Member Spotlight

Lisa Mathew, MD, wants to quell any misconceptions that private practice is dull or routine. “That has not been my experience at all,” says Dr. Mathew, a partner with South Denver Gastroenterology in the suburbs of Denver, Colorado.

For Dr. Mathew, working in private practice offers a rich professional experience, not just in the day-to-day experiences of medicine, but in practice management innovation and patient care delivery. “It’s an area within GI where we can be quite nimble in trialing new technologies, optimizing patients’ access to care and working to ensure a positive patient experience,” she said.

Nationwide, a flourishing GI private practice community engages in ongoing dialogue about improvements, navigating a changing healthcare environment, and innovation. “That has been a surprising and wonderful twist in my career,” she added.

uem

Dr. Mathew fosters that dialogue through Gastro Broadcast, a podcast she shares with several other GI physicians. Targeted toward private GI practice, it highlights innovations within the community, providing updates on practice management and other technological advances.

In an interview, she spoke frankly about her favorite recent podcast guest, the challenges she’s faced in her career, and why her fellow GI specialists are her “tribe.”
 

Q: Why did you choose GI?

Dr. Mathew: In medical school at Duke University, I was considering going into ob.gyn., but academically I was a little more drawn toward internal medicine. While I was in my residency at the University of Pennsylvania, I really clicked with the gastroenterologists. I enjoyed their sense of humor. They were dealing with complex medical issues but doing so with a sense of levity and enjoyment in their work. When I entered fellowship at the University of Washington, I felt like I found my tribe. This was a group of people who really love their work, love medicine, love being able to develop their procedural skills, and keep a sense of humor about themselves. I married a cardiologist (and he’s a hilarious cardiologist), but the world of cardiology is a little more buttoned up. I like that GI is a little more relaxed.

Q: What gives you the most joy in your day-to-day practice?

Dr. Mathew: My patients. They are funny and genuine, and they allow you into these moments of vulnerability — it’s an honor to walk through that together. I’m always so grateful for the trust they put in me in those moments. As my practice has matured, it’s been incredible to watch those relationships grow, as well as begin caring for husbands, wives, sons and daughters of my patients. I enjoy being a part of my community.

Q: Can you talk about an interesting recent guest you had on your podcast? Who was it and why did he or she stand out?

Dr. Mathew: Russ Arjal, MD, AGAF, cofounder, chief medical officer and president of Telebelly Health. He’s been working on a platform for exclusively telehealth services that improves access to care; pairing patients with brick-and-mortar gastroenterology to provide any necessary procedural care, such as colonoscopy and upper endoscopy. It was a fantastic interview. I think it’s so refreshing and inspiring to see how people innovate within the field of GI. On the procedural side, you see this all the time. With my advanced endoscopy colleagues, they’re constantly pushing the boundaries of what we can do procedurally. My academic colleagues are constantly thinking through what the next best treatment is or how best can we optimize care. And, in the world of private practice, we’re thinking about practice care delivery — how to improve access and make the experience of being a patient better, with the ultimate goal of improving health outcomes.
 

Q: What fears did you have to push past to get to where you are in your career?

Dr. Mathew: Imposter Syndrome is a very, very common issue, maybe somewhat more for women in GI. I think it’s something that everybody wrestles with to some degree. For me, it was developing confidence not just in my clinical skills, but in learning all the complexities of running a small business. It takes time to develop confidence in your abilities and judgment. I think to some degree, that’s normal. It just takes a while to settle into whatever your chosen career path is. Having a community and strong mentors to support me has made all the difference.

Q: Describe your biggest practice-related challenge and what you are doing to address it.

Dr. Mathew: One of the greatest challenges in my career has been navigating COVID — both with just the tremendous sea change it had on our ability to practice, as well as the financial consequences to someone in private practice. Those were very challenging times to deliver the care that was needed, protect staff, and to maintain a small business. Fortunately, as with many practices across the nation, we’ve emerged through that.

We pivoted, we innovated with telehealth and other services that allowed us to care for our patients. But there were a lot of lessons learned and a lot of difficult moments.
 

Q: What teacher or mentor had the greatest impact on you?

Dr. Mathew: My dad has taught me the value of hard work. Being a physician just comes in tandem with hard work. And my mom, who is a nurse, has always shown the importance of empathy. Without it, everything else is a little empty. Medicine is a combination of skill and hard work, but also an ability to connect with other people. Empathy is essential to that.

Q: Describe how you would spend a free Saturday afternoon.

Dr. Mathew: We have three children who are native Coloradans so skiing is their birthright. Our entire family are diehard skiers. This is our joy. When you talk about the beach versus mountains debate, we are firmly team mountains. On a perfect Saturday afternoon, I’m on the slopes with my little crew, just tearing it up, having a great time.

Lightning Round

Texting or talking?

Texting

Favorite city in U.S. besides the one you live in?

Washington, D.C.

Favorite breakfast?

Avocado toast

Place you most want to travel to?

South America

Favorite junk food?

Candy

Favorite season?

Winter

How many cups of coffee do you drink per day?

2 or 3

If you weren’t a gastroenterologist, what would you be?

Ski coach

Best Halloween costume you ever wore?

Bunch of grapes

Favorite type of music?

Indie folk

Favorite movie genre?

Books, not into movies

Cat person or dog person?

Neither, but I am a certified beekeeper

What song do you have to sing along with when you hear it?

Anything by Queen

Introvert or extrovert?

Extrovert with introverted tendencies

Favorite holiday?

Thanksgiving

Optimist or pessimist?

100% glass half full

Lisa Mathew, MD, wants to quell any misconceptions that private practice is dull or routine. “That has not been my experience at all,” says Dr. Mathew, a partner with South Denver Gastroenterology in the suburbs of Denver, Colorado.

For Dr. Mathew, working in private practice offers a rich professional experience, not just in the day-to-day experiences of medicine, but in practice management innovation and patient care delivery. “It’s an area within GI where we can be quite nimble in trialing new technologies, optimizing patients’ access to care and working to ensure a positive patient experience,” she said.

Nationwide, a flourishing GI private practice community engages in ongoing dialogue about improvements, navigating a changing healthcare environment, and innovation. “That has been a surprising and wonderful twist in my career,” she added.

uem

Dr. Mathew fosters that dialogue through Gastro Broadcast, a podcast she shares with several other GI physicians. Targeted toward private GI practice, it highlights innovations within the community, providing updates on practice management and other technological advances.

In an interview, she spoke frankly about her favorite recent podcast guest, the challenges she’s faced in her career, and why her fellow GI specialists are her “tribe.”
 

Q: Why did you choose GI?

Dr. Mathew: In medical school at Duke University, I was considering going into ob.gyn., but academically I was a little more drawn toward internal medicine. While I was in my residency at the University of Pennsylvania, I really clicked with the gastroenterologists. I enjoyed their sense of humor. They were dealing with complex medical issues but doing so with a sense of levity and enjoyment in their work. When I entered fellowship at the University of Washington, I felt like I found my tribe. This was a group of people who really love their work, love medicine, love being able to develop their procedural skills, and keep a sense of humor about themselves. I married a cardiologist (and he’s a hilarious cardiologist), but the world of cardiology is a little more buttoned up. I like that GI is a little more relaxed.

Q: What gives you the most joy in your day-to-day practice?

Dr. Mathew: My patients. They are funny and genuine, and they allow you into these moments of vulnerability — it’s an honor to walk through that together. I’m always so grateful for the trust they put in me in those moments. As my practice has matured, it’s been incredible to watch those relationships grow, as well as begin caring for husbands, wives, sons and daughters of my patients. I enjoy being a part of my community.

Q: Can you talk about an interesting recent guest you had on your podcast? Who was it and why did he or she stand out?

Dr. Mathew: Russ Arjal, MD, AGAF, cofounder, chief medical officer and president of Telebelly Health. He’s been working on a platform for exclusively telehealth services that improves access to care; pairing patients with brick-and-mortar gastroenterology to provide any necessary procedural care, such as colonoscopy and upper endoscopy. It was a fantastic interview. I think it’s so refreshing and inspiring to see how people innovate within the field of GI. On the procedural side, you see this all the time. With my advanced endoscopy colleagues, they’re constantly pushing the boundaries of what we can do procedurally. My academic colleagues are constantly thinking through what the next best treatment is or how best can we optimize care. And, in the world of private practice, we’re thinking about practice care delivery — how to improve access and make the experience of being a patient better, with the ultimate goal of improving health outcomes.
 

Q: What fears did you have to push past to get to where you are in your career?

Dr. Mathew: Imposter Syndrome is a very, very common issue, maybe somewhat more for women in GI. I think it’s something that everybody wrestles with to some degree. For me, it was developing confidence not just in my clinical skills, but in learning all the complexities of running a small business. It takes time to develop confidence in your abilities and judgment. I think to some degree, that’s normal. It just takes a while to settle into whatever your chosen career path is. Having a community and strong mentors to support me has made all the difference.

Q: Describe your biggest practice-related challenge and what you are doing to address it.

Dr. Mathew: One of the greatest challenges in my career has been navigating COVID — both with just the tremendous sea change it had on our ability to practice, as well as the financial consequences to someone in private practice. Those were very challenging times to deliver the care that was needed, protect staff, and to maintain a small business. Fortunately, as with many practices across the nation, we’ve emerged through that.

We pivoted, we innovated with telehealth and other services that allowed us to care for our patients. But there were a lot of lessons learned and a lot of difficult moments.
 

Q: What teacher or mentor had the greatest impact on you?

Dr. Mathew: My dad has taught me the value of hard work. Being a physician just comes in tandem with hard work. And my mom, who is a nurse, has always shown the importance of empathy. Without it, everything else is a little empty. Medicine is a combination of skill and hard work, but also an ability to connect with other people. Empathy is essential to that.

Q: Describe how you would spend a free Saturday afternoon.

Dr. Mathew: We have three children who are native Coloradans so skiing is their birthright. Our entire family are diehard skiers. This is our joy. When you talk about the beach versus mountains debate, we are firmly team mountains. On a perfect Saturday afternoon, I’m on the slopes with my little crew, just tearing it up, having a great time.

Lightning Round

Texting or talking?

Texting

Favorite city in U.S. besides the one you live in?

Washington, D.C.

Favorite breakfast?

Avocado toast

Place you most want to travel to?

South America

Favorite junk food?

Candy

Favorite season?

Winter

How many cups of coffee do you drink per day?

2 or 3

If you weren’t a gastroenterologist, what would you be?

Ski coach

Best Halloween costume you ever wore?

Bunch of grapes

Favorite type of music?

Indie folk

Favorite movie genre?

Books, not into movies

Cat person or dog person?

Neither, but I am a certified beekeeper

What song do you have to sing along with when you hear it?

Anything by Queen

Introvert or extrovert?

Extrovert with introverted tendencies

Favorite holiday?

Thanksgiving

Optimist or pessimist?

100% glass half full

Lisa Mathew, MD, wants to quell any misconceptions that private practice is dull or routine. “That has not been my experience at all,” says Dr. Mathew, a partner with South Denver Gastroenterology in the suburbs of Denver, Colorado.

For Dr. Mathew, working in private practice offers a rich professional experience, not just in the day-to-day experiences of medicine, but in practice management innovation and patient care delivery. “It’s an area within GI where we can be quite nimble in trialing new technologies, optimizing patients’ access to care and working to ensure a positive patient experience,” she said.

Nationwide, a flourishing GI private practice community engages in ongoing dialogue about improvements, navigating a changing healthcare environment, and innovation. “That has been a surprising and wonderful twist in my career,” she added.

uem

Dr. Mathew fosters that dialogue through Gastro Broadcast, a podcast she shares with several other GI physicians. Targeted toward private GI practice, it highlights innovations within the community, providing updates on practice management and other technological advances.

In an interview, she spoke frankly about her favorite recent podcast guest, the challenges she’s faced in her career, and why her fellow GI specialists are her “tribe.”
 

Q: Why did you choose GI?

Dr. Mathew: In medical school at Duke University, I was considering going into ob.gyn., but academically I was a little more drawn toward internal medicine. While I was in my residency at the University of Pennsylvania, I really clicked with the gastroenterologists. I enjoyed their sense of humor. They were dealing with complex medical issues but doing so with a sense of levity and enjoyment in their work. When I entered fellowship at the University of Washington, I felt like I found my tribe. This was a group of people who really love their work, love medicine, love being able to develop their procedural skills, and keep a sense of humor about themselves. I married a cardiologist (and he’s a hilarious cardiologist), but the world of cardiology is a little more buttoned up. I like that GI is a little more relaxed.

Q: What gives you the most joy in your day-to-day practice?

Dr. Mathew: My patients. They are funny and genuine, and they allow you into these moments of vulnerability — it’s an honor to walk through that together. I’m always so grateful for the trust they put in me in those moments. As my practice has matured, it’s been incredible to watch those relationships grow, as well as begin caring for husbands, wives, sons and daughters of my patients. I enjoy being a part of my community.

Q: Can you talk about an interesting recent guest you had on your podcast? Who was it and why did he or she stand out?

Dr. Mathew: Russ Arjal, MD, AGAF, cofounder, chief medical officer and president of Telebelly Health. He’s been working on a platform for exclusively telehealth services that improves access to care; pairing patients with brick-and-mortar gastroenterology to provide any necessary procedural care, such as colonoscopy and upper endoscopy. It was a fantastic interview. I think it’s so refreshing and inspiring to see how people innovate within the field of GI. On the procedural side, you see this all the time. With my advanced endoscopy colleagues, they’re constantly pushing the boundaries of what we can do procedurally. My academic colleagues are constantly thinking through what the next best treatment is or how best can we optimize care. And, in the world of private practice, we’re thinking about practice care delivery — how to improve access and make the experience of being a patient better, with the ultimate goal of improving health outcomes.
 

Q: What fears did you have to push past to get to where you are in your career?

Dr. Mathew: Imposter Syndrome is a very, very common issue, maybe somewhat more for women in GI. I think it’s something that everybody wrestles with to some degree. For me, it was developing confidence not just in my clinical skills, but in learning all the complexities of running a small business. It takes time to develop confidence in your abilities and judgment. I think to some degree, that’s normal. It just takes a while to settle into whatever your chosen career path is. Having a community and strong mentors to support me has made all the difference.

Q: Describe your biggest practice-related challenge and what you are doing to address it.

Dr. Mathew: One of the greatest challenges in my career has been navigating COVID — both with just the tremendous sea change it had on our ability to practice, as well as the financial consequences to someone in private practice. Those were very challenging times to deliver the care that was needed, protect staff, and to maintain a small business. Fortunately, as with many practices across the nation, we’ve emerged through that.

We pivoted, we innovated with telehealth and other services that allowed us to care for our patients. But there were a lot of lessons learned and a lot of difficult moments.
 

Q: What teacher or mentor had the greatest impact on you?

Dr. Mathew: My dad has taught me the value of hard work. Being a physician just comes in tandem with hard work. And my mom, who is a nurse, has always shown the importance of empathy. Without it, everything else is a little empty. Medicine is a combination of skill and hard work, but also an ability to connect with other people. Empathy is essential to that.

Q: Describe how you would spend a free Saturday afternoon.

Dr. Mathew: We have three children who are native Coloradans so skiing is their birthright. Our entire family are diehard skiers. This is our joy. When you talk about the beach versus mountains debate, we are firmly team mountains. On a perfect Saturday afternoon, I’m on the slopes with my little crew, just tearing it up, having a great time.

Lightning Round

Texting or talking?

Texting

Favorite city in U.S. besides the one you live in?

Washington, D.C.

Favorite breakfast?

Avocado toast

Place you most want to travel to?

South America

Favorite junk food?

Candy

Favorite season?

Winter

How many cups of coffee do you drink per day?

2 or 3

If you weren’t a gastroenterologist, what would you be?

Ski coach

Best Halloween costume you ever wore?

Bunch of grapes

Favorite type of music?

Indie folk

Favorite movie genre?

Books, not into movies

Cat person or dog person?

Neither, but I am a certified beekeeper

What song do you have to sing along with when you hear it?

Anything by Queen

Introvert or extrovert?

Extrovert with introverted tendencies

Favorite holiday?

Thanksgiving

Optimist or pessimist?

100% glass half full

What exactly is a healthy diet?

Scott Ketover, MD, AGAF, FASGE, will be the first to admit that’s not an easy question to answer. “As much research and information as we have, we don’t really know what a healthy diet is,” said Dr. Ketover, president and CEO of MNGI Digestive Health in Minneapolis, Minnesota. He was recognized by AGA this year with the Distinguished Clinician Award in Private Practice.

When patients ask questions about a healthy diet, Dr. Ketover responds with a dose of common sense: “If it’s food that didn’t exist in the year 1900, don’t eat it.” Your grandmother’s apple pie is fine in moderation, he said, but the apple pie you get at the McDonald’s drive-through could sit on your shelf for 6 months and look the same.

That is not something you should eat, he emphasizes.

tastiwrucuspiswechipothuno

Q: Why did you choose GI? 

Dr. Ketover: I was a medical student working on my pediatrics rotation at Children’s Minnesota (Minneapolis Pediatrics Hospital). A 17-year-old young man who had Crohn’s disease really turned this into my lifelong passion. The patient confided in me that when he was 11, he had an ileostomy. He wore an ileostomy bag for 6 years and kept it hidden from all his friends. He was petrified of their knowing. And he told me at the age of 17 that if he knew how hard it was going to be to keep that secret, he would’ve preferred to have died rather than have the ileostomy. That got me thinking a lot about Crohn’s disease, and certainly how it affects patients. It became a very motivating thing for me to be involved in something that could potentially prevent this situation for others. 

Today, we have much better treatment for Crohn’s than we did 30 years ago. So that’s all a good thing. 
 

Q: Wellness and therapeutic diets are a specific interest of yours. Can you talk about this?

Dr. Ketover: We talk about things like Cheetos, Twinkies — those are not real foods. I do direct patients to ‘think’ when they go to the grocery store. All the good stuff is in the perimeter of the store. When you walk down the aisles, it’s all the processed food with added chemicals. It’s hard to point at specific things though and say: this is bad for you, but we do know that we should eat real food as often as we can. And I think that will contribute to our knowledge and learning about the intestinal microbiome. Again, we’re really at the beginning of our infancy of this, even though there’s lots of probiotics and things out there that claim to make you healthier. We don’t really know yet. And it’s going to take more time. 

Q: What role does diet play in improving the intestinal microbiome? 

Dr. Ketover: When you look at people who are healthy and who have low incidence of chronic diseases or inflammatory conditions, obesity, cancer, we’re starting to study their microbiome to see how it differs from people who have those illnesses and conditions and try to understand what the different constituents are of the microbiome. And then the big question is: Okay, so once we know that, how do we take ‘the unhealthy microbiome’ and change it to the ‘healthy microbiome’?

The only method we currently have is fecal transplant for Clostridioides difficile. And that’s just not a feasible way to change the microbiome for most people. 

Some studies are going on with this. There’s been laboratory studies done with lab animals that show that fecal transplant can reverse obesity.
 

Q: Describe your biggest practice-related challenge and what you are doing to address it. 

Dr. Ketover: The biggest challenge these days for medical practices is the relationship with the payer world and prior authorization. Where we’ve seen the greatest impact of prior authorization, unfortunately, is in the Medicare Advantage programs. Payers receive money from the federal government on plans that they can better manage the patient on, rather than Medicare. That results in a tremendous amount of prior authorization.

I get particularly incensed when I see that a lot of payers are practicing medicine without a license and they’re not relying on the professionals who are actually in the exam room with patients and doing the history and physical examination to determine what is an appropriate course of diagnosis or therapy for a patient.

It comes around every January. We have patients who are stable on meds, then their insurance gets renewed and the pharmacy formulary changes. Patients stable on various therapies are either kicked off them, or we have to go through the prior authorization process again for the same patient for the umpteenth time to keep them on a stable therapy.

How do I address that? It’s in conversations with payers and policy makers. There’s a lot going on in Washington, talking about prior authorization. I’m not sure that non-practitioners fully feel the pain that it delivers to patients.
 

Q: What teacher or mentor had the greatest impact on you?

Dr. Ketover: Phillip M. Kibort, MD, the pediatric physician I worked with as a medical student who really turned me on to GI medicine. We worked together on several patients and I was able to develop an appreciation for the breadth and depth of GI-related abnormalities and diseases and therapies. And I really got excited by the spectrum of opportunity that I would have as a physician to help treat patients with GI illness. 

Q: What would you do differently if you had a chance?

Dr. Ketover: I’d travel more both for work and for pleasure. I really enjoy my relationships that I’ve created with lots of other gastroenterologists as well as non-physicians around policy issues. I’m involved in a couple of national organizations that talk to politicians on Capitol Hill and at state houses about patient advocacy. I would have done more of that earlier in my career if I could have.

Q: What do you like to do in your free time?

Dr. Ketover: I like to run, bike, walk. I like being outside as much as possible and enjoy being active.

Lightning Round

Texting or talking?

Texting, very efficient

Favorite city in U.S. besides the one you live in?

Waikiki, Honolulu

Favorite breakfast?

Pancakes

Place you most want to travel to?

Australia and New Zealand

Favorite junk food?

Pretzels and ice cream

Favorite season?

Summer

How many cups of coffee do you drink per day?

2-3

If you weren’t a gastroenterologist, what would you be?

Public policy writer

Who inspires you?

My wife

Best Halloween costume you ever wore?

Cowboy

Favorite type of music?

Classic rock

Favorite movie genre?

Science fiction, space exploration

Cat person or dog person?

Dog

Favorite sport?

Football — to watch

What song do you have to sing along with when you hear it?

Bohemian Rhapsody

Introvert or extrovert?

Introvert

Optimist or pessimist?

Optimist

What exactly is a healthy diet?

Scott Ketover, MD, AGAF, FASGE, will be the first to admit that’s not an easy question to answer. “As much research and information as we have, we don’t really know what a healthy diet is,” said Dr. Ketover, president and CEO of MNGI Digestive Health in Minneapolis, Minnesota. He was recognized by AGA this year with the Distinguished Clinician Award in Private Practice.

When patients ask questions about a healthy diet, Dr. Ketover responds with a dose of common sense: “If it’s food that didn’t exist in the year 1900, don’t eat it.” Your grandmother’s apple pie is fine in moderation, he said, but the apple pie you get at the McDonald’s drive-through could sit on your shelf for 6 months and look the same.

That is not something you should eat, he emphasizes.

tastiwrucuspiswechipothuno

Q: Why did you choose GI? 

Dr. Ketover: I was a medical student working on my pediatrics rotation at Children’s Minnesota (Minneapolis Pediatrics Hospital). A 17-year-old young man who had Crohn’s disease really turned this into my lifelong passion. The patient confided in me that when he was 11, he had an ileostomy. He wore an ileostomy bag for 6 years and kept it hidden from all his friends. He was petrified of their knowing. And he told me at the age of 17 that if he knew how hard it was going to be to keep that secret, he would’ve preferred to have died rather than have the ileostomy. That got me thinking a lot about Crohn’s disease, and certainly how it affects patients. It became a very motivating thing for me to be involved in something that could potentially prevent this situation for others. 

Today, we have much better treatment for Crohn’s than we did 30 years ago. So that’s all a good thing. 
 

Q: Wellness and therapeutic diets are a specific interest of yours. Can you talk about this?

Dr. Ketover: We talk about things like Cheetos, Twinkies — those are not real foods. I do direct patients to ‘think’ when they go to the grocery store. All the good stuff is in the perimeter of the store. When you walk down the aisles, it’s all the processed food with added chemicals. It’s hard to point at specific things though and say: this is bad for you, but we do know that we should eat real food as often as we can. And I think that will contribute to our knowledge and learning about the intestinal microbiome. Again, we’re really at the beginning of our infancy of this, even though there’s lots of probiotics and things out there that claim to make you healthier. We don’t really know yet. And it’s going to take more time. 

Q: What role does diet play in improving the intestinal microbiome? 

Dr. Ketover: When you look at people who are healthy and who have low incidence of chronic diseases or inflammatory conditions, obesity, cancer, we’re starting to study their microbiome to see how it differs from people who have those illnesses and conditions and try to understand what the different constituents are of the microbiome. And then the big question is: Okay, so once we know that, how do we take ‘the unhealthy microbiome’ and change it to the ‘healthy microbiome’?

The only method we currently have is fecal transplant for Clostridioides difficile. And that’s just not a feasible way to change the microbiome for most people. 

Some studies are going on with this. There’s been laboratory studies done with lab animals that show that fecal transplant can reverse obesity.
 

Q: Describe your biggest practice-related challenge and what you are doing to address it. 

Dr. Ketover: The biggest challenge these days for medical practices is the relationship with the payer world and prior authorization. Where we’ve seen the greatest impact of prior authorization, unfortunately, is in the Medicare Advantage programs. Payers receive money from the federal government on plans that they can better manage the patient on, rather than Medicare. That results in a tremendous amount of prior authorization.

I get particularly incensed when I see that a lot of payers are practicing medicine without a license and they’re not relying on the professionals who are actually in the exam room with patients and doing the history and physical examination to determine what is an appropriate course of diagnosis or therapy for a patient.

It comes around every January. We have patients who are stable on meds, then their insurance gets renewed and the pharmacy formulary changes. Patients stable on various therapies are either kicked off them, or we have to go through the prior authorization process again for the same patient for the umpteenth time to keep them on a stable therapy.

How do I address that? It’s in conversations with payers and policy makers. There’s a lot going on in Washington, talking about prior authorization. I’m not sure that non-practitioners fully feel the pain that it delivers to patients.
 

Q: What teacher or mentor had the greatest impact on you?

Dr. Ketover: Phillip M. Kibort, MD, the pediatric physician I worked with as a medical student who really turned me on to GI medicine. We worked together on several patients and I was able to develop an appreciation for the breadth and depth of GI-related abnormalities and diseases and therapies. And I really got excited by the spectrum of opportunity that I would have as a physician to help treat patients with GI illness. 

Q: What would you do differently if you had a chance?

Dr. Ketover: I’d travel more both for work and for pleasure. I really enjoy my relationships that I’ve created with lots of other gastroenterologists as well as non-physicians around policy issues. I’m involved in a couple of national organizations that talk to politicians on Capitol Hill and at state houses about patient advocacy. I would have done more of that earlier in my career if I could have.

Q: What do you like to do in your free time?

Dr. Ketover: I like to run, bike, walk. I like being outside as much as possible and enjoy being active.

Lightning Round

Texting or talking?

Texting, very efficient

Favorite city in U.S. besides the one you live in?

Waikiki, Honolulu

Favorite breakfast?

Pancakes

Place you most want to travel to?

Australia and New Zealand

Favorite junk food?

Pretzels and ice cream

Favorite season?

Summer

How many cups of coffee do you drink per day?

2-3

If you weren’t a gastroenterologist, what would you be?

Public policy writer

Who inspires you?

My wife

Best Halloween costume you ever wore?

Cowboy

Favorite type of music?

Classic rock

Favorite movie genre?

Science fiction, space exploration

Cat person or dog person?

Dog

Favorite sport?

Football — to watch

What song do you have to sing along with when you hear it?

Bohemian Rhapsody

Introvert or extrovert?

Introvert

Optimist or pessimist?

Optimist

What exactly is a healthy diet?

Scott Ketover, MD, AGAF, FASGE, will be the first to admit that’s not an easy question to answer. “As much research and information as we have, we don’t really know what a healthy diet is,” said Dr. Ketover, president and CEO of MNGI Digestive Health in Minneapolis, Minnesota. He was recognized by AGA this year with the Distinguished Clinician Award in Private Practice.

When patients ask questions about a healthy diet, Dr. Ketover responds with a dose of common sense: “If it’s food that didn’t exist in the year 1900, don’t eat it.” Your grandmother’s apple pie is fine in moderation, he said, but the apple pie you get at the McDonald’s drive-through could sit on your shelf for 6 months and look the same.

That is not something you should eat, he emphasizes.

tastiwrucuspiswechipothuno

Q: Why did you choose GI? 

Dr. Ketover: I was a medical student working on my pediatrics rotation at Children’s Minnesota (Minneapolis Pediatrics Hospital). A 17-year-old young man who had Crohn’s disease really turned this into my lifelong passion. The patient confided in me that when he was 11, he had an ileostomy. He wore an ileostomy bag for 6 years and kept it hidden from all his friends. He was petrified of their knowing. And he told me at the age of 17 that if he knew how hard it was going to be to keep that secret, he would’ve preferred to have died rather than have the ileostomy. That got me thinking a lot about Crohn’s disease, and certainly how it affects patients. It became a very motivating thing for me to be involved in something that could potentially prevent this situation for others. 

Today, we have much better treatment for Crohn’s than we did 30 years ago. So that’s all a good thing. 
 

Q: Wellness and therapeutic diets are a specific interest of yours. Can you talk about this?

Dr. Ketover: We talk about things like Cheetos, Twinkies — those are not real foods. I do direct patients to ‘think’ when they go to the grocery store. All the good stuff is in the perimeter of the store. When you walk down the aisles, it’s all the processed food with added chemicals. It’s hard to point at specific things though and say: this is bad for you, but we do know that we should eat real food as often as we can. And I think that will contribute to our knowledge and learning about the intestinal microbiome. Again, we’re really at the beginning of our infancy of this, even though there’s lots of probiotics and things out there that claim to make you healthier. We don’t really know yet. And it’s going to take more time. 

Q: What role does diet play in improving the intestinal microbiome? 

Dr. Ketover: When you look at people who are healthy and who have low incidence of chronic diseases or inflammatory conditions, obesity, cancer, we’re starting to study their microbiome to see how it differs from people who have those illnesses and conditions and try to understand what the different constituents are of the microbiome. And then the big question is: Okay, so once we know that, how do we take ‘the unhealthy microbiome’ and change it to the ‘healthy microbiome’?

The only method we currently have is fecal transplant for Clostridioides difficile. And that’s just not a feasible way to change the microbiome for most people. 

Some studies are going on with this. There’s been laboratory studies done with lab animals that show that fecal transplant can reverse obesity.
 

Q: Describe your biggest practice-related challenge and what you are doing to address it. 

Dr. Ketover: The biggest challenge these days for medical practices is the relationship with the payer world and prior authorization. Where we’ve seen the greatest impact of prior authorization, unfortunately, is in the Medicare Advantage programs. Payers receive money from the federal government on plans that they can better manage the patient on, rather than Medicare. That results in a tremendous amount of prior authorization.

I get particularly incensed when I see that a lot of payers are practicing medicine without a license and they’re not relying on the professionals who are actually in the exam room with patients and doing the history and physical examination to determine what is an appropriate course of diagnosis or therapy for a patient.

It comes around every January. We have patients who are stable on meds, then their insurance gets renewed and the pharmacy formulary changes. Patients stable on various therapies are either kicked off them, or we have to go through the prior authorization process again for the same patient for the umpteenth time to keep them on a stable therapy.

How do I address that? It’s in conversations with payers and policy makers. There’s a lot going on in Washington, talking about prior authorization. I’m not sure that non-practitioners fully feel the pain that it delivers to patients.
 

Q: What teacher or mentor had the greatest impact on you?

Dr. Ketover: Phillip M. Kibort, MD, the pediatric physician I worked with as a medical student who really turned me on to GI medicine. We worked together on several patients and I was able to develop an appreciation for the breadth and depth of GI-related abnormalities and diseases and therapies. And I really got excited by the spectrum of opportunity that I would have as a physician to help treat patients with GI illness. 

Q: What would you do differently if you had a chance?

Dr. Ketover: I’d travel more both for work and for pleasure. I really enjoy my relationships that I’ve created with lots of other gastroenterologists as well as non-physicians around policy issues. I’m involved in a couple of national organizations that talk to politicians on Capitol Hill and at state houses about patient advocacy. I would have done more of that earlier in my career if I could have.

Q: What do you like to do in your free time?

Dr. Ketover: I like to run, bike, walk. I like being outside as much as possible and enjoy being active.

Lightning Round

Texting or talking?

Texting, very efficient

Favorite city in U.S. besides the one you live in?

Waikiki, Honolulu

Favorite breakfast?

Pancakes

Place you most want to travel to?

Australia and New Zealand

Favorite junk food?

Pretzels and ice cream

Favorite season?

Summer

How many cups of coffee do you drink per day?

2-3

If you weren’t a gastroenterologist, what would you be?

Public policy writer

Who inspires you?

My wife

Best Halloween costume you ever wore?

Cowboy

Favorite type of music?

Classic rock

Favorite movie genre?

Science fiction, space exploration

Cat person or dog person?

Dog

Favorite sport?

Football — to watch

What song do you have to sing along with when you hear it?

Bohemian Rhapsody

Introvert or extrovert?

Introvert

Optimist or pessimist?

Optimist

Growing up in a household where GI issues dominated conversations, it’s no surprise that Shida Haghighat, MD, chose gastroenterology as her area of study in medicine.

She watched her father suffer from the complications of Crohn’s disease and her brother struggle with irritable bowel syndrome. “We always needed to know where the nearest bathroom was. I grew up with that around me, and I was always just fascinated by the gut and the digestive system,” said Dr. Haghighat, who just finished up her fellowship at the University of Miami and is now a gastroenterologist at University of California, Los Angeles. She also serves as social media editor for AGA’s Gastro Hep Advances.

Haghighat_Shida_CA_web.jpg

As she got to know the personalities of the GI department in the first year of medical school, “I realized that our senses of humor and personalities kind of aligned, and I was like, ‘Oh yeah, this is where I’m supposed to be,’ ” said Dr. Haghighat, who can be found on X @DoctorShida.

Humor is something Dr. Haghighat has reached for throughout her life and career. She eventually channeled her gift for satire onto the stage and the internet, as a stand-up comedian. In an interview with GI & Hepatology News, she spoke about the connection between GI medicine and humor, and the creative ways she has helped promote cancer screening in underserved populations.
 

Q: What practice challenges have you faced in your career?

Dr. Haghighat: I trained in a county hospital, so I’ve always worked with underserved and vulnerable populations. One of the challenges has been just navigation of care, especially as it pertains to cancer diagnoses or cancer screening. A lot of the time, patients don’t understand why they have to do a test or something invasive like a colonoscopy for symptoms they don’t have. 

Q: A focus of yours has been improving uptake of screening in underserved communities. Please talk about the work you’ve done in this area.

Dr. Haghighat: I was at Los Angeles General Medical Center — a county hospital in Los Angeles — for residency, where we treated underserved, uninsured patients. I noticed in our primary care clinics a very low uptake of colon cancer screening. Patients didn’t want to bring the stool tests back or get colonoscopies. I surveyed a bunch of the patients and asked: How can we make colon cancer screening easier for you? About a third of the patients said, “If I can do it in the clinic before I go home, that would be great.”

So, I started this initiative called “Go Before You Go.” We would ask patients, “Hey, do you need to go to the bathroom right now, if you can?” Our nurses handed them the stool test to do in the bathroom before they left the clinic after their doctor visits.

We saw really good results with that. Surprisingly, a lot of people can go on demand. We saw increased screening rates, and that quality improvement project went on to win multiple first place awards in research competitions. So that’s what got me interested, and that’s where I had my beginnings of increasing preventative services in underserved communities on the ground.
 

Q: Can you discuss some health disparity studies you’ve done in this area?

Dr. Haghighat: As a GI at Jackson Memorial Hospital in Miami, I was seeing cancer disparities firsthand every day. I wanted to approach these disparities from a research funding standpoint on a federal level. I was particularly interested in gastric cancer because it’s not common enough in the United States to warrant universal screening, but it’s very common among certain racial and ethnic minorities, which would warrant targeted screening.

I evaluated cancer funding allocation from the National Cancer Institute among the most common cancers in the United States and found that cancer afflicting a higher proportion of racial and ethnic minorities was receiving lower funding. One of those cancers was stomach cancer. This study basically highlighted that, to decrease these disparities, a top-down policy approach is necessary to distribute cancer research funding equitably across these groups. 

A lot of stomach cancer comes from a bacteria called Helicobacter pylori, which can be more prevalent in certain countries. In another study, I looked at country of birth as a risk factor for stomach cancer, specifically for gastric intestinal metaplasia, which is a precursor for gastric cancer . 

We found that country of birth is a key risk factor for gastric intestinal metaplasia and that it should be incorporated into risk stratification for targeted screening. 
 

Q: Outside of medicine, you perform as a stand-up comedian. You have a popular satirical alias on social media. How did you get interested in stand-up comedy?

Dr. Haghighat: I gave my medical school’s commencement speech, and I had sprinkled a few jokes in there. Afterward, multiple people approached me and said, “You should really consider stand-up comedy. Your timing and delivery are great.” A few months later, I started my intern year in Los Angeles and simultaneously took stand-up comedy classes. I started performing at local clubs around town throughout residency, and I had two or three good sets that I could rely on. And so that’s how I got into stand-up comedy.

My intern year is also when I started this social media satire account. It was a way to cope with the anxieties and stress of residency. Before I knew it, the account gained multitudes of followers, doctors, and other medical professionals. And I joke that the more hours I work in a week, the more memes I make, the more posts I make. It’s kind of a creative outlet for me after a long day.
 

Q: What types of things do you talk about during your stand-up act?

Dr. Haghighat: A lot of it is about growing up in an immigrant household as a first-generation Iranian American. One of my favorite jokes is, my parents gave me so many options for a career. They said I could be a family doctor, a surgeon, a plastic surgeon, and if I worked hard, even a wife of a surgeon. But I talk a lot about being a woman in medicine. That always gets a lot of laughs. And now that I’ve graduated GI fellowship, I’m excited to incorporate some GI jokes because it turns out people love poop jokes.

Lightning Round

Texting or talking?

Text

Favorite city in U.S. besides the one you live in?

Denver

Cat or dog person

Dog

Best place you went on vacation

Patagonia

Favorite sport

Basketball

Favorite ice cream

Rocky Road

What song do you have to sing along with when you hear it?

Celine Dion’s My Heart Will Go On

Growing up in a household where GI issues dominated conversations, it’s no surprise that Shida Haghighat, MD, chose gastroenterology as her area of study in medicine.

She watched her father suffer from the complications of Crohn’s disease and her brother struggle with irritable bowel syndrome. “We always needed to know where the nearest bathroom was. I grew up with that around me, and I was always just fascinated by the gut and the digestive system,” said Dr. Haghighat, who just finished up her fellowship at the University of Miami and is now a gastroenterologist at University of California, Los Angeles. She also serves as social media editor for AGA’s Gastro Hep Advances.

Haghighat_Shida_CA_web.jpg

As she got to know the personalities of the GI department in the first year of medical school, “I realized that our senses of humor and personalities kind of aligned, and I was like, ‘Oh yeah, this is where I’m supposed to be,’ ” said Dr. Haghighat, who can be found on X @DoctorShida.

Humor is something Dr. Haghighat has reached for throughout her life and career. She eventually channeled her gift for satire onto the stage and the internet, as a stand-up comedian. In an interview with GI & Hepatology News, she spoke about the connection between GI medicine and humor, and the creative ways she has helped promote cancer screening in underserved populations.
 

Q: What practice challenges have you faced in your career?

Dr. Haghighat: I trained in a county hospital, so I’ve always worked with underserved and vulnerable populations. One of the challenges has been just navigation of care, especially as it pertains to cancer diagnoses or cancer screening. A lot of the time, patients don’t understand why they have to do a test or something invasive like a colonoscopy for symptoms they don’t have. 

Q: A focus of yours has been improving uptake of screening in underserved communities. Please talk about the work you’ve done in this area.

Dr. Haghighat: I was at Los Angeles General Medical Center — a county hospital in Los Angeles — for residency, where we treated underserved, uninsured patients. I noticed in our primary care clinics a very low uptake of colon cancer screening. Patients didn’t want to bring the stool tests back or get colonoscopies. I surveyed a bunch of the patients and asked: How can we make colon cancer screening easier for you? About a third of the patients said, “If I can do it in the clinic before I go home, that would be great.”

So, I started this initiative called “Go Before You Go.” We would ask patients, “Hey, do you need to go to the bathroom right now, if you can?” Our nurses handed them the stool test to do in the bathroom before they left the clinic after their doctor visits.

We saw really good results with that. Surprisingly, a lot of people can go on demand. We saw increased screening rates, and that quality improvement project went on to win multiple first place awards in research competitions. So that’s what got me interested, and that’s where I had my beginnings of increasing preventative services in underserved communities on the ground.
 

Q: Can you discuss some health disparity studies you’ve done in this area?

Dr. Haghighat: As a GI at Jackson Memorial Hospital in Miami, I was seeing cancer disparities firsthand every day. I wanted to approach these disparities from a research funding standpoint on a federal level. I was particularly interested in gastric cancer because it’s not common enough in the United States to warrant universal screening, but it’s very common among certain racial and ethnic minorities, which would warrant targeted screening.

I evaluated cancer funding allocation from the National Cancer Institute among the most common cancers in the United States and found that cancer afflicting a higher proportion of racial and ethnic minorities was receiving lower funding. One of those cancers was stomach cancer. This study basically highlighted that, to decrease these disparities, a top-down policy approach is necessary to distribute cancer research funding equitably across these groups. 

A lot of stomach cancer comes from a bacteria called Helicobacter pylori, which can be more prevalent in certain countries. In another study, I looked at country of birth as a risk factor for stomach cancer, specifically for gastric intestinal metaplasia, which is a precursor for gastric cancer . 

We found that country of birth is a key risk factor for gastric intestinal metaplasia and that it should be incorporated into risk stratification for targeted screening. 
 

Q: Outside of medicine, you perform as a stand-up comedian. You have a popular satirical alias on social media. How did you get interested in stand-up comedy?

Dr. Haghighat: I gave my medical school’s commencement speech, and I had sprinkled a few jokes in there. Afterward, multiple people approached me and said, “You should really consider stand-up comedy. Your timing and delivery are great.” A few months later, I started my intern year in Los Angeles and simultaneously took stand-up comedy classes. I started performing at local clubs around town throughout residency, and I had two or three good sets that I could rely on. And so that’s how I got into stand-up comedy.

My intern year is also when I started this social media satire account. It was a way to cope with the anxieties and stress of residency. Before I knew it, the account gained multitudes of followers, doctors, and other medical professionals. And I joke that the more hours I work in a week, the more memes I make, the more posts I make. It’s kind of a creative outlet for me after a long day.
 

Q: What types of things do you talk about during your stand-up act?

Dr. Haghighat: A lot of it is about growing up in an immigrant household as a first-generation Iranian American. One of my favorite jokes is, my parents gave me so many options for a career. They said I could be a family doctor, a surgeon, a plastic surgeon, and if I worked hard, even a wife of a surgeon. But I talk a lot about being a woman in medicine. That always gets a lot of laughs. And now that I’ve graduated GI fellowship, I’m excited to incorporate some GI jokes because it turns out people love poop jokes.

Lightning Round

Texting or talking?

Text

Favorite city in U.S. besides the one you live in?

Denver

Cat or dog person

Dog

Best place you went on vacation

Patagonia

Favorite sport

Basketball

Favorite ice cream

Rocky Road

What song do you have to sing along with when you hear it?

Celine Dion’s My Heart Will Go On

Growing up in a household where GI issues dominated conversations, it’s no surprise that Shida Haghighat, MD, chose gastroenterology as her area of study in medicine.

She watched her father suffer from the complications of Crohn’s disease and her brother struggle with irritable bowel syndrome. “We always needed to know where the nearest bathroom was. I grew up with that around me, and I was always just fascinated by the gut and the digestive system,” said Dr. Haghighat, who just finished up her fellowship at the University of Miami and is now a gastroenterologist at University of California, Los Angeles. She also serves as social media editor for AGA’s Gastro Hep Advances.

Haghighat_Shida_CA_web.jpg

As she got to know the personalities of the GI department in the first year of medical school, “I realized that our senses of humor and personalities kind of aligned, and I was like, ‘Oh yeah, this is where I’m supposed to be,’ ” said Dr. Haghighat, who can be found on X @DoctorShida.

Humor is something Dr. Haghighat has reached for throughout her life and career. She eventually channeled her gift for satire onto the stage and the internet, as a stand-up comedian. In an interview with GI & Hepatology News, she spoke about the connection between GI medicine and humor, and the creative ways she has helped promote cancer screening in underserved populations.
 

Q: What practice challenges have you faced in your career?

Dr. Haghighat: I trained in a county hospital, so I’ve always worked with underserved and vulnerable populations. One of the challenges has been just navigation of care, especially as it pertains to cancer diagnoses or cancer screening. A lot of the time, patients don’t understand why they have to do a test or something invasive like a colonoscopy for symptoms they don’t have. 

Q: A focus of yours has been improving uptake of screening in underserved communities. Please talk about the work you’ve done in this area.

Dr. Haghighat: I was at Los Angeles General Medical Center — a county hospital in Los Angeles — for residency, where we treated underserved, uninsured patients. I noticed in our primary care clinics a very low uptake of colon cancer screening. Patients didn’t want to bring the stool tests back or get colonoscopies. I surveyed a bunch of the patients and asked: How can we make colon cancer screening easier for you? About a third of the patients said, “If I can do it in the clinic before I go home, that would be great.”

So, I started this initiative called “Go Before You Go.” We would ask patients, “Hey, do you need to go to the bathroom right now, if you can?” Our nurses handed them the stool test to do in the bathroom before they left the clinic after their doctor visits.

We saw really good results with that. Surprisingly, a lot of people can go on demand. We saw increased screening rates, and that quality improvement project went on to win multiple first place awards in research competitions. So that’s what got me interested, and that’s where I had my beginnings of increasing preventative services in underserved communities on the ground.
 

Q: Can you discuss some health disparity studies you’ve done in this area?

Dr. Haghighat: As a GI at Jackson Memorial Hospital in Miami, I was seeing cancer disparities firsthand every day. I wanted to approach these disparities from a research funding standpoint on a federal level. I was particularly interested in gastric cancer because it’s not common enough in the United States to warrant universal screening, but it’s very common among certain racial and ethnic minorities, which would warrant targeted screening.

I evaluated cancer funding allocation from the National Cancer Institute among the most common cancers in the United States and found that cancer afflicting a higher proportion of racial and ethnic minorities was receiving lower funding. One of those cancers was stomach cancer. This study basically highlighted that, to decrease these disparities, a top-down policy approach is necessary to distribute cancer research funding equitably across these groups. 

A lot of stomach cancer comes from a bacteria called Helicobacter pylori, which can be more prevalent in certain countries. In another study, I looked at country of birth as a risk factor for stomach cancer, specifically for gastric intestinal metaplasia, which is a precursor for gastric cancer . 

We found that country of birth is a key risk factor for gastric intestinal metaplasia and that it should be incorporated into risk stratification for targeted screening. 
 

Q: Outside of medicine, you perform as a stand-up comedian. You have a popular satirical alias on social media. How did you get interested in stand-up comedy?

Dr. Haghighat: I gave my medical school’s commencement speech, and I had sprinkled a few jokes in there. Afterward, multiple people approached me and said, “You should really consider stand-up comedy. Your timing and delivery are great.” A few months later, I started my intern year in Los Angeles and simultaneously took stand-up comedy classes. I started performing at local clubs around town throughout residency, and I had two or three good sets that I could rely on. And so that’s how I got into stand-up comedy.

My intern year is also when I started this social media satire account. It was a way to cope with the anxieties and stress of residency. Before I knew it, the account gained multitudes of followers, doctors, and other medical professionals. And I joke that the more hours I work in a week, the more memes I make, the more posts I make. It’s kind of a creative outlet for me after a long day.
 

Q: What types of things do you talk about during your stand-up act?

Dr. Haghighat: A lot of it is about growing up in an immigrant household as a first-generation Iranian American. One of my favorite jokes is, my parents gave me so many options for a career. They said I could be a family doctor, a surgeon, a plastic surgeon, and if I worked hard, even a wife of a surgeon. But I talk a lot about being a woman in medicine. That always gets a lot of laughs. And now that I’ve graduated GI fellowship, I’m excited to incorporate some GI jokes because it turns out people love poop jokes.

Lightning Round

Texting or talking?

Text

Favorite city in U.S. besides the one you live in?

Denver

Cat or dog person

Dog

Best place you went on vacation

Patagonia

Favorite sport

Basketball

Favorite ice cream

Rocky Road

What song do you have to sing along with when you hear it?

Celine Dion’s My Heart Will Go On

Reflecting on his career in gastroenterology, Andy Tau, MD, (@DrBloodandGuts on X) claims the discipline chose him, in many ways.

“I love gaming, which my mom said would never pay off. Then one day she nearly died from a peptic ulcer, and endoscopy saved her,” said Dr. Tau, a GI hospitalist who practices with Austin Gastroenterology in Austin, Texas. One of his specialties is endoscopic hemostasis.

Endoscopy functions similarly to a game because the interface between the operator and the patient is a controller and a video screen, he explained. “Movements in my hands translate directly onto the screen. Obviously, endoscopy is serious business, but the tactile feel was very familiar and satisfying to me.”

Tau_J_Andy_Tex_web.jpg

Advocating for the GI hospitalist and the versatile role they play in hospital medicine, is another passion of his. “The dedicated GI hospitalist indirectly improves the efficiency of an outpatient practice, while directly improving inpatient outcomes, collegiality, and even one’s own skills as an endoscopist,” Dr. Tau wrote in an opinion piece in GI & Hepatology News .

He expounded more on this topic and others in an interview, recalling what he learned from one mentor about maintaining a sense of humor at the bedside.
 

Q: You’ve said that GI hospitalists are the future of patient care. Can you explain why you feel this way?

Dr. Tau: From a quality perspective, even though it’s hard to put into one word, the care of acute GI pathology and endoscopy can be seen as a specialty in and of itself. These skills include hemostasis, enteral access, percutaneous endoscopic gastrostomy (PEG), balloon-assisted enteroscopy, luminal stenting, advanced tissue closure, and endoscopic retrograde cholangiopancreatography. The greater availability of a GI hospitalist, as opposed to an outpatient GI doctor rounding at the ends of days, likely shortens admissions and improves the logistics of scheduling inpatient cases. 

From a financial perspective, the landscape of GI practice is changing because of GI physician shortages relative to increased demand for outpatient procedures. Namely, the outpatient gastroenterologists simply have too much on their plate and inefficiencies abound when they have to juggle inpatient and outpatient work. Thus, two tracks are forming, especially in large busy hospitals. This is the same evolution of the pure outpatient internist and inpatient internist 20 years ago. 
 

Q: What attributes does a GI hospitalist bring to the table? 

Dr. Tau: A GI hospitalist is one who can multitask through interruptions, manage end-of-life issues, craves therapeutic endoscopy (even if that’s hemostasis), and can keep more erratic hours based on the number of consults that come in. She/he tends to want immediate gratification and doesn’t mind the lack of continuity of care. Lastly, the GI hospitalist has to be brave and yet careful as the patients are sicker and thus complications may be higher and certainly less well tolerated. 

Q: Are there enough of them going into practice right now? 

Dr. Tau: Not really! The demand seems to outstrip supply based on what I see. There is a definite financial lure as the market rate for them rises (because more GIs are leaving the hospital for pure outpatient practice), but burnout can be an issue. Interestingly, fellows are typically highly trained and familiar with inpatient work, but once in practice, most choose the outpatient track. I think it’s a combination of work-life balance, inefficiency of inpatient endoscopy, and perhaps the strain of daily, erratic consultation.

Q: You received the 2021 Travis County Medical Society (TCMS) Young Physician of the Year. What achievements led to this honor? 

Dr. Tau: I am not sure I am deserving of that award, but I think it was related to personal risk and some long hours as a GI hospitalist during the COVID pandemic. I may have the unfortunate distinction of performing more procedures on COVID patients than any other physician in the city. My hospital was the largest COVID-designated site in the city. There were countless PEG tubes in COVID survivors and a lot of bleeders for some reason. A critical care physician on the front lines and health director of the city of Austin received Physician of the Year, deservedly. 

Q: What teacher or mentor had the greatest impact on you?

Dr. Tau: David Y. Graham, MD, MACG, got me into GI as a medical student and taught me to never tolerate any loose ends when it came to patient care as a resident. He trained me at every level — from medical school, residency, and through my fellowship. His advice is often delivered sly and dry, but his humor-laden truths continue to ring true throughout my life. One story: my whole family tested positive for Helicobacter pylori after my mother survived peptic ulcer hemorrhage. I was the only one who tested negative! I asked Dr Graham about it and he quipped, “You’re lucky! It’s because your mother didn’t love (and kiss) you as much!”

Even to this moment I laugh about that. I share that with my patients when they ask about how they contracted H. pylori. 

Lightning Round

Favorite junk food?

McDonalds fries

Favorite movie genre?

Psychological thriller

Cat person or dog person?

Dog 

What was your favorite Halloween costume? 

Ninja turtle 

Favorite sport:

Football (played in college)

Introvert or extrovert?

Extrovert unless sleep deprived. 

Favorite holiday:

Thanksgiving

The book you read over and over:

Swiss Family Robinson 

Favorite travel destination:

Hawaii

Optimist or pessimist?  

A happy pessimist.

Reflecting on his career in gastroenterology, Andy Tau, MD, (@DrBloodandGuts on X) claims the discipline chose him, in many ways.

“I love gaming, which my mom said would never pay off. Then one day she nearly died from a peptic ulcer, and endoscopy saved her,” said Dr. Tau, a GI hospitalist who practices with Austin Gastroenterology in Austin, Texas. One of his specialties is endoscopic hemostasis.

Endoscopy functions similarly to a game because the interface between the operator and the patient is a controller and a video screen, he explained. “Movements in my hands translate directly onto the screen. Obviously, endoscopy is serious business, but the tactile feel was very familiar and satisfying to me.”

Tau_J_Andy_Tex_web.jpg

Advocating for the GI hospitalist and the versatile role they play in hospital medicine, is another passion of his. “The dedicated GI hospitalist indirectly improves the efficiency of an outpatient practice, while directly improving inpatient outcomes, collegiality, and even one’s own skills as an endoscopist,” Dr. Tau wrote in an opinion piece in GI & Hepatology News .

He expounded more on this topic and others in an interview, recalling what he learned from one mentor about maintaining a sense of humor at the bedside.
 

Q: You’ve said that GI hospitalists are the future of patient care. Can you explain why you feel this way?

Dr. Tau: From a quality perspective, even though it’s hard to put into one word, the care of acute GI pathology and endoscopy can be seen as a specialty in and of itself. These skills include hemostasis, enteral access, percutaneous endoscopic gastrostomy (PEG), balloon-assisted enteroscopy, luminal stenting, advanced tissue closure, and endoscopic retrograde cholangiopancreatography. The greater availability of a GI hospitalist, as opposed to an outpatient GI doctor rounding at the ends of days, likely shortens admissions and improves the logistics of scheduling inpatient cases. 

From a financial perspective, the landscape of GI practice is changing because of GI physician shortages relative to increased demand for outpatient procedures. Namely, the outpatient gastroenterologists simply have too much on their plate and inefficiencies abound when they have to juggle inpatient and outpatient work. Thus, two tracks are forming, especially in large busy hospitals. This is the same evolution of the pure outpatient internist and inpatient internist 20 years ago. 
 

Q: What attributes does a GI hospitalist bring to the table? 

Dr. Tau: A GI hospitalist is one who can multitask through interruptions, manage end-of-life issues, craves therapeutic endoscopy (even if that’s hemostasis), and can keep more erratic hours based on the number of consults that come in. She/he tends to want immediate gratification and doesn’t mind the lack of continuity of care. Lastly, the GI hospitalist has to be brave and yet careful as the patients are sicker and thus complications may be higher and certainly less well tolerated. 

Q: Are there enough of them going into practice right now? 

Dr. Tau: Not really! The demand seems to outstrip supply based on what I see. There is a definite financial lure as the market rate for them rises (because more GIs are leaving the hospital for pure outpatient practice), but burnout can be an issue. Interestingly, fellows are typically highly trained and familiar with inpatient work, but once in practice, most choose the outpatient track. I think it’s a combination of work-life balance, inefficiency of inpatient endoscopy, and perhaps the strain of daily, erratic consultation.

Q: You received the 2021 Travis County Medical Society (TCMS) Young Physician of the Year. What achievements led to this honor? 

Dr. Tau: I am not sure I am deserving of that award, but I think it was related to personal risk and some long hours as a GI hospitalist during the COVID pandemic. I may have the unfortunate distinction of performing more procedures on COVID patients than any other physician in the city. My hospital was the largest COVID-designated site in the city. There were countless PEG tubes in COVID survivors and a lot of bleeders for some reason. A critical care physician on the front lines and health director of the city of Austin received Physician of the Year, deservedly. 

Q: What teacher or mentor had the greatest impact on you?

Dr. Tau: David Y. Graham, MD, MACG, got me into GI as a medical student and taught me to never tolerate any loose ends when it came to patient care as a resident. He trained me at every level — from medical school, residency, and through my fellowship. His advice is often delivered sly and dry, but his humor-laden truths continue to ring true throughout my life. One story: my whole family tested positive for Helicobacter pylori after my mother survived peptic ulcer hemorrhage. I was the only one who tested negative! I asked Dr Graham about it and he quipped, “You’re lucky! It’s because your mother didn’t love (and kiss) you as much!”

Even to this moment I laugh about that. I share that with my patients when they ask about how they contracted H. pylori. 

Lightning Round

Favorite junk food?

McDonalds fries

Favorite movie genre?

Psychological thriller

Cat person or dog person?

Dog 

What was your favorite Halloween costume? 

Ninja turtle 

Favorite sport:

Football (played in college)

Introvert or extrovert?

Extrovert unless sleep deprived. 

Favorite holiday:

Thanksgiving

The book you read over and over:

Swiss Family Robinson 

Favorite travel destination:

Hawaii

Optimist or pessimist?  

A happy pessimist.

Reflecting on his career in gastroenterology, Andy Tau, MD, (@DrBloodandGuts on X) claims the discipline chose him, in many ways.

“I love gaming, which my mom said would never pay off. Then one day she nearly died from a peptic ulcer, and endoscopy saved her,” said Dr. Tau, a GI hospitalist who practices with Austin Gastroenterology in Austin, Texas. One of his specialties is endoscopic hemostasis.

Endoscopy functions similarly to a game because the interface between the operator and the patient is a controller and a video screen, he explained. “Movements in my hands translate directly onto the screen. Obviously, endoscopy is serious business, but the tactile feel was very familiar and satisfying to me.”

Tau_J_Andy_Tex_web.jpg

Advocating for the GI hospitalist and the versatile role they play in hospital medicine, is another passion of his. “The dedicated GI hospitalist indirectly improves the efficiency of an outpatient practice, while directly improving inpatient outcomes, collegiality, and even one’s own skills as an endoscopist,” Dr. Tau wrote in an opinion piece in GI & Hepatology News .

He expounded more on this topic and others in an interview, recalling what he learned from one mentor about maintaining a sense of humor at the bedside.
 

Q: You’ve said that GI hospitalists are the future of patient care. Can you explain why you feel this way?

Dr. Tau: From a quality perspective, even though it’s hard to put into one word, the care of acute GI pathology and endoscopy can be seen as a specialty in and of itself. These skills include hemostasis, enteral access, percutaneous endoscopic gastrostomy (PEG), balloon-assisted enteroscopy, luminal stenting, advanced tissue closure, and endoscopic retrograde cholangiopancreatography. The greater availability of a GI hospitalist, as opposed to an outpatient GI doctor rounding at the ends of days, likely shortens admissions and improves the logistics of scheduling inpatient cases. 

From a financial perspective, the landscape of GI practice is changing because of GI physician shortages relative to increased demand for outpatient procedures. Namely, the outpatient gastroenterologists simply have too much on their plate and inefficiencies abound when they have to juggle inpatient and outpatient work. Thus, two tracks are forming, especially in large busy hospitals. This is the same evolution of the pure outpatient internist and inpatient internist 20 years ago. 
 

Q: What attributes does a GI hospitalist bring to the table? 

Dr. Tau: A GI hospitalist is one who can multitask through interruptions, manage end-of-life issues, craves therapeutic endoscopy (even if that’s hemostasis), and can keep more erratic hours based on the number of consults that come in. She/he tends to want immediate gratification and doesn’t mind the lack of continuity of care. Lastly, the GI hospitalist has to be brave and yet careful as the patients are sicker and thus complications may be higher and certainly less well tolerated. 

Q: Are there enough of them going into practice right now? 

Dr. Tau: Not really! The demand seems to outstrip supply based on what I see. There is a definite financial lure as the market rate for them rises (because more GIs are leaving the hospital for pure outpatient practice), but burnout can be an issue. Interestingly, fellows are typically highly trained and familiar with inpatient work, but once in practice, most choose the outpatient track. I think it’s a combination of work-life balance, inefficiency of inpatient endoscopy, and perhaps the strain of daily, erratic consultation.

Q: You received the 2021 Travis County Medical Society (TCMS) Young Physician of the Year. What achievements led to this honor? 

Dr. Tau: I am not sure I am deserving of that award, but I think it was related to personal risk and some long hours as a GI hospitalist during the COVID pandemic. I may have the unfortunate distinction of performing more procedures on COVID patients than any other physician in the city. My hospital was the largest COVID-designated site in the city. There were countless PEG tubes in COVID survivors and a lot of bleeders for some reason. A critical care physician on the front lines and health director of the city of Austin received Physician of the Year, deservedly. 

Q: What teacher or mentor had the greatest impact on you?

Dr. Tau: David Y. Graham, MD, MACG, got me into GI as a medical student and taught me to never tolerate any loose ends when it came to patient care as a resident. He trained me at every level — from medical school, residency, and through my fellowship. His advice is often delivered sly and dry, but his humor-laden truths continue to ring true throughout my life. One story: my whole family tested positive for Helicobacter pylori after my mother survived peptic ulcer hemorrhage. I was the only one who tested negative! I asked Dr Graham about it and he quipped, “You’re lucky! It’s because your mother didn’t love (and kiss) you as much!”

Even to this moment I laugh about that. I share that with my patients when they ask about how they contracted H. pylori. 

Lightning Round

Favorite junk food?

McDonalds fries

Favorite movie genre?

Psychological thriller

Cat person or dog person?

Dog 

What was your favorite Halloween costume? 

Ninja turtle 

Favorite sport:

Football (played in college)

Introvert or extrovert?

Extrovert unless sleep deprived. 

Favorite holiday:

Thanksgiving

The book you read over and over:

Swiss Family Robinson 

Favorite travel destination:

Hawaii

Optimist or pessimist?  

A happy pessimist.

Faced with an opportunity to advocate for patients, Rajeev Jain, MD, AGAF, is never afraid to speak up. He recently spoke out publicly against a major payer’s new advance notification process for colonoscopy and endoscopy procedures, cautioning it was a glidepath toward far-reaching prior authorization requirements.

UnitedHealthcare plans to collect a larger scope of data for this new policy, “which I fear will disrupt and deny patients’ access to lifesaving care,” Dr. Jain, a gastroenterologist with Texas Digestive Disease Consultants and a member of the American Gastroenterological Association’s (AGA) Prior Authorization Reform Task Force, wrote in an opinion piece in the Dallas Morning News.

Jain_Rajeev_TX_web.jpg

Insurance coverage should be fair to the end goal of taking good care of patients, said Dr. Jain. “And if they’re putting processes in place, which are solely to be an impediment to excellent care, then that’s not right.”

Through his extensive participation in AGA panels and other influential groups, Dr. Jain has sought to improve clinical practice and reduce physician burnout. As Director and now Chair of the Board of Directors” of the American Board of Internal Medicine, Dr. Jain participated in conversations to make the maintenance of certification (MOC) process more accessible and less burdensome for doctors.

People spent a lot of time studying for ABIM’s 10-year MOC exam, sometimes even taking a course to help them pass. Now, there’s an option in all specialties to take a 30-question exam every quarter.

On average, it takes someone roughly 2 minutes to answer each question on this short exam. “Per quarter, you’re roughly spending an hour to do that instead of taking a big 10-year exam, where people were spending money and missing work,” said Dr. Jain. This modality enables physicians to meet credentialing requirements “in a way that it meets many of the desires of our practitioners,” he added.

Dr. Jain expounded on his work to advocate for patients and physicians in an interview.



Q: I’d like to discuss your opinion piece on UnitedHealthcare’s advanced notification process. Where does that policy stand now? I’m wondering if your opinion piece led to any changes.

Dr. Jain: There’s not a metric I can use to measure its success. But I will tell you this: I’ve had numerous patients mention to me, “Hey, I saw your article in the Dallas Morning News. That was great.” And that would lead to a conversation.



Q: Why do you think UHC’s policy was a tool for prior authorization?

Dr. Jain: Imagine you go to see a gastroenterologist in clinic, and the GI believes you need a procedure for certain symptoms or abnormal laboratory tests or imaging. It’s not a screening procedure. It’s a diagnostic procedure. Now, the insurance company is going to say, “Well, we can’t schedule that until you do a preauthorization.”

That could take a day. It could take a week. It could take longer. And now, the patient has lost that moment where they can get this settled. It’s not just the schedule for the patient. They’re going to get anesthesia, be it conscious sedation or deeper sedation, and they’re going to need a ride home. They have to coordinate things with family members or friends. Those little logistics add up to a lot of times why patients cancel or don’t show up or don’t follow through, because we couldn’t get it scheduled at that moment.

I feel like we are trying to attack this problem from many different angles, and my opinion piece was one of those tactics. The patients and the rank-and-file gastroenterologists appreciate the AGA being at the forefront of this issue.

166137_photo_web.jpg

Lightning Round:

Favorite type of music?

1980s alternative

Favorite movie genre?

Comedy



Cat person or dog person?

Dog



Favorite sport:

College football



What song do you have to sing along with when you hear it?

“I Ran,” by a Flock of Seagulls

Faced with an opportunity to advocate for patients, Rajeev Jain, MD, AGAF, is never afraid to speak up. He recently spoke out publicly against a major payer’s new advance notification process for colonoscopy and endoscopy procedures, cautioning it was a glidepath toward far-reaching prior authorization requirements.

UnitedHealthcare plans to collect a larger scope of data for this new policy, “which I fear will disrupt and deny patients’ access to lifesaving care,” Dr. Jain, a gastroenterologist with Texas Digestive Disease Consultants and a member of the American Gastroenterological Association’s (AGA) Prior Authorization Reform Task Force, wrote in an opinion piece in the Dallas Morning News.

Jain_Rajeev_TX_web.jpg

Insurance coverage should be fair to the end goal of taking good care of patients, said Dr. Jain. “And if they’re putting processes in place, which are solely to be an impediment to excellent care, then that’s not right.”

Through his extensive participation in AGA panels and other influential groups, Dr. Jain has sought to improve clinical practice and reduce physician burnout. As Director and now Chair of the Board of Directors” of the American Board of Internal Medicine, Dr. Jain participated in conversations to make the maintenance of certification (MOC) process more accessible and less burdensome for doctors.

People spent a lot of time studying for ABIM’s 10-year MOC exam, sometimes even taking a course to help them pass. Now, there’s an option in all specialties to take a 30-question exam every quarter.

On average, it takes someone roughly 2 minutes to answer each question on this short exam. “Per quarter, you’re roughly spending an hour to do that instead of taking a big 10-year exam, where people were spending money and missing work,” said Dr. Jain. This modality enables physicians to meet credentialing requirements “in a way that it meets many of the desires of our practitioners,” he added.

Dr. Jain expounded on his work to advocate for patients and physicians in an interview.



Q: I’d like to discuss your opinion piece on UnitedHealthcare’s advanced notification process. Where does that policy stand now? I’m wondering if your opinion piece led to any changes.

Dr. Jain: There’s not a metric I can use to measure its success. But I will tell you this: I’ve had numerous patients mention to me, “Hey, I saw your article in the Dallas Morning News. That was great.” And that would lead to a conversation.



Q: Why do you think UHC’s policy was a tool for prior authorization?

Dr. Jain: Imagine you go to see a gastroenterologist in clinic, and the GI believes you need a procedure for certain symptoms or abnormal laboratory tests or imaging. It’s not a screening procedure. It’s a diagnostic procedure. Now, the insurance company is going to say, “Well, we can’t schedule that until you do a preauthorization.”

That could take a day. It could take a week. It could take longer. And now, the patient has lost that moment where they can get this settled. It’s not just the schedule for the patient. They’re going to get anesthesia, be it conscious sedation or deeper sedation, and they’re going to need a ride home. They have to coordinate things with family members or friends. Those little logistics add up to a lot of times why patients cancel or don’t show up or don’t follow through, because we couldn’t get it scheduled at that moment.

I feel like we are trying to attack this problem from many different angles, and my opinion piece was one of those tactics. The patients and the rank-and-file gastroenterologists appreciate the AGA being at the forefront of this issue.

166137_photo_web.jpg

Lightning Round:

Favorite type of music?

1980s alternative

Favorite movie genre?

Comedy



Cat person or dog person?

Dog



Favorite sport:

College football



What song do you have to sing along with when you hear it?

“I Ran,” by a Flock of Seagulls

Faced with an opportunity to advocate for patients, Rajeev Jain, MD, AGAF, is never afraid to speak up. He recently spoke out publicly against a major payer’s new advance notification process for colonoscopy and endoscopy procedures, cautioning it was a glidepath toward far-reaching prior authorization requirements.

UnitedHealthcare plans to collect a larger scope of data for this new policy, “which I fear will disrupt and deny patients’ access to lifesaving care,” Dr. Jain, a gastroenterologist with Texas Digestive Disease Consultants and a member of the American Gastroenterological Association’s (AGA) Prior Authorization Reform Task Force, wrote in an opinion piece in the Dallas Morning News.

Jain_Rajeev_TX_web.jpg

Insurance coverage should be fair to the end goal of taking good care of patients, said Dr. Jain. “And if they’re putting processes in place, which are solely to be an impediment to excellent care, then that’s not right.”

Through his extensive participation in AGA panels and other influential groups, Dr. Jain has sought to improve clinical practice and reduce physician burnout. As Director and now Chair of the Board of Directors” of the American Board of Internal Medicine, Dr. Jain participated in conversations to make the maintenance of certification (MOC) process more accessible and less burdensome for doctors.

People spent a lot of time studying for ABIM’s 10-year MOC exam, sometimes even taking a course to help them pass. Now, there’s an option in all specialties to take a 30-question exam every quarter.

On average, it takes someone roughly 2 minutes to answer each question on this short exam. “Per quarter, you’re roughly spending an hour to do that instead of taking a big 10-year exam, where people were spending money and missing work,” said Dr. Jain. This modality enables physicians to meet credentialing requirements “in a way that it meets many of the desires of our practitioners,” he added.

Dr. Jain expounded on his work to advocate for patients and physicians in an interview.



Q: I’d like to discuss your opinion piece on UnitedHealthcare’s advanced notification process. Where does that policy stand now? I’m wondering if your opinion piece led to any changes.

Dr. Jain: There’s not a metric I can use to measure its success. But I will tell you this: I’ve had numerous patients mention to me, “Hey, I saw your article in the Dallas Morning News. That was great.” And that would lead to a conversation.



Q: Why do you think UHC’s policy was a tool for prior authorization?

Dr. Jain: Imagine you go to see a gastroenterologist in clinic, and the GI believes you need a procedure for certain symptoms or abnormal laboratory tests or imaging. It’s not a screening procedure. It’s a diagnostic procedure. Now, the insurance company is going to say, “Well, we can’t schedule that until you do a preauthorization.”

That could take a day. It could take a week. It could take longer. And now, the patient has lost that moment where they can get this settled. It’s not just the schedule for the patient. They’re going to get anesthesia, be it conscious sedation or deeper sedation, and they’re going to need a ride home. They have to coordinate things with family members or friends. Those little logistics add up to a lot of times why patients cancel or don’t show up or don’t follow through, because we couldn’t get it scheduled at that moment.

I feel like we are trying to attack this problem from many different angles, and my opinion piece was one of those tactics. The patients and the rank-and-file gastroenterologists appreciate the AGA being at the forefront of this issue.

166137_photo_web.jpg

Lightning Round:

Favorite type of music?

1980s alternative

Favorite movie genre?

Comedy



Cat person or dog person?

Dog



Favorite sport:

College football



What song do you have to sing along with when you hear it?

“I Ran,” by a Flock of Seagulls

Sonali Paul, MD, once thought she was an anomaly in the world of medicine. “As I was going through training, I didn’t think others like me existed, a gay South Asian transplant hepatologist. I certainly didn’t have mentors that looked like me. I didn’t have anyone to look up to,” she said.

Fighting to promote health care equity in the LGBTQI+ population has been a cornerstone of her career. As cofounder and an executive board member of Rainbows in Gastro, a sexual and gender minorities affinity group that builds community among LGBTQI+ medical trainees and physicians in gastroenterology, Dr. Paul often goes into the community to promote open discussions about health equity in sexual and gender minority populations.

Paul_Sonali_ILLINOIS_1_web.jpg

“Our mission is CHARM: community, healing, advocacy, research, and mentorship,” said Dr. Paul, a transplant hepatologist with the University of Chicago Medicine with a specific niche within fatty liver disease and obesity medicine. She serves as an associate program director for the Internal Medicine Residency Program specifically for diversity, equity, and inclusion.

In 2022 she received the University of Chicago’s Department of Medicine Diversity Award.

Dr. Paul has worked to establish policies such as documenting preferred gender identity of patients in electronic medical records and using pronoun cards on ID badges to make LGBTQI+ patients more comfortable. Rainbows in Gastro has shown trainees they can be open about their sexual orientation and gender identity without fear of retribution. “I’ve had medical students and residents come to me and say they were going to go into endocrine or some other field because they thought it was more gay friendly, until they saw our group and the work we’re doing,” Dr. Paul said.

In an interview, she talks more about her two key passions: reducing disparities and promoting health equity.

Q: You presented “Embrace the Rainbow: Creating Inclusive LGBTQ+ Spaces in Medicine” at the University of Chicago Medicine Grand Rounds. What were some of the key takeaways of that presentation?

Dr. Paul: One is education. Knowing the history of the LGBT community and how marginalization and discrimination affects the individual coming into that clinic is important. Having little things like pronoun badges or a rainbow flag, having nondiscrimination policies that include sexual orientation, gender identity that are displayed in the clinics, are very small things that seem almost trivial to some people. But I can tell you for myself, it matters if I walk into a door and there’s a rainbow flag there. I feel immediately safer.

Q: What are your hopes and aspirations for the field of GI moving forward?

Dr. Paul: I didn’t learn about social determinants of health in medical school, but more and more I think we’re starting to pivot and really look at those things. I hope GI and hepatology continues to do that.

For me, it’s looking at everything through a health disparities lens, seeing the health disparities across communities and finding solutions to mitigate them. How do we get people access to transplant for all our patients, and really examining the social determinants of health in the health care we provide?

Q: Your clinical focus has been on nonalcoholic fatty liver disease. Can you tell me how you got interested in that area of medicine?

Dr. Paul: There’s been a name change for the disease itself. It’s now metabolic dysfunction-associated steatotic liver disease (MASLD). I got interested from an obesity medicine perspective. I thought the liver pathology was interesting but I wanted to approach it from a different kind of perspective and not just focus on the liver, but also the metabolic factors.

I practice from that kind of lens: Looking at a lot of the metabolic comorbidities that happen with fatty liver disease to help patients with weight loss.

Q: What do you think about the new weight loss drugs?

Dr. Paul: I think they’re very effective. They’re obviously very popular. Weight loss is a really hard thing and I think they are really changing the game. A newer one that was just approved, tirzepatide (Zepbound, Lilly) resulted in up to 20% body weight loss. I think if there’s a medicine that we can give to avoid surgery for some people, I think that’s great. I think what is quite disheartening is insurance access to the medications.

Q: Is there any type of research you’re doing in this area right now?

Dr. Paul: I’m interested in the changes in fatty liver with gender-affirming hormone therapy with estrogen and testosterone, an area that’s never been studied.

Q: Describe how you would spend a free Saturday afternoon.

Dr. Paul: With my wife, my 9-year-old son, and two dogs. One of our favorite places to go is the Lincoln Park Zoo. We go there, especially over the summer, sometimes every week just to walk around. And, my son loves animals. Or, play with our dogs.

LIGHTNING ROUND

What is your favorite junk food? 
Doritos

What is your favorite holiday?
Thanksgiving

Is there a book that you reread often?
“Interpreter of Maladies” by Jhumpa Lahiri 

What is your favorite movie genre?
Comedy

Are you an introvert or extrovert? 
Somewhere in the middle.

Sonali Paul, MD, once thought she was an anomaly in the world of medicine. “As I was going through training, I didn’t think others like me existed, a gay South Asian transplant hepatologist. I certainly didn’t have mentors that looked like me. I didn’t have anyone to look up to,” she said.

Fighting to promote health care equity in the LGBTQI+ population has been a cornerstone of her career. As cofounder and an executive board member of Rainbows in Gastro, a sexual and gender minorities affinity group that builds community among LGBTQI+ medical trainees and physicians in gastroenterology, Dr. Paul often goes into the community to promote open discussions about health equity in sexual and gender minority populations.

Paul_Sonali_ILLINOIS_1_web.jpg

“Our mission is CHARM: community, healing, advocacy, research, and mentorship,” said Dr. Paul, a transplant hepatologist with the University of Chicago Medicine with a specific niche within fatty liver disease and obesity medicine. She serves as an associate program director for the Internal Medicine Residency Program specifically for diversity, equity, and inclusion.

In 2022 she received the University of Chicago’s Department of Medicine Diversity Award.

Dr. Paul has worked to establish policies such as documenting preferred gender identity of patients in electronic medical records and using pronoun cards on ID badges to make LGBTQI+ patients more comfortable. Rainbows in Gastro has shown trainees they can be open about their sexual orientation and gender identity without fear of retribution. “I’ve had medical students and residents come to me and say they were going to go into endocrine or some other field because they thought it was more gay friendly, until they saw our group and the work we’re doing,” Dr. Paul said.

In an interview, she talks more about her two key passions: reducing disparities and promoting health equity.

Q: You presented “Embrace the Rainbow: Creating Inclusive LGBTQ+ Spaces in Medicine” at the University of Chicago Medicine Grand Rounds. What were some of the key takeaways of that presentation?

Dr. Paul: One is education. Knowing the history of the LGBT community and how marginalization and discrimination affects the individual coming into that clinic is important. Having little things like pronoun badges or a rainbow flag, having nondiscrimination policies that include sexual orientation, gender identity that are displayed in the clinics, are very small things that seem almost trivial to some people. But I can tell you for myself, it matters if I walk into a door and there’s a rainbow flag there. I feel immediately safer.

Q: What are your hopes and aspirations for the field of GI moving forward?

Dr. Paul: I didn’t learn about social determinants of health in medical school, but more and more I think we’re starting to pivot and really look at those things. I hope GI and hepatology continues to do that.

For me, it’s looking at everything through a health disparities lens, seeing the health disparities across communities and finding solutions to mitigate them. How do we get people access to transplant for all our patients, and really examining the social determinants of health in the health care we provide?

Q: Your clinical focus has been on nonalcoholic fatty liver disease. Can you tell me how you got interested in that area of medicine?

Dr. Paul: There’s been a name change for the disease itself. It’s now metabolic dysfunction-associated steatotic liver disease (MASLD). I got interested from an obesity medicine perspective. I thought the liver pathology was interesting but I wanted to approach it from a different kind of perspective and not just focus on the liver, but also the metabolic factors.

I practice from that kind of lens: Looking at a lot of the metabolic comorbidities that happen with fatty liver disease to help patients with weight loss.

Q: What do you think about the new weight loss drugs?

Dr. Paul: I think they’re very effective. They’re obviously very popular. Weight loss is a really hard thing and I think they are really changing the game. A newer one that was just approved, tirzepatide (Zepbound, Lilly) resulted in up to 20% body weight loss. I think if there’s a medicine that we can give to avoid surgery for some people, I think that’s great. I think what is quite disheartening is insurance access to the medications.

Q: Is there any type of research you’re doing in this area right now?

Dr. Paul: I’m interested in the changes in fatty liver with gender-affirming hormone therapy with estrogen and testosterone, an area that’s never been studied.

Q: Describe how you would spend a free Saturday afternoon.

Dr. Paul: With my wife, my 9-year-old son, and two dogs. One of our favorite places to go is the Lincoln Park Zoo. We go there, especially over the summer, sometimes every week just to walk around. And, my son loves animals. Or, play with our dogs.

LIGHTNING ROUND

What is your favorite junk food? 
Doritos

What is your favorite holiday?
Thanksgiving

Is there a book that you reread often?
“Interpreter of Maladies” by Jhumpa Lahiri 

What is your favorite movie genre?
Comedy

Are you an introvert or extrovert? 
Somewhere in the middle.

Sonali Paul, MD, once thought she was an anomaly in the world of medicine. “As I was going through training, I didn’t think others like me existed, a gay South Asian transplant hepatologist. I certainly didn’t have mentors that looked like me. I didn’t have anyone to look up to,” she said.

Fighting to promote health care equity in the LGBTQI+ population has been a cornerstone of her career. As cofounder and an executive board member of Rainbows in Gastro, a sexual and gender minorities affinity group that builds community among LGBTQI+ medical trainees and physicians in gastroenterology, Dr. Paul often goes into the community to promote open discussions about health equity in sexual and gender minority populations.

Paul_Sonali_ILLINOIS_1_web.jpg

“Our mission is CHARM: community, healing, advocacy, research, and mentorship,” said Dr. Paul, a transplant hepatologist with the University of Chicago Medicine with a specific niche within fatty liver disease and obesity medicine. She serves as an associate program director for the Internal Medicine Residency Program specifically for diversity, equity, and inclusion.

In 2022 she received the University of Chicago’s Department of Medicine Diversity Award.

Dr. Paul has worked to establish policies such as documenting preferred gender identity of patients in electronic medical records and using pronoun cards on ID badges to make LGBTQI+ patients more comfortable. Rainbows in Gastro has shown trainees they can be open about their sexual orientation and gender identity without fear of retribution. “I’ve had medical students and residents come to me and say they were going to go into endocrine or some other field because they thought it was more gay friendly, until they saw our group and the work we’re doing,” Dr. Paul said.

In an interview, she talks more about her two key passions: reducing disparities and promoting health equity.

Q: You presented “Embrace the Rainbow: Creating Inclusive LGBTQ+ Spaces in Medicine” at the University of Chicago Medicine Grand Rounds. What were some of the key takeaways of that presentation?

Dr. Paul: One is education. Knowing the history of the LGBT community and how marginalization and discrimination affects the individual coming into that clinic is important. Having little things like pronoun badges or a rainbow flag, having nondiscrimination policies that include sexual orientation, gender identity that are displayed in the clinics, are very small things that seem almost trivial to some people. But I can tell you for myself, it matters if I walk into a door and there’s a rainbow flag there. I feel immediately safer.

Q: What are your hopes and aspirations for the field of GI moving forward?

Dr. Paul: I didn’t learn about social determinants of health in medical school, but more and more I think we’re starting to pivot and really look at those things. I hope GI and hepatology continues to do that.

For me, it’s looking at everything through a health disparities lens, seeing the health disparities across communities and finding solutions to mitigate them. How do we get people access to transplant for all our patients, and really examining the social determinants of health in the health care we provide?

Q: Your clinical focus has been on nonalcoholic fatty liver disease. Can you tell me how you got interested in that area of medicine?

Dr. Paul: There’s been a name change for the disease itself. It’s now metabolic dysfunction-associated steatotic liver disease (MASLD). I got interested from an obesity medicine perspective. I thought the liver pathology was interesting but I wanted to approach it from a different kind of perspective and not just focus on the liver, but also the metabolic factors.

I practice from that kind of lens: Looking at a lot of the metabolic comorbidities that happen with fatty liver disease to help patients with weight loss.

Q: What do you think about the new weight loss drugs?

Dr. Paul: I think they’re very effective. They’re obviously very popular. Weight loss is a really hard thing and I think they are really changing the game. A newer one that was just approved, tirzepatide (Zepbound, Lilly) resulted in up to 20% body weight loss. I think if there’s a medicine that we can give to avoid surgery for some people, I think that’s great. I think what is quite disheartening is insurance access to the medications.

Q: Is there any type of research you’re doing in this area right now?

Dr. Paul: I’m interested in the changes in fatty liver with gender-affirming hormone therapy with estrogen and testosterone, an area that’s never been studied.

Q: Describe how you would spend a free Saturday afternoon.

Dr. Paul: With my wife, my 9-year-old son, and two dogs. One of our favorite places to go is the Lincoln Park Zoo. We go there, especially over the summer, sometimes every week just to walk around. And, my son loves animals. Or, play with our dogs.

LIGHTNING ROUND

What is your favorite junk food? 
Doritos

What is your favorite holiday?
Thanksgiving

Is there a book that you reread often?
“Interpreter of Maladies” by Jhumpa Lahiri 

What is your favorite movie genre?
Comedy

Are you an introvert or extrovert? 
Somewhere in the middle.

In 2021, when Eric Esrailian, MD, MPH, was awarded the Benemerenti Medal from Pope Francis for his humanitarian work, he recognized other people worldwide who save lives daily – but without recognition. They’re motivated for “the right reasons. To be clear, I do not deserve this honor. It is honestly overwhelming and humbling,” he said in 2021 when news of the award reached him in Los Angeles where he holds the Lincy Foundation Chair in Clinical Gastroenterology at the University of California, Los Angeles. He also serves as chief of the Vatche and Tamar Manoukian Division of Digestive Diseases, and director of the Melvin and Bren Simon Digestive Diseases Center.

Esrailian_Eric_ Pope Francis_web.jpg

Dr. Esrailian, the son of Armenian immigrants, says that humanitarian work has been ingrained in him since childhood. His great-grandparents were Armenian genocide survivors and their struggles have never left him. He’s devoted his life not only to medicine, but to documenting the history of the Armenian genocide and leading, or supporting, efforts to resolve humanitarian crises in Armenia and around the world. Earlier this year, he, with Kim Kardashian and singer/actor Cher, published op-eds that addressed a humanitarian crisis building as a result of Azerbaijan’s blockade of the Lachin corridor – which is the only road that links Armenia to the ethnic Armenian–populated sections of Nagorno-Karabakh. In September, Armenia and Azerbaijan reached a tentative agreement to end the blockade, but more needs to be done, he says. Tragedies continue to unfold, and he is redoubling his efforts to bring more attention to this humanitarian crisis, he said.

Because storytelling is an important part of raising awareness, in 2016 Dr. Esrailian and partners produced two films about stories of perseverance, endurance, and the inextinguishable fire of the human spirit. The first film was “The Promise,” a historical war drama set in the Ottoman Empire and released in 2016. In 2017, he and partners released “Intent to Destroy: Death, Denial, & Depiction,” a documentary about the Armenian genocide. The documentary received an Emmy nomination for Outstanding Historical Documentary. And, in 2020, he produced “Francesco,” a film about Pope Francis that documented his pilgrimage to Armenia in 2016.

“The Promise” had such an impact on viewers that in 2017 Dr. Esrailian and the UCLA School of Law created The Promise Institute for Human Rights as a center of human rights education, research, and advocacy. In 2019, Dr. Esrailian and UCLA followed up with The Promise Armenian Institute as a place for academic research and teaching of Armenian studies, language, and culture. “The impact from building these two institutes has been transformational, and they will be part of UCLA forever,” he said.

His philanthropic efforts connecting health, human rights, education, and the arts has had an impact worldwide. One person can make a difference, Dr. Esrailian said: “I’ve learned along the way that an individual can have more of an impact than ever imagined, but you have to dream big and never give up.”

In this interview, he tells us more about his work.
 

Q: Not many doctors wear hats in medicine and filmmaking. Describe your journey as a filmmaker.

Esrailian_Eric_Calif_web.jpg

Dr. Esrailian: I’ve always been interested in storytelling. I was an English minor at Berkeley. My late mentor, Kirk Kerkorian, a legendary philanthropist, businessman, and entrepreneur, pushed me to take storytelling and do something that would potentially help secure Armenian Genocide recognition by the United States. Because of genocide denialists and geopolitical pressure, he felt the United States government was reluctant to recognize the Armenian Genocide. He thought having some visual materials for educational and outreach efforts would be transformational, and as it turns out, they were.

If you talk to any advocacy organization that tried for years to get Armenian Genocide recognition, they’d say that both films, “The Promise” (a feature film) and “Intent to Destroy” (a documentary), and the social impact media campaign we launched around them, were influential in moving the needle with legislators in the United States who, 3 years after “The Promise” was released, recognized the genocide. This was followed by the Library of Congress in 2020 and President Biden’s executive branch in 2021.
 

Q: What has been your most rewarding accomplishment?

Dr. Esrailian: Giving a voice to people who don’t have a voice is something that I’m proud of. Sometimes, it’s questionable what impact it may have because we still see atrocities committed all over the world. In September, Azerbaijan completed an ethnic cleansing campaign of Armenians from a region called Artsakh, officially the Republic of Nagorno-Karabakh.

Despite having so many relationships with powerful people in government and in high-profile media, and despite our documentaries, op-eds, and interactions with influential leaders on a regular basis, it always feels like it’s not enough. Obviously, the perpetrators are still able to abuse human rights and conduct these campaigns. Nevertheless, I don’t think we should be deterred. Allowing human rights violations to occur with impunity only emboldens perpetrators even more. It takes a long time to bring people to justice through international courts, but it does happen – eventually. That’s something I’m going to continue to work on.
 

Q: What should be the role of physicians in supporting human rights?

Dr. Esrailian: Physicians and health care providers play an important role in human rights. If you look back throughout history, whether it’s the International Committee of the Red Cross, or Doctors Without Borders, or other organizations, physicians and health care professionals are often on the front lines, helping people. Unfortunately, physicians have also been part of human rights violations, like the Holocaust or other genocides. But I do think that in this day and age, with the reputation that physicians have, we can be policy advocates and upstanders in addition to taking care of patients. Telling our stories to the world is important so that people know what’s actually happening on the ground.

Lightning round

Do you prefer texting or talking?  
Talking

How many cups of coffee do you drink each day?
Two

What was the last movie you watched?
Mission Impossible

If you weren’t a gastroenterologist, what would you be?  
Entrepreneur

Who inspires you?  
My family

In 2021, when Eric Esrailian, MD, MPH, was awarded the Benemerenti Medal from Pope Francis for his humanitarian work, he recognized other people worldwide who save lives daily – but without recognition. They’re motivated for “the right reasons. To be clear, I do not deserve this honor. It is honestly overwhelming and humbling,” he said in 2021 when news of the award reached him in Los Angeles where he holds the Lincy Foundation Chair in Clinical Gastroenterology at the University of California, Los Angeles. He also serves as chief of the Vatche and Tamar Manoukian Division of Digestive Diseases, and director of the Melvin and Bren Simon Digestive Diseases Center.

Esrailian_Eric_ Pope Francis_web.jpg

Dr. Esrailian, the son of Armenian immigrants, says that humanitarian work has been ingrained in him since childhood. His great-grandparents were Armenian genocide survivors and their struggles have never left him. He’s devoted his life not only to medicine, but to documenting the history of the Armenian genocide and leading, or supporting, efforts to resolve humanitarian crises in Armenia and around the world. Earlier this year, he, with Kim Kardashian and singer/actor Cher, published op-eds that addressed a humanitarian crisis building as a result of Azerbaijan’s blockade of the Lachin corridor – which is the only road that links Armenia to the ethnic Armenian–populated sections of Nagorno-Karabakh. In September, Armenia and Azerbaijan reached a tentative agreement to end the blockade, but more needs to be done, he says. Tragedies continue to unfold, and he is redoubling his efforts to bring more attention to this humanitarian crisis, he said.

Because storytelling is an important part of raising awareness, in 2016 Dr. Esrailian and partners produced two films about stories of perseverance, endurance, and the inextinguishable fire of the human spirit. The first film was “The Promise,” a historical war drama set in the Ottoman Empire and released in 2016. In 2017, he and partners released “Intent to Destroy: Death, Denial, & Depiction,” a documentary about the Armenian genocide. The documentary received an Emmy nomination for Outstanding Historical Documentary. And, in 2020, he produced “Francesco,” a film about Pope Francis that documented his pilgrimage to Armenia in 2016.

“The Promise” had such an impact on viewers that in 2017 Dr. Esrailian and the UCLA School of Law created The Promise Institute for Human Rights as a center of human rights education, research, and advocacy. In 2019, Dr. Esrailian and UCLA followed up with The Promise Armenian Institute as a place for academic research and teaching of Armenian studies, language, and culture. “The impact from building these two institutes has been transformational, and they will be part of UCLA forever,” he said.

His philanthropic efforts connecting health, human rights, education, and the arts has had an impact worldwide. One person can make a difference, Dr. Esrailian said: “I’ve learned along the way that an individual can have more of an impact than ever imagined, but you have to dream big and never give up.”

In this interview, he tells us more about his work.
 

Q: Not many doctors wear hats in medicine and filmmaking. Describe your journey as a filmmaker.

Esrailian_Eric_Calif_web.jpg

Dr. Esrailian: I’ve always been interested in storytelling. I was an English minor at Berkeley. My late mentor, Kirk Kerkorian, a legendary philanthropist, businessman, and entrepreneur, pushed me to take storytelling and do something that would potentially help secure Armenian Genocide recognition by the United States. Because of genocide denialists and geopolitical pressure, he felt the United States government was reluctant to recognize the Armenian Genocide. He thought having some visual materials for educational and outreach efforts would be transformational, and as it turns out, they were.

If you talk to any advocacy organization that tried for years to get Armenian Genocide recognition, they’d say that both films, “The Promise” (a feature film) and “Intent to Destroy” (a documentary), and the social impact media campaign we launched around them, were influential in moving the needle with legislators in the United States who, 3 years after “The Promise” was released, recognized the genocide. This was followed by the Library of Congress in 2020 and President Biden’s executive branch in 2021.
 

Q: What has been your most rewarding accomplishment?

Dr. Esrailian: Giving a voice to people who don’t have a voice is something that I’m proud of. Sometimes, it’s questionable what impact it may have because we still see atrocities committed all over the world. In September, Azerbaijan completed an ethnic cleansing campaign of Armenians from a region called Artsakh, officially the Republic of Nagorno-Karabakh.

Despite having so many relationships with powerful people in government and in high-profile media, and despite our documentaries, op-eds, and interactions with influential leaders on a regular basis, it always feels like it’s not enough. Obviously, the perpetrators are still able to abuse human rights and conduct these campaigns. Nevertheless, I don’t think we should be deterred. Allowing human rights violations to occur with impunity only emboldens perpetrators even more. It takes a long time to bring people to justice through international courts, but it does happen – eventually. That’s something I’m going to continue to work on.
 

Q: What should be the role of physicians in supporting human rights?

Dr. Esrailian: Physicians and health care providers play an important role in human rights. If you look back throughout history, whether it’s the International Committee of the Red Cross, or Doctors Without Borders, or other organizations, physicians and health care professionals are often on the front lines, helping people. Unfortunately, physicians have also been part of human rights violations, like the Holocaust or other genocides. But I do think that in this day and age, with the reputation that physicians have, we can be policy advocates and upstanders in addition to taking care of patients. Telling our stories to the world is important so that people know what’s actually happening on the ground.

Lightning round

Do you prefer texting or talking?  
Talking

How many cups of coffee do you drink each day?
Two

What was the last movie you watched?
Mission Impossible

If you weren’t a gastroenterologist, what would you be?  
Entrepreneur

Who inspires you?  
My family

In 2021, when Eric Esrailian, MD, MPH, was awarded the Benemerenti Medal from Pope Francis for his humanitarian work, he recognized other people worldwide who save lives daily – but without recognition. They’re motivated for “the right reasons. To be clear, I do not deserve this honor. It is honestly overwhelming and humbling,” he said in 2021 when news of the award reached him in Los Angeles where he holds the Lincy Foundation Chair in Clinical Gastroenterology at the University of California, Los Angeles. He also serves as chief of the Vatche and Tamar Manoukian Division of Digestive Diseases, and director of the Melvin and Bren Simon Digestive Diseases Center.

Esrailian_Eric_ Pope Francis_web.jpg

Dr. Esrailian, the son of Armenian immigrants, says that humanitarian work has been ingrained in him since childhood. His great-grandparents were Armenian genocide survivors and their struggles have never left him. He’s devoted his life not only to medicine, but to documenting the history of the Armenian genocide and leading, or supporting, efforts to resolve humanitarian crises in Armenia and around the world. Earlier this year, he, with Kim Kardashian and singer/actor Cher, published op-eds that addressed a humanitarian crisis building as a result of Azerbaijan’s blockade of the Lachin corridor – which is the only road that links Armenia to the ethnic Armenian–populated sections of Nagorno-Karabakh. In September, Armenia and Azerbaijan reached a tentative agreement to end the blockade, but more needs to be done, he says. Tragedies continue to unfold, and he is redoubling his efforts to bring more attention to this humanitarian crisis, he said.

Because storytelling is an important part of raising awareness, in 2016 Dr. Esrailian and partners produced two films about stories of perseverance, endurance, and the inextinguishable fire of the human spirit. The first film was “The Promise,” a historical war drama set in the Ottoman Empire and released in 2016. In 2017, he and partners released “Intent to Destroy: Death, Denial, & Depiction,” a documentary about the Armenian genocide. The documentary received an Emmy nomination for Outstanding Historical Documentary. And, in 2020, he produced “Francesco,” a film about Pope Francis that documented his pilgrimage to Armenia in 2016.

“The Promise” had such an impact on viewers that in 2017 Dr. Esrailian and the UCLA School of Law created The Promise Institute for Human Rights as a center of human rights education, research, and advocacy. In 2019, Dr. Esrailian and UCLA followed up with The Promise Armenian Institute as a place for academic research and teaching of Armenian studies, language, and culture. “The impact from building these two institutes has been transformational, and they will be part of UCLA forever,” he said.

His philanthropic efforts connecting health, human rights, education, and the arts has had an impact worldwide. One person can make a difference, Dr. Esrailian said: “I’ve learned along the way that an individual can have more of an impact than ever imagined, but you have to dream big and never give up.”

In this interview, he tells us more about his work.
 

Q: Not many doctors wear hats in medicine and filmmaking. Describe your journey as a filmmaker.

Esrailian_Eric_Calif_web.jpg

Dr. Esrailian: I’ve always been interested in storytelling. I was an English minor at Berkeley. My late mentor, Kirk Kerkorian, a legendary philanthropist, businessman, and entrepreneur, pushed me to take storytelling and do something that would potentially help secure Armenian Genocide recognition by the United States. Because of genocide denialists and geopolitical pressure, he felt the United States government was reluctant to recognize the Armenian Genocide. He thought having some visual materials for educational and outreach efforts would be transformational, and as it turns out, they were.

If you talk to any advocacy organization that tried for years to get Armenian Genocide recognition, they’d say that both films, “The Promise” (a feature film) and “Intent to Destroy” (a documentary), and the social impact media campaign we launched around them, were influential in moving the needle with legislators in the United States who, 3 years after “The Promise” was released, recognized the genocide. This was followed by the Library of Congress in 2020 and President Biden’s executive branch in 2021.
 

Q: What has been your most rewarding accomplishment?

Dr. Esrailian: Giving a voice to people who don’t have a voice is something that I’m proud of. Sometimes, it’s questionable what impact it may have because we still see atrocities committed all over the world. In September, Azerbaijan completed an ethnic cleansing campaign of Armenians from a region called Artsakh, officially the Republic of Nagorno-Karabakh.

Despite having so many relationships with powerful people in government and in high-profile media, and despite our documentaries, op-eds, and interactions with influential leaders on a regular basis, it always feels like it’s not enough. Obviously, the perpetrators are still able to abuse human rights and conduct these campaigns. Nevertheless, I don’t think we should be deterred. Allowing human rights violations to occur with impunity only emboldens perpetrators even more. It takes a long time to bring people to justice through international courts, but it does happen – eventually. That’s something I’m going to continue to work on.
 

Q: What should be the role of physicians in supporting human rights?

Dr. Esrailian: Physicians and health care providers play an important role in human rights. If you look back throughout history, whether it’s the International Committee of the Red Cross, or Doctors Without Borders, or other organizations, physicians and health care professionals are often on the front lines, helping people. Unfortunately, physicians have also been part of human rights violations, like the Holocaust or other genocides. But I do think that in this day and age, with the reputation that physicians have, we can be policy advocates and upstanders in addition to taking care of patients. Telling our stories to the world is important so that people know what’s actually happening on the ground.

Lightning round

Do you prefer texting or talking?  
Talking

How many cups of coffee do you drink each day?
Two

What was the last movie you watched?
Mission Impossible

If you weren’t a gastroenterologist, what would you be?  
Entrepreneur

Who inspires you?  
My family

Ask Joanna Melia, MD, what her biggest practice challenge is, and she’d say the need for more precision medicine in inflammatory bowel disease.

Gastroenterologists have more treatments at their disposal today than ever before, particularly in the last decade. “We have had tremendous advances in many areas of understanding contributors to disease,” said Dr. Melia, an assistant professor of medicine at Johns Hopkins Medicine in Baltimore who specializes in inflammatory bowel disease (IBD). But the hurdle is in translating the science to clinical care that is individualized to each patient based on condition and stage of the condition.

Melia_Joanna_Maryland_web.jpg

“That still remains a bit of a dream,” she said. Much of her career has been devoted to chasing down a particular genetic variant that contributes to IBD, with the goal of reaching more precise treatments for patients.

In an interview, she shared how she entered this line of work, and what her research has revealed about Crohn’s disease, manganese, and a common genetic variant known as ZIP8.

Q: Your expertise is in inflammatory bowel disease and manganese deficiency. Why did you choose these two areas as your focus in GI?

Dr. Melia: In talking to many patients with IBD, I was always struck by the questions around nutritional factors related to disease. As a fellow, I was embedded in a lab that focused on genetics of IBD. A micronutrient transporter, ZIP8, has a mutation in it that increases the risk of Crohn’s disease.

I’ve dedicated the last 8 years to understanding how this mutation can increase risk. It initially started out as a project focused on zinc, because that’s what the transporter was thought to regulate. However, it’s evolved as we’ve learned more about it, underscoring the importance of manganese, another micronutrient that we derive from food.

We have established that having this mutation changes how the body handles manganese and affects downstream processes that involve manganese. What I’m doing now is trying to connect those dots on why those processes are important in Crohn’s disease and whether we can target them for treatment.

Q: How does manganese deficiency lead to chronic IBD?

Dr. Melia: In individuals with this mutation, their blood manganese levels are lower than people who don’t have this mutation. When we talk about manganese deficiency or insufficiency, what we’re really talking about is lower blood levels. But it’s more complicated than that at the tissue level.

What we and other groups are working on right now is trying to understand if the manganese levels change in the gut and what happens in inflammation. The gut is a particularly interesting area for manganese, in that much of the manganese that we eat is excreted. We only absorb a small amount of it. And so, manganese levels within the gut lumen may actually be quite high – and may be even higher in inflammation. But there are things we don’t understand about that and how it relates to mucosal levels of manganese and Crohn’s disease. The ileum, the site of the Crohn’s disease that’s specifically associated with this mutation, might be particularly sensitive to changes in the manganese levels or the downstream processes that changing manganese availability affects.

One of those processes is glycosylation. Manganese is important to properly glycosylate your proteins. Many enzymes help cells put sugars on proteins, and many of those enzymes need manganese to do it. Glycosylation of proteins is important so cells know where those proteins should go, and the sugars help them stay where they need to be. When you change protein glycosylation, you can stress the cells. We know individuals who carry this mutation have changes in the glycosylation of their proteins. What we’re working on right now is understanding which key proteins might change when that happens, and why that’s a potential problem, especially in the ileum.

Q: How might your research inform clinical practice?

Dr. Melia: We’ve seen significant progress in new medications and new pathways that have emerged. We still have this fundamental problem that our immune-targeting medicines are only helping about 50% of the patients.

It’s critical that we begin to identify new pathways. And my hope is that in studying genes like the ZIP8 (SLC39A8), which is associated with the dysregulated processing of manganese, we can understand different pathways and mechanisms to target.

As an example, if we could help correct the glycosylation problem, that would help to boost the barrier function of the gut and perhaps decrease the activation of those immune cells, because you’re just reinforcing the barrier integrity of the gut.

We want to target that glycosylation problem as we would treat patients with congenital disorders of glycosylation by giving supplemental sugars. We think this problem of glycosylation extends beyond patients with the ZIP8 mutation, but it is also really important for patients with the mutation. So, the goal would be to use ZIP8 genetics to help prioritize patients for therapy targeting this problem.

Q: You’re involved in the American Gastroenterological Association Future Leaders Program. What is your role in this program? Why is it important?

Dr. Melia: I was very grateful for the opportunity to participate in the AGA’s Future Leaders Program. I think it was exceedingly valuable for two main reasons. One, it really offered an insight into the role of the AGA and the important role that the AGA plays in the careers of gastroenterologists. Two, it was such a unique opportunity to work with colleagues nationwide and to build a network of individuals who are all at a similar stage in their careers. It was a very inspiring group to meet and to have the opportunity to work with as part of that program, and I thank the AGA for supporting such an initiative.

Q: What teacher or mentor had the greatest impact on you?

Dr. Melia: I have been blessed by many clinical and research mentors through my career. I was inspired to do science at the lab of Ramnik Xavier, MD, at Massachusetts General Hospital. At Johns Hopkins, I credit Cindy Sears, MD, and Anne Marie O’Broin Lennon, MBBCh, PhD, as two physician scientists who have really shaped how I have tried to integrate my clinical and research career.

LIGHTNING ROUND

Do you prefer texting or talking?
Texting

If you weren’t a gastroenterologist, what would you be?
Teacher

What was the last movie you watched?
Great Bear Rainforest

What is your most favorite city in the U.S.?
Surry, Maine

What song do you absolutely have to sing along with when you hear it?
Any song by Whitney Houston.

Are you an introvert or extrovert?
Introvert

How many cups of coffee do you drink per day?
One

Ask Joanna Melia, MD, what her biggest practice challenge is, and she’d say the need for more precision medicine in inflammatory bowel disease.

Gastroenterologists have more treatments at their disposal today than ever before, particularly in the last decade. “We have had tremendous advances in many areas of understanding contributors to disease,” said Dr. Melia, an assistant professor of medicine at Johns Hopkins Medicine in Baltimore who specializes in inflammatory bowel disease (IBD). But the hurdle is in translating the science to clinical care that is individualized to each patient based on condition and stage of the condition.

Melia_Joanna_Maryland_web.jpg

“That still remains a bit of a dream,” she said. Much of her career has been devoted to chasing down a particular genetic variant that contributes to IBD, with the goal of reaching more precise treatments for patients.

In an interview, she shared how she entered this line of work, and what her research has revealed about Crohn’s disease, manganese, and a common genetic variant known as ZIP8.

Q: Your expertise is in inflammatory bowel disease and manganese deficiency. Why did you choose these two areas as your focus in GI?

Dr. Melia: In talking to many patients with IBD, I was always struck by the questions around nutritional factors related to disease. As a fellow, I was embedded in a lab that focused on genetics of IBD. A micronutrient transporter, ZIP8, has a mutation in it that increases the risk of Crohn’s disease.

I’ve dedicated the last 8 years to understanding how this mutation can increase risk. It initially started out as a project focused on zinc, because that’s what the transporter was thought to regulate. However, it’s evolved as we’ve learned more about it, underscoring the importance of manganese, another micronutrient that we derive from food.

We have established that having this mutation changes how the body handles manganese and affects downstream processes that involve manganese. What I’m doing now is trying to connect those dots on why those processes are important in Crohn’s disease and whether we can target them for treatment.

Q: How does manganese deficiency lead to chronic IBD?

Dr. Melia: In individuals with this mutation, their blood manganese levels are lower than people who don’t have this mutation. When we talk about manganese deficiency or insufficiency, what we’re really talking about is lower blood levels. But it’s more complicated than that at the tissue level.

What we and other groups are working on right now is trying to understand if the manganese levels change in the gut and what happens in inflammation. The gut is a particularly interesting area for manganese, in that much of the manganese that we eat is excreted. We only absorb a small amount of it. And so, manganese levels within the gut lumen may actually be quite high – and may be even higher in inflammation. But there are things we don’t understand about that and how it relates to mucosal levels of manganese and Crohn’s disease. The ileum, the site of the Crohn’s disease that’s specifically associated with this mutation, might be particularly sensitive to changes in the manganese levels or the downstream processes that changing manganese availability affects.

One of those processes is glycosylation. Manganese is important to properly glycosylate your proteins. Many enzymes help cells put sugars on proteins, and many of those enzymes need manganese to do it. Glycosylation of proteins is important so cells know where those proteins should go, and the sugars help them stay where they need to be. When you change protein glycosylation, you can stress the cells. We know individuals who carry this mutation have changes in the glycosylation of their proteins. What we’re working on right now is understanding which key proteins might change when that happens, and why that’s a potential problem, especially in the ileum.

Q: How might your research inform clinical practice?

Dr. Melia: We’ve seen significant progress in new medications and new pathways that have emerged. We still have this fundamental problem that our immune-targeting medicines are only helping about 50% of the patients.

It’s critical that we begin to identify new pathways. And my hope is that in studying genes like the ZIP8 (SLC39A8), which is associated with the dysregulated processing of manganese, we can understand different pathways and mechanisms to target.

As an example, if we could help correct the glycosylation problem, that would help to boost the barrier function of the gut and perhaps decrease the activation of those immune cells, because you’re just reinforcing the barrier integrity of the gut.

We want to target that glycosylation problem as we would treat patients with congenital disorders of glycosylation by giving supplemental sugars. We think this problem of glycosylation extends beyond patients with the ZIP8 mutation, but it is also really important for patients with the mutation. So, the goal would be to use ZIP8 genetics to help prioritize patients for therapy targeting this problem.

Q: You’re involved in the American Gastroenterological Association Future Leaders Program. What is your role in this program? Why is it important?

Dr. Melia: I was very grateful for the opportunity to participate in the AGA’s Future Leaders Program. I think it was exceedingly valuable for two main reasons. One, it really offered an insight into the role of the AGA and the important role that the AGA plays in the careers of gastroenterologists. Two, it was such a unique opportunity to work with colleagues nationwide and to build a network of individuals who are all at a similar stage in their careers. It was a very inspiring group to meet and to have the opportunity to work with as part of that program, and I thank the AGA for supporting such an initiative.

Q: What teacher or mentor had the greatest impact on you?

Dr. Melia: I have been blessed by many clinical and research mentors through my career. I was inspired to do science at the lab of Ramnik Xavier, MD, at Massachusetts General Hospital. At Johns Hopkins, I credit Cindy Sears, MD, and Anne Marie O’Broin Lennon, MBBCh, PhD, as two physician scientists who have really shaped how I have tried to integrate my clinical and research career.

LIGHTNING ROUND

Do you prefer texting or talking?
Texting

If you weren’t a gastroenterologist, what would you be?
Teacher

What was the last movie you watched?
Great Bear Rainforest

What is your most favorite city in the U.S.?
Surry, Maine

What song do you absolutely have to sing along with when you hear it?
Any song by Whitney Houston.

Are you an introvert or extrovert?
Introvert

How many cups of coffee do you drink per day?
One

Ask Joanna Melia, MD, what her biggest practice challenge is, and she’d say the need for more precision medicine in inflammatory bowel disease.

Gastroenterologists have more treatments at their disposal today than ever before, particularly in the last decade. “We have had tremendous advances in many areas of understanding contributors to disease,” said Dr. Melia, an assistant professor of medicine at Johns Hopkins Medicine in Baltimore who specializes in inflammatory bowel disease (IBD). But the hurdle is in translating the science to clinical care that is individualized to each patient based on condition and stage of the condition.

Melia_Joanna_Maryland_web.jpg

“That still remains a bit of a dream,” she said. Much of her career has been devoted to chasing down a particular genetic variant that contributes to IBD, with the goal of reaching more precise treatments for patients.

In an interview, she shared how she entered this line of work, and what her research has revealed about Crohn’s disease, manganese, and a common genetic variant known as ZIP8.

Q: Your expertise is in inflammatory bowel disease and manganese deficiency. Why did you choose these two areas as your focus in GI?

Dr. Melia: In talking to many patients with IBD, I was always struck by the questions around nutritional factors related to disease. As a fellow, I was embedded in a lab that focused on genetics of IBD. A micronutrient transporter, ZIP8, has a mutation in it that increases the risk of Crohn’s disease.

I’ve dedicated the last 8 years to understanding how this mutation can increase risk. It initially started out as a project focused on zinc, because that’s what the transporter was thought to regulate. However, it’s evolved as we’ve learned more about it, underscoring the importance of manganese, another micronutrient that we derive from food.

We have established that having this mutation changes how the body handles manganese and affects downstream processes that involve manganese. What I’m doing now is trying to connect those dots on why those processes are important in Crohn’s disease and whether we can target them for treatment.

Q: How does manganese deficiency lead to chronic IBD?

Dr. Melia: In individuals with this mutation, their blood manganese levels are lower than people who don’t have this mutation. When we talk about manganese deficiency or insufficiency, what we’re really talking about is lower blood levels. But it’s more complicated than that at the tissue level.

What we and other groups are working on right now is trying to understand if the manganese levels change in the gut and what happens in inflammation. The gut is a particularly interesting area for manganese, in that much of the manganese that we eat is excreted. We only absorb a small amount of it. And so, manganese levels within the gut lumen may actually be quite high – and may be even higher in inflammation. But there are things we don’t understand about that and how it relates to mucosal levels of manganese and Crohn’s disease. The ileum, the site of the Crohn’s disease that’s specifically associated with this mutation, might be particularly sensitive to changes in the manganese levels or the downstream processes that changing manganese availability affects.

One of those processes is glycosylation. Manganese is important to properly glycosylate your proteins. Many enzymes help cells put sugars on proteins, and many of those enzymes need manganese to do it. Glycosylation of proteins is important so cells know where those proteins should go, and the sugars help them stay where they need to be. When you change protein glycosylation, you can stress the cells. We know individuals who carry this mutation have changes in the glycosylation of their proteins. What we’re working on right now is understanding which key proteins might change when that happens, and why that’s a potential problem, especially in the ileum.

Q: How might your research inform clinical practice?

Dr. Melia: We’ve seen significant progress in new medications and new pathways that have emerged. We still have this fundamental problem that our immune-targeting medicines are only helping about 50% of the patients.

It’s critical that we begin to identify new pathways. And my hope is that in studying genes like the ZIP8 (SLC39A8), which is associated with the dysregulated processing of manganese, we can understand different pathways and mechanisms to target.

As an example, if we could help correct the glycosylation problem, that would help to boost the barrier function of the gut and perhaps decrease the activation of those immune cells, because you’re just reinforcing the barrier integrity of the gut.

We want to target that glycosylation problem as we would treat patients with congenital disorders of glycosylation by giving supplemental sugars. We think this problem of glycosylation extends beyond patients with the ZIP8 mutation, but it is also really important for patients with the mutation. So, the goal would be to use ZIP8 genetics to help prioritize patients for therapy targeting this problem.

Q: You’re involved in the American Gastroenterological Association Future Leaders Program. What is your role in this program? Why is it important?

Dr. Melia: I was very grateful for the opportunity to participate in the AGA’s Future Leaders Program. I think it was exceedingly valuable for two main reasons. One, it really offered an insight into the role of the AGA and the important role that the AGA plays in the careers of gastroenterologists. Two, it was such a unique opportunity to work with colleagues nationwide and to build a network of individuals who are all at a similar stage in their careers. It was a very inspiring group to meet and to have the opportunity to work with as part of that program, and I thank the AGA for supporting such an initiative.

Q: What teacher or mentor had the greatest impact on you?

Dr. Melia: I have been blessed by many clinical and research mentors through my career. I was inspired to do science at the lab of Ramnik Xavier, MD, at Massachusetts General Hospital. At Johns Hopkins, I credit Cindy Sears, MD, and Anne Marie O’Broin Lennon, MBBCh, PhD, as two physician scientists who have really shaped how I have tried to integrate my clinical and research career.

LIGHTNING ROUND

Do you prefer texting or talking?
Texting

If you weren’t a gastroenterologist, what would you be?
Teacher

What was the last movie you watched?
Great Bear Rainforest

What is your most favorite city in the U.S.?
Surry, Maine

What song do you absolutely have to sing along with when you hear it?
Any song by Whitney Houston.

Are you an introvert or extrovert?
Introvert

How many cups of coffee do you drink per day?
One

Sameer K. Berry, MD, MBA, comes from a family of GI doctors. As a child, he used to accompany his father when he made rounds at the local county hospital.

Berry_Sameer_NY_web.jpg

Dr. Berry: Gastroenterologists continue to witness unnecessary patient suffering due to antiquated care delivery models and perverse incentives in our healthcare system. Oshi’s care model was designed to align incentives and provide patients with access to clinicians who are traditionally not reimbursed in fee-for-service healthcare while also helping GI practices provide this care to their patients. During my clinical training it was easy for me to order expensive and invasive testing for my patients, but very difficult for me to get them the multidisciplinary care they needed. Many of the patients I would see didn’t need more MRIs, CT scans, or expensive medications. They needed access to a team of clinicians to help with all the aspects of GI care, including diet, behavioral, and medical.



Q: Why is multidisciplinary care the right approach?

Dr. Berry: GI is a very complex field with many nuances that can impact a patient’s symptoms. As physicians, our role is now evolving to oversee a team of clinicians working together to maximize expertise in nutrition and the gut-brain axis. With these new multidisciplinary care models, GI practices can expand their capabilities. At Oshi Health, every single patient has access to a nurse practitioner, dietician, psychologist, and health coach — all overseen by a gastroenterologist — as a covered benefit through their health plan. Providing multidisciplinary care through a virtual-first model solves some of the scalability challenges of these intensive care models and can significantly improve access to care.



Q: What grant-funded clinical research are you doing right now?

Dr. Berry: Most of my research focuses on evaluating the impact of novel care delivery models in GI and the evaluation of digital technologies in GI and how we can incorporate those digital technologies into clinical practice. How can we determine what type of care can be done remotely via video visits? What can be done on the phone or via text messaging? How can we get these new services paid for so patients can reap the benefits of seeing their doctor more frequently?



Q: What teacher or mentor had the greatest impact on you?

Dr. Berry: Dr. John Allen, MD, MBA has had an incredible impact on my career. He’s the former president of the American Gastroenterological Association, and was the chief clinical officer and a professor at the University of Michigan. He’s one of the rare GI doctors that has both a strong clinical and leadership role in GI. I can’t thank him enough for planting the seeds to encourage me to focus on improving the ways we deliver care to patients.



Q: Describe how you would spend a free Saturday afternoon.

Dr. Berry: Roaming around and exploring a new neighborhood either in New York City or anywhere in the world. If I wasn’t going to be a doctor, I’d probably be an anthropologist. I love observing people in their element, and exploring new neighborhoods that are off the beaten path is a great way to do that.

Lightning round! Do you prefer texting or talking?
Texting


What’s high on your list of travel destinations?
Antarctica


Where was your most memorable vacation?
Patagonia


How many cups of coffee do you drink daily?
Four


What’s your favorite holiday?
Halloween


What’s your favorite junk food?
In-N-Out Burger


If you weren’t a gastroenterologist, what would you be?
Anthropologist

 

Sameer K. Berry, MD, MBA, comes from a family of GI doctors. As a child, he used to accompany his father when he made rounds at the local county hospital.

Berry_Sameer_NY_web.jpg

Dr. Berry: Gastroenterologists continue to witness unnecessary patient suffering due to antiquated care delivery models and perverse incentives in our healthcare system. Oshi’s care model was designed to align incentives and provide patients with access to clinicians who are traditionally not reimbursed in fee-for-service healthcare while also helping GI practices provide this care to their patients. During my clinical training it was easy for me to order expensive and invasive testing for my patients, but very difficult for me to get them the multidisciplinary care they needed. Many of the patients I would see didn’t need more MRIs, CT scans, or expensive medications. They needed access to a team of clinicians to help with all the aspects of GI care, including diet, behavioral, and medical.



Q: Why is multidisciplinary care the right approach?

Dr. Berry: GI is a very complex field with many nuances that can impact a patient’s symptoms. As physicians, our role is now evolving to oversee a team of clinicians working together to maximize expertise in nutrition and the gut-brain axis. With these new multidisciplinary care models, GI practices can expand their capabilities. At Oshi Health, every single patient has access to a nurse practitioner, dietician, psychologist, and health coach — all overseen by a gastroenterologist — as a covered benefit through their health plan. Providing multidisciplinary care through a virtual-first model solves some of the scalability challenges of these intensive care models and can significantly improve access to care.



Q: What grant-funded clinical research are you doing right now?

Dr. Berry: Most of my research focuses on evaluating the impact of novel care delivery models in GI and the evaluation of digital technologies in GI and how we can incorporate those digital technologies into clinical practice. How can we determine what type of care can be done remotely via video visits? What can be done on the phone or via text messaging? How can we get these new services paid for so patients can reap the benefits of seeing their doctor more frequently?



Q: What teacher or mentor had the greatest impact on you?

Dr. Berry: Dr. John Allen, MD, MBA has had an incredible impact on my career. He’s the former president of the American Gastroenterological Association, and was the chief clinical officer and a professor at the University of Michigan. He’s one of the rare GI doctors that has both a strong clinical and leadership role in GI. I can’t thank him enough for planting the seeds to encourage me to focus on improving the ways we deliver care to patients.



Q: Describe how you would spend a free Saturday afternoon.

Dr. Berry: Roaming around and exploring a new neighborhood either in New York City or anywhere in the world. If I wasn’t going to be a doctor, I’d probably be an anthropologist. I love observing people in their element, and exploring new neighborhoods that are off the beaten path is a great way to do that.

Lightning round! Do you prefer texting or talking?
Texting


What’s high on your list of travel destinations?
Antarctica


Where was your most memorable vacation?
Patagonia


How many cups of coffee do you drink daily?
Four


What’s your favorite holiday?
Halloween


What’s your favorite junk food?
In-N-Out Burger


If you weren’t a gastroenterologist, what would you be?
Anthropologist

 

Sameer K. Berry, MD, MBA, comes from a family of GI doctors. As a child, he used to accompany his father when he made rounds at the local county hospital.

Berry_Sameer_NY_web.jpg

Dr. Berry: Gastroenterologists continue to witness unnecessary patient suffering due to antiquated care delivery models and perverse incentives in our healthcare system. Oshi’s care model was designed to align incentives and provide patients with access to clinicians who are traditionally not reimbursed in fee-for-service healthcare while also helping GI practices provide this care to their patients. During my clinical training it was easy for me to order expensive and invasive testing for my patients, but very difficult for me to get them the multidisciplinary care they needed. Many of the patients I would see didn’t need more MRIs, CT scans, or expensive medications. They needed access to a team of clinicians to help with all the aspects of GI care, including diet, behavioral, and medical.



Q: Why is multidisciplinary care the right approach?

Dr. Berry: GI is a very complex field with many nuances that can impact a patient’s symptoms. As physicians, our role is now evolving to oversee a team of clinicians working together to maximize expertise in nutrition and the gut-brain axis. With these new multidisciplinary care models, GI practices can expand their capabilities. At Oshi Health, every single patient has access to a nurse practitioner, dietician, psychologist, and health coach — all overseen by a gastroenterologist — as a covered benefit through their health plan. Providing multidisciplinary care through a virtual-first model solves some of the scalability challenges of these intensive care models and can significantly improve access to care.



Q: What grant-funded clinical research are you doing right now?

Dr. Berry: Most of my research focuses on evaluating the impact of novel care delivery models in GI and the evaluation of digital technologies in GI and how we can incorporate those digital technologies into clinical practice. How can we determine what type of care can be done remotely via video visits? What can be done on the phone or via text messaging? How can we get these new services paid for so patients can reap the benefits of seeing their doctor more frequently?



Q: What teacher or mentor had the greatest impact on you?

Dr. Berry: Dr. John Allen, MD, MBA has had an incredible impact on my career. He’s the former president of the American Gastroenterological Association, and was the chief clinical officer and a professor at the University of Michigan. He’s one of the rare GI doctors that has both a strong clinical and leadership role in GI. I can’t thank him enough for planting the seeds to encourage me to focus on improving the ways we deliver care to patients.



Q: Describe how you would spend a free Saturday afternoon.

Dr. Berry: Roaming around and exploring a new neighborhood either in New York City or anywhere in the world. If I wasn’t going to be a doctor, I’d probably be an anthropologist. I love observing people in their element, and exploring new neighborhoods that are off the beaten path is a great way to do that.

Lightning round! Do you prefer texting or talking?
Texting


What’s high on your list of travel destinations?
Antarctica


Where was your most memorable vacation?
Patagonia


How many cups of coffee do you drink daily?
Four


What’s your favorite holiday?
Halloween


What’s your favorite junk food?
In-N-Out Burger


If you weren’t a gastroenterologist, what would you be?
Anthropologist

 

The gluten-free section in the grocery store didn’t exist when Renee Euler, MS, RD, LD, was diagnosed with celiac disease 30 years ago. A physician handed her a fax about the gluten-free diet from a national support group and said: “Here, read this.”

There was no Google to inform decisions. Patients had to rely on fact sheets or a book from the library.

Euler_Renee_Albuquerque_web.jpg

Q: What fears did you have to push past to get to where you are in your career?

Ms. Euler: Leaving a successful career as a landscape architect and going back to school was definitely a huge hurdle. When I started my practice in 2017, in my area there were no outpatient GI dietitians providing specialized care for adults with conditions like celiac disease, irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD). I was starting out with no real support.

Realizing that I was going to start a private practice of my own to help the people I wanted to help, was another big fear. “Am I going to succeed? Am I going to fail? What’s going to happen?” But over the years, my practice has grown as I learned to bill insurance and started receiving referrals from a large local GI practice, both of which have been the keys to my success. I have also limited my practice to GI clients so that I can focus my attention on this specialized area of nutrition and stay up to date on the latest developments.
 

Q: What interests you about the intersection between diet and GI disorders?

Ms. Euler: It’s not just about diet. We’re learning so much about how the gut microbiome can have a potential impact [on other parts of our health]. It’s interesting in terms of how we respond to certain foods, for instance, could affect our mental health. This especially applies to IBS and how the microbiome might be connected to these conditions.

It’s very challenging. There is so much information out there that is not super accurate, or it’s misleading.
 

Q: You serve as a liaison between the American Gastroenterological Association and the Academy of Nutrition and Dietetics. As a nutritionist with a focus on GI, how do you work with gastroenterologists to manage GI disorders?

Ms. Euler: Some of the dietary therapies that GI doctors recommend don’t provide sufficient guidance. They hand out that two-page fact sheet about diet and send the patient on their way. A lot of these diets have more nuance than what can be expressed in a two-page handout.

Many times, the physician doesn’t know the nuance, or they don’t have time to go over it. That’s where we can really help.

Patients often want diet to be the answer. They want to be told: “You need to eat this and only this, and everything will be fine, and diet’s going to change your world, and you won’t have to take medication.”

What they often don’t realize and understand, is a lot of these dietary therapies are not black and white. Celiac disease means a gluten-free diet for life. But a lot of these dietary therapies that get thrown out to patients as a possibility, like low FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols), are not lifetime diets. They’re tools for us to use to find out what the offending foods are for this person, and what can we do to get their symptoms under control.
 

Q: What is the biggest practice-related challenge in getting patients to alter their diet to improve their symptoms?

Ms. Euler: A lot of patients that come to me already have over restricted diets. They’re trying to solve things themselves. Rightfully so, a lot of them have a lot of food fears because they have been living with very uncomfortable symptoms for years, and they’re trying to find answers. Those food fears unfortunately are reinforced by social media and the news.

One of my biggest challenges with those clients is working through that process of building their confidence to broaden their diets and add foods back in, without causing their symptoms to flare up. The goal is to get them back on track to having a nutritious diet while trying to manage symptoms.
 

Q: Can you give me an anecdotal example of a case that wasn’t easy, and you ended up helping that person?

Ms. Euler: I had a patient who had been listening to all the wellness gurus. She was overrestricted to the point of eating just 10 different foods due to allergic and GI symptoms. Patients like this are definitely a challenge because you have to reorient them to the fact that what they’re doing isn’t necessarily working,

My initial assessments are 90 minutes long, so I have a lot of time to sit with a patient and hear their story and understand their background.

I suggested to the patient: “Why don’t we try adding these foods back in, but eliminating these other types of foods and see whether that would help?” 48 hours later, she sent me an email, telling me that she and her husband had talked this through, and they thought I hit the nail on the head: She was focusing on the wrong foods which were causing problems. Those are always great messages to get from patients, when they say: “Oh my gosh, I hadn’t even considered that.”
 

Q: Describe how you would spend a free Saturday afternoon.

Ms. Euler: They’re so rare – those free Saturday afternoons, but it would probably be a good book that would turn into a nap on the couch.

LIGHTNING ROUND

Do you prefer texting or talking?

Talking in person



What’s your favorite breakfast?

Greek yogurt with fiber, flax seeds, and berries



What’s your favorite junk food?

Ice cream



What’s your favorite fruit?

Garden grown strawberries



What’s your favorite holiday?

Thanksgiving



What’s your favorite type of music?

Jazz



If you weren’t a GI nutritionist, what would you be?

Probably a landscape architect.

The gluten-free section in the grocery store didn’t exist when Renee Euler, MS, RD, LD, was diagnosed with celiac disease 30 years ago. A physician handed her a fax about the gluten-free diet from a national support group and said: “Here, read this.”

There was no Google to inform decisions. Patients had to rely on fact sheets or a book from the library.

Euler_Renee_Albuquerque_web.jpg

Q: What fears did you have to push past to get to where you are in your career?

Ms. Euler: Leaving a successful career as a landscape architect and going back to school was definitely a huge hurdle. When I started my practice in 2017, in my area there were no outpatient GI dietitians providing specialized care for adults with conditions like celiac disease, irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD). I was starting out with no real support.

Realizing that I was going to start a private practice of my own to help the people I wanted to help, was another big fear. “Am I going to succeed? Am I going to fail? What’s going to happen?” But over the years, my practice has grown as I learned to bill insurance and started receiving referrals from a large local GI practice, both of which have been the keys to my success. I have also limited my practice to GI clients so that I can focus my attention on this specialized area of nutrition and stay up to date on the latest developments.
 

Q: What interests you about the intersection between diet and GI disorders?

Ms. Euler: It’s not just about diet. We’re learning so much about how the gut microbiome can have a potential impact [on other parts of our health]. It’s interesting in terms of how we respond to certain foods, for instance, could affect our mental health. This especially applies to IBS and how the microbiome might be connected to these conditions.

It’s very challenging. There is so much information out there that is not super accurate, or it’s misleading.
 

Q: You serve as a liaison between the American Gastroenterological Association and the Academy of Nutrition and Dietetics. As a nutritionist with a focus on GI, how do you work with gastroenterologists to manage GI disorders?

Ms. Euler: Some of the dietary therapies that GI doctors recommend don’t provide sufficient guidance. They hand out that two-page fact sheet about diet and send the patient on their way. A lot of these diets have more nuance than what can be expressed in a two-page handout.

Many times, the physician doesn’t know the nuance, or they don’t have time to go over it. That’s where we can really help.

Patients often want diet to be the answer. They want to be told: “You need to eat this and only this, and everything will be fine, and diet’s going to change your world, and you won’t have to take medication.”

What they often don’t realize and understand, is a lot of these dietary therapies are not black and white. Celiac disease means a gluten-free diet for life. But a lot of these dietary therapies that get thrown out to patients as a possibility, like low FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols), are not lifetime diets. They’re tools for us to use to find out what the offending foods are for this person, and what can we do to get their symptoms under control.
 

Q: What is the biggest practice-related challenge in getting patients to alter their diet to improve their symptoms?

Ms. Euler: A lot of patients that come to me already have over restricted diets. They’re trying to solve things themselves. Rightfully so, a lot of them have a lot of food fears because they have been living with very uncomfortable symptoms for years, and they’re trying to find answers. Those food fears unfortunately are reinforced by social media and the news.

One of my biggest challenges with those clients is working through that process of building their confidence to broaden their diets and add foods back in, without causing their symptoms to flare up. The goal is to get them back on track to having a nutritious diet while trying to manage symptoms.
 

Q: Can you give me an anecdotal example of a case that wasn’t easy, and you ended up helping that person?

Ms. Euler: I had a patient who had been listening to all the wellness gurus. She was overrestricted to the point of eating just 10 different foods due to allergic and GI symptoms. Patients like this are definitely a challenge because you have to reorient them to the fact that what they’re doing isn’t necessarily working,

My initial assessments are 90 minutes long, so I have a lot of time to sit with a patient and hear their story and understand their background.

I suggested to the patient: “Why don’t we try adding these foods back in, but eliminating these other types of foods and see whether that would help?” 48 hours later, she sent me an email, telling me that she and her husband had talked this through, and they thought I hit the nail on the head: She was focusing on the wrong foods which were causing problems. Those are always great messages to get from patients, when they say: “Oh my gosh, I hadn’t even considered that.”
 

Q: Describe how you would spend a free Saturday afternoon.

Ms. Euler: They’re so rare – those free Saturday afternoons, but it would probably be a good book that would turn into a nap on the couch.

LIGHTNING ROUND

Do you prefer texting or talking?

Talking in person



What’s your favorite breakfast?

Greek yogurt with fiber, flax seeds, and berries



What’s your favorite junk food?

Ice cream



What’s your favorite fruit?

Garden grown strawberries



What’s your favorite holiday?

Thanksgiving



What’s your favorite type of music?

Jazz



If you weren’t a GI nutritionist, what would you be?

Probably a landscape architect.

The gluten-free section in the grocery store didn’t exist when Renee Euler, MS, RD, LD, was diagnosed with celiac disease 30 years ago. A physician handed her a fax about the gluten-free diet from a national support group and said: “Here, read this.”

There was no Google to inform decisions. Patients had to rely on fact sheets or a book from the library.

Euler_Renee_Albuquerque_web.jpg

Q: What fears did you have to push past to get to where you are in your career?

Ms. Euler: Leaving a successful career as a landscape architect and going back to school was definitely a huge hurdle. When I started my practice in 2017, in my area there were no outpatient GI dietitians providing specialized care for adults with conditions like celiac disease, irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD). I was starting out with no real support.

Realizing that I was going to start a private practice of my own to help the people I wanted to help, was another big fear. “Am I going to succeed? Am I going to fail? What’s going to happen?” But over the years, my practice has grown as I learned to bill insurance and started receiving referrals from a large local GI practice, both of which have been the keys to my success. I have also limited my practice to GI clients so that I can focus my attention on this specialized area of nutrition and stay up to date on the latest developments.
 

Q: What interests you about the intersection between diet and GI disorders?

Ms. Euler: It’s not just about diet. We’re learning so much about how the gut microbiome can have a potential impact [on other parts of our health]. It’s interesting in terms of how we respond to certain foods, for instance, could affect our mental health. This especially applies to IBS and how the microbiome might be connected to these conditions.

It’s very challenging. There is so much information out there that is not super accurate, or it’s misleading.
 

Q: You serve as a liaison between the American Gastroenterological Association and the Academy of Nutrition and Dietetics. As a nutritionist with a focus on GI, how do you work with gastroenterologists to manage GI disorders?

Ms. Euler: Some of the dietary therapies that GI doctors recommend don’t provide sufficient guidance. They hand out that two-page fact sheet about diet and send the patient on their way. A lot of these diets have more nuance than what can be expressed in a two-page handout.

Many times, the physician doesn’t know the nuance, or they don’t have time to go over it. That’s where we can really help.

Patients often want diet to be the answer. They want to be told: “You need to eat this and only this, and everything will be fine, and diet’s going to change your world, and you won’t have to take medication.”

What they often don’t realize and understand, is a lot of these dietary therapies are not black and white. Celiac disease means a gluten-free diet for life. But a lot of these dietary therapies that get thrown out to patients as a possibility, like low FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols), are not lifetime diets. They’re tools for us to use to find out what the offending foods are for this person, and what can we do to get their symptoms under control.
 

Q: What is the biggest practice-related challenge in getting patients to alter their diet to improve their symptoms?

Ms. Euler: A lot of patients that come to me already have over restricted diets. They’re trying to solve things themselves. Rightfully so, a lot of them have a lot of food fears because they have been living with very uncomfortable symptoms for years, and they’re trying to find answers. Those food fears unfortunately are reinforced by social media and the news.

One of my biggest challenges with those clients is working through that process of building their confidence to broaden their diets and add foods back in, without causing their symptoms to flare up. The goal is to get them back on track to having a nutritious diet while trying to manage symptoms.
 

Q: Can you give me an anecdotal example of a case that wasn’t easy, and you ended up helping that person?

Ms. Euler: I had a patient who had been listening to all the wellness gurus. She was overrestricted to the point of eating just 10 different foods due to allergic and GI symptoms. Patients like this are definitely a challenge because you have to reorient them to the fact that what they’re doing isn’t necessarily working,

My initial assessments are 90 minutes long, so I have a lot of time to sit with a patient and hear their story and understand their background.

I suggested to the patient: “Why don’t we try adding these foods back in, but eliminating these other types of foods and see whether that would help?” 48 hours later, she sent me an email, telling me that she and her husband had talked this through, and they thought I hit the nail on the head: She was focusing on the wrong foods which were causing problems. Those are always great messages to get from patients, when they say: “Oh my gosh, I hadn’t even considered that.”
 

Q: Describe how you would spend a free Saturday afternoon.

Ms. Euler: They’re so rare – those free Saturday afternoons, but it would probably be a good book that would turn into a nap on the couch.

LIGHTNING ROUND

Do you prefer texting or talking?

Talking in person



What’s your favorite breakfast?

Greek yogurt with fiber, flax seeds, and berries



What’s your favorite junk food?

Ice cream



What’s your favorite fruit?

Garden grown strawberries



What’s your favorite holiday?

Thanksgiving



What’s your favorite type of music?

Jazz



If you weren’t a GI nutritionist, what would you be?

Probably a landscape architect.