Episode 125 - Lewis Shi: "I am committed to what I am doing."

Associate Professor Lewis Shi from the Department of Orthopaedic Surgery & Rehabilitation Medicine shares his determination to be a doctor from a young age. After spending 12 years at Harvard as a "Preparation H," he found his niche in shoulder surgery and continues his fulfilling life as a surgeon, a mentor, and a researcher, all while having his family as his greatest support. Tune in to hear his advice on commitment and practice. 

Transcript

Stephen 00:00
Hello, and welcome to The Course. I'm your host, Stephen, and today I'm speaking with Professor Louis Shi, an Associate Professor of Orthopedic Surgery and Rehabilitation Medicine at the UChicago School of Medicine. Professor Shi specializes in orthopedic surgery and sports medicine and is an active researcher who has published over a hundred peer reviewed articles.

He's also the Editor in Chief of the Journal of Shoulder and Elbow Arthroplasty. He's here today to speak with us about how he arrived at this specialization, what it's like to balance surgery, teaching and research, and how he became a University of Chicago professor.

Dr. Shi, welcome to The Course. Thank you so much for joining us. How are you?

Lewis Shi 00:38
Thank you very much for having me. 

Stephen 00:39
It's a pleasure. Just to get the basics out of the way, could you please tell us your title, your role at UChicago and in broad strokes, what you do there and what your role there is.

Lewis Shi 00:53
Thank you. So I am a physician at the University of Chicago Medical Center. So my role, first and foremost, is patient care. So I work as a physician and in my role, I also teach residents, fellows, and medical students. My academic appointment at the university is, associate professor of orthopedic surgery. 

Stephen 01:17
We often ask people in advance, like what they imagine themselves doing as a kid. Astronaut is a common answer, that type of thing. But I believe in your pre interview, you actually said physician. So did you actually always want to be a doctor? 

Lewis Shi 01:30
My formative years was spent in Beijing, China. So I was born and raised in Beijing and I lived there until I was 12. So everything about my life before then was very different. And. My life in the United States, since then, in terms of my career, has been since arriving in the United States, because age 12, I guess, is a time when you're have more sense of yourself, maybe more identity in terms of future life.

I was, you know, grew up in the eighties. I arrived in US, in late eighties, while in China. You know, I was in Beijing, sorry, in large city, but, you know, it certainly is not like the international environment it is now. I didn't really learn English. So that's why I came to the United States and that's one of the first things is learn the culture of the US as well as the language itself.

And I grew up in the U.S. in a small town in the southern part of the U.S. in Florida, Tallahassee, Florida. And it is during my middle school and high school years that I developed an interest in medicine. Shadowing physicians, volunteering in the hospital, and went to a few health career camps, introducing me to a life of a health provider. Not just a physician, but nursing, pharmacists, and other type of careers involved in healthcare. And it is at that time that I became interested thinking that maybe medicine is something I wanted to pursue. 

Stephen 03:09 
 When you got to college, was that pretty much the track that you had decided to follow? Like by the time you arrived on campus, like you knew you wanted to study medicine. 

Lewis Shi 03:18
I went to a college, a Harvard college in Cambridge, and it is certainly a liberal arts school. And I was learning, taking courses in different areas. I did focus on biochemistry, which was,my major, but certainly half the courses was in other things.

I did a minor in applied math, which was my interest throughout high school and certainly in college as well. But at that time, I certainly was interested in medicine and it was on my, on my mind to pursue medical school. I took the traditional pre-med courses such as working in chemistry and various levels of biology and through that time.

I explore further about what medicine was about and then I realized that I gone to medical school was a natural next step. And even then, afterwards, I still have various career options open to me, whether practicing clinician, or basic science researcher or even joining industry or even consultant in healthcare. So I did decide to go to medical school after college,

Stephen 04:26
I'm curious though, you mentioned applied math, like, is that something that you feel you have used or that has like come up in your career at all? Or is that something that you kind of had to leave behind? 

Lewis Shi 04:36
Apply math with mathematics in general was an interest of mine, my father, study mathematics in graduate school. And that was one thing that I always, you know, competed in as a high school student. At the college level, I, you know, was interested in that. I felt apply math could have a future impact in my career.

But I don't do it at a highest level in terms of the knowledge that I learned in college in terms of my day we certainly will get into some of my research. I do quite a bit of biostatistics, you know, research qualitative research. So I think some of that background does help me in terms of my day to day.

Stephen 05:20
I'm looking at your education and training on the UChicago website now. It's Harvard, Harvard, Harvard, Harvard from 2000 to 2012. Can you explain to me and to our listeners, like what the different steps were? 

Lewis Shi 05:33
So for those not, you know, aware of the medical education system, in the United States, we do four years of undergraduate college. And then medical school is four years. After that, if one chooses to become a clinician or inward researcher, most physicians end up going to residency. Depending on the specialty, it could be three to seven or eight years.

And then after residency, one can further specialize in a fellowship. And I spent four years in college and in medical school. I actually spent six years in medical school because I took two years off to do basic science research. And then I did five years of orthopedic surgery residency.

And then I did another year of fellowship specialized in shoulder surgery. So I am a shoulder surgeon. Yes, I was in Harvard for a long time. They call folks like me “Preparation H”. So the, it was 

Stephen 06:38
I'm sure you appreciate that nickname a lot. 

Lewis Shi 06:40
So in college, you know, I was applying to medical school and Harvard was certainly one of the top medical schools I was accepted in and being familiar with that environment, I opted to stay at Harvard. And then during Harvard Medical School, I was exposed to different specialties. 

I was contemplating other things, internal medicine, eventually possibly do GI or cardiology, some of the other subsurgical fields, including urology and plastic surgery, and then I fell in love with orthopedics because of the type of surgery and the type of people and type of patients. People as in the surgeons, my future colleagues. So you'd like to apply in orthopedic surgery, which is one of the more competitive specialties in residency to, to apply in. 

And I was fortunately able to match into the Harvard teaching hospital system. Part of the reason I think I matched there is because I've been working with the professors and the surgeons there. So they knew me, they knew what kind of person I was, therefore I probably had a leg up. In fact, if I didn't have that option, I, you know, do not know where I would have matched. So I was lucky to have gotten into Harvard.

And then next level, I apply in the fellowship and I certainly had different options. And then, because different life decisions happened to, I was in Boston and it's hard to move another year. So I decided to stay there for another year, and trained with a well known shoulder surgeon at Massachusetts General Hospital. So that was my training career. I was in Boston for 17 or so years. 

Stephen 08:23
You said you fell in love with orthopedics, I'm curious how that happens. You know, I've talked to plenty of, people in other fields about how they you know, they took one class and got hooked or they read one book and got hooked and I don't really know how that works for a surgeon, but what drew you I guess to surgery and then what drew you to orthopedics? 

Lewis Shi 08:41
I was interested in a hands-on specialty, meaning I was interested in being a proceduralist. What it means is surgeons or medical specialties that involve using hands such as, you know, GI procedure, doing endoscopies or cardiologist, interventional, you know, putting in pacemakers, other things.

So I was exploring these options and I knew that, you know, I want my future career to be a combination of using my brain, thinking through problems, as well as using my hand to help patients. and then I, you know, as a third year medical student, we rotate through different specialties. and orthopedics is the specialty that clicked.

I mentioned I like the people, meaning the surgeons, the residents I was working with. In general, they seem to be a happy group. In terms of, outlook on life, the quality of life, and then the patient I was taking care of, in general, most patients that, you know, we interact with, particularly now, they get better, right?

Orthopedics is one of those things. It may be episodic care. I do not take care of patients for their life. I'm not a primary care or family physician. I may get referred their kids. I'm not a family doctor that takes care of generations of family, year in, year out. I'm someone, people come to me with a problem, an injury, I solve that problem, hopefully they're happy with my care, hopefully they're happy with the outcome of their, you know, process, healing process, whether that's surgery or non-operative treatment, and they get better, and people leave my clinic. They're happy to say, hopefully I never see you again. And I'm happy with that. 

All right. And that's, you know, among the reasons why other things include the patient population I work with. I work with patients that are very young teenagers, athletes in high school who injure their shoulder, their elbow. I take care of patients in their 80s and 90s. I just operated on a 95 year old doing a shoulder replacement. He's very healthy. He's got years to go. I improved his quality of life. So there's a breadth of pathology I take care of. There's breadth of patient age and background. So these are all the reasons why orthopedics is what I chose, as well as shoulder surgery. 

There's some specialties in orthopedics that some of those things I talked about may not exactly apply, such as orthopedic oncology, for example, those patients with, you know, cancer of the bone, those patients will, you do have a obviously long term relationship with them.

And unfortunately, some of those patients do not do as well. But in what I chose sports medicine slash shoulder surgery, I enjoy my patient relationship, even though they may be episodic. 

Stephen 11:37
I have to say, though, I mean, you know, we talked to people in all sorts of different specialties on the show. And, you know, it takes a certain type of person to be a music professor. It takes a certain type of person to study history. But, when it comes to actually operating on people, I mean, I feel like that is something that's sort of either you are or you aren't. 

And I'm curious, like, was there a moment for you where you decided, yep, I, you know, I can do surgery. Like I, this is where I meant to be. Or is that just kind of something that you felt like you knew going in?

Lewis Shi 12:20
I will give you my perspective, because I do a lot of teaching, work with residence trainees and students, and even college students that come across my research lab and we teach students and residents and fellows in the operating room. There are many surgeons or budding surgeons who are super talented and they're in the OR, they just have a commending presence, their hand and whatnot. You can tell they're a born surgeon. 

I'm not one of those people, fortunately for me, most trainees and who is going to surgery, most of us can learn. And this is a teachable thing. And we can improve, you know, number of hours during a surgery. 

You know, some patients come see me they look at me, they think I'm young and they said, how many of these have you done? You know, we, I do a lot of shoulder replacements, which is one of the bigger surgeries. I tell them I've done probably 1500 or, you know, 2000 and they look at me like, are you sure, you look so young, but you know, it's experience, right?

I can't tell you whether it was the 200th or 500th or 1000th where I was more comfortable. It's a gradual process. you know, one in the first few years of my career, I had a senior mentor who said, you know, Lewis, you know, you learn to operate in the first five years of practice. And this is again, after four years of college, four years of medical school, five years residency, one year fellowship, you're in your late thirties or mid-thirties, you're starting your career.

And I thought to myself, I was pretty good already, right? I knew what I was doing. But then, you know, as I went on the five years and the second five years into 10 years, and now I'm in my 13th year of practice, I'm realizing that's certainly the case. It's really, that's why they call it a practice, right?

It's a medical practice. You are learning about, you know, how to take care of patients, how to talk to them, how to make them feel comfortable, how to behave in the operating room, how to treat other team members so that everyone's on the same page, what to do with complications and etc. And what learn to want to operate, learn when to not operate. And this is a, it's a gradual process. 

Stephen 14:30
You mentioned students, you mentioned, research, and, could you just quickly, draw out for us what your role entails, like, kind of, you know, what percentage of your time, how many days of the week, like, are you in surgery? How much time do you spend teaching and doing research? How does that look? 

Lewis Shi 14:47
So my week look like about two days in the operating room. I'm doing surgery for those two days, which means I'm not doing anything else. I'm doing one surgery after the other, and then two days I'm in clinic seeing patients, seeing new patients, evaluating them. Some of them are getting ready for surgery. Others are post op patients. So I have two whole days. I'm just seeing patients. 

And then one day, a quote unquote academic day where I'm doing research, I'm, writing manuscripts, I'm preparing PowerPoints and that adds up to, you know, also traveling, etc. 

Now when I'm teaching, what I mean, most of my teaching as a surgeon is while I am doing my clinical duty. For example, in clinic, I'll have a resident or student with me, And they're working together. They may be seeing a patient first, evaluating that patient, and then formulating a plan. I go back with them to see the same patient. I'll examine the patient with them, and then we'll come up with a diagnosis together. The things they're picking up, they're seeing how I am taking care of the patient. 

And then in surgery, there will be my assistants, residents or students, who are scrubbed in as part of the same surgery. I'm the surgeon, I'm doing the surgery, but there will be parts of it where they get involved, some of it where I'm doing everything, they're holding retractors, others they're a little bit more involved. So that's the teaching I have. 

Now, research, as I like to say, mostly happens on nights and weekends, right? So, yes, I have the one-day research, I, you know, meet, I speak to students in the late evenings over zooms, go over data, so that happens kind of off hours, even though technically I have 20 percent dedicated research, but, you know, you could joke about I am 90 percent clinical, 90 percent research. That's because everything happens on different hours of the day. 

Stephen 16:45
And teaching throughout both, it sounds like. 

Lewis Shi 16:47
Yes. In terms of research, you know, big part of the research obviously is to have producing impactful outcome. But a lot of it is actually particular for me is to mentor students. And then, all the way I've a high school student in my lab, many college students and some medical students, probably is the majority of the people that's working together with me.

And then some residents, even though their chief job as a resident is to learn to be an orthopedic surgeon. That entails surgery and seeing patients in clinic. Many of them are interested in academia or interested in research, and then they will get involved in the research as well, despite their busy lives, because they work longer hours than I as an attending surgeon. 

Stephen 17:39
Wow. well, can you explain a little bit more about what your research sort of entails and what you and the people around you are interested in and researching right now. 

Lewis Shi 17:50
My research is divided into two different types. One, I will call it clinical research. The other will be a translational research. So clinical research will be very much tied into how we do surgery, how can we improve the surgeries done, how we take care of patients. of the nitty gritty detail. That will entail, for example, I am inventing or I'm designing a different way of doing the surgery. And can I look at my outcome for the last two years of these type of surgery for the patients that did this and then compare to the standard of care and then comparing that cohort and writing up the results and then publishing it. And the presenting at the national meetings and trying to write it up so that other patient knows my experience.

Or looking at, you know, prospective study thinking does bone marrow aspirate, which is source of stem cell, does that enhance healing of the rotator cuff? And that's the study I'm starting. And that's a prospective study that involves funding, you know, getting grants from different agencies, and then, you know, perhaps randomizing patients into one group versus the other, and then seeing the outcome. These are examples of clinical research. Obviously, we would need to get consents of patients, and that involves a team of students and nurses and researchers to work together. That will be clinical research. 

The transitional research. I'm very lucky to be at a place like University of Chicago, which has world caliber scientist where we're doing basic science research but having a clinical application to it.

Dr. TC He is a basic scientist I work with at UOC and we're looking at different ways to enhance tendon and cartilage healing, so that, you know, give you example of a logistics of a small study. Let's say there's some tissue sample from surgery that may ordinarily be discarded. But with patient's permission, we may harvest some of that and then bring them to lab, look at the DNA, genetic expression, protein profiles, and see how can we optimize the healing of patients after surgery. 

There are other scientists across the university that I work with, including, professor of chemistry, as well as molecular engineering. We have multiple collaborative projects with different things, different people across the university. I think that's the beauty of this place where I am looking for techniques and different ways where surgery can be improved through the brightest minds that the university can attract.

And then these, you know, world famous professors are looking for clinical real-world applications to the technology, to the science that they have, and that's why we work together in trying to improve patient care.

Stephen 21:07
That's really interesting. I mean, how does that type of collaboration come about when you're not even like in the same, you know, department or school? 

Lewis Shi 21:14
Yes, that's a very good question.

There are mechanisms within the university that encourages such collaboration across disciplines across departments. So they're, you know, different funding mechanism to induce several seemingly unrelated people, departments to work together.

In the examples I used, Dr. He is my long-term collaborator. He happened to be a basic scientist in the orthopedic department. So we know each other that way, but the molecular engineer, Dr. Chen, and then the chemistry professor, Dr. Tian, they are colleagues I met because our kids go to the same school.

So through various dinner parties, and there's a university has a laboratory school, which is where the children of the faculty often go to those schools. And for these exact same reasons, so that there are additional opportunities for the parents, i.e., the professors to bond with the students through various other venues. So they're just different gatherings. We started talking about, you know, the things we're interested in. And we're like, well, yeah, we can collaborate on this. 

And then and then bore out these, you know, now we end up meeting, you know, once a month and go over our results together. So, I don't know if this applies to other people, but it seemed to be very common that some of these meetings are random, but maybe not so random. Maybe it's by design.

Stephen 22:46
There are formal and informal structures there to bring people together. That's funny. One thing I did want to ask is just, what advice would you have for someone who is looking to, to follow in your footsteps?

Lewis 22:58
I would hope everyone can follow their own passion, but if they're interested in what I've done and the pathway I've led, I am always available to talk to people. And what I mean is, find your mentor. Mentor is important. I've been very fortunate to have good mentors in my career, who've at every stage I looked up to and who's guided me through this process. And even though I'm, you know, more senior now, I still have mentors who are, you know, guiding me to the next steps. 

In my life, I felt like when I look back at the decision I make, some people ask me whether I could have chosen a different way. I always feel like once I have a fork in the road, once I take the fork, I don't tend to look back on it, right?

I'm so committed to what I'm doing. Do I doubt my decision three years ago, ten years ago? I never do that because it seems like I'm so committed on this path. And if I'm making sense is my recommendation to younger folks is to be committed once you go down a path, there will still be many different options for you to choose from.

And so that, and then once you choose that, there will still be more options. o be committed and find the mentors. I think, and then, you know, follow your passion.

Stephen 24:20
Yeah, that is great. And yeah, applicable across the board. Not just if you're looking to become a surgeon. I might be able to guess based on some, some things that you've said already, but just, to close us out here, could you please tell us what you find most fulfilling about what you do?

Lewis Shi 24:37
So I certainly love taking care of patients when they come back with great results and they're very thankful, that's certainly something that, you know, even I may just need one patient like that a day that, that makes my day and then there are patients that, I know that I've helped over the years that do great and they don't come see me to tell me they're thankful, but I know they’re out there. So that's my life, helping patients. 

I've talked about teaching and mentoring is a big part of my life and the students that find their niche in life, whether they end up choosing orthopedics and or research or do something else for the moments, the length of time that we're working together.

I’m thankful for the opportunity to have guided them in a certain way. And the last thing I certainly want to talk about, which I haven't really talked about much about is certainly my family. I enjoy the ability to spend time with my wife and my kids, that's certainly what sustains me and drives me in my work and teaching and patient care.

Stephen 25:42
Thank you, Professor Shi, for your time today, and Course Takers, if you enjoyed today's interview, please check out the others. Leave us a comment, subscribe, follow, and share this episode with your friends and family. You can find out more about the University of Chicago through uchicago.edu or the University's campus in Hong Kong through uchicago.hk Stay tuned for more, and thanks for listening.