A Conversation with Dr. Robert Bacallao

“The hard work allows you to be prepared when the door opens.”

Bio

Robert Bacallao, MD, is a Professor of Medicine and an Adjunct Professor of Anatomy, Cell Biology & Physiology at the Indiana University School of Medicine. Dr. Bacallao completed his training from the University of Illinois and completed his fellowship in Nephrology from UCLA. Dr. Bacallao is widely regarded for his research on polycystic kidney disease, and has published extensively on its pathogenesis. He is the founder of Apoptocys, a company which aims to bring novel therapy interventions to people with ADPKD. He is involved in medical student, resident, and fellow training as a faculty member at Indiana University.

What were some major events or turning points in your life?

“My father was an electrical engineer, and not quite understanding the American system of education. He had no understanding of the value of a liberal arts education. When you attended university in Cuba, you were going to be one of three things. You were either going to be a doctor, a lawyer or an engineer. There were no other options. So, at 18, I sat down with him, and I said I’m going to study engineering, but the goal will be to be a doctor. That was the agreement.”

Eventually, Dr. Bacallao made it to medical school. “The mentor I had in med school was Dr. Clifford Pilz, who was the Chair of Medicine at the West Side VA. His knowledge of medicine was encyclopedic. The interesting thing about Cliff was despite all of the weaknesses in the VA system that occurred in the 1970s and 1980s, you were never permitted as a resident to claim any of those weaknesses as an excuse for not delivering superb care to your patients. That would get you on the wrong side of Dr. Pilz immediately.”

In the next part of his life, Dr. Bacallao worked for a nephrology fellowship. “As it happened, my sister was working as the secretary for Dr. Charles Kleeman at UCLA. Dr. Kleeman was boarded in endocrine nutrition and nephrology, but he felt himself to be a nephrologist first and foremost. So, on the strength of my sister’s capabilities as a secretary, I came into an interview where everyone was already pre-prepared to accept me based on that singular fact. I look back at it and I just think, ‘Of all the things.’”

At UCLA, Dr. Bacallao had a series of what he would call “cosmic accidents.” He met great mentors such as Dr. Leon Fine and Dr. Bill Wickner who served as mentors to him. Perhaps the greatest of these “accidents” was a relationship Dr. Bacallao established with researcher Dr. Günther Grall, head of the Biomedical Institute in Salzburg, Austria. Through a simple relationship that came about through a series of chess matches, Dr. Grall would open the door for Dr. Bacallao to attend the European Molecular Biology Laboratory and continue his education.

What should mentees and mentors remember as they work with one another?

“There’s going to be gaps in your knowledge. You’re going to have to keep working that problem throughout your entire career, but you need to recognize when you’re out of your depth and to ask for help. That’s the great thing. I’ve never had anyone denigrate me for asking for help ever. So, I just never do it to anyone else.”

Trust, Dr. Bacallao believes, is one of the core pillars of a strong mentor and mentee relationship. “To me I always have this ratio of 10:1. It takes tenfold more effort to rebuild trust that’s been lost than it is to maintain it. I think several things have eliminated trust in our system. One, medicine has become a corporate enterprise. At the end of the day, if it’s a corporate enterprise, it’s about making money. Period. I can’t tell you how many conversations where I’ve talked to well-meaning experts in delivery of healthcare and how they keep talking about if we just apply some good business practices, healthcare will be that much more efficient.”

“I keep pointing out to them that healthcare is not in and of itself a business. You do have to make some money to keep things going because that’s the economic system we find ourselves in, but the minute you’ve made it into a profit-making enterprise, you have skewed the relationship between you and your patients.”

What would be your advice to those who struggle to find mentors?

“This was one of the interesting things I find about medical education that is a bit problematic. I mentioned I didn’t get a liberal arts education. As time has gone on, I actually think that is probably the most important thing to have under your belt, to have worked through the problem of the human existence.”

“If you look at our medical training, we take highly talented people who have, in essence, delayed adolescence for as long as possible. In college, they weren’t being all that social. They were in the libraries. Their social interactions were contracted to that. Then you go to med school. Med school is a lot of work and there’s not a lot of free time. So, that’s not really expanding your horizons.”

“My advice to them is get out of your shell. Spend some time. Read a novel from a top ten list of novels from the year, novels that start telling you about the human existence, and some of the problems that any good English literature major would have spent times discussing in a book club or in class or writing essays about because those human experiences are what will end up making you a better doctor.”

What is one thing you wish you knew when you started medical school?

“Stay humble. Just stay humble. There are some patients that I look back on in which the communication was blocked because I was arrogant, and that was my fault. We’re all going to have our failures as physicians, and you need to recognize that right at the get-go. There are going to be cases where you’re going to sit back, and they are going to haunt you for the rest of your life. Got to move on. Stay humble.”

Pearls of Wisdom

1. Understand the power of the helping hand. Our careers are formed as a result of the blessings of many people in our life.
2. Hard work allows you to be prepared when the door opens. You have to be standing at the net with the racket.
3. Get out of your shell. We need to look outside of medicine in order to broaden our thinking. This is instrumental in understanding the lives of our patients.