EP180: The Art of Pathology: Balancing Passion and Profession with Dr. Edward Gutmann

The Balance of Work and Passion with Dr. Edward J Gutmann

In this episode of The Girl Doc Survival Guide, Christine welcomes Dr. Edward J Gutmann, MD, a cytopathologist at Dartmouth Hitchcock Medical Center. They discuss Dr. Gutmann's career path which includes studying English and history, and how these experiences inform his work in pathology. Dr. Gutmann shares a memorable anecdote about choosing a Bob Weir concert over an academic lecture, highlighting the importance of personal passions alongside professional commitments. They explore the roles of pathologists, the transient nature of their work compared to tangible products like zippers, and the significance of mentorship and networking in their field. The conversation also addresses the challenges faced by introverts in medicine and the impact of stereotypes among medical professionals. The episode concludes with reflections on the importance of relationships and positive communication in fostering better patient care.

00:00 Introduction to Dr. Edward J Gutmann

00:51 Anecdotes and Personal Stories

05:00 The Importance of Networking in Medicine

06:59 Reflections on a Zipper Factory Visit

08:46 The Impact of Pathologists

12:26 Balancing Personal and Professional Life

14:05 Final Thoughts on Medical Stereotypes

Transcript

Christine Ko: [00:00:00] Welcome back to The Girl Doc Survival Guide. Today I'm very pleased to be with Dr. Edward J Gutmann. Dr. Edward J Gutmann, MD is a cytopathologist at Dartmouth Hitchcock Medical Center since 2001. He was an English major at SUNY Buffalo and spent time as a visiting student at Princeton University and did some of his pre-medical work there. He attended Albert Einstein College of Medicine as well as attending Harvard University to study the History of Science. He's interested in public perceptions of pathologists as well as the History of Medicine. He's also a writer and recently wrote a piece for CAP Today, which I read, and that's how we're here today reflecting on a visit to a zipper factory and how that relates to the practice of pathology.

Welcome to Eddie. 

Edward Gutmann: Thanks, Christine. Thanks for having me. Appreciate it. 

Christine Ko: Could you first share a personal anecdote? 

Edward Gutmann: The United States and Canadian Academy of Pathology is a major academic organization. [00:01:00] It's a major academic meeting of academic pathologists. I presume you've attended the meetings. 

Christine Ko: I actually have not.

Edward Gutmann: Really? So you go to the derm meetings more? They were having their annual meeting in Vancouver, British Columbia. This was many years ago when I was a junior attending and the first night of the meeting, coincided with a Rat Dog concert in Vancouver, and Rat Dog was Bob Weir's band. I'm not sure you know who Bob Weir is, but he was the rhythm guitarist for the Grateful Dead. And I, like many people of my generation; I'm a big fan of the Grateful Dead. But I'm also an academic pathologist and I was in Vancouver to go to an academic meeting, and I basically had a dilemma because there were some academic sessions the same night and the same time as the concert. I didn't know what to do, and I was checking into the conference, registering. That evening, unsure what to do; ahead of me in line was the Chair [00:02:00] of Pathology at Massachusetts General Hospital. I trained at Mass General, and the chair at the time was Bob Colvin, who was a brilliant renal pathologist and a very serious scholar and a wonderful person. I consulted with him, and I asked him what I should do. He basically paused for a second and thought, and he said, Look, Eddie, which will you remember in the future? Going to the pathology seminar, a session on cytopathology or going to the concert? And he may have had a little twinkle in his eye. This was many years ago. Which do you think I did?

Christine Ko: You went to the concert.

Edward Gutmann: I did go to the concert. I don't remember anything about the conference. To be candid, I don't remember anything about the concert either. But what I do remember is that after the concert I got Bob Weir's autograph. I have the autographs of the three surviving members of the original Grateful Dead, and one of them I obtained by not going to that [00:03:00] academic conference evening session. 

Christine Ko: I love that story. Lots of things about it. One is that USCAP, I know it's a major meeting, and my understanding is that almost all pathologists do attend it. And the fact that you asked me if I've gone and I have not, it does show that my origins are from dermatology. My major reason for not going is not that I'm not pathology trained, but more because there's just so many meetings and so many societies. That kind of ties into your story because you're already at a meeting and then you also have this sort of conflicting, personal, more like hobby or life choice, right? Not really work related, but something that you're very passionate about. For me, there's just too many meetings, too many things; I think for all of us in medicine. There's too many things at work that we could potentially be doing that it would just be all consuming, right? So yes, I [00:04:00] try to stay out of the fray in a way, in my own head, and yes, so I still have not attended an USCAP meeting.

Edward Gutmann: In candor, I tend to attend it when it's in Vancouver because I like the city.

Christine Ko: Also, I like your story because you asked one of your mentors, someone you trained with, and I really appreciate that. He was like, what are you really gonna remember? And then I also appreciate that you said, in all honesty, I actually don't remember the concert really either. We are so overloaded in medicine that I expect myself to learn something with just one exposure to it. That is not how I learn. I need to have heard something or read it or be exposed to it in some way from a lecture or a paper or a little email or something on social media at least five times , but probably more like 10 plus times before I'm like, Oh, okay. Now I think I can remember that.

Edward Gutmann: I hear you on that. Some people don't, including myself, don't learn that well from [00:05:00] lectures. One of the reasons to go to the conferences is really for networking. There's a social aspect to it, and I don't think it's inappropriate to acknowledge the social aspect of it, even though these are billed as academic meetings. 

Christine Ko: Yes. The way you phrased it where you're like, I don't think it's inappropriate to talk about the social aspect, the networking, which is very important. I am shy and I am an introvert, and I would be okay being by myself for much of the time, and yet I am a hundred percent in agreement that relationships are really important, especially in our careers, whatever career that is. For me, it wasn't so emphasized that I understood that clearly, that part of the reason to go to these meetings is to be social and make relationships and make the ones you have stronger and the ones that you don't have, create them.

Edward Gutmann: I know I read something you wrote or maybe an interview with you in which you said you [00:06:00] were an introvert, which I didn't believe because you do this podcast. Basically, I call myself a compensated introvert. I think I'm an introvert as well, and so I was speculating that we may have a very brief and quiet conversation together of two introverts.... Maybe would last for maybe 60 seconds or something. So I guess we've done pretty well so far. 

Christine Ko: Being an introvert, I like Susan Cain's definition. She's the author of Quiet. I think a lot of people have read that book and especially introverts appreciate it. She says it's just about energy. So do you get energy from other people much of the time, and that would be more extroversion. And if you're an introvert, it's that you get more energy from not being around people. And you find it's somewhat draining to be around people. And I think that's what I mean. I actually do really like talking to people about the things that I wanna talk about. So the podcast is perfect in that sense. 

Edward Gutmann: Yeah. 

Christine Ko: You [00:07:00] did write this article for CAP Today that was talking about a visit to a zipper factory and you talked about the products that we produce as physicians. Can you talk a little bit about that?

Edward Gutmann: My father was a mechanical engineer, and he was the chief and only engineer for this zipper company many years before that visit. I used to go to the factory with him occasionally. The company's grown. The company is now, by some measures, the second largest zipper company in the world. I was able to go to the factory floor. And during that visit, the president of the company told me that some of the machines were actually designed or built, maintained and repaired, or some combination of them, by my father years ago. And he told me that they were still running. It was poignant for me to see machines that my father had been involved with. I saw [00:08:00] rows of steel machines that were basically manufacturing zippers or parts of zippers. Zippers are a very tangible product and durable. In the paper I reflect on how permanent or impermanent our products as pathologists are; the diagnostic reports that we make on specimens, our trainees can be considered a product in a sense, and our academic articles are a type of product. So basically the paper is a riff where I play off this notion of permanence and impermanence with regard to the three products of pathologists. And I contrast them with zippers.

There's a misunderstanding that pathologists don't care about patients because they're pathologists. And I'd like to think that we care as much about patients as surgeons, as internists, as radiologists, as psychiatrists, but the care is manifest in a different way. It's manifest in what's the end product of a [00:09:00] pretty complicated process involving moving slides, looking at slides, looking up clinical histories, thinking about a patient's age and trying to put out the correct diagnosis to guide patient care. Guidelines are that the written reports and the slides can be just be trashed in 10 years. That's as long as they have to be kept. They're really not as permanent as a zipper. The other product the residents or fellows, our trainees, and we talked about going to the conferences. We see some of our trainees at these meetings, and it's very gratifying to see that they've done well. So in that regard, there's some permanence there. Also some of what we taught our trainees can live on. They may remember some pearl that we told them, Always look out for this. Don't make this mistake. And then the third product are our publications. They get listed on a website, PubMed; they can be cited and can be useful to people in the future. Some of them don't get [00:10:00] cited too much. A paper that you wrote or I wrote may not be cited at all. Now we're talking about a paper that I wrote about a reflection on a visit to a zipper factory. I am quite skeptical that this paper is gonna be cited very often and it's really not gonna contribute much to my H index.

Christine Ko: Your H index, it's a way to measure how much of an impact perhaps a paper has. So you're saying it's not really gonna have much of an impact, at least not in academia. So may I ask, why did you write it? 

Edward Gutmann: Because I thought it was something potentially of interest to other people. And I've done that to some degree throughout my career. I've marched to a different drummer to some degree, and I think some of these papers, which touch on maybe some more humanistic aspects of medicine are potentially of interest to some people.

Christine Ko: Yes. I asked the question because I thought you would answer like that. I suppose that as a human [00:11:00] being, not necessarily physician or dermatologist or dermatopathologist or anything, I have decided reluctantly, I will say, as an introvert, that I think ultimately our product is the impact we have on other people. I think that goes along with what you said. The reports that we put out as a pathologist, that has an impact on the patient, whether it's something not cancer or whether it's cancer. And then you said the trainees. And I think that's a really perfect example of relationships. I am only where I am because of the teachers and the mentors that I've had for sure. Like you said, I definitely remember various things that my teachers and mentors have told me. Dr. Gary Cole was my program director, Dr. Edward Jeffes, he was one of my first teachers as a first year derm resident at the VA. Definitely Dr. Ronald Barr, who was my first dermpath teacher. And then the third thing you said is papers. And that's how we are here today. Your writing definitely had an impact on me. I think that [00:12:00] matters more to me actually than an H Index, which I think is just a dry number.

Edward Gutmann: To respond to what you said, you just mentioned the names of various people. It's interesting years later, their names are coming up, so they are living on. You never know what effect you're gonna have.

Christine Ko: Yes. You marched to the beat of your own drummer, even your first anecdote about going to the concert in the middle of the USCAP meeting and getting a degree at Harvard in the History of Science in 1999. Would you have advice on how you have thrived in academia? 

Edward Gutmann: I wouldn't say I've thrived. But I've survived. Isn't your podcast, does the title say something about survival? Before I answer you how have you survived?

Christine Ko: I think I was just surviving. Part of it was personal things like when I was a young parent. I have two children, and my second child is deaf and needed cochlear implants. All of that is just mental load and appointments and things that need [00:13:00] to be done. And I think I just always felt like there's not enough time. So it goes back to your first anecdote about choices. Do you go to this really cool concert and end up getting an autograph of a Grateful Dead member that you'll have forever in your life? Versus the USCAP meeting, which you also wanted to do.

For me, the difference between surviving and thriving are actually your quote from Thoreau, to stand on the meeting of two eternities, the past and the future, which I thought was beautiful. In later life, at this point, I am trying to do that, to be present in each thing that I'm doing. To think about how the past influences that and how I would wanna be in the future.

Edward Gutmann: Yeah. It's a quote from Thoreau, from the first chapter of Walden. To stand on the meeting of two eternities, the past and future, which is precisely the present moment, to toe that line.

Christine Ko: Yes. Beautiful. Do you have any final thoughts?

Edward Gutmann: I wrote a paper [00:14:00] some years ago with an internist, "Much Ado about Not Doing Nothing", and it's about negative stereotypes of medical specialists and the potential negative effects on medical students. There's this saying, I'm gonna read it. An internist is someone who knows everything and does nothing. A surgeon is someone who does everything and knows nothing. A psychiatrist is someone who knows nothing and does nothing. And a pathologist is someone who knows everything and does everything too late. At the onset that can be viewed as an innocuous sort of jab. We all tease each other a little bit, but Dr. Salzman and I wrote the paper because we thought that this notion of positive doctor relationships are important, and I don't think there's been that much written about doctor relationships. Medicine is really like a team sport. It's a serious sport. We wrote a paper sort of advocating that it'd be useful to make positive comments about other specialists, not just refrain from making the disparaging ones. Not only should we not [00:15:00] make negative comments about other specialists, but anything we can do to foster relationships are important, not just for our wellbeing, but if we have relationships with the other specialists, it makes it easier for us to communicate about cases when there's a problem case, something that clinically doesn't make sense or I have a question as a pathologist. Patients benefit from these relationships because they foster positive care. 

Christine Ko: I completely agree with you. Life is about relationships and definitely the relationships that we have with our colleagues is very important. Doctors are just human, and human beings stereotype. I don't say that to make it okay, but it's something that we do. We categorize. Stereotyping, it's generally negative, but it is a way of categorizing, and to categorize a certain specialty as X does this or that is, is just a way of making sense of the world and making our lives [00:16:00] easier in the sense that we don't have to decide about everything over and over again each time that we just have a category of, okay, this is generally my understanding about whatever. But stereotyping is detrimental in that we're not fully thinking about it as deeply as we should. It goes back to the time factor. It's true we don't have time to think about everything. We do have to cut corners in some ways, but I think to think more deeply about each person that we interact with, whether it's a colleague, whether it's a patient, whether it's friend, family member, et cetera, I think is important. Thank you for your time today and spending time with me.

Edward Gutmann: Thank you. It was an honor to get the invitation.

Christine Ko: Thanks.