead to chronic IBD?
Dr. Melia: In individuals with this mutation, their blood manganese levels are lower than people who don’t have this mutation. When we talk about manganese deficiency or insufficiency, what we’re really talking about is lower blood levels. But it’s more complicated than that at the tissue level.
What we and other groups are working on right now is trying to understand if the manganese levels change in the gut and what happens in inflammation. The gut is a particularly interesting area for manganese, in that much of the manganese that we eat is excreted. We only absorb a small amount of it. And so, manganese levels within the gut lumen may actually be quite high – and may be even higher in inflammation. But there are things we don’t understand about that and how it relates to mucosal levels of manganese and Crohn’s disease. The ileum, the site of the Crohn’s disease that’s specifically associated with this mutation, might be particularly sensitive to changes in the manganese levels or the downstream processes that changing manganese availability affects.
One of those processes is glycosylation. Manganese is important to properly glycosylate your proteins. Many enzymes help cells put sugars on proteins, and many of those enzymes need manganese to do it. Glycosylation of proteins is important so cells know where those proteins should go, and the sugars help them stay where they need to be. When you change protein glycosylation, you can stress the cells. We know individuals who carry this mutation have changes in the glycosylation of their proteins. What we’re working on right now is understanding which key proteins might change when that happens, and why that’s a potential problem, especially in the ileum.
Q: How might your research inform clinical practice?
Dr. Melia: We’ve seen significant progress in new medications and new pathways that have emerged. We still have this fundamental problem that our immune-targeting medicines are only helping about 50% of the patients.
It’s critical that we begin to identify new pathways. And my hope is that in studying genes like the ZIP8 (SLC39A8), which is associated with the dysregulated processing of manganese, we can understand different pathways and mechanisms to target.
As an example, if we could help correct the glycosylation problem, that would help to boost the barrier function of the gut and perhaps decrease the activation of those immune cells, because you’re just reinforcing the barrier integrity of the gut.
We want to target that glycosylation problem as we would treat patients with congenital disorders of glycosylation by giving supplemental sugars. We think this problem of glycosylation extends beyond patients with the ZIP8 mutation, but it is also really important for patients with the mutation. So, the goal would be to use ZIP8 genetics to help prioritize patients for therapy targeting this problem.
Q: You’re involved in the American Gastroenterological Association Future Leaders Program. What is your role in this program? Why is it important?
Dr. Melia: I was very grateful for the opportunity to participate in the AGA’s Future Leaders Program. I think it was exceedingly valuable for two main reasons. One, it really offered an insight into the role of the AGA and the important role that the AGA plays in the careers of gastroenterologists. Two, it was such a unique opportunity to work with colleagues nationwide and to build a network of individuals who are all at a similar stage in their careers. It was a very inspiring group to meet and to have the opportunity to work with as part of that program, and I thank the AGA for supporting such an initiative.
Q: What teacher or mentor had the greatest impact on you?
Dr. Melia: I have been blessed by many clinical and research mentors through my career. I was inspired to do science at the lab of Ramnik Xavier, MD, at Massachusetts General Hospital. At Johns Hopkins, I credit Cindy Sears, MD, and Anne Marie O’Broin Lennon, MBBCh, PhD, as two physician scientists who have really shaped how I have tried to integrate my clinical and research career.
LIGHTNING ROUND
Do you prefer texting or talking?
Texting
If you weren’t a gastroenterologist, what would you be?
Teacher
What was the last movie you watched?
Great Bear Rainforest
What is your most favorite city in the U.S.?
Surry, Maine
What song do you absolutely have to sing along with when you hear it?
Any song by Whitney Houston.
Are you an introvert or extrovert?
Introvert
How many cups of coffee do you drink per day?
One
Gastroenterologists have more treatments at their disposal today than ever before, particularly in the last decade. “We have had tremendous advances in many areas of understanding contributors to disease,” said Dr. Melia, an assistant professor of medicine at Johns Hopkins Medicine in Baltimore who specializes in inflammatory bowel disease (IBD). But the hurdle is in translating the science to clinical care that is individualized to each patient based on condition and stage of the condition.
“That still remains a bit of a dream,” she said. Much of her career has been devoted to chasing down a particular genetic variant that contributes to IBD, with the goal of reaching more precise treatments for patients.
In an interview, she shared how she entered this line of work, and what her research has revealed about Crohn’s disease, manganese, and a common genetic variant known as ZIP8.
Q: Your expertise is in inflammatory bowel disease and manganese deficiency. Why did you choose these two areas as your focus in GI?
Dr. Melia: In talking to many patients with IBD, I was always struck by the questions around nutritional factors related to disease. As a fellow, I was embedded in a lab that focused on genetics of IBD. A micronutrient transporter, ZIP8, has a mutation in it that increases the risk of Crohn’s disease.
I’ve dedicated the last 8 years to understanding how this mutation can increase risk. It initially started out as a project focused on zinc, because that’s what the transporter was thought to regulate. However, it’s evolved as we’ve learned more about it, underscoring the importance of manganese, another micronutrient that we derive from food.
We have established that having this mutation changes how the body handles manganese and affects downstream processes that involve manganese. What I’m doing now is trying to connect those dots on why those processes are important in Crohn’s disease and whether we can target them for treatment.
Q: How does manganese deficiency lead to chronic IBD?
Dr. Melia: In individuals with this mutation, their blood manganese levels are lower than people who don’t have this mutation. When we talk about manganese deficiency or insufficiency, what we’re really talking about is lower blood levels. But it’s more complicated than that at the tissue level.
What we and other groups are working on right now is trying to understand if the manganese levels change in the gut and what happens in inflammation. The gut is a particularly interesting area for manganese, in that much of the manganese that we eat is excreted. We only absorb a small amount of it. And so, manganese levels within the gut lumen may actually be quite high – and may be even higher in inflammation. But there are things we don’t understand about that and how it relates to mucosal levels of manganese and Crohn’s disease. The ileum, the site of the Crohn’s disease that’s specifically associated with this mutation, might be particularly sensitive to changes in the manganese levels or the downstream processes that changing manganese availability affects.
One of those processes is glycosylation. Manganese is important to properly glycosylate your proteins. Many enzymes help cells put sugars on proteins, and many of those enzymes need manganese to do it. Glycosylation of proteins is important so cells know where those proteins should go, and the sugars help them stay where they need to be. When you change protein glycosylation, you can stress the cells. We know individuals who carry this mutation have changes in the glycosylation of their proteins. What we’re working on right now is understanding which key proteins might change when that happens, and why that’s a potential problem, especially in the ileum.
Q: How might your research inform clinical practice?
Dr. Melia: We’ve seen significant progress in new medications and new pathways that have emerged. We still have this fundamental problem that our immune-targeting medicines are only helping about 50% of the patients.
It’s critical that we begin to identify new pathways. And my hope is that in studying genes like the ZIP8 (SLC39A8), which is associated with the dysregulated processing of manganese, we can understand different pathways and mechanisms to target.
As an example, if we could help correct the glycosylation problem, that would help to boost the barrier function of the gut and perhaps decrease the activation of those immune cells, because you’re just reinforcing the barrier integrity of the gut.
We want to target that glycosylation problem as we would treat patients with congenital disorders of glycosylation by giving supplemental sugars. We think this problem of glycosylation extends beyond patients with the ZIP8 mutation, but it is also really important for patients with the mutation. So, the goal would be to use ZIP8 genetics to help prioritize patients for therapy targeting this problem.
Q: You’re involved in the American Gastroenterological Association Future Leaders Program. What is your role in this program? Why is it important?
Dr. Melia: I was very grateful for the opportunity to participate in the AGA’s Future Leaders Program. I think it was exceedingly valuable for two main reasons. One, it really offered an insight into the role of the AGA and the important role that the AGA plays in the careers of gastroenterologists. Two, it was such a unique opportunity to work with colleagues nationwide and to build a network of individuals who are all at a similar stage in their careers. It was a very inspiring group to meet and to have the opportunity to work with as part of that program, and I thank the AGA for supporting such an initiative.
Q: What teacher or mentor had the greatest impact on you?
Dr. Melia: I have been blessed by many clinical and research mentors through my career. I was inspired to do science at the lab of Ramnik Xavier, MD, at Massachusetts General Hospital. At Johns Hopkins, I credit Cindy Sears, MD, and Anne Marie O’Broin Lennon, MBBCh, PhD, as two physician scientists who have really shaped how I have tried to integrate my clinical and research career.
LIGHTNING ROUND
Do you prefer texting or talking?
Texting
If you weren’t a gastroenterologist, what would you be?
Teacher
What was the last movie you watched?
Great Bear Rainforest
What is your most favorite city in the U.S.?
Surry, Maine
What song do you absolutely have to sing along with when you hear it?
Any song by Whitney Houston.
Are you an introvert or extrovert?
Introvert
How many cups of coffee do you drink per day?
One
Gastroenterologists have more treatments at their disposal today than ever before, particularly in the last decade. “We have had tremendous advances in many areas of understanding contributors to disease,” said Dr. Melia, an assistant professor of medicine at Johns Hopkins Medicine in Baltimore who specializes in inflammatory bowel disease (IBD). But the hurdle is in translating the science to clinical care that is individualized to each patient based on condition and stage of the condition.
“That still remains a bit of a dream,” she said. Much of her career has been devoted to chasing down a particular genetic variant that contributes to IBD, with the goal of reaching more precise treatments for patients.
In an interview, she shared how she entered this line of work, and what her research has revealed about Crohn’s disease, manganese, and a common genetic variant known as ZIP8.
Q: Your expertise is in inflammatory bowel disease and manganese deficiency. Why did you choose these two areas as your focus in GI?
Dr. Melia: In talking to many patients with IBD, I was always struck by the questions around nutritional factors related to disease. As a fellow, I was embedded in a lab that focused on genetics of IBD. A micronutrient transporter, ZIP8, has a mutation in it that increases the risk of Crohn’s disease.
I’ve dedicated the last 8 years to understanding how this mutation can increase risk. It initially started out as a project focused on zinc, because that’s what the transporter was thought to regulate. However, it’s evolved as we’ve learned more about it, underscoring the importance of manganese, another micronutrient that we derive from food.
We have established that having this mutation changes how the body handles manganese and affects downstream processes that involve manganese. What I’m doing now is trying to connect those dots on why those processes are important in Crohn’s disease and whether we can target them for treatment.
Q: How does manganese deficiency lead to chronic IBD?
Dr. Melia: In individuals with this mutation, their blood manganese levels are lower than people who don’t have this mutation. When we talk about manganese deficiency or insufficiency, what we’re really talking about is lower blood levels. But it’s more complicated than that at the tissue level.
What we and other groups are working on right now is trying to understand if the manganese levels change in the gut and what happens in inflammation. The gut is a particularly interesting area for manganese, in that much of the manganese that we eat is excreted. We only absorb a small amount of it. And so, manganese levels within the gut lumen may actually be quite high – and may be even higher in inflammation. But there are things we don’t understand about that and how it relates to mucosal levels of manganese and Crohn’s disease. The ileum, the site of the Crohn’s disease that’s specifically associated with this mutation, might be particularly sensitive to changes in the manganese levels or the downstream processes that changing manganese availability affects.
One of those processes is glycosylation. Manganese is important to properly glycosylate your proteins. Many enzymes help cells put sugars on proteins, and many of those enzymes need manganese to do it. Glycosylation of proteins is important so cells know where those proteins should go, and the sugars help them stay where they need to be. When you change protein glycosylation, you can stress the cells. We know individuals who carry this mutation have changes in the glycosylation of their proteins. What we’re working on right now is understanding which key proteins might change when that happens, and why that’s a potential problem, especially in the ileum.
Q: How might your research inform clinical practice?
Dr. Melia: We’ve seen significant progress in new medications and new pathways that have emerged. We still have this fundamental problem that our immune-targeting medicines are only helping about 50% of the patients.
It’s critical that we begin to identify new pathways. And my hope is that in studying genes like the ZIP8 (SLC39A8), which is associated with the dysregulated processing of manganese, we can understand different pathways and mechanisms to target.
As an example, if we could help correct the glycosylation problem, that would help to boost the barrier function of the gut and perhaps decrease the activation of those immune cells, because you’re just reinforcing the barrier integrity of the gut.
We want to target that glycosylation problem as we would treat patients with congenital disorders of glycosylation by giving supplemental sugars. We think this problem of glycosylation extends beyond patients with the ZIP8 mutation, but it is also really important for patients with the mutation. So, the goal would be to use ZIP8 genetics to help prioritize patients for therapy targeting this problem.
Q: You’re involved in the American Gastroenterological Association Future Leaders Program. What is your role in this program? Why is it important?
Dr. Melia: I was very grateful for the opportunity to participate in the AGA’s Future Leaders Program. I think it was exceedingly valuable for two main reasons. One, it really offered an insight into the role of the AGA and the important role that the AGA plays in the careers of gastroenterologists. Two, it was such a unique opportunity to work with colleagues nationwide and to build a network of individuals who are all at a similar stage in their careers. It was a very inspiring group to meet and to have the opportunity to work with as part of that program, and I thank the AGA for supporting such an initiative.
Q: What teacher or mentor had the greatest impact on you?
Dr. Melia: I have been blessed by many clinical and research mentors through my career. I was inspired to do science at the lab of Ramnik Xavier, MD, at Massachusetts General Hospital. At Johns Hopkins, I credit Cindy Sears, MD, and Anne Marie O’Broin Lennon, MBBCh, PhD, as two physician scientists who have really shaped how I have tried to integrate my clinical and research career.
LIGHTNING ROUND
Do you prefer texting or talking?
Texting
If you weren’t a gastroenterologist, what would you be?
Teacher
What was the last movie you watched?
Great Bear Rainforest
What is your most favorite city in the U.S.?
Surry, Maine
What song do you absolutely have to sing along with when you hear it?
Any song by Whitney Houston.
Are you an introvert or extrovert?
Introvert
How many cups of coffee do you drink per day?
One
New York GI advocates for team approach in GI care
“I was a little kid, so I wasn’t helping him,” but he said he learned a great deal by sitting in the hallways and listening to his father talk to patients. “I could clearly hear the human suffering on the other side.”
This experience had a big impact on Dr. Berry, who continues the family trade. Like his father, talking with patients about their condition is his favorite part of the job, but especially talking about the role of diet, lifestyle, and stress on GI health, said Dr. Berry, who is a gastroenterologist and clinical assistant professor of medicine at New York University’s Grossman School of Medicine.
In addition to his clinical practice, Dr.Berry serves as the co-founder & chief medical officer at Oshi Health. Oshi is an integrative healthcare clinic that is entirely virtual and entirely and solely about GI health. The clinic works with GI clinicians and other healthcare providers, allowing patients access to multidisciplinary care that has proven to reduce healthcare costs and improve patient outcomes. The company was recently named a recipient of funding through the American College of Gastroenterology and the American Gastroenterological Association’s Center for GI Innovation & Technology’s GI Opportunity Fund.
The Oshi model is a whole-person, multidisciplinary GI care model, which includes traditional medical care for GI conditions but also provides access to health coaching, nutrition and diet support, and behavioral and mental health services. Research shows the approach is effective in mitigating symptoms. A 2020 randomized controlled trial published in Lancet Gastroenterology and Hepatology demonstrated that integrated multidisciplinary care led to improvement in symptoms, quality of life, and cost of care for complex GI conditions, as compared with the traditional GI specialist care model. Numerous similar studies have found that integrated care teams were better equipped to meet the needs of patients with inflammatory bowel disease (IBD) and patients with disorders of gut-brain interaction (DGBIs), patient outcomes and satisfaction were better, overall direct and indirect costs were lower and psychological health needs better addressed.
Q: What was the inspiration behind Oshi Health?
Dr. Berry: Gastroenterologists continue to witness unnecessary patient suffering due to antiquated care delivery models and perverse incentives in our healthcare system. Oshi’s care model was designed to align incentives and provide patients with access to clinicians who are traditionally not reimbursed in fee-for-service healthcare while also helping GI practices provide this care to their patients. During my clinical training it was easy for me to order expensive and invasive testing for my patients, but very difficult for me to get them the multidisciplinary care they needed. Many of the patients I would see didn’t need more MRIs, CT scans, or expensive medications. They needed access to a team of clinicians to help with all the aspects of GI care, including diet, behavioral, and medical.
Q: Why is multidisciplinary care the right approach?
Dr. Berry: GI is a very complex field with many nuances that can impact a patient’s symptoms. As physicians, our role is now evolving to oversee a team of clinicians working together to maximize expertise in nutrition and the gut-brain axis. With these new multidisciplinary care models, GI practices can expand their capabilities. At Oshi Health, every single patient has access to a nurse practitioner, dietician, psychologist, and health coach — all overseen by a gastroenterologist — as a covered benefit through their health plan. Providing multidisciplinary care through a virtual-first model solves some of the scalability challenges of these intensive care models and can significantly improve access to care.
Q: What grant-funded clinical research are you doing right now?
Dr. Berry: Most of my research focuses on evaluating the impact of novel care delivery models in GI and the evaluation of digital technologies in GI and how we can incorporate those digital technologies into clinical practice. How can we determine what type of care can be done remotely via video visits? What can be done on the phone or via text messaging? How can we get these new services paid for so patients can reap the benefits of seeing their doctor more frequently?
Q: What teacher or mentor had the greatest impact on you?
Dr. Berry: Dr. John Allen, MD, MBA has had an incredible impact on my career. He’s the former president of the American Gastroenterological Association, and was the chief clinical officer and a professor at the University of Michigan. He’s one of the rare GI doctors that has both a strong clinical and leadership role in GI. I can’t thank him enough for planting the seeds to encourage me to focus on improving the ways we deliver care to patients.
Q: Describe how you would spend a free Saturday afternoon.
Dr. Berry: Roaming around and exploring a new neighborhood either in New York City or anywhere in the world. If I wasn’t going to be a doctor, I’d probably be an anthropologist. I love observing people in their element, and exploring new neighborhoods that are off the beaten path is a great way to do that.
Lightning round! Do you prefer texting or talking?
Texting
What’s high on your list of travel destinations?
Antarctica
Where was your most memorable vacation?
Patagonia
How many cups of coffee do you drink daily?
Four
What’s your favorite holiday?
Halloween
What’s your favorite junk food?
In-N-Out Burger
If you weren’t a gastroenterologist, what would you be?
Anthropologist
“I was a little kid, so I wasn’t helping him,” but he said he learned a great deal by sitting in the hallways and listening to his father talk to patients. “I could clearly hear the human suffering on the other side.”
This experience had a big impact on Dr. Berry, who continues the family trade. Like his father, talking with patients about their condition is his favorite part of the job, but especially talking about the role of diet, lifestyle, and stress on GI health, said Dr. Berry, who is a gastroenterologist and clinical assistant professor of medicine at New York University’s Grossman School of Medicine.
In addition to his clinical practice, Dr.Berry serves as the co-founder & chief medical officer at Oshi Health. Oshi is an integrative healthcare clinic that is entirely virtual and entirely and solely about GI health. The clinic works with GI clinicians and other healthcare providers, allowing patients access to multidisciplinary care that has proven to reduce healthcare costs and improve patient outcomes. The company was recently named a recipient of funding through the American College of Gastroenterology and the American Gastroenterological Association’s Center for GI Innovation & Technology’s GI Opportunity Fund.
The Oshi model is a whole-person, multidisciplinary GI care model, which includes traditional medical care for GI conditions but also provides access to health coaching, nutrition and diet support, and behavioral and mental health services. Research shows the approach is effective in mitigating symptoms. A 2020 randomized controlled trial published in Lancet Gastroenterology and Hepatology demonstrated that integrated multidisciplinary care led to improvement in symptoms, quality of life, and cost of care for complex GI conditions, as compared with the traditional GI specialist care model. Numerous similar studies have found that integrated care teams were better equipped to meet the needs of patients with inflammatory bowel disease (IBD) and patients with disorders of gut-brain interaction (DGBIs), patient outcomes and satisfaction were better, overall direct and indirect costs were lower and psychological health needs better addressed.
Q: What was the inspiration behind Oshi Health?
Dr. Berry: Gastroenterologists continue to witness unnecessary patient suffering due to antiquated care delivery models and perverse incentives in our healthcare system. Oshi’s care model was designed to align incentives and provide patients with access to clinicians who are traditionally not reimbursed in fee-for-service healthcare while also helping GI practices provide this care to their patients. During my clinical training it was easy for me to order expensive and invasive testing for my patients, but very difficult for me to get them the multidisciplinary care they needed. Many of the patients I would see didn’t need more MRIs, CT scans, or expensive medications. They needed access to a team of clinicians to help with all the aspects of GI care, including diet, behavioral, and medical.
Q: Why is multidisciplinary care the right approach?
Dr. Berry: GI is a very complex field with many nuances that can impact a patient’s symptoms. As physicians, our role is now evolving to oversee a team of clinicians working together to maximize expertise in nutrition and the gut-brain axis. With these new multidisciplinary care models, GI practices can expand their capabilities. At Oshi Health, every single patient has access to a nurse practitioner, dietician, psychologist, and health coach — all overseen by a gastroenterologist — as a covered benefit through their health plan. Providing multidisciplinary care through a virtual-first model solves some of the scalability challenges of these intensive care models and can significantly improve access to care.
Q: What grant-funded clinical research are you doing right now?
Dr. Berry: Most of my research focuses on evaluating the impact of novel care delivery models in GI and the evaluation of digital technologies in GI and how we can incorporate those digital technologies into clinical practice. How can we determine what type of care can be done remotely via video visits? What can be done on the phone or via text messaging? How can we get these new services paid for so patients can reap the benefits of seeing their doctor more frequently?
Q: What teacher or mentor had the greatest impact on you?
Dr. Berry: Dr. John Allen, MD, MBA has had an incredible impact on my career. He’s the former president of the American Gastroenterological Association, and was the chief clinical officer and a professor at the University of Michigan. He’s one of the rare GI doctors that has both a strong clinical and leadership role in GI. I can’t thank him enough for planting the seeds to encourage me to focus on improving the ways we deliver care to patients.
Q: Describe how you would spend a free Saturday afternoon.
Dr. Berry: Roaming around and exploring a new neighborhood either in New York City or anywhere in the world. If I wasn’t going to be a doctor, I’d probably be an anthropologist. I love observing people in their element, and exploring new neighborhoods that are off the beaten path is a great way to do that.
Lightning round! Do you prefer texting or talking?
Texting
What’s high on your list of travel destinations?
Antarctica
Where was your most memorable vacation?
Patagonia
How many cups of coffee do you drink daily?
Four
What’s your favorite holiday?
Halloween
What’s your favorite junk food?
In-N-Out Burger
If you weren’t a gastroenterologist, what would you be?
Anthropologist
“I was a little kid, so I wasn’t helping him,” but he said he learned a great deal by sitting in the hallways and listening to his father talk to patients. “I could clearly hear the human suffering on the other side.”
This experience had a big impact on Dr. Berry, who continues the family trade. Like his father, talking with patients about their condition is his favorite part of the job, but especially talking about the role of diet, lifestyle, and stress on GI health, said Dr. Berry, who is a gastroenterologist and clinical assistant professor of medicine at New York University’s Grossman School of Medicine.
In addition to his clinical practice, Dr.Berry serves as the co-founder & chief medical officer at Oshi Health. Oshi is an integrative healthcare clinic that is entirely virtual and entirely and solely about GI health. The clinic works with GI clinicians and other healthcare providers, allowing patients access to multidisciplinary care that has proven to reduce healthcare costs and improve patient outcomes. The company was recently named a recipient of funding through the American College of Gastroenterology and the American Gastroenterological Association’s Center for GI Innovation & Technology’s GI Opportunity Fund.
The Oshi model is a whole-person, multidisciplinary GI care model, which includes traditional medical care for GI conditions but also provides access to health coaching, nutrition and diet support, and behavioral and mental health services. Research shows the approach is effective in mitigating symptoms. A 2020 randomized controlled trial published in Lancet Gastroenterology and Hepatology demonstrated that integrated multidisciplinary care led to improvement in symptoms, quality of life, and cost of care for complex GI conditions, as compared with the traditional GI specialist care model. Numerous similar studies have found that integrated care teams were better equipped to meet the needs of patients with inflammatory bowel disease (IBD) and patients with disorders of gut-brain interaction (DGBIs), patient outcomes and satisfaction were better, overall direct and indirect costs were lower and psychological health needs better addressed.
Q: What was the inspiration behind Oshi Health?
Dr. Berry: Gastroenterologists continue to witness unnecessary patient suffering due to antiquated care delivery models and perverse incentives in our healthcare system. Oshi’s care model was designed to align incentives and provide patients with access to clinicians who are traditionally not reimbursed in fee-for-service healthcare while also helping GI practices provide this care to their patients. During my clinical training it was easy for me to order expensive and invasive testing for my patients, but very difficult for me to get them the multidisciplinary care they needed. Many of the patients I would see didn’t need more MRIs, CT scans, or expensive medications. They needed access to a team of clinicians to help with all the aspects of GI care, including diet, behavioral, and medical.
Q: Why is multidisciplinary care the right approach?
Dr. Berry: GI is a very complex field with many nuances that can impact a patient’s symptoms. As physicians, our role is now evolving to oversee a team of clinicians working together to maximize expertise in nutrition and the gut-brain axis. With these new multidisciplinary care models, GI practices can expand their capabilities. At Oshi Health, every single patient has access to a nurse practitioner, dietician, psychologist, and health coach — all overseen by a gastroenterologist — as a covered benefit through their health plan. Providing multidisciplinary care through a virtual-first model solves some of the scalability challenges of these intensive care models and can significantly improve access to care.
Q: What grant-funded clinical research are you doing right now?
Dr. Berry: Most of my research focuses on evaluating the impact of novel care delivery models in GI and the evaluation of digital technologies in GI and how we can incorporate those digital technologies into clinical practice. How can we determine what type of care can be done remotely via video visits? What can be done on the phone or via text messaging? How can we get these new services paid for so patients can reap the benefits of seeing their doctor more frequently?
Q: What teacher or mentor had the greatest impact on you?
Dr. Berry: Dr. John Allen, MD, MBA has had an incredible impact on my career. He’s the former president of the American Gastroenterological Association, and was the chief clinical officer and a professor at the University of Michigan. He’s one of the rare GI doctors that has both a strong clinical and leadership role in GI. I can’t thank him enough for planting the seeds to encourage me to focus on improving the ways we deliver care to patients.
Q: Describe how you would spend a free Saturday afternoon.
Dr. Berry: Roaming around and exploring a new neighborhood either in New York City or anywhere in the world. If I wasn’t going to be a doctor, I’d probably be an anthropologist. I love observing people in their element, and exploring new neighborhoods that are off the beaten path is a great way to do that.
Lightning round! Do you prefer texting or talking?
Texting
What’s high on your list of travel destinations?
Antarctica
Where was your most memorable vacation?
Patagonia
How many cups of coffee do you drink daily?
Four
What’s your favorite holiday?
Halloween
What’s your favorite junk food?
In-N-Out Burger
If you weren’t a gastroenterologist, what would you be?
Anthropologist
Bridging the gap between GI disorders and nutrition
The gluten-free section in the grocery store didn’t exist when Renee Euler, MS, RD, LD, was diagnosed with celiac disease 30 years ago. A physician handed her a fax about the gluten-free diet from a national support group and said: “Here, read this.”
There was no Google to inform decisions. Patients had to rely on fact sheets or a book from the library.
“I didn’t realize how much nutrition was going to change my world,” said Ms. Euler, who worked as a landscape architect for 15 years before making a pivotal decision to go back to school and train as a dietitian.
Volunteering as a support group leader, and volunteering with the University of Chicago Celiac Disease Center guided this important career change. Ms. Euler discovered she enjoyed teaching people how to live a gluten-free life and that they could enjoy travel and social functions while adhering to dietary restrictions.
she emphasized.
Ms. Euler has made it her life’s work to navigate GI disorders with physicians and patients alike.
She runs her own business, Nutrition Redefined, in Albuquerque and is the chair of the National Celiac Association Celiac/Gluten Intolerance Support Group in Albuquerque. Previously, she chaired the Dietitians in Medical Nutrition Therapy Dietetic Practice Group, a part of the Academy of Nutrition and Dietetics.
In an interview, she talked about the unique dietary struggles people with celiac and other gastrointestinal conditions face, and the strategies she uses to help these patients overcome hurdles and live a more normal life.
Q: What fears did you have to push past to get to where you are in your career?
Ms. Euler: Leaving a successful career as a landscape architect and going back to school was definitely a huge hurdle. When I started my practice in 2017, in my area there were no outpatient GI dietitians providing specialized care for adults with conditions like celiac disease, irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD). I was starting out with no real support.
Realizing that I was going to start a private practice of my own to help the people I wanted to help, was another big fear. “Am I going to succeed? Am I going to fail? What’s going to happen?” But over the years, my practice has grown as I learned to bill insurance and started receiving referrals from a large local GI practice, both of which have been the keys to my success. I have also limited my practice to GI clients so that I can focus my attention on this specialized area of nutrition and stay up to date on the latest developments.
Q: What interests you about the intersection between diet and GI disorders?
Ms. Euler: It’s not just about diet. We’re learning so much about how the gut microbiome can have a potential impact [on other parts of our health]. It’s interesting in terms of how we respond to certain foods, for instance, could affect our mental health. This especially applies to IBS and how the microbiome might be connected to these conditions.
It’s very challenging. There is so much information out there that is not super accurate, or it’s misleading.
Q: You serve as a liaison between the American Gastroenterological Association and the Academy of Nutrition and Dietetics. As a nutritionist with a focus on GI, how do you work with gastroenterologists to manage GI disorders?
Ms. Euler: Some of the dietary therapies that GI doctors recommend don’t provide sufficient guidance. They hand out that two-page fact sheet about diet and send the patient on their way. A lot of these diets have more nuance than what can be expressed in a two-page handout.
Many times, the physician doesn’t know the nuance, or they don’t have time to go over it. That’s where we can really help.
Patients often want diet to be the answer. They want to be told: “You need to eat this and only this, and everything will be fine, and diet’s going to change your world, and you won’t have to take medication.”
What they often don’t realize and understand, is a lot of these dietary therapies are not black and white. Celiac disease means a gluten-free diet for life. But a lot of these dietary therapies that get thrown out to patients as a possibility, like low FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols), are not lifetime diets. They’re tools for us to use to find out what the offending foods are for this person, and what can we do to get their symptoms under control.
Q: What is the biggest practice-related challenge in getting patients to alter their diet to improve their symptoms?
Ms. Euler: A lot of patients that come to me already have over restricted diets. They’re trying to solve things themselves. Rightfully so, a lot of them have a lot of food fears because they have been living with very uncomfortable symptoms for years, and they’re trying to find answers. Those food fears unfortunately are reinforced by social media and the news.
One of my biggest challenges with those clients is working through that process of building their confidence to broaden their diets and add foods back in, without causing their symptoms to flare up. The goal is to get them back on track to having a nutritious diet while trying to manage symptoms.
Q: Can you give me an anecdotal example of a case that wasn’t easy, and you ended up helping that person?
Ms. Euler: I had a patient who had been listening to all the wellness gurus. She was overrestricted to the point of eating just 10 different foods due to allergic and GI symptoms. Patients like this are definitely a challenge because you have to reorient them to the fact that what they’re doing isn’t necessarily working,
My initial assessments are 90 minutes long, so I have a lot of time to sit with a patient and hear their story and understand their background.
I suggested to the patient: “Why don’t we try adding these foods back in, but eliminating these other types of foods and see whether that would help?” 48 hours later, she sent me an email, telling me that she and her husband had talked this through, and they thought I hit the nail on the head: She was focusing on the wrong foods which were causing problems. Those are always great messages to get from patients, when they say: “Oh my gosh, I hadn’t even considered that.”
Q: Describe how you would spend a free Saturday afternoon.
Ms. Euler: They’re so rare – those free Saturday afternoons, but it would probably be a good book that would turn into a nap on the couch.
LIGHTNING ROUND
Do you prefer texting or talking?
Talking in person
What’s your favorite breakfast?
Greek yogurt with fiber, flax seeds, and berries
What’s your favorite junk food?
Ice cream
What’s your favorite fruit?
Garden grown strawberries
What’s your favorite holiday?
Thanksgiving
What’s your favorite type of music?
Jazz
If you weren’t a GI nutritionist, what would you be?
Probably a landscape architect.
The gluten-free section in the grocery store didn’t exist when Renee Euler, MS, RD, LD, was diagnosed with celiac disease 30 years ago. A physician handed her a fax about the gluten-free diet from a national support group and said: “Here, read this.”
There was no Google to inform decisions. Patients had to rely on fact sheets or a book from the library.
“I didn’t realize how much nutrition was going to change my world,” said Ms. Euler, who worked as a landscape architect for 15 years before making a pivotal decision to go back to school and train as a dietitian.
Volunteering as a support group leader, and volunteering with the University of Chicago Celiac Disease Center guided this important career change. Ms. Euler discovered she enjoyed teaching people how to live a gluten-free life and that they could enjoy travel and social functions while adhering to dietary restrictions.
she emphasized.
Ms. Euler has made it her life’s work to navigate GI disorders with physicians and patients alike.
She runs her own business, Nutrition Redefined, in Albuquerque and is the chair of the National Celiac Association Celiac/Gluten Intolerance Support Group in Albuquerque. Previously, she chaired the Dietitians in Medical Nutrition Therapy Dietetic Practice Group, a part of the Academy of Nutrition and Dietetics.
In an interview, she talked about the unique dietary struggles people with celiac and other gastrointestinal conditions face, and the strategies she uses to help these patients overcome hurdles and live a more normal life.
Q: What fears did you have to push past to get to where you are in your career?
Ms. Euler: Leaving a successful career as a landscape architect and going back to school was definitely a huge hurdle. When I started my practice in 2017, in my area there were no outpatient GI dietitians providing specialized care for adults with conditions like celiac disease, irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD). I was starting out with no real support.
Realizing that I was going to start a private practice of my own to help the people I wanted to help, was another big fear. “Am I going to succeed? Am I going to fail? What’s going to happen?” But over the years, my practice has grown as I learned to bill insurance and started receiving referrals from a large local GI practice, both of which have been the keys to my success. I have also limited my practice to GI clients so that I can focus my attention on this specialized area of nutrition and stay up to date on the latest developments.
Q: What interests you about the intersection between diet and GI disorders?
Ms. Euler: It’s not just about diet. We’re learning so much about how the gut microbiome can have a potential impact [on other parts of our health]. It’s interesting in terms of how we respond to certain foods, for instance, could affect our mental health. This especially applies to IBS and how the microbiome might be connected to these conditions.
It’s very challenging. There is so much information out there that is not super accurate, or it’s misleading.
Q: You serve as a liaison between the American Gastroenterological Association and the Academy of Nutrition and Dietetics. As a nutritionist with a focus on GI, how do you work with gastroenterologists to manage GI disorders?
Ms. Euler: Some of the dietary therapies that GI doctors recommend don’t provide sufficient guidance. They hand out that two-page fact sheet about diet and send the patient on their way. A lot of these diets have more nuance than what can be expressed in a two-page handout.
Many times, the physician doesn’t know the nuance, or they don’t have time to go over it. That’s where we can really help.
Patients often want diet to be the answer. They want to be told: “You need to eat this and only this, and everything will be fine, and diet’s going to change your world, and you won’t have to take medication.”
What they often don’t realize and understand, is a lot of these dietary therapies are not black and white. Celiac disease means a gluten-free diet for life. But a lot of these dietary therapies that get thrown out to patients as a possibility, like low FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols), are not lifetime diets. They’re tools for us to use to find out what the offending foods are for this person, and what can we do to get their symptoms under control.
Q: What is the biggest practice-related challenge in getting patients to alter their diet to improve their symptoms?
Ms. Euler: A lot of patients that come to me already have over restricted diets. They’re trying to solve things themselves. Rightfully so, a lot of them have a lot of food fears because they have been living with very uncomfortable symptoms for years, and they’re trying to find answers. Those food fears unfortunately are reinforced by social media and the news.
One of my biggest challenges with those clients is working through that process of building their confidence to broaden their diets and add foods back in, without causing their symptoms to flare up. The goal is to get them back on track to having a nutritious diet while trying to manage symptoms.
Q: Can you give me an anecdotal example of a case that wasn’t easy, and you ended up helping that person?
Ms. Euler: I had a patient who had been listening to all the wellness gurus. She was overrestricted to the point of eating just 10 different foods due to allergic and GI symptoms. Patients like this are definitely a challenge because you have to reorient them to the fact that what they’re doing isn’t necessarily working,
My initial assessments are 90 minutes long, so I have a lot of time to sit with a patient and hear their story and understand their background.
I suggested to the patient: “Why don’t we try adding these foods back in, but eliminating these other types of foods and see whether that would help?” 48 hours later, she sent me an email, telling me that she and her husband had talked this through, and they thought I hit the nail on the head: She was focusing on the wrong foods which were causing problems. Those are always great messages to get from patients, when they say: “Oh my gosh, I hadn’t even considered that.”
Q: Describe how you would spend a free Saturday afternoon.
Ms. Euler: They’re so rare – those free Saturday afternoons, but it would probably be a good book that would turn into a nap on the couch.
LIGHTNING ROUND
Do you prefer texting or talking?
Talking in person
What’s your favorite breakfast?
Greek yogurt with fiber, flax seeds, and berries
What’s your favorite junk food?
Ice cream
What’s your favorite fruit?
Garden grown strawberries
What’s your favorite holiday?
Thanksgiving
What’s your favorite type of music?
Jazz
If you weren’t a GI nutritionist, what would you be?
Probably a landscape architect.
The gluten-free section in the grocery store didn’t exist when Renee Euler, MS, RD, LD, was diagnosed with celiac disease 30 years ago. A physician handed her a fax about the gluten-free diet from a national support group and said: “Here, read this.”
There was no Google to inform decisions. Patients had to rely on fact sheets or a book from the library.
“I didn’t realize how much nutrition was going to change my world,” said Ms. Euler, who worked as a landscape architect for 15 years before making a pivotal decision to go back to school and train as a dietitian.
Volunteering as a support group leader, and volunteering with the University of Chicago Celiac Disease Center guided this important career change. Ms. Euler discovered she enjoyed teaching people how to live a gluten-free life and that they could enjoy travel and social functions while adhering to dietary restrictions.
she emphasized.
Ms. Euler has made it her life’s work to navigate GI disorders with physicians and patients alike.
She runs her own business, Nutrition Redefined, in Albuquerque and is the chair of the National Celiac Association Celiac/Gluten Intolerance Support Group in Albuquerque. Previously, she chaired the Dietitians in Medical Nutrition Therapy Dietetic Practice Group, a part of the Academy of Nutrition and Dietetics.
In an interview, she talked about the unique dietary struggles people with celiac and other gastrointestinal conditions face, and the strategies she uses to help these patients overcome hurdles and live a more normal life.
Q: What fears did you have to push past to get to where you are in your career?
Ms. Euler: Leaving a successful career as a landscape architect and going back to school was definitely a huge hurdle. When I started my practice in 2017, in my area there were no outpatient GI dietitians providing specialized care for adults with conditions like celiac disease, irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD). I was starting out with no real support.
Realizing that I was going to start a private practice of my own to help the people I wanted to help, was another big fear. “Am I going to succeed? Am I going to fail? What’s going to happen?” But over the years, my practice has grown as I learned to bill insurance and started receiving referrals from a large local GI practice, both of which have been the keys to my success. I have also limited my practice to GI clients so that I can focus my attention on this specialized area of nutrition and stay up to date on the latest developments.
Q: What interests you about the intersection between diet and GI disorders?
Ms. Euler: It’s not just about diet. We’re learning so much about how the gut microbiome can have a potential impact [on other parts of our health]. It’s interesting in terms of how we respond to certain foods, for instance, could affect our mental health. This especially applies to IBS and how the microbiome might be connected to these conditions.
It’s very challenging. There is so much information out there that is not super accurate, or it’s misleading.
Q: You serve as a liaison between the American Gastroenterological Association and the Academy of Nutrition and Dietetics. As a nutritionist with a focus on GI, how do you work with gastroenterologists to manage GI disorders?
Ms. Euler: Some of the dietary therapies that GI doctors recommend don’t provide sufficient guidance. They hand out that two-page fact sheet about diet and send the patient on their way. A lot of these diets have more nuance than what can be expressed in a two-page handout.
Many times, the physician doesn’t know the nuance, or they don’t have time to go over it. That’s where we can really help.
Patients often want diet to be the answer. They want to be told: “You need to eat this and only this, and everything will be fine, and diet’s going to change your world, and you won’t have to take medication.”
What they often don’t realize and understand, is a lot of these dietary therapies are not black and white. Celiac disease means a gluten-free diet for life. But a lot of these dietary therapies that get thrown out to patients as a possibility, like low FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols), are not lifetime diets. They’re tools for us to use to find out what the offending foods are for this person, and what can we do to get their symptoms under control.
Q: What is the biggest practice-related challenge in getting patients to alter their diet to improve their symptoms?
Ms. Euler: A lot of patients that come to me already have over restricted diets. They’re trying to solve things themselves. Rightfully so, a lot of them have a lot of food fears because they have been living with very uncomfortable symptoms for years, and they’re trying to find answers. Those food fears unfortunately are reinforced by social media and the news.
One of my biggest challenges with those clients is working through that process of building their confidence to broaden their diets and add foods back in, without causing their symptoms to flare up. The goal is to get them back on track to having a nutritious diet while trying to manage symptoms.
Q: Can you give me an anecdotal example of a case that wasn’t easy, and you ended up helping that person?
Ms. Euler: I had a patient who had been listening to all the wellness gurus. She was overrestricted to the point of eating just 10 different foods due to allergic and GI symptoms. Patients like this are definitely a challenge because you have to reorient them to the fact that what they’re doing isn’t necessarily working,
My initial assessments are 90 minutes long, so I have a lot of time to sit with a patient and hear their story and understand their background.
I suggested to the patient: “Why don’t we try adding these foods back in, but eliminating these other types of foods and see whether that would help?” 48 hours later, she sent me an email, telling me that she and her husband had talked this through, and they thought I hit the nail on the head: She was focusing on the wrong foods which were causing problems. Those are always great messages to get from patients, when they say: “Oh my gosh, I hadn’t even considered that.”
Q: Describe how you would spend a free Saturday afternoon.
Ms. Euler: They’re so rare – those free Saturday afternoons, but it would probably be a good book that would turn into a nap on the couch.
LIGHTNING ROUND
Do you prefer texting or talking?
Talking in person
What’s your favorite breakfast?
Greek yogurt with fiber, flax seeds, and berries
What’s your favorite junk food?
Ice cream
What’s your favorite fruit?
Garden grown strawberries
What’s your favorite holiday?
Thanksgiving
What’s your favorite type of music?
Jazz
If you weren’t a GI nutritionist, what would you be?
Probably a landscape architect.
Florida GI gets candid about imposter syndrome, insurers, starting a GI fellowship
Her first faculty position as assistant program director for the gastroenterology fellowship program at the University of Iowa offered some inspiration. “I loved teaching and working with trainees and knew I always wanted to remain in this realm,” Dr. Naveed said.
When she moved to Orlando to join AdventHealth, she noticed there was no gastroenterology training program. “I was strictly in private practice. Though I love working with patients, I constantly felt like something was missing. When the opportunity to start a fellowship program came, I was highly motivated to bring it to fruition.”
The AdventHealth fellowship is almost done with its inaugural year.
“Starting a fellowship at a new institution is a very challenging yet incredibly rewarding experience,” she said. In this Q&A, she discusses her strategies for dealing with insurance companies and imposter syndrome, and why she looks to her father as her role model in medicine.
Q: Why did you choose GI?
Dr. Naveed: Gastroenterology is a rapidly evolving field which makes it incredibly fascinating. The initial draw was that I was always excited to learn about GI physiology and disease. I also was fortunate to train with amazing gastroenterologists during residency. I had great examples of strong and successful female GIs to look up to. Lastly, for the most part, gastroenterologists are all fairly laid back and have an interesting sense of humor.
Q: What gives you the most joy in your day-to-day practice?
Dr. Naveed: I love learning and teaching. As a program director, I am directly involved with fellows, residents, and students, but there are always additional enrichment opportunities beyond these interactions. I value teaching clinic medical assistants so they feel more confident and empowered in their work. I also try to educate my nurse practitioners. The best compliment at the end of a long day is that they learned something valuable.
Q: How do you stay current with advances in your field?
Dr. Naveed: Between my role as a physician and as an educator, I owe it to my patients and trainees to stay current with advances in the field. But of course, this is challenging, and at times it feels like there are not enough hours in the day. While reading journal articles and attending conferences are great ways to refresh one’s knowledge, the winner for me has been social media (specifically Twitter). It’s easy to find a “Tweetorial” on almost any topic. There are some excellent initiatives on Twitter such as Monday Night IBD, ACG Evidence-Based GI Doc, Scoping Sundays, and GI Journal Club where important articles, new treatment options, and challenging cases are discussed. Of course, I also learn a lot from my fellows and residents.
Q: What fears did you have to push past to get to where you are in your career?
Dr. Naveed: Pushing past imposter syndrome, which is a feeling of self-doubt despite education, experience, and accomplishments. It is something many of us deal with. I’ve had to retire the notion that I am not experienced enough to achieve a particular career goal.
Q: What habits have you established that have benefited your career most?
Dr. Naveed: It’s a challenge to not immediately say “yes” to every opportunity or project. It’s also difficult to learn to delegate. I am lucky to have a great team, and I have learned that delegating certain tasks or projects helps everyone grow. Also, if I say no to an opportunity, I still try to suggest another colleague or mentee who may be interested and/or a good fit.
Q: Describe your biggest practice-related challenge and what you are doing to address it.
Dr. Naveed: Pushback from insurance companies to approve medications or interventions is incredibly frustrating for myself and the patient. It is also incredibly time consuming and requires significant clinical bandwidth that could otherwise be used in other capacities. While not a solution, I at least try to make sure the patient is kept updated and understands causes of delay, and more importantly, what we are doing to address the issue. I have realized that it’s always preferable to empower the patient, rather than leave them uninformed, which can foster frustration and dissatisfaction.
Q: What teacher or mentor had the greatest impact on you?
Dr. Naveed: I have been blessed with many mentors at different points in my medical career that have greatly impacted and shaped my journey. During my fellowship at University of Texas Southwestern (UTSW), Nisa Kubiliun, MD, was not only a mentor, but also an incredible sponsor. She saw potential in me and encouraged involvement in activities critical for career advancement. Arjmand Mufti, MD, the former program director of the UTSW GI fellowship, is still always just a call away when I need advice regarding my GI fellowship program at AdventHealth. I also have mentors and sponsors within my own institution who invest time and energy into my success.
Q: Outside of teachers and mentors, who or what has had the strongest influence in your life?
Dr. Naveed: My father, who is also a physician, has had a profound influence on my personal and professional development. His own medical journey has been incredibly unique. He has practiced medicine internationally, trained and worked in a traditional academic setting, established a very successful private practice, and now has transitioned to running a hospital-based practice. He has seen it all (and he’s also a brilliant physician), and he is always able to talk me through any situation.
Q: What principles guide you?
Dr. Naveed: Treating my patients how I would want a physician to treat my family is central to my practice. Also, I try to approach any successes with gratitude, and likewise, be patient with inevitable failures. It can be challenging, but I try to find the lesson in every failed venture.
Q: What would you do differently if you had a chance?
Dr. Naveed: I have always had an interest in international medical missions but have yet to participate in one. I have previously passed on such opportunities, thinking it was not the right time, but in hindsight I wish I had taken the leap. I still hope to eventually accomplish this goal.
Q: Describe a scene of your vision for the future.
Dr. Naveed: I hope that our GI fellowship continues to flourish and attract exceptional faculty and candidates. I want to remain involved in graduate medical education, but I hope to continue to challenge myself and advance within this domain. Most importantly, I hope I can continue to balance my career aspirations with my personal goals. I want to continue to be present for my family and kids.
Q: Describe how you would spend a free Saturday afternoon.
Dr. Naveed: You can usually find me at the local farmer’s market with my husband and kids. Afterwards, we’re definitely going to get Chick-fil-A followed by ice cream.
Lightning round
If you weren’t a gastroenterologist, what would you be?
International event planner.
How many cups of coffee do you drink per day?
Usually three.
Favorite breakfast?
Eggs, corned beef hash, toast.
Texting or talking?
Texting always unless it’s Mom or Dad. They always get a call.
Place you most want to travel?
Japan.
Follow Dr. Naveed on Twitter at @MN_GIMD
Her first faculty position as assistant program director for the gastroenterology fellowship program at the University of Iowa offered some inspiration. “I loved teaching and working with trainees and knew I always wanted to remain in this realm,” Dr. Naveed said.
When she moved to Orlando to join AdventHealth, she noticed there was no gastroenterology training program. “I was strictly in private practice. Though I love working with patients, I constantly felt like something was missing. When the opportunity to start a fellowship program came, I was highly motivated to bring it to fruition.”
The AdventHealth fellowship is almost done with its inaugural year.
“Starting a fellowship at a new institution is a very challenging yet incredibly rewarding experience,” she said. In this Q&A, she discusses her strategies for dealing with insurance companies and imposter syndrome, and why she looks to her father as her role model in medicine.
Q: Why did you choose GI?
Dr. Naveed: Gastroenterology is a rapidly evolving field which makes it incredibly fascinating. The initial draw was that I was always excited to learn about GI physiology and disease. I also was fortunate to train with amazing gastroenterologists during residency. I had great examples of strong and successful female GIs to look up to. Lastly, for the most part, gastroenterologists are all fairly laid back and have an interesting sense of humor.
Q: What gives you the most joy in your day-to-day practice?
Dr. Naveed: I love learning and teaching. As a program director, I am directly involved with fellows, residents, and students, but there are always additional enrichment opportunities beyond these interactions. I value teaching clinic medical assistants so they feel more confident and empowered in their work. I also try to educate my nurse practitioners. The best compliment at the end of a long day is that they learned something valuable.
Q: How do you stay current with advances in your field?
Dr. Naveed: Between my role as a physician and as an educator, I owe it to my patients and trainees to stay current with advances in the field. But of course, this is challenging, and at times it feels like there are not enough hours in the day. While reading journal articles and attending conferences are great ways to refresh one’s knowledge, the winner for me has been social media (specifically Twitter). It’s easy to find a “Tweetorial” on almost any topic. There are some excellent initiatives on Twitter such as Monday Night IBD, ACG Evidence-Based GI Doc, Scoping Sundays, and GI Journal Club where important articles, new treatment options, and challenging cases are discussed. Of course, I also learn a lot from my fellows and residents.
Q: What fears did you have to push past to get to where you are in your career?
Dr. Naveed: Pushing past imposter syndrome, which is a feeling of self-doubt despite education, experience, and accomplishments. It is something many of us deal with. I’ve had to retire the notion that I am not experienced enough to achieve a particular career goal.
Q: What habits have you established that have benefited your career most?
Dr. Naveed: It’s a challenge to not immediately say “yes” to every opportunity or project. It’s also difficult to learn to delegate. I am lucky to have a great team, and I have learned that delegating certain tasks or projects helps everyone grow. Also, if I say no to an opportunity, I still try to suggest another colleague or mentee who may be interested and/or a good fit.
Q: Describe your biggest practice-related challenge and what you are doing to address it.
Dr. Naveed: Pushback from insurance companies to approve medications or interventions is incredibly frustrating for myself and the patient. It is also incredibly time consuming and requires significant clinical bandwidth that could otherwise be used in other capacities. While not a solution, I at least try to make sure the patient is kept updated and understands causes of delay, and more importantly, what we are doing to address the issue. I have realized that it’s always preferable to empower the patient, rather than leave them uninformed, which can foster frustration and dissatisfaction.
Q: What teacher or mentor had the greatest impact on you?
Dr. Naveed: I have been blessed with many mentors at different points in my medical career that have greatly impacted and shaped my journey. During my fellowship at University of Texas Southwestern (UTSW), Nisa Kubiliun, MD, was not only a mentor, but also an incredible sponsor. She saw potential in me and encouraged involvement in activities critical for career advancement. Arjmand Mufti, MD, the former program director of the UTSW GI fellowship, is still always just a call away when I need advice regarding my GI fellowship program at AdventHealth. I also have mentors and sponsors within my own institution who invest time and energy into my success.
Q: Outside of teachers and mentors, who or what has had the strongest influence in your life?
Dr. Naveed: My father, who is also a physician, has had a profound influence on my personal and professional development. His own medical journey has been incredibly unique. He has practiced medicine internationally, trained and worked in a traditional academic setting, established a very successful private practice, and now has transitioned to running a hospital-based practice. He has seen it all (and he’s also a brilliant physician), and he is always able to talk me through any situation.
Q: What principles guide you?
Dr. Naveed: Treating my patients how I would want a physician to treat my family is central to my practice. Also, I try to approach any successes with gratitude, and likewise, be patient with inevitable failures. It can be challenging, but I try to find the lesson in every failed venture.
Q: What would you do differently if you had a chance?
Dr. Naveed: I have always had an interest in international medical missions but have yet to participate in one. I have previously passed on such opportunities, thinking it was not the right time, but in hindsight I wish I had taken the leap. I still hope to eventually accomplish this goal.
Q: Describe a scene of your vision for the future.
Dr. Naveed: I hope that our GI fellowship continues to flourish and attract exceptional faculty and candidates. I want to remain involved in graduate medical education, but I hope to continue to challenge myself and advance within this domain. Most importantly, I hope I can continue to balance my career aspirations with my personal goals. I want to continue to be present for my family and kids.
Q: Describe how you would spend a free Saturday afternoon.
Dr. Naveed: You can usually find me at the local farmer’s market with my husband and kids. Afterwards, we’re definitely going to get Chick-fil-A followed by ice cream.
Lightning round
If you weren’t a gastroenterologist, what would you be?
International event planner.
How many cups of coffee do you drink per day?
Usually three.
Favorite breakfast?
Eggs, corned beef hash, toast.
Texting or talking?
Texting always unless it’s Mom or Dad. They always get a call.
Place you most want to travel?
Japan.
Follow Dr. Naveed on Twitter at @MN_GIMD
Her first faculty position as assistant program director for the gastroenterology fellowship program at the University of Iowa offered some inspiration. “I loved teaching and working with trainees and knew I always wanted to remain in this realm,” Dr. Naveed said.
When she moved to Orlando to join AdventHealth, she noticed there was no gastroenterology training program. “I was strictly in private practice. Though I love working with patients, I constantly felt like something was missing. When the opportunity to start a fellowship program came, I was highly motivated to bring it to fruition.”
The AdventHealth fellowship is almost done with its inaugural year.
“Starting a fellowship at a new institution is a very challenging yet incredibly rewarding experience,” she said. In this Q&A, she discusses her strategies for dealing with insurance companies and imposter syndrome, and why she looks to her father as her role model in medicine.
Q: Why did you choose GI?
Dr. Naveed: Gastroenterology is a rapidly evolving field which makes it incredibly fascinating. The initial draw was that I was always excited to learn about GI physiology and disease. I also was fortunate to train with amazing gastroenterologists during residency. I had great examples of strong and successful female GIs to look up to. Lastly, for the most part, gastroenterologists are all fairly laid back and have an interesting sense of humor.
Q: What gives you the most joy in your day-to-day practice?
Dr. Naveed: I love learning and teaching. As a program director, I am directly involved with fellows, residents, and students, but there are always additional enrichment opportunities beyond these interactions. I value teaching clinic medical assistants so they feel more confident and empowered in their work. I also try to educate my nurse practitioners. The best compliment at the end of a long day is that they learned something valuable.
Q: How do you stay current with advances in your field?
Dr. Naveed: Between my role as a physician and as an educator, I owe it to my patients and trainees to stay current with advances in the field. But of course, this is challenging, and at times it feels like there are not enough hours in the day. While reading journal articles and attending conferences are great ways to refresh one’s knowledge, the winner for me has been social media (specifically Twitter). It’s easy to find a “Tweetorial” on almost any topic. There are some excellent initiatives on Twitter such as Monday Night IBD, ACG Evidence-Based GI Doc, Scoping Sundays, and GI Journal Club where important articles, new treatment options, and challenging cases are discussed. Of course, I also learn a lot from my fellows and residents.
Q: What fears did you have to push past to get to where you are in your career?
Dr. Naveed: Pushing past imposter syndrome, which is a feeling of self-doubt despite education, experience, and accomplishments. It is something many of us deal with. I’ve had to retire the notion that I am not experienced enough to achieve a particular career goal.
Q: What habits have you established that have benefited your career most?
Dr. Naveed: It’s a challenge to not immediately say “yes” to every opportunity or project. It’s also difficult to learn to delegate. I am lucky to have a great team, and I have learned that delegating certain tasks or projects helps everyone grow. Also, if I say no to an opportunity, I still try to suggest another colleague or mentee who may be interested and/or a good fit.
Q: Describe your biggest practice-related challenge and what you are doing to address it.
Dr. Naveed: Pushback from insurance companies to approve medications or interventions is incredibly frustrating for myself and the patient. It is also incredibly time consuming and requires significant clinical bandwidth that could otherwise be used in other capacities. While not a solution, I at least try to make sure the patient is kept updated and understands causes of delay, and more importantly, what we are doing to address the issue. I have realized that it’s always preferable to empower the patient, rather than leave them uninformed, which can foster frustration and dissatisfaction.
Q: What teacher or mentor had the greatest impact on you?
Dr. Naveed: I have been blessed with many mentors at different points in my medical career that have greatly impacted and shaped my journey. During my fellowship at University of Texas Southwestern (UTSW), Nisa Kubiliun, MD, was not only a mentor, but also an incredible sponsor. She saw potential in me and encouraged involvement in activities critical for career advancement. Arjmand Mufti, MD, the former program director of the UTSW GI fellowship, is still always just a call away when I need advice regarding my GI fellowship program at AdventHealth. I also have mentors and sponsors within my own institution who invest time and energy into my success.
Q: Outside of teachers and mentors, who or what has had the strongest influence in your life?
Dr. Naveed: My father, who is also a physician, has had a profound influence on my personal and professional development. His own medical journey has been incredibly unique. He has practiced medicine internationally, trained and worked in a traditional academic setting, established a very successful private practice, and now has transitioned to running a hospital-based practice. He has seen it all (and he’s also a brilliant physician), and he is always able to talk me through any situation.
Q: What principles guide you?
Dr. Naveed: Treating my patients how I would want a physician to treat my family is central to my practice. Also, I try to approach any successes with gratitude, and likewise, be patient with inevitable failures. It can be challenging, but I try to find the lesson in every failed venture.
Q: What would you do differently if you had a chance?
Dr. Naveed: I have always had an interest in international medical missions but have yet to participate in one. I have previously passed on such opportunities, thinking it was not the right time, but in hindsight I wish I had taken the leap. I still hope to eventually accomplish this goal.
Q: Describe a scene of your vision for the future.
Dr. Naveed: I hope that our GI fellowship continues to flourish and attract exceptional faculty and candidates. I want to remain involved in graduate medical education, but I hope to continue to challenge myself and advance within this domain. Most importantly, I hope I can continue to balance my career aspirations with my personal goals. I want to continue to be present for my family and kids.
Q: Describe how you would spend a free Saturday afternoon.
Dr. Naveed: You can usually find me at the local farmer’s market with my husband and kids. Afterwards, we’re definitely going to get Chick-fil-A followed by ice cream.
Lightning round
If you weren’t a gastroenterologist, what would you be?
International event planner.
How many cups of coffee do you drink per day?
Usually three.
Favorite breakfast?
Eggs, corned beef hash, toast.
Texting or talking?
Texting always unless it’s Mom or Dad. They always get a call.
Place you most want to travel?
Japan.
Follow Dr. Naveed on Twitter at @MN_GIMD
Launching an entirely virtual health care GI practice
that partners with health systems to offer GI care services throughout the country.
Dr. Arjal, who as a cofounder of Telebelly Health also serves as chief medical officer and president of the practice, previously served as vice president of Puget Sound Gastroenterology and practiced in the Seattle area for 13 years. He served as vice president of clinical affairs for Gastro Health, the nation’s second-largest gastroenterology group, which acquired the Puget Sound practice in 2019. But then in 2021, he founded Telebelly with Sheri Rudberg, MBA, JD, who serves as CEO of the business; Alex Brown, who leads product development; and Nakort Valles, who serves as the company’s chief technology officer.
Building a new business whose goal is to transform GI health care delivery has been his biggest challenge to date. “I am proud of Telebelly because its goals are goals we all share, which is to try to get people in the door and take good care of them,” Dr. Arjal said.
Through virtual care clinics like Telebelly Health, patients can see a provider who is affiliated with a practice, even if the provider is in another state provided he or she is licensed in the patient’s home state. Some states have passed legislation to permanently allow out-of-state physicians to practice telehealth in their state if they follow the state’s requirements. In some states, that may amount to accepting an out-of-state medical license or requiring out-of-state clinicians to pass an exam.
Telebelly Health has served thousands of patients since September when the practice was launched. “We are scaling pretty quickly and will be doubling the number of providers in the next couple of months,” Dr. Arjal said.
In this Q&A, he talks more about his new business venture and his vision for the future of medicine.
Question: Why did you choose GI?
Answer: I wanted to do something that was cognitive where I interacted with and really got to know patients. I also wanted to be a proceduralist. I never wanted to be a surgeon – I knew that wasn’t for me. I fell in love with GI the first year in med school. I thought the pathology was interesting, and what GIs did in the acute setting as well as the outpatient setting was compelling.
Q. What achievement are you most proud of?
A. Prior to Telebelly, I led a large regional GI group in a competitive marketplace. Now, with Telebelly, building a team with a vision to transform the space has been the biggest challenge I have taken on. It’s still a work in progress, but we’ve had a great start. Starting a company wasn’t easy. It was something that I didn’t know a lot about, so I had to take a fair bit of risk. I wasn’t sure if I had it in me at the beginning. It’s not something I’d ever done before, so I was testing myself. I am proud that we were able to launch the company and have successfully scaled it. It’s been more successful than I expected.
Q. Describe your biggest practice-related challenge and what you are doing to address it.
A. Access to care. I think it’s very hard to see somebody with GI expertise and it certainly got worse during the pandemic. In my previous role, we used advanced practice providers. We tried to implement technology, sometimes effectively, sometimes not. But in general, we wanted to try to increase the supply of providers and compress these patient journeys to get people in the door. But that’s still a very difficult challenge we’re all trying to solve.
Q. What teacher or mentor had the greatest impact on you?
A. I would say two: James Trotter, MD, a hepatologist at the University of Colorado where I trained. He had a terrific impact in the sense that he was 100% focused on patients and got to know them as people. This taught me what it meant to be a clinician that was sort of a humanist. He cared so much for his patients that I still think about what Jim would do in a room today, 15 years after I finished my fellowship.
When I started my first job at Puget Sound Gastroenterology in the Seattle area, Robin Sloane, MD, was one of the senior partners of the group. I had a lot to learn after finishing fellowship. He was wonderful and gracious and really taught me a ton about the practical aspects of medicine. I felt this was an extension of my training in that he was a real clinician who really cared deeply for his patients. If I hadn’t met those two, my career and maybe my view of just what I did day-to-day would be different. They were both very, very impactful for me.
Q. Outside of teachers and mentors, who has had the strongest influence on your life?
A. Two people: my mother and my wife. My mother was a single parent and we were immigrants to the country. She was an ambitious woman who didn’t let anything stop her. I certainly learned a ton about resilience, work ethic. She’s somebody who always treated people well. My wife also supported and believed in me, and without her, I would not have had the courage to start a company.
Q. Describe a scene of your vision for the future.
A. I think we need to change our mindset in terms of how we interact with patients. I think there’s going to be a lot of clinical testing that is performed away from the physician’s office. It’s going to become more democratized and more decentralized. And I think in the future, patients will have more agency in how they interact with the system. I think artificial intelligence will potentially augment all of this as well. We’ll have patients who are more engaged, have more choice and easier access to expert care. They’ll come in with more information on their hands and they won’t have to wait as long. I think the wait times to get to a GI clinic now are way too long.
What I’d also like to see are providers spending more time doing things that they’re trained to do rather than documentation, summarizing data, and dealing with administrative headaches. I think almost everybody has that goal, but I think that’s achievable.
I want providers to have an iron man or iron woman suit when they see a patient, to have more data at their fingertips, to spend more time with the patients and have smarter visits.
Q. What did you fear most early in your career?
A. Failure for the most part, and comfort. For a long time, I wanted to start a company and change the space. Fear of failure has been ingrained in me and I think that’s true for a lot of physicians. I had always been a perfectionist.
Q. What gives you the most joy in your day-to-day practice?
A. Seeing patients is by far the thing I enjoy most. I don’t love documenting or digging up information, but I like getting to know folks. In general, I’m a social person and my outpatient clinic gives me the most joy, probably more than anything else.
Q. How do you stay current with advances in your field?
A. I’m curious about all new things, so I stay current through traditional means: I go to conferences regularly, I take postgraduate courses, I listen to podcasts, talk to colleagues, and read journals on a regular basis. But there are a lot of adjacent sources I pay attention to as well, such as nonmedical journals and nonmedical podcasts. I talk to folks outside the space and try to learn from them as well.
Q. What habits have you established that have benefited your career?
A. I do the same thing every day before my clinic days or my endoscopy days. I make reading a part of each day so I can slow down and be more present. Every day I try not to perform just what I do workwise, but I try to find some balance either with my family, or through exercise. I think I’ve been pretty good at separating work life from personal life.
Lightning round questions
Texting or talking? Talking.
Favorite junk food? Peanut butter M&Ms.
How many cups of coffee do you drink per day? Three.
If you weren’t a gastroenterologist, what would you be? Venture capitalist.
Introvert or extrovert? Both.
that partners with health systems to offer GI care services throughout the country.
Dr. Arjal, who as a cofounder of Telebelly Health also serves as chief medical officer and president of the practice, previously served as vice president of Puget Sound Gastroenterology and practiced in the Seattle area for 13 years. He served as vice president of clinical affairs for Gastro Health, the nation’s second-largest gastroenterology group, which acquired the Puget Sound practice in 2019. But then in 2021, he founded Telebelly with Sheri Rudberg, MBA, JD, who serves as CEO of the business; Alex Brown, who leads product development; and Nakort Valles, who serves as the company’s chief technology officer.
Building a new business whose goal is to transform GI health care delivery has been his biggest challenge to date. “I am proud of Telebelly because its goals are goals we all share, which is to try to get people in the door and take good care of them,” Dr. Arjal said.
Through virtual care clinics like Telebelly Health, patients can see a provider who is affiliated with a practice, even if the provider is in another state provided he or she is licensed in the patient’s home state. Some states have passed legislation to permanently allow out-of-state physicians to practice telehealth in their state if they follow the state’s requirements. In some states, that may amount to accepting an out-of-state medical license or requiring out-of-state clinicians to pass an exam.
Telebelly Health has served thousands of patients since September when the practice was launched. “We are scaling pretty quickly and will be doubling the number of providers in the next couple of months,” Dr. Arjal said.
In this Q&A, he talks more about his new business venture and his vision for the future of medicine.
Question: Why did you choose GI?
Answer: I wanted to do something that was cognitive where I interacted with and really got to know patients. I also wanted to be a proceduralist. I never wanted to be a surgeon – I knew that wasn’t for me. I fell in love with GI the first year in med school. I thought the pathology was interesting, and what GIs did in the acute setting as well as the outpatient setting was compelling.
Q. What achievement are you most proud of?
A. Prior to Telebelly, I led a large regional GI group in a competitive marketplace. Now, with Telebelly, building a team with a vision to transform the space has been the biggest challenge I have taken on. It’s still a work in progress, but we’ve had a great start. Starting a company wasn’t easy. It was something that I didn’t know a lot about, so I had to take a fair bit of risk. I wasn’t sure if I had it in me at the beginning. It’s not something I’d ever done before, so I was testing myself. I am proud that we were able to launch the company and have successfully scaled it. It’s been more successful than I expected.
Q. Describe your biggest practice-related challenge and what you are doing to address it.
A. Access to care. I think it’s very hard to see somebody with GI expertise and it certainly got worse during the pandemic. In my previous role, we used advanced practice providers. We tried to implement technology, sometimes effectively, sometimes not. But in general, we wanted to try to increase the supply of providers and compress these patient journeys to get people in the door. But that’s still a very difficult challenge we’re all trying to solve.
Q. What teacher or mentor had the greatest impact on you?
A. I would say two: James Trotter, MD, a hepatologist at the University of Colorado where I trained. He had a terrific impact in the sense that he was 100% focused on patients and got to know them as people. This taught me what it meant to be a clinician that was sort of a humanist. He cared so much for his patients that I still think about what Jim would do in a room today, 15 years after I finished my fellowship.
When I started my first job at Puget Sound Gastroenterology in the Seattle area, Robin Sloane, MD, was one of the senior partners of the group. I had a lot to learn after finishing fellowship. He was wonderful and gracious and really taught me a ton about the practical aspects of medicine. I felt this was an extension of my training in that he was a real clinician who really cared deeply for his patients. If I hadn’t met those two, my career and maybe my view of just what I did day-to-day would be different. They were both very, very impactful for me.
Q. Outside of teachers and mentors, who has had the strongest influence on your life?
A. Two people: my mother and my wife. My mother was a single parent and we were immigrants to the country. She was an ambitious woman who didn’t let anything stop her. I certainly learned a ton about resilience, work ethic. She’s somebody who always treated people well. My wife also supported and believed in me, and without her, I would not have had the courage to start a company.
Q. Describe a scene of your vision for the future.
A. I think we need to change our mindset in terms of how we interact with patients. I think there’s going to be a lot of clinical testing that is performed away from the physician’s office. It’s going to become more democratized and more decentralized. And I think in the future, patients will have more agency in how they interact with the system. I think artificial intelligence will potentially augment all of this as well. We’ll have patients who are more engaged, have more choice and easier access to expert care. They’ll come in with more information on their hands and they won’t have to wait as long. I think the wait times to get to a GI clinic now are way too long.
What I’d also like to see are providers spending more time doing things that they’re trained to do rather than documentation, summarizing data, and dealing with administrative headaches. I think almost everybody has that goal, but I think that’s achievable.
I want providers to have an iron man or iron woman suit when they see a patient, to have more data at their fingertips, to spend more time with the patients and have smarter visits.
Q. What did you fear most early in your career?
A. Failure for the most part, and comfort. For a long time, I wanted to start a company and change the space. Fear of failure has been ingrained in me and I think that’s true for a lot of physicians. I had always been a perfectionist.
Q. What gives you the most joy in your day-to-day practice?
A. Seeing patients is by far the thing I enjoy most. I don’t love documenting or digging up information, but I like getting to know folks. In general, I’m a social person and my outpatient clinic gives me the most joy, probably more than anything else.
Q. How do you stay current with advances in your field?
A. I’m curious about all new things, so I stay current through traditional means: I go to conferences regularly, I take postgraduate courses, I listen to podcasts, talk to colleagues, and read journals on a regular basis. But there are a lot of adjacent sources I pay attention to as well, such as nonmedical journals and nonmedical podcasts. I talk to folks outside the space and try to learn from them as well.
Q. What habits have you established that have benefited your career?
A. I do the same thing every day before my clinic days or my endoscopy days. I make reading a part of each day so I can slow down and be more present. Every day I try not to perform just what I do workwise, but I try to find some balance either with my family, or through exercise. I think I’ve been pretty good at separating work life from personal life.
Lightning round questions
Texting or talking? Talking.
Favorite junk food? Peanut butter M&Ms.
How many cups of coffee do you drink per day? Three.
If you weren’t a gastroenterologist, what would you be? Venture capitalist.
Introvert or extrovert? Both.
that partners with health systems to offer GI care services throughout the country.
Dr. Arjal, who as a cofounder of Telebelly Health also serves as chief medical officer and president of the practice, previously served as vice president of Puget Sound Gastroenterology and practiced in the Seattle area for 13 years. He served as vice president of clinical affairs for Gastro Health, the nation’s second-largest gastroenterology group, which acquired the Puget Sound practice in 2019. But then in 2021, he founded Telebelly with Sheri Rudberg, MBA, JD, who serves as CEO of the business; Alex Brown, who leads product development; and Nakort Valles, who serves as the company’s chief technology officer.
Building a new business whose goal is to transform GI health care delivery has been his biggest challenge to date. “I am proud of Telebelly because its goals are goals we all share, which is to try to get people in the door and take good care of them,” Dr. Arjal said.
Through virtual care clinics like Telebelly Health, patients can see a provider who is affiliated with a practice, even if the provider is in another state provided he or she is licensed in the patient’s home state. Some states have passed legislation to permanently allow out-of-state physicians to practice telehealth in their state if they follow the state’s requirements. In some states, that may amount to accepting an out-of-state medical license or requiring out-of-state clinicians to pass an exam.
Telebelly Health has served thousands of patients since September when the practice was launched. “We are scaling pretty quickly and will be doubling the number of providers in the next couple of months,” Dr. Arjal said.
In this Q&A, he talks more about his new business venture and his vision for the future of medicine.
Question: Why did you choose GI?
Answer: I wanted to do something that was cognitive where I interacted with and really got to know patients. I also wanted to be a proceduralist. I never wanted to be a surgeon – I knew that wasn’t for me. I fell in love with GI the first year in med school. I thought the pathology was interesting, and what GIs did in the acute setting as well as the outpatient setting was compelling.
Q. What achievement are you most proud of?
A. Prior to Telebelly, I led a large regional GI group in a competitive marketplace. Now, with Telebelly, building a team with a vision to transform the space has been the biggest challenge I have taken on. It’s still a work in progress, but we’ve had a great start. Starting a company wasn’t easy. It was something that I didn’t know a lot about, so I had to take a fair bit of risk. I wasn’t sure if I had it in me at the beginning. It’s not something I’d ever done before, so I was testing myself. I am proud that we were able to launch the company and have successfully scaled it. It’s been more successful than I expected.
Q. Describe your biggest practice-related challenge and what you are doing to address it.
A. Access to care. I think it’s very hard to see somebody with GI expertise and it certainly got worse during the pandemic. In my previous role, we used advanced practice providers. We tried to implement technology, sometimes effectively, sometimes not. But in general, we wanted to try to increase the supply of providers and compress these patient journeys to get people in the door. But that’s still a very difficult challenge we’re all trying to solve.
Q. What teacher or mentor had the greatest impact on you?
A. I would say two: James Trotter, MD, a hepatologist at the University of Colorado where I trained. He had a terrific impact in the sense that he was 100% focused on patients and got to know them as people. This taught me what it meant to be a clinician that was sort of a humanist. He cared so much for his patients that I still think about what Jim would do in a room today, 15 years after I finished my fellowship.
When I started my first job at Puget Sound Gastroenterology in the Seattle area, Robin Sloane, MD, was one of the senior partners of the group. I had a lot to learn after finishing fellowship. He was wonderful and gracious and really taught me a ton about the practical aspects of medicine. I felt this was an extension of my training in that he was a real clinician who really cared deeply for his patients. If I hadn’t met those two, my career and maybe my view of just what I did day-to-day would be different. They were both very, very impactful for me.
Q. Outside of teachers and mentors, who has had the strongest influence on your life?
A. Two people: my mother and my wife. My mother was a single parent and we were immigrants to the country. She was an ambitious woman who didn’t let anything stop her. I certainly learned a ton about resilience, work ethic. She’s somebody who always treated people well. My wife also supported and believed in me, and without her, I would not have had the courage to start a company.
Q. Describe a scene of your vision for the future.
A. I think we need to change our mindset in terms of how we interact with patients. I think there’s going to be a lot of clinical testing that is performed away from the physician’s office. It’s going to become more democratized and more decentralized. And I think in the future, patients will have more agency in how they interact with the system. I think artificial intelligence will potentially augment all of this as well. We’ll have patients who are more engaged, have more choice and easier access to expert care. They’ll come in with more information on their hands and they won’t have to wait as long. I think the wait times to get to a GI clinic now are way too long.
What I’d also like to see are providers spending more time doing things that they’re trained to do rather than documentation, summarizing data, and dealing with administrative headaches. I think almost everybody has that goal, but I think that’s achievable.
I want providers to have an iron man or iron woman suit when they see a patient, to have more data at their fingertips, to spend more time with the patients and have smarter visits.
Q. What did you fear most early in your career?
A. Failure for the most part, and comfort. For a long time, I wanted to start a company and change the space. Fear of failure has been ingrained in me and I think that’s true for a lot of physicians. I had always been a perfectionist.
Q. What gives you the most joy in your day-to-day practice?
A. Seeing patients is by far the thing I enjoy most. I don’t love documenting or digging up information, but I like getting to know folks. In general, I’m a social person and my outpatient clinic gives me the most joy, probably more than anything else.
Q. How do you stay current with advances in your field?
A. I’m curious about all new things, so I stay current through traditional means: I go to conferences regularly, I take postgraduate courses, I listen to podcasts, talk to colleagues, and read journals on a regular basis. But there are a lot of adjacent sources I pay attention to as well, such as nonmedical journals and nonmedical podcasts. I talk to folks outside the space and try to learn from them as well.
Q. What habits have you established that have benefited your career?
A. I do the same thing every day before my clinic days or my endoscopy days. I make reading a part of each day so I can slow down and be more present. Every day I try not to perform just what I do workwise, but I try to find some balance either with my family, or through exercise. I think I’ve been pretty good at separating work life from personal life.
Lightning round questions
Texting or talking? Talking.
Favorite junk food? Peanut butter M&Ms.
How many cups of coffee do you drink per day? Three.
If you weren’t a gastroenterologist, what would you be? Venture capitalist.
Introvert or extrovert? Both.
Brooklyn gastroenterologist: Good listening skills make a doctor a better teacher, person
After the 2004 Indian Ocean earthquake and tsunami, he traveled to his home country of Sri Lanka to help people who were in need and establish an orphanage. He has applied his skills as a gastroenterologist in the U.S. military and the New York City Police Department.
He was in New York during the 9-11 terrorist attacks. To this day, he treats patients with residual GI problems and precancerous changes associated with 9-11. “I’m involved in screening those people who were the first responders referred by the NYPD,” he says.
This year Dr. Iswara earned the Distinguished Clinician Award in Private Practice from the American Gastroenterological Association. “He puts his patients first in every endeavor – and every question that he asks with regards to research and education is linked to the ultimate measuring stick of improving patient care,” according to an AGA announcement of the award.
When dealing with patients and colleagues, he offers this simple pearl of advice: Listen and then listen some more.
“Once you listen more, you can find out their issues much more in depth, and you can give a satisfying answer to them and their problems. Listening is a kindness and a compassionate thing. It not only makes you become a better teacher, but a better person,” said Dr. Iswara, attending gastroenterologist at Maimonides Medical Center in New York.
In an interview, he talked more in depth about his GI beginnings, his role as a mentor, and why he always starts the day with a prayer. He also confided about the useful time management habit kept from his military days that gives him energy.
Question: What gives you joy in day-to-day practice?
Dr. Iswara: One of the main joys is my colleagues, coworkers, fellows, and my patients. The patients come No. 1. As I walk into my practice area or in the hospital, there is a sense of inner happiness in my mind to see the smiles of the patients and the greetings I get from the patients and all the coworkers. I also see smiling patients with anxiety in their face, trying to get my attention to take care of them.
After I see the patient, I change to a different mode, a kind of a professional mode to give the best to the people whom I’m caring for, who are trusting me with their lives.
One thing I do in my mind before I even start the day, I do a silent prayer to guide me, to give compassionate care and safe care. I will not harm anyone who is depending on my care.
Q: Who was your mentor?
Dr. Iswara: I was lucky enough to have been trained by Baroukh El Kodsi, MD, at Maimonides Medical Center. He recently passed away and was a legend in Brooklyn. I was his first-generation trainee, and I was able to pass on my skills to my trainees. Now so many people who are in Brooklyn; they were trained by me, so it’s kind of growth by generations.
When I finished the training with Dr. Kodsi, he hired me as an associate director of the GI department at Maimonides. I became the program director, then division chief, then I became a director of advanced endoscopy. All these gastroenterology procedures started after 1975 while I was doing the training, so I was one of the pioneers to bring all this new technology to our hospital. I’m still involved in fellowship education.
Q: Can we talk more about your accomplishments? Perhaps you can discuss your AGA award and what you received it for.
Dr. Iswara: I’m humbled and honored by this role, and I’ll be forever grateful to AGA for this prestigious honor at the late stage of my career.
I have been a continuous AGA member for the last 45 years. I probably have one of the longest durations of being an actively practicing gastroenterologist in Brooklyn. I’ve also done academic work, teaching so many young gastroenterologists, motivating several of them to become leading gastroenterologists.
Q: If you could describe a scene of your vision for the future, what it would it be in terms of how gastroenterology is practiced?
Dr. Iswara: I’d like to see the newer generation practice more of a clinical medicine than technical medicine. Sometimes when I see the young people, they sit in front of the computer more than talking and touching the patient. There has to be some sort of a balance where the newer people should be taught more bedside personal care, touching the patient, looking at the patient’s face. They are kind of under pressure to write longer notes than to examine the patient, so I think this has to change.
Q: Describe how you would spend a free Saturday afternoon.
Dr. Iswara: When I was in the military, I was told that to prevent battle fatigue you had to take a rest. I really try to take a rest almost 2 hours every day in the daytime. This rejuvenates me.
We live in New York, and I love to go to shows, especially magic shows. I love magic and illusion.
On free Saturday evenings, I also spend time with my grandchildren in the city, watching them in their baseball, soccer, swimming, and other activities. I love to spend time with them.
Lightning round
Texting or talking?
Texting
Favorite city in the U.S. besides the one you live?
Naples, Fla.
Favorite breakfast?
Pancakes
Dark Chocolate or milk chocolate?
Cadbury from England
Last movie you watched?
“To Sir, With Love”
After the 2004 Indian Ocean earthquake and tsunami, he traveled to his home country of Sri Lanka to help people who were in need and establish an orphanage. He has applied his skills as a gastroenterologist in the U.S. military and the New York City Police Department.
He was in New York during the 9-11 terrorist attacks. To this day, he treats patients with residual GI problems and precancerous changes associated with 9-11. “I’m involved in screening those people who were the first responders referred by the NYPD,” he says.
This year Dr. Iswara earned the Distinguished Clinician Award in Private Practice from the American Gastroenterological Association. “He puts his patients first in every endeavor – and every question that he asks with regards to research and education is linked to the ultimate measuring stick of improving patient care,” according to an AGA announcement of the award.
When dealing with patients and colleagues, he offers this simple pearl of advice: Listen and then listen some more.
“Once you listen more, you can find out their issues much more in depth, and you can give a satisfying answer to them and their problems. Listening is a kindness and a compassionate thing. It not only makes you become a better teacher, but a better person,” said Dr. Iswara, attending gastroenterologist at Maimonides Medical Center in New York.
In an interview, he talked more in depth about his GI beginnings, his role as a mentor, and why he always starts the day with a prayer. He also confided about the useful time management habit kept from his military days that gives him energy.
Question: What gives you joy in day-to-day practice?
Dr. Iswara: One of the main joys is my colleagues, coworkers, fellows, and my patients. The patients come No. 1. As I walk into my practice area or in the hospital, there is a sense of inner happiness in my mind to see the smiles of the patients and the greetings I get from the patients and all the coworkers. I also see smiling patients with anxiety in their face, trying to get my attention to take care of them.
After I see the patient, I change to a different mode, a kind of a professional mode to give the best to the people whom I’m caring for, who are trusting me with their lives.
One thing I do in my mind before I even start the day, I do a silent prayer to guide me, to give compassionate care and safe care. I will not harm anyone who is depending on my care.
Q: Who was your mentor?
Dr. Iswara: I was lucky enough to have been trained by Baroukh El Kodsi, MD, at Maimonides Medical Center. He recently passed away and was a legend in Brooklyn. I was his first-generation trainee, and I was able to pass on my skills to my trainees. Now so many people who are in Brooklyn; they were trained by me, so it’s kind of growth by generations.
When I finished the training with Dr. Kodsi, he hired me as an associate director of the GI department at Maimonides. I became the program director, then division chief, then I became a director of advanced endoscopy. All these gastroenterology procedures started after 1975 while I was doing the training, so I was one of the pioneers to bring all this new technology to our hospital. I’m still involved in fellowship education.
Q: Can we talk more about your accomplishments? Perhaps you can discuss your AGA award and what you received it for.
Dr. Iswara: I’m humbled and honored by this role, and I’ll be forever grateful to AGA for this prestigious honor at the late stage of my career.
I have been a continuous AGA member for the last 45 years. I probably have one of the longest durations of being an actively practicing gastroenterologist in Brooklyn. I’ve also done academic work, teaching so many young gastroenterologists, motivating several of them to become leading gastroenterologists.
Q: If you could describe a scene of your vision for the future, what it would it be in terms of how gastroenterology is practiced?
Dr. Iswara: I’d like to see the newer generation practice more of a clinical medicine than technical medicine. Sometimes when I see the young people, they sit in front of the computer more than talking and touching the patient. There has to be some sort of a balance where the newer people should be taught more bedside personal care, touching the patient, looking at the patient’s face. They are kind of under pressure to write longer notes than to examine the patient, so I think this has to change.
Q: Describe how you would spend a free Saturday afternoon.
Dr. Iswara: When I was in the military, I was told that to prevent battle fatigue you had to take a rest. I really try to take a rest almost 2 hours every day in the daytime. This rejuvenates me.
We live in New York, and I love to go to shows, especially magic shows. I love magic and illusion.
On free Saturday evenings, I also spend time with my grandchildren in the city, watching them in their baseball, soccer, swimming, and other activities. I love to spend time with them.
Lightning round
Texting or talking?
Texting
Favorite city in the U.S. besides the one you live?
Naples, Fla.
Favorite breakfast?
Pancakes
Dark Chocolate or milk chocolate?
Cadbury from England
Last movie you watched?
“To Sir, With Love”
After the 2004 Indian Ocean earthquake and tsunami, he traveled to his home country of Sri Lanka to help people who were in need and establish an orphanage. He has applied his skills as a gastroenterologist in the U.S. military and the New York City Police Department.
He was in New York during the 9-11 terrorist attacks. To this day, he treats patients with residual GI problems and precancerous changes associated with 9-11. “I’m involved in screening those people who were the first responders referred by the NYPD,” he says.
This year Dr. Iswara earned the Distinguished Clinician Award in Private Practice from the American Gastroenterological Association. “He puts his patients first in every endeavor – and every question that he asks with regards to research and education is linked to the ultimate measuring stick of improving patient care,” according to an AGA announcement of the award.
When dealing with patients and colleagues, he offers this simple pearl of advice: Listen and then listen some more.
“Once you listen more, you can find out their issues much more in depth, and you can give a satisfying answer to them and their problems. Listening is a kindness and a compassionate thing. It not only makes you become a better teacher, but a better person,” said Dr. Iswara, attending gastroenterologist at Maimonides Medical Center in New York.
In an interview, he talked more in depth about his GI beginnings, his role as a mentor, and why he always starts the day with a prayer. He also confided about the useful time management habit kept from his military days that gives him energy.
Question: What gives you joy in day-to-day practice?
Dr. Iswara: One of the main joys is my colleagues, coworkers, fellows, and my patients. The patients come No. 1. As I walk into my practice area or in the hospital, there is a sense of inner happiness in my mind to see the smiles of the patients and the greetings I get from the patients and all the coworkers. I also see smiling patients with anxiety in their face, trying to get my attention to take care of them.
After I see the patient, I change to a different mode, a kind of a professional mode to give the best to the people whom I’m caring for, who are trusting me with their lives.
One thing I do in my mind before I even start the day, I do a silent prayer to guide me, to give compassionate care and safe care. I will not harm anyone who is depending on my care.
Q: Who was your mentor?
Dr. Iswara: I was lucky enough to have been trained by Baroukh El Kodsi, MD, at Maimonides Medical Center. He recently passed away and was a legend in Brooklyn. I was his first-generation trainee, and I was able to pass on my skills to my trainees. Now so many people who are in Brooklyn; they were trained by me, so it’s kind of growth by generations.
When I finished the training with Dr. Kodsi, he hired me as an associate director of the GI department at Maimonides. I became the program director, then division chief, then I became a director of advanced endoscopy. All these gastroenterology procedures started after 1975 while I was doing the training, so I was one of the pioneers to bring all this new technology to our hospital. I’m still involved in fellowship education.
Q: Can we talk more about your accomplishments? Perhaps you can discuss your AGA award and what you received it for.
Dr. Iswara: I’m humbled and honored by this role, and I’ll be forever grateful to AGA for this prestigious honor at the late stage of my career.
I have been a continuous AGA member for the last 45 years. I probably have one of the longest durations of being an actively practicing gastroenterologist in Brooklyn. I’ve also done academic work, teaching so many young gastroenterologists, motivating several of them to become leading gastroenterologists.
Q: If you could describe a scene of your vision for the future, what it would it be in terms of how gastroenterology is practiced?
Dr. Iswara: I’d like to see the newer generation practice more of a clinical medicine than technical medicine. Sometimes when I see the young people, they sit in front of the computer more than talking and touching the patient. There has to be some sort of a balance where the newer people should be taught more bedside personal care, touching the patient, looking at the patient’s face. They are kind of under pressure to write longer notes than to examine the patient, so I think this has to change.
Q: Describe how you would spend a free Saturday afternoon.
Dr. Iswara: When I was in the military, I was told that to prevent battle fatigue you had to take a rest. I really try to take a rest almost 2 hours every day in the daytime. This rejuvenates me.
We live in New York, and I love to go to shows, especially magic shows. I love magic and illusion.
On free Saturday evenings, I also spend time with my grandchildren in the city, watching them in their baseball, soccer, swimming, and other activities. I love to spend time with them.
Lightning round
Texting or talking?
Texting
Favorite city in the U.S. besides the one you live?
Naples, Fla.
Favorite breakfast?
Pancakes
Dark Chocolate or milk chocolate?
Cadbury from England
Last movie you watched?
“To Sir, With Love”
Taking a global leap into GI technology
Sharmila Anandasabapathy, MD, knew she wanted to focus on endoscopy when she first started her career.
While leading an endoscopy unit in New York City, Dr. Anandasabapathy began developing endoscopic and imaging technologies for underresourced and underserved areas. These technologies eventually made their way into global clinical trials.
“We’ve gone to clinical trial in over 2,000 patients worldwide. When I made that jump into global GI, I was able to make that jump into global health in general,” said Dr. Anandasabapathy.
As vice president for global programs at Baylor College of Medicine in Houston, Dr. Anandasabapathy currently focuses on clinical and translational research.
“We’re looking at the development of new, low-cost devices for early cancer detection in GI globally. I oversee our global programs across the whole college, so it’s GI, it’s surgery, it’s anesthesia, it’s obstetrics, it’s everything.”
In an interview, Dr. Anandasabapathy discussed what attracted her to gastroenterology and why she always takes the time to smile at her patients.
Q: Why did you choose GI?
A: There’s two questions in there: Why I chose GI and why I chose endoscopy.
I chose GI because when I was in my internal medicine training, they seemed like the happiest people in the hospital. They liked what they did. You could make a meaningful impact even at 3 a.m. if you were coming in for a variceal bleed. Everybody seemed happy with their choice of specialty. I was ready to be an oncologist, and I ended up becoming a gastroenterologist.
I chose endoscopy because it was where I wanted to be when I woke up in the morning. I was happy there. I love the procedures; I love the hand-eye coordination. I liked the fact that these were relatively shorter procedures, that it was technology based, and there was infinite growth.
Q: Was there a time when you really helped a patient by doing that endoscopy, preventing Barrett’s esophagus or even cancer?
A: I can think of several times where we had early cancers and it was a question between endoscopic treatment or surgery. It was always discussed with the surgeons. We made the decision within a multidisciplinary group and with the patient, but we usually went with the endoscopic options and the patients have done great. We’ve given them a greater quality of life, and I think that’s really rewarding.
Q: What gives you the most joy in your day-to-day practice?
A: My patients. I work with Barrett’s esophagus patients, and they tend to be well informed about the research and the science. I’m lucky to have a patient population that is really interested and willing to participate in that. I also like my students, my junior faculty. I like teaching and the global application of teaching.
Q: What fears did you have to push past to get to where you are in your career?
A: That I would never become an independent researcher and do it alone. I was able to, over time. The ability to transition from being independent to teaching others and making them independent is a wonderful one.
Early on when I was doing GI, I remember looking at my division, and there were about 58 gastroenterologists and only 2 women. I thought at the time, “Well, can I do it? Is this a field that is conducive with being a woman and having a family?” It turned out that it is. Today, I’m really gratified to see that there are more women in GI than there ever were before.
Q: Have you ever received advice that you’ve ignored?A: Yes. Early in my training in internal medicine, I was told that I smiled too much and that my personality was such that patients and others would think I was too glib. Medicine was a serious business, and you shouldn’t be smiling. That’s not my personality – I’m not Eeyore. I think it’s served me well to be positive, and it’s served me well with patients to be smiling. Especially when you’re dealing with patients who have precancer or dysplasia and are scared – they want reassurance and they want a level of confidence. I’m glad I ignored that advice.
Q: What would be your advice to medical students?
A: Think about where you want to be when you wake up in the morning. If it’s either in a GI practice or doing GI research or doing endoscopy, then you should absolutely do it.
Lightning round
Cat person or dog person
Dog
Favorite sport
Tennis
What song do you have to sing along with when you hear it?
Dancing Queen
Favorite music genre
1980s pop
Favorite movie, show, or book
Wuthering Heights
Dr. Anandasabapathy is on LinkedIn and on Twitter at @anandasabapathy , @bcmglobalhealth , and @bcm_gihep .
Sharmila Anandasabapathy, MD, knew she wanted to focus on endoscopy when she first started her career.
While leading an endoscopy unit in New York City, Dr. Anandasabapathy began developing endoscopic and imaging technologies for underresourced and underserved areas. These technologies eventually made their way into global clinical trials.
“We’ve gone to clinical trial in over 2,000 patients worldwide. When I made that jump into global GI, I was able to make that jump into global health in general,” said Dr. Anandasabapathy.
As vice president for global programs at Baylor College of Medicine in Houston, Dr. Anandasabapathy currently focuses on clinical and translational research.
“We’re looking at the development of new, low-cost devices for early cancer detection in GI globally. I oversee our global programs across the whole college, so it’s GI, it’s surgery, it’s anesthesia, it’s obstetrics, it’s everything.”
In an interview, Dr. Anandasabapathy discussed what attracted her to gastroenterology and why she always takes the time to smile at her patients.
Q: Why did you choose GI?
A: There’s two questions in there: Why I chose GI and why I chose endoscopy.
I chose GI because when I was in my internal medicine training, they seemed like the happiest people in the hospital. They liked what they did. You could make a meaningful impact even at 3 a.m. if you were coming in for a variceal bleed. Everybody seemed happy with their choice of specialty. I was ready to be an oncologist, and I ended up becoming a gastroenterologist.
I chose endoscopy because it was where I wanted to be when I woke up in the morning. I was happy there. I love the procedures; I love the hand-eye coordination. I liked the fact that these were relatively shorter procedures, that it was technology based, and there was infinite growth.
Q: Was there a time when you really helped a patient by doing that endoscopy, preventing Barrett’s esophagus or even cancer?
A: I can think of several times where we had early cancers and it was a question between endoscopic treatment or surgery. It was always discussed with the surgeons. We made the decision within a multidisciplinary group and with the patient, but we usually went with the endoscopic options and the patients have done great. We’ve given them a greater quality of life, and I think that’s really rewarding.
Q: What gives you the most joy in your day-to-day practice?
A: My patients. I work with Barrett’s esophagus patients, and they tend to be well informed about the research and the science. I’m lucky to have a patient population that is really interested and willing to participate in that. I also like my students, my junior faculty. I like teaching and the global application of teaching.
Q: What fears did you have to push past to get to where you are in your career?
A: That I would never become an independent researcher and do it alone. I was able to, over time. The ability to transition from being independent to teaching others and making them independent is a wonderful one.
Early on when I was doing GI, I remember looking at my division, and there were about 58 gastroenterologists and only 2 women. I thought at the time, “Well, can I do it? Is this a field that is conducive with being a woman and having a family?” It turned out that it is. Today, I’m really gratified to see that there are more women in GI than there ever were before.
Q: Have you ever received advice that you’ve ignored?A: Yes. Early in my training in internal medicine, I was told that I smiled too much and that my personality was such that patients and others would think I was too glib. Medicine was a serious business, and you shouldn’t be smiling. That’s not my personality – I’m not Eeyore. I think it’s served me well to be positive, and it’s served me well with patients to be smiling. Especially when you’re dealing with patients who have precancer or dysplasia and are scared – they want reassurance and they want a level of confidence. I’m glad I ignored that advice.
Q: What would be your advice to medical students?
A: Think about where you want to be when you wake up in the morning. If it’s either in a GI practice or doing GI research or doing endoscopy, then you should absolutely do it.
Lightning round
Cat person or dog person
Dog
Favorite sport
Tennis
What song do you have to sing along with when you hear it?
Dancing Queen
Favorite music genre
1980s pop
Favorite movie, show, or book
Wuthering Heights
Dr. Anandasabapathy is on LinkedIn and on Twitter at @anandasabapathy , @bcmglobalhealth , and @bcm_gihep .
Sharmila Anandasabapathy, MD, knew she wanted to focus on endoscopy when she first started her career.
While leading an endoscopy unit in New York City, Dr. Anandasabapathy began developing endoscopic and imaging technologies for underresourced and underserved areas. These technologies eventually made their way into global clinical trials.
“We’ve gone to clinical trial in over 2,000 patients worldwide. When I made that jump into global GI, I was able to make that jump into global health in general,” said Dr. Anandasabapathy.
As vice president for global programs at Baylor College of Medicine in Houston, Dr. Anandasabapathy currently focuses on clinical and translational research.
“We’re looking at the development of new, low-cost devices for early cancer detection in GI globally. I oversee our global programs across the whole college, so it’s GI, it’s surgery, it’s anesthesia, it’s obstetrics, it’s everything.”
In an interview, Dr. Anandasabapathy discussed what attracted her to gastroenterology and why she always takes the time to smile at her patients.
Q: Why did you choose GI?
A: There’s two questions in there: Why I chose GI and why I chose endoscopy.
I chose GI because when I was in my internal medicine training, they seemed like the happiest people in the hospital. They liked what they did. You could make a meaningful impact even at 3 a.m. if you were coming in for a variceal bleed. Everybody seemed happy with their choice of specialty. I was ready to be an oncologist, and I ended up becoming a gastroenterologist.
I chose endoscopy because it was where I wanted to be when I woke up in the morning. I was happy there. I love the procedures; I love the hand-eye coordination. I liked the fact that these were relatively shorter procedures, that it was technology based, and there was infinite growth.
Q: Was there a time when you really helped a patient by doing that endoscopy, preventing Barrett’s esophagus or even cancer?
A: I can think of several times where we had early cancers and it was a question between endoscopic treatment or surgery. It was always discussed with the surgeons. We made the decision within a multidisciplinary group and with the patient, but we usually went with the endoscopic options and the patients have done great. We’ve given them a greater quality of life, and I think that’s really rewarding.
Q: What gives you the most joy in your day-to-day practice?
A: My patients. I work with Barrett’s esophagus patients, and they tend to be well informed about the research and the science. I’m lucky to have a patient population that is really interested and willing to participate in that. I also like my students, my junior faculty. I like teaching and the global application of teaching.
Q: What fears did you have to push past to get to where you are in your career?
A: That I would never become an independent researcher and do it alone. I was able to, over time. The ability to transition from being independent to teaching others and making them independent is a wonderful one.
Early on when I was doing GI, I remember looking at my division, and there were about 58 gastroenterologists and only 2 women. I thought at the time, “Well, can I do it? Is this a field that is conducive with being a woman and having a family?” It turned out that it is. Today, I’m really gratified to see that there are more women in GI than there ever were before.
Q: Have you ever received advice that you’ve ignored?A: Yes. Early in my training in internal medicine, I was told that I smiled too much and that my personality was such that patients and others would think I was too glib. Medicine was a serious business, and you shouldn’t be smiling. That’s not my personality – I’m not Eeyore. I think it’s served me well to be positive, and it’s served me well with patients to be smiling. Especially when you’re dealing with patients who have precancer or dysplasia and are scared – they want reassurance and they want a level of confidence. I’m glad I ignored that advice.
Q: What would be your advice to medical students?
A: Think about where you want to be when you wake up in the morning. If it’s either in a GI practice or doing GI research or doing endoscopy, then you should absolutely do it.
Lightning round
Cat person or dog person
Dog
Favorite sport
Tennis
What song do you have to sing along with when you hear it?
Dancing Queen
Favorite music genre
1980s pop
Favorite movie, show, or book
Wuthering Heights
Dr. Anandasabapathy is on LinkedIn and on Twitter at @anandasabapathy , @bcmglobalhealth , and @bcm_gihep .
GI lends itself to multiple career paths, says Boston physician
Daniel Leffler, MD, MS, AGAF, has some advice for young physicians starting out in their careers: Don’t be afraid of change.
“Just because you’re a doctor doesn’t mean you have to spend the rest of your career doing patient care. We don’t teach that in medical school as well as we should,” said Dr. Leffler. “If you’re interested in a skill set and move in a different direction, that’s totally okay. Many people have major career shifts, whether it’s early, mid- or late career.”
Dr. Leffler followed his own advice in 2016 when he left his longtime job as an associate professor at Harvard Medical School and accepted a position with Takeda Pharmaceuticals. As its medical director, he had a specific goal: To find more therapeutic options for patients with celiac disease.
“Gastroenterology is a fantastic field of medicine, and it somehow continues to get more and more exciting,” said Dr. Leffler, who continues to see patients at Beth Israel Deaconess Medical Center in Boston. “There are just so many careers you can have within gastroenterology, whether you are a full-time endoscopist, in a teaching career, or doing lab work.”
He discussed the events that led to this career change in an interview with GI & Hepatology News.
Q: Why did you choose GI?
Dr. Leffler: I think for a lot of people GI is just an incredibly diverse field where you can see all types of patients and you have an unusually wide armamentarium of diagnostic and therapeutic options. Our ability to see inside in the GI tract relatively easily and obtain tissue and do functional studies is unique. It makes it a very dynamic field.
Q: What gives you the most joy in your day-to-day practice?
Dr. Leffler: I think it’s taking a fresh look at somebody whose symptoms have been incorrectly diagnosed or diagnosed preliminarily as one thing and opening different options and working with the patient to hopefully find a more targeted therapy based on a more definitive diagnosis.
Q: Describe your biggest practice-related challenge and what you are doing to address it.
Dr. Leffler: There are two challenges. For celiac disease, all I have is a gluten-free diet. It would be nice to have other options, the same way we do with almost every other GI disease, whether it’s acid-related disorders or chronic constipation or inflammatory bowel disease. We have a range of therapies we can pick and choose from, tailoring those to the individual. We are not there yet, unfortunately, in celiac disease, so that’s a huge challenge.
Another challenge is awareness of celiac disease. It’s not what it should be. We see a lot of patients who either were misdiagnosed or went many years without getting a proper diagnosis or got diagnosed and did not have proper education or follow up.
Q: How has your job changed since you first began your career? Perhaps we could discuss your switch from Harvard/Beth Israel Deaconess to Takeda Pharmaceuticals.
Dr. Leffler: I became convinced some years ago that the next big thing for celiac disease was an effective therapy beyond the gluten-free diet. Takeda had acquired rights to two of the therapies that I was most interested in, even though they were very early. There was a new glutenase, TAK-062, and a new immune-tolerizing molecule that became TAK-101. Takeda had moved its research center to Boston, and they were looking for someone to work on their celiac program. Moving from an academic position, which I loved, was a really difficult decision.
I didn’t leave without a conversation with the division chief at the time, Tom Lamont, MD. I basically said, “If this doesn’t work out, will you take me back?” I wasn’t sure how much I’d like working in industry. The other thing, on both sides, was that I was allowed to keep a clinic. I still see patients on Fridays and really, to me, I have the best of both worlds.
Q: What teacher or mentor had the greatest impact on you?
Dr. Leffler: I really think of Ciaran Kelly, MD at Beth Israel Deaconess, Detlef Schuppan, MD, who also was at Beth Israel Deaconess, but is now at the University of Mainz in Germany. And Peter Green, MD at Columbia University. These three are the physicians I’ve interacted with the most and learned the most from.
Q: What habits have you established that have benefited your career most?
Dr. Leffler: I do try to focus on being a good collaborator. Playing that long game of working for the good of the project and not necessarily what is next for you, has served me very well over the years.
Lightening round
Superpower?
Optimism
Favorite movie to quote?
The Big Lebowski
What is your favorite form of exercise?
Elliptical
Name one thing on your bucket list.
Ethiopia travel
How many cups of coffee do you drink per day?
Two-ish
Dr. Leffler is on LinkedIn.
Daniel Leffler, MD, MS, AGAF, has some advice for young physicians starting out in their careers: Don’t be afraid of change.
“Just because you’re a doctor doesn’t mean you have to spend the rest of your career doing patient care. We don’t teach that in medical school as well as we should,” said Dr. Leffler. “If you’re interested in a skill set and move in a different direction, that’s totally okay. Many people have major career shifts, whether it’s early, mid- or late career.”
Dr. Leffler followed his own advice in 2016 when he left his longtime job as an associate professor at Harvard Medical School and accepted a position with Takeda Pharmaceuticals. As its medical director, he had a specific goal: To find more therapeutic options for patients with celiac disease.
“Gastroenterology is a fantastic field of medicine, and it somehow continues to get more and more exciting,” said Dr. Leffler, who continues to see patients at Beth Israel Deaconess Medical Center in Boston. “There are just so many careers you can have within gastroenterology, whether you are a full-time endoscopist, in a teaching career, or doing lab work.”
He discussed the events that led to this career change in an interview with GI & Hepatology News.
Q: Why did you choose GI?
Dr. Leffler: I think for a lot of people GI is just an incredibly diverse field where you can see all types of patients and you have an unusually wide armamentarium of diagnostic and therapeutic options. Our ability to see inside in the GI tract relatively easily and obtain tissue and do functional studies is unique. It makes it a very dynamic field.
Q: What gives you the most joy in your day-to-day practice?
Dr. Leffler: I think it’s taking a fresh look at somebody whose symptoms have been incorrectly diagnosed or diagnosed preliminarily as one thing and opening different options and working with the patient to hopefully find a more targeted therapy based on a more definitive diagnosis.
Q: Describe your biggest practice-related challenge and what you are doing to address it.
Dr. Leffler: There are two challenges. For celiac disease, all I have is a gluten-free diet. It would be nice to have other options, the same way we do with almost every other GI disease, whether it’s acid-related disorders or chronic constipation or inflammatory bowel disease. We have a range of therapies we can pick and choose from, tailoring those to the individual. We are not there yet, unfortunately, in celiac disease, so that’s a huge challenge.
Another challenge is awareness of celiac disease. It’s not what it should be. We see a lot of patients who either were misdiagnosed or went many years without getting a proper diagnosis or got diagnosed and did not have proper education or follow up.
Q: How has your job changed since you first began your career? Perhaps we could discuss your switch from Harvard/Beth Israel Deaconess to Takeda Pharmaceuticals.
Dr. Leffler: I became convinced some years ago that the next big thing for celiac disease was an effective therapy beyond the gluten-free diet. Takeda had acquired rights to two of the therapies that I was most interested in, even though they were very early. There was a new glutenase, TAK-062, and a new immune-tolerizing molecule that became TAK-101. Takeda had moved its research center to Boston, and they were looking for someone to work on their celiac program. Moving from an academic position, which I loved, was a really difficult decision.
I didn’t leave without a conversation with the division chief at the time, Tom Lamont, MD. I basically said, “If this doesn’t work out, will you take me back?” I wasn’t sure how much I’d like working in industry. The other thing, on both sides, was that I was allowed to keep a clinic. I still see patients on Fridays and really, to me, I have the best of both worlds.
Q: What teacher or mentor had the greatest impact on you?
Dr. Leffler: I really think of Ciaran Kelly, MD at Beth Israel Deaconess, Detlef Schuppan, MD, who also was at Beth Israel Deaconess, but is now at the University of Mainz in Germany. And Peter Green, MD at Columbia University. These three are the physicians I’ve interacted with the most and learned the most from.
Q: What habits have you established that have benefited your career most?
Dr. Leffler: I do try to focus on being a good collaborator. Playing that long game of working for the good of the project and not necessarily what is next for you, has served me very well over the years.
Lightening round
Superpower?
Optimism
Favorite movie to quote?
The Big Lebowski
What is your favorite form of exercise?
Elliptical
Name one thing on your bucket list.
Ethiopia travel
How many cups of coffee do you drink per day?
Two-ish
Dr. Leffler is on LinkedIn.
Daniel Leffler, MD, MS, AGAF, has some advice for young physicians starting out in their careers: Don’t be afraid of change.
“Just because you’re a doctor doesn’t mean you have to spend the rest of your career doing patient care. We don’t teach that in medical school as well as we should,” said Dr. Leffler. “If you’re interested in a skill set and move in a different direction, that’s totally okay. Many people have major career shifts, whether it’s early, mid- or late career.”
Dr. Leffler followed his own advice in 2016 when he left his longtime job as an associate professor at Harvard Medical School and accepted a position with Takeda Pharmaceuticals. As its medical director, he had a specific goal: To find more therapeutic options for patients with celiac disease.
“Gastroenterology is a fantastic field of medicine, and it somehow continues to get more and more exciting,” said Dr. Leffler, who continues to see patients at Beth Israel Deaconess Medical Center in Boston. “There are just so many careers you can have within gastroenterology, whether you are a full-time endoscopist, in a teaching career, or doing lab work.”
He discussed the events that led to this career change in an interview with GI & Hepatology News.
Q: Why did you choose GI?
Dr. Leffler: I think for a lot of people GI is just an incredibly diverse field where you can see all types of patients and you have an unusually wide armamentarium of diagnostic and therapeutic options. Our ability to see inside in the GI tract relatively easily and obtain tissue and do functional studies is unique. It makes it a very dynamic field.
Q: What gives you the most joy in your day-to-day practice?
Dr. Leffler: I think it’s taking a fresh look at somebody whose symptoms have been incorrectly diagnosed or diagnosed preliminarily as one thing and opening different options and working with the patient to hopefully find a more targeted therapy based on a more definitive diagnosis.
Q: Describe your biggest practice-related challenge and what you are doing to address it.
Dr. Leffler: There are two challenges. For celiac disease, all I have is a gluten-free diet. It would be nice to have other options, the same way we do with almost every other GI disease, whether it’s acid-related disorders or chronic constipation or inflammatory bowel disease. We have a range of therapies we can pick and choose from, tailoring those to the individual. We are not there yet, unfortunately, in celiac disease, so that’s a huge challenge.
Another challenge is awareness of celiac disease. It’s not what it should be. We see a lot of patients who either were misdiagnosed or went many years without getting a proper diagnosis or got diagnosed and did not have proper education or follow up.
Q: How has your job changed since you first began your career? Perhaps we could discuss your switch from Harvard/Beth Israel Deaconess to Takeda Pharmaceuticals.
Dr. Leffler: I became convinced some years ago that the next big thing for celiac disease was an effective therapy beyond the gluten-free diet. Takeda had acquired rights to two of the therapies that I was most interested in, even though they were very early. There was a new glutenase, TAK-062, and a new immune-tolerizing molecule that became TAK-101. Takeda had moved its research center to Boston, and they were looking for someone to work on their celiac program. Moving from an academic position, which I loved, was a really difficult decision.
I didn’t leave without a conversation with the division chief at the time, Tom Lamont, MD. I basically said, “If this doesn’t work out, will you take me back?” I wasn’t sure how much I’d like working in industry. The other thing, on both sides, was that I was allowed to keep a clinic. I still see patients on Fridays and really, to me, I have the best of both worlds.
Q: What teacher or mentor had the greatest impact on you?
Dr. Leffler: I really think of Ciaran Kelly, MD at Beth Israel Deaconess, Detlef Schuppan, MD, who also was at Beth Israel Deaconess, but is now at the University of Mainz in Germany. And Peter Green, MD at Columbia University. These three are the physicians I’ve interacted with the most and learned the most from.
Q: What habits have you established that have benefited your career most?
Dr. Leffler: I do try to focus on being a good collaborator. Playing that long game of working for the good of the project and not necessarily what is next for you, has served me very well over the years.
Lightening round
Superpower?
Optimism
Favorite movie to quote?
The Big Lebowski
What is your favorite form of exercise?
Elliptical
Name one thing on your bucket list.
Ethiopia travel
How many cups of coffee do you drink per day?
Two-ish
Dr. Leffler is on LinkedIn.