A Vision for the Future of Medicine

— Michael Chiang, MD, describes the elegant intricacies of the human eye and what's next


"The Doctor's Art" is a weekly podcast that explores what makes medicine meaningful, featuring profiles and stories from clinicians, patients, educators, leaders, and others working in healthcare. Listen and subscribe/follow on Apple, Spotify, Amazon, Google, Stitcher, and Podchaser.

For over 50 years, the National Eye Institute (NEI) has been a driving force for cutting-edge research, education, and public health guidance. In this episode, Henry Bair and Tyler Johnson, MD, talk to Michael F. Chiang, MD, director of the NEI. A pediatric ophthalmologist by training, Chiang's work focuses on the application of biomedical informatics to ophthalmology in areas ranging from telehealth to artificial intelligence to health data management.

Over the course of their conversation, Chiang describes the elegant intricacies of the human eye, shares what excites him most about digital health, discusses the urgent need for reformation in medical education, and shares his mission as the leader of the nation's foremost agency for promoting eye health.

In this episode, you will hear about:

  • 2:22 Chiang's upbringing in a family of engineers and his eventual path to ophthalmology
  • 6:43 How the practice of ophthalmology is changing and the role of informatics in this change
  • 10:39 What pediatric ophthalmology entails, and why this work inspires Chiang to this day
  • 14:20 The mechanical intricacies of the human eye
  • 18:03 Chiang's reflections on how his education in engineering shaped the way he practices medicine
  • 22:55 The importance of patient stories and how modern clinical practice leaves little time for them
  • 25:55 How artificial intelligence is changing medicine and what that means for the future role of doctors
  • 33:40 What excites Chiang most about the future of medicine, and what concerns him the most
  • 44:10 Chiang's vision for the NEI
  • 46:04 Advice to young clinicians on lifelong curiosity and adaptability

The following is a partial transcript (note errors are possible):

Bair: As some of our listeners may have picked up from recent episodes, I've matched into ophthalmology. In fact, this episode's release should coincide with the time I begin residency. So, for me, it's a particularly special privilege to speak with you today.

Johnson: Yeah, Mike, just on behalf of all of us at Stanford, we're really glad that you and your colleagues would let Henry into the field. So thank you for allowing him to match.

Chiang: Well, you know, Henry, we've just met, and so I can't speak to whether that was a good idea or a bad idea, but it's a great field.

Bair: All right. Well, we will see. All right. So to kick us off proper, can you share with us what first drew you to a career in medicine and then specifically to ophthalmology?

Chiang: Yeah, absolutely. Henry, I grew up in a family where almost everybody was an engineer, and I just assumed that when people grew up, they became engineers. It was all the toys that we played with. And that was basically my childhood. And so I went to college, assuming that I would be an engineer. And in fact, that was my major in college, electrical engineering.

You know, it happened that I spent a summer working in a startup company in Mountain View, California. I went to Stanford for college and they built cardiac ultrasound machines. And so what I did was circuit design. And then another summer, I actually spent working in a lab in the medical school where we wrote little computer programs to analyze images. And the images actually came from cardiac ultrasound machines. And it was meant to diagnose patients who were having heart disease, you know, rejection after heart transplant surgery.

And that actually fascinated me, that you could build a machine and then use it to treat somebody and, you know, help somebody. And that's actually what made me want to become a physician. And so I went off to medical school. Now, this was now the early to mid 1990s. At the time, a field that was very hot was computational neuroscience and artificial neural networks. And they were very hot then. And then they became un-hot and then became hot again now.

And so when I started medical school, I thought I wanted to be a neurosurgeon. And I thought that I could understand the brain and model it using computers and then operate on the brain. I basically, you know, found a lab that was in the neurosurgery research division at one of the local teaching hospitals. And I studied information processing in neurons there.

And it happened to be that the lab, my mentor there was Dick Maslin, and he worked at Massachusetts General Hospital in Boston, and he happened to study the rabbit retina as a model tissue. And that's how I learned about vision and visual information processing. And after being in that lab for a few years, I loved it. And I decided that I actually wanted to be an ophthalmologist.

You know, as a medical student, I also met the person who became my wife, who wanted to become a pediatrician. That's basically how I ended up going into ophthalmology. You know, what I learned from this, I guess, is that what I thought I would be doing in 5 years was often not what I was actually doing in 5 years. And I learned that that's okay, that, you know, you don't have to worry about it, but that it is good to remain thoughtful about how your life and career may end up evolving.

Bair: So can you share with us some of the expectations and what actually happened that you went through? You mentioned every 5 years things would kind of change up a little bit. So, for example, when you were starting residency, what were you hoping for? And then after residency, what were you hoping for? And then where did you end up in actuality?

Chiang: When I started off as a resident, I knew that the reason I went into medicine was to apply technology to the practice of medicine and ophthalmology and thought I wanted to build devices. When I was a resident -- this is now the late 90s, early 2000s -- everything was about paper charts and handwritten notes and x-ray films. And I thought, there just must be a better way to do this.

And so at the same time, you know, technologies like the Web were starting to become mainstream. And so I thought, well, maybe the world doesn't need more people to build devices. Maybe we need more people to manage data. And that's how I learned about informatics. At the time there wasn't a clear career path, you know, for people who wanted to do that field. And so it was a very confusing time.

But, you know, I decided that what I want to do is, you know, first of all, I became a pediatric ophthalmologist. That's a subspecialty within ophthalmology and then decided what I want to do is another, you know, fellowship training in informatics. And that would somehow blend those within my career. And that's how I got started. And it was another evolution that I wouldn't have imagined, you know, when I first started.

For the full transcript, visit The Doctor's Art.

Copyright © The Doctor's Art Podcast 2023.