Q&A of a Q&A’er: I Interview Jae Won Joh

February 6, 2011 § 3 Comments

By: Andrew Cheung

There are a number of people on Quora who make the place what it is.  Yet for their prolific efforts I found that I knew relatively little about themselves.  This is an experiment to learn more.

This week’s subject is Jae Won Joh, Quora’s resident medical expert.  Strap in and turn your Instapaper on, this one’s a doozy.

All emphasis his.

What keeps you coming back to Quora these days?

A few things:
1) I really like the random bits of knowledge I acquire from reading various Q&A.
2) People upvoting my medical answers: if it’s been a while since I wrote it, I often will reread my own answer for review purposes; if I can add any new information that I’ve picked up, I’ll make a note to do so.
3) Someone asks me to answer a question. I like to look at it and start rolling it over in my head. One thing I’ve noticed is that what is taught in medical school and what people seem to be curious about on Quora are quite radically different.
4) Habit: Quora is one of the first things I check every morning; the intellectual stimulation is a great way to kick my brain into gear.

What areas of medicine would you like to pursue, or have you decided on one?

Warning: this is going to be a fairly long explanation. Let me give you some idea of where I am in my journey to picking a field. When I first came to medical school, I was actually one of the few really interested in primary care–after all, it’s what the classic image of a doctor is, right? The idea of a doctor standing strong with his patients as he helps them fight disease and grow old is such a romantic notion. Screw the specialists, the media says they’re just out for money…
How wrong I was.
After shadowing a family medicine doctor for a year…that love has faded to a mere wisp. Patients who know anything about how their body works beyond the sludge they read in popular magazines and books are rare, and while that’s not really a problem (I love to teach!), I’ve found that very few trust me more than their weekly copy of Cosmo or some new book explaining the latest fad diet. And for those of you reading this who would argue that one of these fad diets worked for you (Paleo included), shut up for a moment and realize that what works for you and even thousands of fellow fanatics can still (and often does) fail miserably for thousands of others[1]. The arrogance I find in people who are not legally liable for the health-related advice they dish out is goddamn infuriating. When you have a real, affordable solution (that you’re willing to be sued for if it doesn’t work) for the people with 60+ BMIs that regularly walk into my county hospital, I might start listening. Maybe. Until then, I’m sticking with the tried and true method of good food (but not too much), good mental health, good exercise, and good rest, all with the humility to admit that everyone has a different balance that works for them.
The other issue I’ve dealt with is non-compliance. It’s a really, really disheartening experience, and I cannot find words that properly express how depressing it is. I recently had a patient “Jamie” who refused to take any medication for high blood pressure, diabetes, and a whole host of other chronic issues for 5 years because she thought she was doing fine on healthy food and exercise–she didn’t have bothersome symptoms, so she ignored her doctor’s instructions to keep taking her medications.
Guess what? The reason I saw Jamie was because she came into the ER with a blood pressure so uncontrollably high it would have killed her without immediate intervention. An echocardiogram of her heart revealed permanent, irreparable structural damage: 5 years of strain had more than halved its pumping ability. How do you even begin to deliver this kind of news to someone, especially when it could have been prevented by a few pills each day?
The experience I’m having with my internal medicine rotation is also worrisome. I really enjoy taking a history, doing a physical exam, looking at lab data and pulling hypotheses/conclusions from them, but that’s a relatively small part of my usual day-to-day work right now, which is disappointing. Most of my time is spent running around making sure labs are run and patient interactions are accurately documented. What’s sad is that as the medical student on the team with only 2-3 patients to manage, I’m often the one who spends the most amount of time with a given patient, since the intern is carrying up to 10 patients; the upper-level resident and attending physician have to keep track of up to 20. Mind you, patient care quality doesn’t really suffer–my superiors can rattle off all the data on a given patient at the drop of a dime, and they stay on top of everything they need to do like well-oiled machines; but it doesn’t change the fact that patients still like to interact with the people who are taking care of them. And I hate that that invaluable time is so limited.
The intellectual/emotional joy is not really there so far in my experience with primary care. And it’s sad. I so, so wanted to go into primary care, especially with the growing shortage that this nation already has. But I don’t think I can deal with this for years without becoming a bitter jaded shell. I care too much to powerlessly watch as patients actively destroy themselves with alcohol, IV drug abuse, smoking, bad food, etc. I think too much about patients’ finances to join the ranks of physicians who often order tests they know are needless, but because of their (legitimate) fear of a medical malpractice lawsuit, they order them anyways, because patients, juries, and judges don’t understand the differential diagnosis process and demand nothing but perfection from a profession fraught with uncertainty. I’m sorry. Call me a coward if you want. I just can’t take it without losing my sanity.
In other words, I don’t dislike primary care because of the salary gap, as the media pundits would have you believe. I dislike it because of the emotional drain from constantly butting heads with people who seem bound and determined to undermine what good I can do for them. Unless something drastically changes my opinion, I’m putting primary care residencies at the bottom of my mental list for now.
I’ve shadowed a decent amount in the ER in my free time, and the adrenaline rush of that experience has thus far been really enjoyable-diagnosis/stabilization of patients is pretty awesome. I’ve also been told by upperclassmen that I might really enjoy surgery, since I’d always be actively doing something that will benefit the patient. Others have pegged me for a future pathologist who chases down puzzles in the lab. Who knows. After over a year of being disillusioned by a field I thought I was going to enter, I have no desire to make any decisions without further experience.

Do your fellow doctors know about your activities on Quora, and dothey have an opinion either way about your contributions?

No one I personally know in the medical field is active on Quora; my undergrad friends David Chiang (we have a long history) and Stephanie Le are both now med students and they were active for a while, but they’ve since quit. My classmate Rishi Kumar was on Quora for about a day. As for doctors I’ve never met, Laszlo B. Tamas is a neurosurgeon who has been very generous with his praise of my contributions; upvotes from him as well as anyone else on this list[2] mean a lot to me.

Are you worried at all that others in the medical community might look down upon your dishing out medical advice?

Somewhat, but I tend to focus on giving out medical information, not advice. I realize that to some, those two are one and the same other than semantics, but it’s an extremely important distinction. I try to explain how aspects of the body work; I rarely give specific advice about anything unless I’m pretty certain that it’s very broadly applicable. Either way, I’m not sure what the medical community at large would think of my Quora activity, particularly given that I’m still just a student.
I do, however, still hope for their approval. The word “doctor” didn’t originally mean “healer”, “provider of cures”, “surgeon”, or anything specific to the field of medicine. In Latin, it means “teacher”, and its origin was the verb “docre”, which means “to teach”. The first line of the Hippocratic oath is not “Do no harm”, as popularly believed–the first line pledges honor to the person who taught the practitioner, and includes a vow to teach others. My Quora activity is, in many ways, my attempt to contribute to the teaching aspect of medicine by spreading what I’ve learned in what is hopefully a readily-digestible format.

Would you/can you see a way to incorporate your contributions into your professional life?

Sort of? My answers often serve as my own quick review material before I jump on UpToDate or Pubmed, so that’s been pretty useful if I have to prepare a presentation or something. Maybe my answers will be read by people who will be future patients; maybe they’ll like/trust me because of them. Maybe some of the entrepreneurial people on the site will be interested in my opinion about a health-related idea. Maybe people will read some of my non-health-related answers and realize that while medicine is a large part of my personality, I have a lot of other facets, and the same is true of all doctors. I honestly have no clue. It’s something I’ve never thought about. If anyone has suggestions, feel free to PM me.

Would you donate your body to science?

Of course. I can honestly think of no better way for my death to be useful to humankind than to serve as an educational experience for hundreds of doctors-in-training who will go on to use that experience to affect thousands of lives.

Out of the ~400 answers you’ve given to the site, are you particularly proud of any of them?

Quite a few, whether it’s because of the upvotes or the research it took to write the answer. Sorted loosely by category:
Medical school:
I really enjoyed answering this question because it struck a chord with emotions I’ve felt about medicine on multiple occasions. Everyone who’s been in med school more than a few months has wondered it they’re really cut out for the job, and has questioned why they’re putting themselves through the rather grueling process. Some people do end up dropping out. This question granted me a unique opportunity to connect with someone who’s struggling with a major career choice, and hopefully give her some food for thought.
Others:
Physiology:
This was the first of many long answers I’ve since written, and I’m really pleased with how much practical information it contains. Pregnancy is a topic that many people are interested in, and I did my best to give a balance of good background, appropriate warnings, and proven advice. Major kudos to my nutrition professor for providing such a strong foundation to this answer!
Others:
Medicine:
freaked out when I saw this question, and immediately opened Pubmed. The search results showed that poorly executed vegan diets for babies have commonly been reported in the medical literature, and I sat in front of my computer for the next 3 hours hammering out this answer. I don’t know that I would say I’m proud of it, per se, but given how many views the question has gotten and how many upvotes the answer has received, I’m hoping that people who choose vegan diets for their babies are at least better informed of the inherent risks. The commentary on my answer has been pretty nifty as well.
Others:
Life:
Most of this answer came from a talk given by my neuroscience professor, but it still took me 6 hours of typing. Formatting a speech in such fashion that it can be read equally well on paper was a surprisingly difficult task (the punctuation is so, so key), especially since I was trying to incorporate my own thoughts at the same time. I started around midnight, and ended up going to bed at 6AM after rereading it multiple times to ensure clarity, flow, and consistency. I’m pretty happy with how it turned out, and it’s sparked a lot of interesting debate.
Others:

I see that some of your answers come with a disclaimer at the bottom.This seems like a recent thing.  What prompted it?

I generally try to remember to pop a disclaimer on answers that contain a great deal of medical information, simply because even at this early stage in my training, I already have a very healthy respect for the legal repercussions of people who might misunderstand and misuse the knowledge I share. I haven’t yet heard of a medical professional who’s been sued for medical knowledge shared online, but I have the feeling it’s coming, and I’d like to avoid being the first.:-/

In what ways could you get more out of the site? — As in, what features are lacking that you would like to see? How could the experience be improved for a power user? What kinds of voices are lacking? Do you see any inherent problems that will hamper Quora’sability to scale? If there is anything about Quora you could change for the better, what would it be?

I really wish there were more analytics available–I’d love to be able to sort all my answers by upvotes/downvotes, # of views, # people following the question, etc. I love data, and there’s not a great way to really crunch numbers. Better analytics would really help me analyze what style of answer seems to really click with people.
This would also help a ton in figuring out who to follow. Back in the early days of Quora, I used to follow everyone who followed me, because just about everyone had excellent answers. Nowadays, I rarely follow anyone because I’m worried that my signal-to-noise ratio will become annoyingly disproportionate (I actually did a mass un-follow at one point, and do not regret a single click of “Unfollow”). With time being limited, I only want to follow people whose answers are consistently “high-yield”, and when I hit a user’s profile, there’s not a great way to help me determine that. “Recent Top Answers” are somewhat helpful, but I’d also like to see the most popular answers they’ve ever given–let me see when people have had their finest moments!
I honestly don’t like Quora’s current attempts at being “social”, and I think it’s a big reason many new users don’t stick around. Starting people off by connecting them to their Facebook/Twitter networks is fine, but right now, the suggestions for other users to follow are utterly inconsistent with the website’s stated goal. Creating “a continually improving collection of questions and answers” means that the impetus for interaction is knowledge, which is entirely different from Facebook (staying in touch) or Twitter (random peoples’ musings), and Quora doesn’t seem to have fully embraced that yet. On Quora, I only want to follow experts in the topics I’m interested in; whether I know them or not is utterly irrelevant. I wish the suggestions on the home page would reflect that, both for myself and other users.
And the Proust Questionnaire:

What is your idea of perfect happiness?

Researching medical ethics and working on ways to optimize the use of technology in medicine while teaching the next generation of medical students and living in a hobbit-style home (built into a hill, round door, cute windows with flowerbeds, the whole nine yards) with a beautiful woman who can match/outdo me intellectually and 3-5 kids.

What is your greatest fear?

That I will die without having made this world a better place to the utmost of my ability.

Which historical figure do you most identify with?

No clue. I’ve never been one to identify with a specific person, historical or otherwise–I just read about them to learn from their accomplishments/thoughts and then move on.

Which living person do you most admire?

See above.

What is the trait you most deplore in yourself?

I don’t do a very good job of keeping up with old friends. If any are reading this, holla.

What is the trait you most deplore in others?

Three-way tie between apathy, not being authentic, and malice. The worst mistake you could possibly make is hurting someone I care about.

What is your greatest extravagance?

My education. I’m already ~$60K in debt, and will probably rack up another $80K or so before I’m done.

On what occasion do you lie?

I have yet to lie in my professional life, and I intend to keep it that way. In terms of personal life, I don’t really lie there either; I’m a pretty open person, and I really have no reason to lie about anything.

What do you dislike most about your appearance?

I hate having facial hair, so I try to keep it shaved whenever possible.

When and where were you happiest?

To be honest, I rarely experience huge peaks of emotion, so I’d say I’m happiest whenever I’m hanging out with people I care about–I especially love cuddling.😉
If you could change one thing about yourself, what would it be?

Maybe height? I’m 6′, but I’ve always had a hankering to be 6’2″ or so, just so that I have some extra barrier against the inevitable decline in height that will occur with old age.

If you could change one thing about your family, what would it be?

I wish I had siblings.

What do you consider your greatest achievement?

Every time I have taught someone something successfully.

If you died and came back as a person or a thing what do you think it would be?

Probably a Zen martial artist monk.

What is your most treasured possession?

My brain.

What do you regard as the lowest depth of misery?

Loneliness.

Who are your heroes in real life?

Anyone who teaches me something.

What is it you most dislike?

Honestly, don’t have an answer off the top of my head.

How would you like to die?

Peacefully at home in the presence of my family.

What is your motto?

Just love the people you love, make their lives better, and they’ll do the same for you. Try to leave the world a better place than when you came into it, I guess. What else is there, really? Love only grows when you give it away.
Andy Cheung makes things with software.  He currently likes mobile stuff, visualizations, and Quora.

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