Leadership lessons from Dr. Fauci [PODCAST]

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“Dr. Fauci navigated the delicate balance between his obligation to the American people as one of our most respected physician-scientists and holding on to his job in a federal government whose leader doesn’t take kindly to independent thought that potentially upstages his own. Dr. Fauci not only survived multiple appearances on the national stage with Trump, as the task force morphed into charade, but he even emerged as a popular folk hero, all the while maintaining his status as a respected medical authority.

Despite having ample opportunity to confront the president on his misinformation, Dr. Fauci focused his unwavering attention on mitigation of the virus, refuting Trump’s often puzzling and sometimes harmful pronouncements, without even having to directly acknowledge them.”

Michael Miyamoto is a cardiologist.

He shares his story and discusses his KevinMD article, “Dealing with a bad boss: lessons from Dr. Fauci.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Michael Miyamoto. He is a cardiologist, and he wrote the KevinMD article “Dealing with a bad boss: lessons from Dr. Fauci.” Michael, welcome to the show.

Michael Miyamoto: Kevin, thanks for inviting me.

Kevin Pho: We’ll get into the article in a little bit, but first off, can you share your story and your journey to where you are today?

Michael Miyamoto: Sure. I’m a cardiologist, a practicing cardiologist in Orange County, California. I grew up in Hawaii. I did my college and medical school training in California and then continued to move eastward. I wound up in Boston for my internship, residency, cardiology fellowship, and some heart failure and transplant. I was at Mass General, and there was a lot of silent pressure to enter academia and end up as a division chief one day. But I also had very excellent clinical mentors there, and it was a tough decision, but I decided to go into practice and moved westward again. So it’s been over 20 years I’ve been practicing here in Orange County. It’s been a very rewarding experience. I really enjoy taking care of patients, and cardiology is something I’ve been interested in ever since I was in college, so it’s been a good fit.

More recently, just thinking about making a bigger impact in the field, I’ve begun to expand my research activities, looking into more of the origins or basic nature of atherosclerosis in humans. So I take care of patients with coronary and other vascular disease all day, thinking about the bigger picture of why humans seem to be so predisposed to atherosclerosis. I’ve been involved in some interesting work with the team that has studied ancient Egyptian mummies, doing CT scans and finding evidence of atherosclerosis even in ancient humans, and trying to figure out the implications of detecting atherosclerosis even in people without, presumably, a lot of exposure to what we consider to be risk factors for vascular disease, and also in some work that I’ve been doing with some very smart anthropologists and a large multidisciplinary team looking at some indigenous Amazonian populations in Bolivia, finding that they have very low rates of atherosclerosis and atrial fibrillation, and using those observations to try to figure out the implications for how to apply their situation more generally to industrialized populations.
So my focus, I think, is a little broader now than just taking care of patients, although I did that full time as well.

Kevin Pho: So that’s an interesting cross-section between anthropology and atherosclerosis. How did you get interested in that?

Michael Miyamoto: Well, it started with our mummy work and some of the connections that were made, somewhat fortuitously, with a group that had been studying some indigenous peoples for a long time, long before we were doing our mummy work. The group, like I said, is multidisciplinary. We have entrepreneurs, anthropologists, physicians, radiologists, neurologists, infectious disease doctors, biostatisticians, and geneticists. So these are very interesting calls that we have every other week. There are really interesting ideas that people bring forward, ideas for further study, and everyone brings a really unique perspective to the questions that we’re interested in exploring. So that’s been a lot of fun.

Kevin Pho: All right, let’s transition now into the KevinMD article that you wrote. It’s titled “Dealing with a bad boss: lessons from Dr. Fauci.” Now, for those who didn’t read the article, can you just walk my audience through it and share the story of why you decided to write it?

Michael Miyamoto: Another avenue that I’ve taken: About 10 years ago, I went to business school for my MBA, and the thing I’ve noticed a lot since then is that a lot of the lessons that we studied in that school revolved around organizational behavior and the way people operate within organizations, much more, I think, than finance and accounting and so on. I’ve really been impressed by how applicable some of these organizational behavior ideas are to the issues that we deal with every day in medicine, in our practice, in large organizations, and throughout society.

So as the pandemic unfolded last spring and the televised White House Coronavirus Task Force briefings were held, it was fascinating for me to watch this whole story unfold. I realized that this was a very interesting case study, an organizational behavior case study, in the way professionals, very highly regarded professionals, may operate within organizational structures. We can all probably think of times when we believe that we’re much more qualified, more expert in a particular field than our boss, and yet we still have to operate within that organizational structure.

This was, I think, a very public example of this, where two very highly esteemed and distinguished physician-scientists were on the task force for their expertise, to help guide the country through this very scary pandemic. And yet they were serving under a boss that admittedly was nowhere near as well-informed or expert in the subject, and yet they reported to this boss. So to see how they thrived, or didn’t, as the case may be, within this organization was very interesting.

I think we’re seeing right now what happens when someone like Dr. Fauci really deftly navigated this situation and is still regarded as a very important resource, nationally and internationally, helping us, based on science and medicine, to get through this pandemic. Now his stature has risen even further with the change in administration. On the other hand, the other physician, Dr. Birx, and not to pile on, her situation was very difficult. She was perceived as being much less forceful in staying true to scientific principles and a little bit more accommodating to some of the misinformation that was emanating from the top. We’re seeing right now she’s basically not in the picture anymore.

I’m sure both had the best of intentions, but the ability to navigate this is a delicate balance between thriving within the organization and being able to survive while staying really true to your principles. I really respect Dr. Fauci for that.

Kevin Pho: Now, what are some specific techniques that you observed Dr. Fauci use to navigate through that difficult political situation and have him survive to his stature today under the Biden administration?

Michael Miyamoto: Yes, so I was very impressed by the fact that, on the one hand, he was very careful not to be directly confrontational. There is this temptation to really react defensively to some of the challenges that are made to you. There’s this natural feeling by many physicians and scientists that they are the expert, they know the most, and everyone should defer to their judgment without question. So I think there were situations where he could have been much more offended and confrontational, which wouldn’t have been productive, and I think that’s a reason why he was so successful.

On the other hand, he didn’t back down when it came to telling it like he saw it. Based on his many years as this distinguished scientist, you really felt like he realized and appreciated his duty to the public to really do his best to hand out the best information, and so he’s really respected for that. So I think he did a good job of balancing the two things: being able to stay in this position, which is important, because if he was sidelined, basically, he would have lost his voice, and at the same time really doing his best to give us the best information based on the best science. I think that is reflected in the fact that he was very successful and is now the chief advisor to the new administration.

Kevin Pho: I touched upon Dr. Birx, who, compared to Dr. Fauci, didn’t fare as well in the aftermath. Is there anything that you feel she could have done differently?

Michael Miyamoto: Yeah, well, again, it’s easy to armchair quarterback, and her situation was very difficult. I think that she probably, in my view, would have been more successful staying truer to her science and medical background rather than going out of her way to make excuses for some of the really questionable recommendations that were emanating from the top. I think by being so deferential and not really coming out a little stronger based on her scientific background, she lost some respect, which was unfortunate, since her career was such a distinguished one.

And then later, after the transition, coming out saying, “Yes, this was difficult. I couldn’t believe what I was hearing,” and so on, I think that really shows the internal struggle that was going on in her, and in many people, I’m sure. But I think it was a little late to say something, and the approach that I think Dr. Fauci took was, in the end, I think, the right one.

Kevin Pho: We’re talking to Michael Miyamoto. He’s a cardiologist, and he wrote the KevinMD article “Dealing with a bad boss: lessons from Dr. Fauci.” Michael, what are some specific lessons that physicians can use in their own organizations, that they can glean from the trials of Drs. Birx and Fauci?

Michael Miyamoto: Yeah, so I’ve been thinking about that a lot. I think that as physicians, more and more, we have people that we report to, people that we’re accountable to. In the old model, even before I became a doctor, physicians operated in small groups or as solo practitioners, and they were their own boss. A lot of the big decisions were made by the doctors, and physicians translated their unquestioned authority from the clinical setting into settings outside of just the office, and that is: How is the practice run? What decisions are being made in terms of allocation of resources, and so on?

It’s a reality that we all increasingly have bosses, so to speak, and there are going to be times when you feel like you know much more about an issue at hand than your boss. That’s natural, especially for physicians. We do bring a unique clinical perspective that I think nonclinical people will find very hard to fully understand or appreciate. But I think we have to avoid this mindset that it’s either our way or the highway. I think we really need to acknowledge the fact that we have to operate within these organizations, and we have to really pay a lot of attention to doing so in a way that’s productive, and keep in mind that we’re all aligned in our interests. With that in mind, I think that we make things a lot more collaborative. I think physicians would do well to look at things with this kind of organizational behavior lens, rather than just problems and challenges that need to be solved ad hoc.

So I think generally physicians are becoming better at navigating this landscape. We’re not taught it very well in medical school. We have rounds with the attending, and we all listen and do what our attending, what our senior resident says. We are working in teams, but I think that through experience, once you get into the real world, it can be very different.

Kevin Pho: My final question: What’s your take-home message that you want to leave with the KevinMD audience?

Michael Miyamoto: Well, I think that medicine’s changing. I think physicians, by and large, are very ambitious, capable people, and so there are a lot of opportunities to do what you’re interested in in medicine. So it’s still a very active clinical practice, but I do writing, I’m involved in medical devices, and this research, more and more, that I mentioned. So there are a lot of things that physicians can do to contribute, and I think that one shouldn’t feel really constrained to any one particular activity, and it’s never too late to really branch out into other interests.

Kevin Pho: Michael, thank you so much for sharing your time and insight, and thanks again for being on the show.

Michael Miyamoto: Thanks for having me.

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