“The Doctor’s Art” is a weekly podcast that explores what makes medicine meaningful, featuring profiles and stories from clinicians, patients, educators, leaders, and others working in healthcare. Listen and subscribe on Apple, Spotify, Amazon, Google, Stitcher, and Podchaser.
What does it take to lead a health department with a budget of more than $50 billion, overseeing the health of nearly 20 million Americans? Here to tell Henry Bair and Tyler Johnson, MD, about that is Nirav R. Shah, MD, MPH, who was the Commissioner of the New York State Department of Health from 2011 to 2014.
Today, Shah is a nationally recognized advocate for patient safety, healthcare innovation, and high-quality, low-cost care. He has served as chief operating officer of Kaiser Permanente in Southern California, an advisor to the CDC Director, senior fellow of the Institute for Healthcare Improvement, and senior scholar at Stanford University’s Clinical Excellence Research Center.
In this episode, Shah joins Bair and Johnson to share his philosophy of healthcare leadership and how meaningful relationships anchor his work.
In this episode, you will hear about:
- 1:53 How Shah’s upbringing and the influence of Jainism steered him away from a lucrative career in finance and into medicine
- 6:21 Two patient stories in which seemingly simple mistakes led to moments of awakening for Shah in recognizing his purpose in medicine
- 13:47 A brief overview of Shah’s career path
- 19:21 Lessons on empathetic leadership that Shah picked up along the way
- 21:57 How forging strong relationships helped Shah find solutions to big issues during his time as New York State’s Health Commissioner
- 31:23 Shah’s current pursuits, including those focused on making a business case for supporting the unpaid caregivers of patients
- 37:46 Why transparency and bureaucratic structure are critical components of healthcare reform in the U.S.
- 41:43 Advice to clinicians on what makes effective leaders and collaborators, and how to find passion for meaningful projects
Following is a partial transcript (note errors are possible):
Bair: So your career has spanned academia, the public sector, and the private sector, including leading some of the largest public healthcare and largest private healthcare organizations in the nation. Can you take us all the way back to the start and tell us what led you to a career in medicine?
Shah: So I’m a pretty typical Indian kid growing up in Buffalo, New York, with immigrant parents who came here in the 60s. I was born and raised in Buffalo, and when your parents are Indian, they often give you three choices on what you can become: a physician, an MD, or a doctor. So I listen to my parents. My brother actually knew he wanted to be a doctor. I wasn’t sure what I wanted to do. And after college I had an offer from Goldman Sachs to start in New York making more money than my engineer father was. And it was very exciting. Or I could go to Yale Medical School. And ultimately Yale won out because I could always go back and do that other stuff. But being a doctor was a gift, an opportunity of a lifetime. And I’m so glad that my parents gave me those three choices.
Johnson: So when you were making that decision between Goldman Sachs, which, as you say, there would have been a lot of things that probably wouldn’t have been too shabby about doing that, when you were making the decision between that and medicine — so I get that you had three options — but genuinely, what made that decision win out?
Shah: Yeah. As much as I like to joke about making money and other interests that you want to pursue when you’re young, my faith is, I’m a Jain, J-A-I-N religion. And so our faith drives us to serve others. And so that service to others has always been a central theme in my life. And I’ve been very lucky that through my profession I have had that opportunity to serve others. So the opportunity to be a doctor, to do good, to do well, to serve others, was really core to many of my central beliefs.
Johnson: So, Henry and I were talking the other day that we feel like there’s this funny, almost an allergy among many doctors to talking about the spiritual dimension of just about anything. Right? Like if a patient starts to bring up spiritual stuff, it’s like, are there palliative care doctors here? Could we get somebody in? We need a consult, right? Like, there’s just this sort of almost reflexive discomfort.
And so as long as you brought it up, we would actually love to know — because we feel like one of the things that this podcast has done for us has been to sort of uncover the fact that a spiritual element to practice is more important to more physicians than I think we often give it credit for — and so all that is to say that as long as you’re bringing it up, could you talk a little bit about how does your spiritual practice or your spiritual worldview help to motivate you or help to inform the way that you understand what you do in the world of medicine?
Shah: Great question. For me, medicine has been the gift of connecting to people, right? You get to understand who they are, what drives them, what motivates them, and you’re allowed to ask just about anything you want and get honest answers as part of the broader conversation about improving health.
And it’s about generosity. They are being very generous with their own stories, sharing them with you. And it’s a gift to you as a physician to accept those. You understand their values, and you accept it with humility. It gives you the opportunity to then help them help themselves. That’s how I see that give-and-take of being a physician. You’re actually getting a lot, as you know, as a physician, but you’re able to give what the patient needs in front of you based on their own values. That’s going to make the biggest difference for them.
So it’s about understanding that at a deep level as a human being, with all their faults, with all their wishes, with their aspirations, and that is the basis and foundation for the therapeutic relationship that ultimately lets you build toward health and build toward what they want to live their lives as. So I think for me, spirituality means compassion, humility, patience, integrity, very broadly. And those are the kinds of things that my spirituality brings for me into medicine and into the patient encounter.
For the full transcript, visit The Doctor’s Art.
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