Advice to fellows: Anticipate where medicine is going

Eric Topol, MD, suggests fellows remember to always ‘tell it like it is.’

I had the pleasure of meeting Eric Topol, MD, several months ago when he came back to The Johns Hopkins Hospital — where he did his cardiology fellowship — to give cardiology grand rounds.

The room was packed. I have never seen such an enthusiastic grand rounds crowd. After his talk, Topol met with the cardiology fellows for more than an hour, and the advice he gave us is worth sharing with you, which I will do this month in Fellows Forum. The advice and information also comes from a follow-up telephone interview with Topol.

Topol and HEPA

Topol went to medical school at the University of Rochester, N.Y. He completed his internal medicine internship and residency at the University of California in San Francisco where he was first exposed to transesophageal echocardiography (TEE) and human extrinsic plasminogen activator (HEPA). At the time, professionals started using TEE as a research tool, and HEPA, a “clot buster” eventually known as tissue plasminogen activator, had been studied in animal models for venous thrombosis. As soon as Topol heard of this magic clot-dissolving bullet, he came up with what could arguably have been the most important scientific question of his career: Could HEPA be used to treat patients who present with an acute MI?

Juan Rivera

He left UCSF and went to The Johns Hopkins Hospital to do a cardiology fellowship. Despite a certain degree of skepticism from some of the faculty members, he pursued his interest in TEE and brought this new technology to the operating room where surgeons were performing bypass procedures. He also started experimenting with HEPA using an atherothrombotic rabbit model. In 1984, he gave recombinant tPA to the first patient in history.

By the end of his fellowship, Topol was interested in doing multi-center trials using tPA for the treatment of acute MI. He found the support he needed at the University of Michigan. He left his fellowship three months early to become the second-in-command of the cardiac catheterization lab. Out of that venture emerged the TAMI Study Group, which led to the GUSTO international trials.

Advice from Topol

According to Topol, the most important things to do during fellowship — besides finding your niche and a good mentor — are to participate in national meetings and give major abstract presentations. It is also important to maintain a 1-1 ratio of abstracts presented to published manuscripts. Regarding potential involvement with industry, this is what Topol had to say: “If you are going to get involved with industry, be careful with the terms of the involvement; make sure that there is no direct economic benefit.”

Topol is convinced that being a successful academician is about anticipating where medicine is going and working on something that excites you. It is about finding, early on, a viable academic niche. He used as examples CT angiography and genomics, a technology and a field that are both still in the early phases of development, but with many potential applications for the near future.

Choosing the first academic job out of fellowship can be quite stressful. Topol believes that the environment in which you are going to work is very important. What is the quality of the institution? Will you have people there to support your work and promote your career? Who will be your mentor? Ideally, you should work in an institution that is committed to research and excellent patient care. Also, working with individuals that share your research interest and finding a good senior mentor work in your favor.

Topol does not want to specify what percentage of your time should be spent on research and clinical work, but thinks that if you want to continue treating patients you have to be aware of their needs and worries. The only way in which you can achieve that goal is by spending time listening and talking to them.

The best advice

We have all heard at least one physician-scientist say that the reason why he or she spends more time in the lab rather than in the wards is because research is more intellectually challenging. When Topol met with us at Hopkins, he said something that I will never forget.

First, he asked us, “How many labs out there are pushing the limits of science?”

Then he said, “Taking care of patients is not about doing something that is intellectually challenging; it is about doing something for someone else.” Research will always be the cornerstone of scientific progress, but staying in touch with our patients will help us shape the direction of our research.

Topol’s best advice for cardiology fellows is, “Tell it like it is,” he said. “When talking to patients, when writing a manuscript, and when presenting research data, tell it like it is.”

I am grateful to Topol for his time and availability, and hope his advice affects you as it did me.

Juan Rivera, MD, is a Fellow at The Johns Hopkins Ciccarone Center for Prevention of Heart Disease and a member of the Cardiology Today Fellows Advisory Board.