When you are online, do look up the sixth edition of The Bethesda Handbook of Clinical Oncology by Dr Jame Abraham and Dr James L. Gulley. You are unlikely to find a review below 4.5/5. And that is from diverse platforms such as Goodreads and Amazon. Abraham is chair, department of haematology and medical oncology, Cleveland Clinic.
And then you have a doctor who taught himself programming while being a specialist in internal medicine, pulmonology and critical care. At the height of the Covid pandemic, he managed the Cleveland Clinic in Abu Dhabi. Dr Madhu Sasidhar is president and CEO of Apollo Hospitals’ hospital division.
Abraham went from Calicut Medical College to the University of Connecticut to the National Cancer Institute and the National Institute of Health in the US to West Virginia University before his current role in Cleveland. Sasidhar went from JIPMER to St Luke’s-Roosevelt Hospital in New York City to Yale University and then capped it all with a master’s in business administration from INSEAD, France. As they were friends at Cleveland Clinic, this reporter sat down with them in Delhi for a freewheeling chat on the sidelines of THE WEEK Health Summit a few weeks ago.
The engineer and the Jesuit priest
While it would be an understatement to call Sasidhar and Abraham overachievers, it came as a surprise when both admitted that they initially had other professions in mind. Abraham wanted to be a Jesuit priest, and one cannot but feel that there is a bit of that vocation left in him. Sasidhar wanted to be an engineer and spent a year in engineering school before joining medical college. Again, one cannot but feel that there is an engineer in him still.
“I’m an accidental physician,” Sasidhar said. “I think it all turned out well. But I had a deep interest in engineering. I used to tinker with electronics. I used to fix things even when I was 13 or 14 years old. And, famously got into trouble for it. I always put things back. But I got very lucky that I absolutely fell in love with it with a subspecialty of critical care.”
Abraham joined medical school at 18 and balanced the rigorous schedule there with his love for literature and commitment to social issues. A favourite aunt was only 42 when she was diagnosed with cancer, and that might have been the moment that forged this soft-spoken oncologist who specialises in breast cancer.
Patient-first in Cleveland
Interestingly, both were not really headed to the Cleveland Clinic when they reached there. Sasidhar and his wife, Dr Amrita Chadha, had promised themselves that they would not move to a cold and snowy place. As on December 2, 2024, 8:30am EST, the temperature in Cleveland stood at -1°C and was dropping.
Abraham’s wife―Shyla Jovitha Abraham, who writes for THE WEEK Health―too, wondered if it was ideal to uproot themselves from their home of 11 years in West Virginia University. But both families moved, and eventually, Abraham and Sasidhar came to like the institution in their own ways.
“What has impressed me the most is that the Cleveland Clinic has allowed many of us to pursue our careers in different paths,” Sasidhar said. “For me, initially as a clinician, then as an inventor, an educator, and as an administrator. Through the Office of Professional Staff Affairs, the clinic allowed me to grow as a clinical leader, also allowing me the time and the space to innovate within clinical IT.”
Both swear by the deep talent pool the institution offers and the patient-first approach that guides every clinician there. “You know, you hear it everywhere, but I think at the Cleveland Clinic, all of us lived it,” Sasidhar said. “If there was something a patient needed, there was not a question asked, we would stay back. And I think the most difficult decisions were always answered through the prism of what is best for our patients.”
Abraham agreed and added: “At the end of the day, I’m a clinician. I’m here to take care of patients. (At Cleveland Clinic) I saw a system that put patients at the centre. And then, as I said, the pool of talented people is amazing. You can just call the pulmonologist who has specific expertise in pulmonary hypertension or one specific subtype. That creates an environment for innovation, research, and education in addition to the patient-centred approach. And then, of course, it creates global leaders in health care.”
Both doctors agreed that another unique characteristic of Cleveland Clinic is that almost everyone there is a practising physician. An example cited was Dr Beri Ridgeway, executive vice president and enterprise chief of staff at Cleveland Clinic. “She leads around 4,500 doctors, and still sees patients and operates,” said Abraham. And this goes up to just below the CEO. Sources said that while the current CEO, Dr Tomislav “Tom” Mihaljevic, does not operate or does so sparingly, his predecessor―Vietnam veteran Dr Delos “Toby” Cosgrove―was active in the operation theatre all through his 13 years at the top.
Clinicians or administrators?
Another aspect that THE WEEK was curious about was how the evolution of their careers has affected their time with patients. As administrators, they have HR pressures, financial tightropes to walk and many other demands on their time. “When we start our journey, most of us do three things,” said Abraham. “We take care of patients, we do research and we teach. And then slowly other things like administration creep up. Eventually, you start gravitating towards one. In the first decade of my career, the focus was patient care and research. In the last five years, it is administration and patient care. You must give up some things, there is no other way.”
Sasidhar said that even as the CEO of Apollo Hospitals he leads with his training as a clinician. He said that he still sets time aside for rounds, to look into crash carts and flowsheets. “And it’s all about how much of an impact can you make. Jame is absolutely right. It is a progression. It feels natural. I always worried about taking off the white coat and I thought maybe I’ll do it one sleeve at a time. But you will know when the time and the opportunity are right. I do miss holding a bronchoscope or intubating somebody. But the time for that, I think, is over now.”
AI in health care
Just as AI’s influence in daily life is broadening, its role in medicine is, too. Sasidhar said that he first taught himself programming and coding because he was fascinated by the computer’s ability to solve problems. At that stage, “humans had to learn the computer’s language, and now computers have learned our language”. And now machines have gone further and learned medical language, which was always hard to understand.
“In some areas like computer vision, which is radiology and things that use computer vision to solve problems, you’re already seeing a lot of progress with commercial solutions in the market,” Sasidhar said. “And I think that will continue to come upstream and continue to help physicians solve clinical problems. I also think in the realm of public health and dealing with large data sets and understanding that AI will make a substantial difference. Similarly in drug discovery and understanding the genome.”
Abraham quoted Yuval Noah Harari to say that AI will “actually redefine who we are”. He said that it will begin at a basic social level like how patients interact with doctors and vice-versa. “And then, of course, the clinical space,” he said. “In oncology, we use a lot of genomics information. In 2024, two Nobel Prizes―physics and chemistry―went to AI research. The physics Nobel went for developing AI algorithms. But the chemistry Nobel was for protein synthesis. Madhu just mentioned protein synthesis. That will revolutionise how we develop medicines, how we understand protein structures and how we develop new drugs for specific targets. So, from a simple doctor-patient relationship to drug development, AI will completely transform medicine.”
While winding up, THE WEEK could not but ask these two versatile doctors this light-hearted question―name your favourite US medical drama. After a round of chuckling and head-shaking, they said this:
Abraham: “I should say ER or Grey’s Anatomy, perhaps. Funnily enough, my son―who is applying for his residency―said that Scrubs inspired him to take up medicine. What a bummer, I thought he was inspired by me!
“So, I don’t have a medical drama in mind, but there is a movie that I would recommend to all my students―And the Band Played On (1993). It’s about the HIV epidemic, the politics and the science behind how the virus was discovered, how it transformed advocacy, and eventually, a drug was discovered. It’s a fascinating movie. It tells a lot about what happened recently with Covid, too. We talk about Covid politics; HIV politics, too, was intense. So, that’s one movie I have watched multiple times.”
Sasidhar: “Frankly, I don’t watch a lot of TV series, but I have seen a few episodes of some of these shows. The one that captivated me is New Amsterdam, because it is set in one of those old New York hospitals. I did my residency in one of those―St. Luke’s-Roosevelt Hospital in New York City, which was celebrating 150 years when I was finishing there. It’s on Amsterdam Avenue, because New York used to be called New Amsterdam.
“So, a very old hospital, and some parts of it really looked like the set of New Amsterdam. I made so many memories there because it was my first experience with clinical medicine in New York City. It was the tail end of the HIV epidemic in New York City, and St. Luke’s was where the first AZT (anti-HIV drug) trial was. So, a lot of history, a lot of character, a very tough clinical environment in the Upper West Side, but also where I learned a lot. So, I used to love watching New Amsterdam.
“But I also have a funny story about my kids. When I was at Cleveland Clinic, my daughter attended an all-girls school there. I think she was in ninth grade or so, and I suddenly got a request that many of these girls wanted to volunteer in the hospital. I was very proud that they were committed to service! So, I got them into many volunteering and research programmes. Only later did I realise that they were all watching Grey’s Anatomy. I guess they were all disappointed that it didn’t work out the way they thought it would!