Like Father, Like Daughter

Medicine is often a family affair – and that’s certainly true in the Hébert family, where John Hébert, recently retired from an over-30-year career in obstetrics and gynecology, passed his scientific and medical instincts down to daughter Tiffany Hébert, now a pathologist, pathology residency program director, and an associate professor of pathology at Montefiore-Einstein. To find out more about how a dedication to patient care runs in the family, these two expert physicians interviewed one another about their lives and the lessons learned over their careers in medicine.

Tiffany Hébert: What made you want to become a physician?

John Hébert: I grew up in Albuquerque, New Mexico, and didn’t have a lot of role models. But I do recall two interactions with physicians. When I was in the ninth grade, my mother had some complications with her last pregnancy and ended up having a cesarean section. The doctor who performed it was the first African American physician I had ever seen – and I never forgot that he successfully took care of my mother and delivered my youngest brother. We also had a family practitioner who encouraged me to pursue a career in medicine. In fact, when I went to medical school, my first elective encounter was back in Albuquerque with that same practitioner. I think those are the things that cemented my desire to become a physician and an obstetrician in particular.

JH: Tiffany, what inspired you to become a pathologist?

TH: My decision to pursue pathology came a lot later than your decision to become a physician. I went into medical school thinking I was going to be an OB/GYN just like you. I enjoyed my OB/GYN rotation, but I enjoyed learning about pathology and histology even more. From the first-year histology course, I remember looking at the tissues under the slide and thinking, “I can actually recognize these things really quickly and easily. I could be good at this.”

I remember you let me borrow a microscope from your office so that I could look at slides on my own. I was really attracted to having the final answer – the knowledge that would guide the patient’s treatment. I was more interested in seeing a tumor than in removing it.

TH: What inspired you to dedicate your career to serving the underserved?

JH: I came from a large family – 10 children in total. Growing up, we were not well off and we took advantage of assistance programs in our community, which really helped us succeed. I’m proud to note that all 10 of us are college graduates – but that wouldn’t have happened without community involvement and other people taking an interest in us. So when I had an opportunity to pay it forward, it came naturally to me.

As a medical student, I started volunteering in areas where students could assist – evaluating children, physical examinations, and so on. Eventually, it moved beyond medicine into community outreach and other areas such as the Urban League and the Rotary Club. It gave me a good feeling to know that I was in a position to make life better for other people who were less advantaged.

JH: Although you’re a pathologist and I’m an OB/GYN, what lessons did you learn from my career?

TH: You left some pretty enormous shoes to fill!  I think the most important thing I learned from you is work ethic and the importance of sacrifice. I grew up watching you prepare lectures, put together content for your students, and host informal get-togethers – so I saw the camaraderie between you and your residents. I try to model things like that because I’ve learned from you that you can’t halfway do medicine. It’s not so much a career as it is a calling – so it’s not enough to just go to work and do your job. You have to ask yourself, “How am I contributing to my community and the rest of the world?”

JH: As director of Montefiore’s pathology residency program and a graduate of the program yourself, how important was it to you that the program worked with underserved communities?

TH: Many of the things that excite me about being here remind me of things I saw with you when I was growing up. I remember going with you to volunteer at the Adolescent Health Center at the high school next door to mine. That made a big impression on me.

A lot of people think of pathology as a basic sciences or as “just looking at slides” – but our department is very involved in the Bronx community. We have point-of-care testing in schools, which reminds me of your work in providing off-site community care. We run a See, Test, & Treat program to screen underserved populations for breast and cervical cancer – along with basic health education provided by our residents. That’s important because in pathology, you sometimes feel divorced from that patient context – but we all went into medicine because we wanted to help people, so I see this as a great opportunity for us all to have direct contact with the people who need us most and to be a real part of our Bronx community.

TH: When you first started, did you set yourself any goals? And, looking back, how many did you achieve?

JH: When I first started to do community outreach, my goal was simple – to make a difference in people’s lives. You mentioned the the Adolescent Health Center; my goal there was twofold: to provide optimal prenatal care in teen pregnancies and to try and make sure that that adolescents had access to appropriate contraception in the future. We know that, once a teenager has a baby, they’re far less likely to continue their education. And, in many cases, the teens we saw at the Adolescent Health Center had become pregnant before they had access to contraception. So, after ensuring that both mom and baby were healthy, we tried to make it possible for the mom to complete her education.

My goal was always to have an impact. I never joined an organization just to pad my résumé. I found that the best way to have an impact was to assume a leadership position so that I was actively involved in policy and effecting change. My wife – your mom – would often tease me by saying that, every organization that I joined, I had to become president. That’s not because I wanted the title, but because I thought I could – and still can – have the most impact by taking a leadership role.

JH: What brings you the most pleasure in your work?

TH: Two things. The first is that I love biology. I enjoy the patient care aspect of my job, the intellectual stimulation of challenging cases, and the knowledge that the right answer will guide my patient’s care. The second is the teaching. I love interacting with young people who are fresh and full of potential. It’s wonderful to share knowledge with them, see the lights go on in their heads, and learn from them. And, of  course, I love seeing amazing things under my microscope every day.

TH: What do you consider to be your greatest achievement to date?

JH: I think my greatest achievement is the success of my graduates. I was a residency program director (as you are now) for 25 years. My graduates practice all over the country; some have gone on to subspecialty fellowships, whereas others now teach at major universities. In 17 of the past 20 years, we had a 100 percent pass rate for board examinations. That’s what I consider my greatest achievement.

I think it’s important to teach the next generation of physicians without compromising clinical care for the patients you serve. Many physicians are excellent clinicians, but have little interest in teaching, or vice versa. I think you have to balance quality education with optimal patient care.

JH: What lessons have you learned from your own career – and are they different to what you learned by observing my career?

TH: I learned a lot about teaching. Nothing in medical education teaches you how to teach! Watching you teach made it seem easy because you’re a natural teacher. It wasn’t so easy for me when I started, because I didn’t have a very good skill base; my classes were one long PowerPoint slide after another. I like to think I’ve improved on that!

I also think medicine has changed over the years. It has become more family-friendly and welcoming to women than it was when you first started. We understand that sacrifices are necessary, but we also understand the value of balance and of maintaining our own wellbeing. I’ve learned a lot from my residents, because they’re from a different generation. At first, there’s that knee-jerk reaction, because it’s not what you’re used to – but then you think to yourself, “Maybe they’re right and the way we did things was wrong.” And look how much happier they are! So I’ve tried to keep an open mind and learn as much from them as I have from you.

TH: What are the most important lessons you’ve learned over your career – and what legacy would you like to leave behind?

JH: The most important lesson I have learned is that it’s essential for physicians to take an active role in training the next generation. We all started on day one with a baseline of zero medical knowledge. To become proficient in your specialty of choice, you have to be educated – and that entails more than just reading a textbook. The clinician who is most well-rounded is the one who recognizes the importance of combining quality teaching with quality clinical care. Admittedly, it takes a little longer; at three o’clock in the morning, when I’m closing an abdomen with a second-year resident, I could get home a lot faster if I did it myself – but that resident would lose a valuable learning opportunity.

As far as my legacy is concerned, I think my graduates speak for themselves. I’m also proud of the fact that the institution from which I just retired recognized my contributions to student and resident education by naming a unit in the hospital after me. There’s no greater legacy than that!

JH: What advice would you give to incoming pathology residents who want to follow in your footsteps?

TH: Remember that you are part of a healthcare team – and that you must interact with that team to have a positive impact on your patient. How? One way is to get involved in tumor boards and become a consultant to the clinicians you work with. Another is to attend conferences together. Remember when you and I went to the American Society of Colposcopy and Cervical Pathology meeting together? I think it’s really important to go to the clinical counterparts of our pathology meetings, so that we know what’s happening on the other side of the coin. When I was very young, I’d sign something out and not think twice about it. Then I went to a tumor board and they decided what was going to happen based on the pathology report. I was stunned. I had never been fully aware of what my work meant to the patients until that moment.

Take advantage of opportunities to get involved with medical education on a national level. One of the most important activities I’ve participated in is the Association of Pathology Chairs’ National Program Directors’ Committee. Getting involved with peers, hearing the wonderful things they’re doing, participating in faculty development… all of those things will make you a better teacher.

Keep an open mind. Listen to and accept constructive feedback – because you’ll always learn from it. Even if you don’t completely agree with it, you may find a kernel of truth in it.

JH: I agree with that. I always told my residents, “You can always learn from any attending you work with – even if it’s what not to do.” Never stop learning.