Eva Sheie (00:03):
The purpose of this podcast is simple. We want you to get to know your doctor before meeting them in person because you're making a life-changing decision and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. There's no substitute for an in-person appointment, but we hope this comes close. I'm your host, Eva Sheie, and you're listening to Meet the Doctor. Welcome to Meet the Doctor. My guest right now is Dr. Jose Foppiani, and he's a plastic surgeon based in Boston. He has a very interesting story. Tell us about your journey to the United States and how you ended up in Boston.

Dr. Foppiani (00:47):
Sure, sure. So effectively I grew up and was born in the Democratic Republic of the Congo. I spent 14 years of my life there. I then spent four years in South Africa. After that, I completed my medical education in Prague, in the Czech Republic, and I joined Dr. Samuel Lin as a postgraduate research fellow at Beth Israel Deaconess Medical Center about a year and a half ago. But I knew Sam for quite some time before actually coming to Boston before Covid. Covid made things a little bit difficult, but we persevered and start to work together over Zoom like everybody else did, and we made best use of the time.

Eva Sheie (01:28):
So what was it that you were doing in Prague that connected you to Dr. Lin in Boston?

Dr. Foppiani (01:33):
So I've always been very dedicated to pursuing research because the one thing that I will tell you is one way to make a long lasting impacts on patients. It's very small steps at the end of the day, especially when you're not, somebody like Dr. Samuel and it takes time to get to this level. So in the beginning, you just try to make small changes, try to find things that are going to make a difference for people. And I connected with Dr. Samuel through one of his online course while I was in the Czech Republic. So I would be either studying or I would be going to let's say the OR during the day, and then usually around midnight or 1:00 AM I would be joining his course that he would be giving in Boston around 6:00 PM at night. We did that for close to a year, year and a half, and pretty much while he was giving his lectures through the end of the evenings, I was working for him remotely.

Eva Sheie (02:30):
What kind of research were you doing at that time?

Dr. Foppiani (02:33):
We were doing a lot of big database research. So effectively those are where you can really see trends when it comes to investigating patient outcomes, but they just require a lot of work. So pretty much for a year and a half, what I was doing with Dr. Lin is between 11 and let's say 1:00 AM we would be taking CPT codes and just cleaning rows and rows and rows of data de-identified data, and it took us nearly a year and a half to go through close to 70,000 patients.

Eva Sheie (03:07):
That sounds so fun.

Dr. Foppiani (03:09):
It was a lot of work, but it was worth it in the end. It was worth it.

Eva Sheie (03:14):
So is one of your skillsets from this work to be able to manipulate and use big databases and move the data around like sequel and

Dr. Foppiani (03:24):
Definitely. I would say that that experience for a year and a half really equipped me with a lot of tools when it comes to performing big database research from cleaning data, from analyzing data. I think more importantly, it's actually being able to identify limitations of dataset. A lot of the time you see people making claims, but as much as the claims are very valuable, knowing what you can say based on the data that you have and what you cannot say I think is as important.

Eva Sheie (03:53):
Do you find that doctors are pretty good at analyzing data just from medical education or is that something you have to spend more time on?

Dr. Foppiani (04:02):
I would say it's definitely something that you need to spend more time on. Medical education has a lot of values. It does bring a lot of skills, but when it comes to pure research and data analytics, it is something that you need to put extra time in. It's not something that's as integrated as it should be in the medical curriculum. I do think it's getting better. I do think medical faculties are recognizing the need for doctors to really be able to understand the data that they're being presented that may be at conferences, maybe at booth for exhibition. So it's getting better.

Eva Sheie (04:36):
Study design and research design is really challenging and nothing showed us how hard that is. More than the last three or four years of watching data be released about Covid and everything surrounding it, and I've paid close attention to that, but even inside of our own space in plastic surgery, I've seen doctors study marketing behavior and publish papers that are completely wrong, a hundred percent wrong, and then refuse to look at the other data that says it's wrong. So it's a bit of a side story, but I do understand where you're coming from in that accuracy and saying what you can say from a set of numbers and being aware of what you can't say is really important.

Dr. Foppiani (05:22):
No, I would agree with, I think I don't think that any of those, let's say papers came from bad intent. It's just a little bit of misunderstanding of, look, this shows something, but you can't make a hard conclusion from it. You may be able to take association out of some of the data sets, but in order to find causality, it's going to require a lot more work than usually what you see.

Eva Sheie (05:44):
Yeah, exactly. Well said. So have you also spent any time treating patients directly or have you been doing research mostly?

Dr. Foppiani (05:54):
So here in Boston? I've been mostly doing research, entirely doing research. As a matter of fact, while I was in Europe, I did participate quite heavily in patient care and also in all of the surgeries. So I do have also that side of things, that experience of things, if that makes sense. And I'm always able to compare what's being done in Europe, what's been in Africa, and what's being done in the US from a patient care standpoint. It's been very interesting to notice the differences.

Eva Sheie (06:21):
Can you lean into that a little bit and speak to what those differences might be?

Dr. Foppiani (06:25):
Sure, sure. There's some positive differences. There's other where, I don't want to say negative, but it's also about resources, utilization, but I would say sometime what Europe and Africa also brings to the table, it's showing you that you don't always need to invest that heavily in a lot of different tests and foreignly here in the us again, it's been getting better as well. So it's a lot of positive things, but often tests are over utilized and something we also do see in research where it's like that was not necessarily needed. You could have done this diagnosis, you could have went forward without this extra test. That doesn't really bring anything to the table at the end of the day. So that resource utilization is something that you really become cognizant of in environment that don't have resources to be spared well here in the us Something that you really see is how far clinicians are really willing to go to really get the best outcomes for their patients. They really have the opportunity here in the us not just through the incredible training that's being done, but just through the time that they're able to spend with patient to really go to bat for them and really get the best outcomes.

Eva Sheie (07:36):
In plastic surgery. That's absolutely true.

Dr. Foppiani (07:37):
In plastic surgery, for sure. 

Eva Sheie (07:39):
The time. 

Dr. Foppiani (07:40):
I cannot speak to other specialties. Fortunately, I would love to, but at least in plastic surgery, that's been my experience so far.

Eva Sheie (07:46):
Yeah, that time is a precious resource. 

Dr. Foppiani (07:50):
It is. 

Eva Sheie (07:51):
It's only possible because we're not in insurance-based medicine.

Dr. Foppiani (07:54):
Yes, definitely. Unfortunately, as soon as you are in a more social system like Europe, is the time that you're able to give to people is extremely, extremely limited. And I would say that this is probably one of the very big disadvantage of social systems. Some places do a lot better than others. We cannot generalize either. You have some countries in Europe that are doing a stellar job within social healthcare, but the reality is, in general, anytime that you're in social healthcare, you just cannot spend the time that the patient would need you to spend with them because that's the thing that we need to do. At the end of the day, we need to spend time to really understand how you feel, what you're expecting, and a lot of the times the discussions are very difficult discussions. It can be about reconstruction, which as you know, after malignancies, it's not something easy to talk about. But even from a cosmetic standpoint, people often don't understand how important it is for how we look in our day-to-Day interaction society is definitely heavily by that, and some people are deeply affected and we need to take the time to take care of those people.

Eva Sheie (09:01):
You're right about reconstruction and in the few, I mean it's anecdotal, but the places I'm thinking of the surgeons seeing those patients do not have time. They have very limited time to spend listening to those breast cancer patients or other kinds of cancer, and they really have to move quickly and the patient really needs them to spend a lot more time.

Dr. Foppiani (09:25):
I would definitely agree with you that there's always room for improvement, and even here, there are instances where you should really be spending more time with the patients, just you cannot do that just from a time feasibility. However, what I just want to bring your attention to is I'm speaking very much in relative terms because if you think that people are not given enough time here, I invite you to try to do that in Europe or in Africa where it's probably even half the time or even less than half the time that's being spent with the same types of patients.

Eva Sheie (09:58):
And Europe is socialized medicine, so you might get a great doctor, but it might take you a really, really, really long time to get in.

Dr. Foppiani (10:05):
Yes, definitely. The waiting time in Europe sometimes can be months and months. There is very big delay in care. There's very, very long waiting lists, so you may get social healthcare, but you just don't get availability to the care that you would need right now.

Eva Sheie (10:22):
And then what about Africa?

Dr. Foppiani (10:24):
Look, Africa is still very much working toward improving its healthcare, and at least in my lifetime, I've seen giant leaps. I've worked in the Congo with the Red Cross. I've worked in hospitals in the Congo as well, trying to provide care for people that just don't have access to it, and we still have a long way to go. We just don't have the resources often to give the care that people would need. One of the reasons why I got into plastic surgery was actually seeing a lot of the patients that were walking into the clinics in the Congo. Might it be a hand amputation might be a burn, and just not having anybody around that could help those people. It's very disheartening, especially when you spend time in the US when you spend time in Europe and you know that some of those procedures may be very difficult, but some aren't, and there's just nobody there to give the care to those people that would really need it.

Eva Sheie (11:20):
Do you see people come through on mission trips or

Dr. Foppiani (11:24):
We do. We do, and mission trips help tremendously. They do alleviate the burden, but the reason why a lot of the mission trips aren't successful, and again, we see a trend that's being corrected is you cannot simply have physicians coming for let's say two weeks a year and then going, you really need to establish long lasting relationship with the physicians and with the doctors that are there, you need to train them. Even if it's two weeks, you train them in something very simple and they're going to be able to do it because the people of the Congo, and I'm sure I'm speaking for Africa in general, they're very resilient. They're very adaptable. If we give them the tool, they can really get the job done. So it's really going to be about establishing long-term relationship with institutions in the US in the Europe, getting those people trained, and we have seen some of those initiatives here at SPS that have trained physicians in South Africa and in other part of Africa, and those are the right first steps. It's not just about going for two weeks. It's about giving them the tool to care for their patients.

Eva Sheie (12:27):
Maybe not a very intelligent question for me to ask, but are there enough doctors?

Dr. Foppiani (12:33):
No, there are not. 

Eva Sheie (12:34):
There just aren't enough.

Dr. Foppiani (12:35):
There just aren't enough to take care of the population that's present. The Congo, I think by 2050 is predicted to have close to 90 million people living in it. It's 

Eva Sheie (12:46):
9 0, ninety? 

Dr. Foppiani (12:46):
90 90 million. Congo is one of the fastest growing population in Sub-Saharan Africa. It's the size of the US in term of just surface areas. It's a gigantic country and we simply do not have enough physicians. We do not have enough institutions. There is just not enough training. There's not enough resources to train the people there, but we have worked remotely. Even actually with Dr. Lin giving lectures over Zoom, we would set an hour of our time, we would get the faculties in my hometown. We'd give a lecture about, let's say the treatment of burn, very basic things. Dr. Lin would be speaking in English, I would be translating in French and something something's that easy to do, not just zoom, nothing really complicated, just an hour of your time. It makes a world of difference through education.

Eva Sheie (13:35):
How many languages do you speak fluently?

Dr. Foppiani (13:37):
Two, English and French. I speak a little bit of Swahili. I do need to brush up on that quite a lot, unfortunately, and a little bit of Czech.

Eva Sheie (13:45):
So in the Congo they speak mostly French?

Dr. Foppiani (13:46):
Mostly French, definitely French is the national language. We also speak Swahili. We speak Ingala also that those are two of the more prominent languages. Most of the time though, we mix French with Swahili together, so we kind of have our own little language.

Eva Sheie (14:02):
And then you must have picked up some Czech while you were up there.

Dr. Foppiani (14:04):
In the Czech Republic. Yes. Yes, definitely. Czech is a very difficult language. I'm going to that.

Eva Sheie (14:09):
I learned Polish. I totally understand.

Dr. Foppiani (14:12):
I'm sure you do have to learning Polish, Polish, Czech, a lot of the central and Eastern European language is very challenging to learn. 

Eva Sheie (14:19):
You can't put that many consonants in a row. It's just not right.

Dr. Foppiani (14:22):
No, no. You just challenge and then you're like, oh my God, I do not understand how to say this. I can't understand the medical book, but all of the declination in Indian, I have no idea what's going on here. I do speak enough, Czech that I could get a patient history. That's kind of what we need to do, but conversationally not there a lot more work needed.

Eva Sheie (14:42):
You could probably order street food and

Dr. Foppiani (14:44):
Yes, that I could do.

Eva Sheie (14:46):
Survive in a restaurant.

Dr. Foppiani (14:46):
And survive in a restaurant. Exactly. I mean that's how it starts at the end of the day. Yes, it does. Baby steps. Baby steps.

Eva Sheie (14:52):
What does your day-to-day look like now? Are you mostly at a desk?

Dr. Foppiani (14:58):
Sure. So right now as research fellow, a lot of the work that we do is kind of like let's say bridging reading and clinical work. So we tend to work at the back of the plastic surgery clinic. Effectively. We're there working at our desk, maybe reading papers, maybe doing calculations, maybe cleaning the big database that we're talking about, and we kind of take that and through our experiences, either through observing physician at our own institution, at other institution, a couple of our fellows are also doing sub internships. We're trying to take that clinical exposure that we get to direct our research. That's something that we're very, very adamant about at Beth Israel, we try to really have meaningful research that has some clinical implication, but the only way that you're going to be able to do that is if you are observing and trying to identify problems that are present within clinical care, if I make any sense.

(15:52)
Because the only way that you're going to be able to target a problem is if you see clearly you need to identify what a problem is in order to really be able to ask the right questions. Okay, this is the problem. How can we solve it? Which way are we going to go? If you don't have a big picture, you're not able to do that, and by asking the right questions, you're really able to build the full landscape of the problem, I'm sure might it be in any form of industry and time that you start dealing with an issue. It's really the tip of the iceberg. Your job is trying to find the root of the iceberg, and in research, we're just asking small questions, one after the other, and we're really trying to get to the root of that problem.

Eva Sheie (16:34):
It sounds awfully similar to how we approach marketing.

Dr. Foppiani (16:37):
Oh, it is. The thing that I find really interesting because as much as you know, I have a medical background, at least back when we're a lot more involved, like the business side of things, there's so many similar thing about effective logical thinking and problem solving, algorithms, marketing, medicine, literature, it doesn't matter really what you're looking at in term of a field, it's about applying principles.

Eva Sheie (17:04):
We're trying to solve a problem at scale by figuring out what is the problem and then asking the right question about 

Dr. Foppiani (17:10):
Exactly. 

Eva Sheie (17:11):
It's exactly the same.

Dr. Foppiani (17:11):
It's always like principles, principles, principles. Doesn't matter what you're looking at.

Eva Sheie (17:17):
I love the idea that you're treating patients at scale by doing research. I think that that is brilliant, and I had not thought about research in that way, that you're actually able to take care of thousands or hundreds of thousands of patients with the work that you're doing and not just one at a time all day long.

Dr. Foppiani (17:38):
No, exactly. At the end of the day, you do need both of those really work hand in hand for us to have a quality functioning healthcare system, but I would say that that's the most rewarding in research. The fact that you really feel that even if it's a small change because it impacts so many people, it is something worth pursuing and putting your heart into. I can tell you that when we think about research, most of the time you're like, oh, you're sitting at a desk just typing things away. And I would say that that's often what people see, but what they don't see is the fact that we're really putting hours and hours of work into things because we know that it could have an impact, not on one person, but many, and that's where we get our motivation to keep moving forward, helping people.

Eva Sheie (18:24):
Have you heard of deep work, the concept of deep work?

Dr. Foppiani (18:26):
No, I haven't

Eva Sheie (18:28):
In any kind of creative work, art or music or marketing, even writing, and I've learned this over 20 years, there's times of the day or parts of the week where I'm much better at what I'm doing, which I guess as you get older becomes more important because you have to find your sweet spot where you're going to be the most impactful. And for me, that's in the morning, and so I started molding my schedule around where I can do deep work, but then if you start doing too much stuff and you don't protect that time, you can really suffer creatively and not get any thinking done. So I wonder if that resonates with you at all. Are there parts of the day where you just really go heads down into numbers or into a project and don't even want to look up. Don't even get a cup of coffee or go to the bathroom.

Dr. Foppiani (19:21):
No, I deeply resonate with that. I'm going to tell you that what happens often is we work on probably 30 projects at the same time, and you cannot be productive if you do the exact same process for eight hours in a row. I'm sure you cannot. You can relate to that, okay, you can think effectively about something for one or two hours, but after that time, you can spend another two on this. It's not going to move forward. You need to say, okay, we made some good progress here. We gave it the time that we need. Let's go to the next problem. Spend one or two hours and you're trying to be very effective. Okay, great. Next problem, you try to balance, let's say numerical tasks. Maybe be statistical analysis versus writing versus creative thinking. The thing that I would say people also don't often see is how close research is to a form of art.

(20:13)
At the end of the day, we have to sit down and we have to be creative. We're like, okay, there are a bunch of smart people in medicine. There's been for a very long time. This problem has been there usually also for a very long time. It means people have thought about solving this for 10 years, five years, even two years. A lot of the time, those people are much smarter than we are. It's like, okay, the way that we're going to approach this is by trying to take a different angle. It's like, okay, how can we think creatively to take another approach to solving the same issue through different, just trying to put different lenses on, and this is kind of that creative protective time that I try to have on a daily basis. It's like, okay, it's like six to eight in the morning, very fresh, have a cup of coffee, sit down.

(21:00)
Now it's really creative thinking time, and something else that we do is because we work with clinician, might be Dr. Samuel Lin, might be Dr. Bernie Lee. They're operating the whole day, so what tends to happen is when they finish their day, might be at 6:00 PM sometimes might be at 10:00 PM It's like, okay, time to jump on the work call. It's very frequent for us with very, very late night call because this is what we have to do. It's about resilience like, okay, we need to get it done. It's10 PM, it's fine, we'll jump on and talk. We'll talk an hour. Trying to wrap our heads around the problem, trying to check in and move forward from there.

Eva Sheie (21:37):
Do they think while they're operating about other things, can they have a parallel process sometimes?

Dr. Foppiani (21:44):
That's a very good question. I will speak probably for myself and what I've seen. I cannot really speak for them, but I would say that anytime that you're scrubbed in the OR your sole focus is on the patient and what you're doing. I do not think that at any point we're in the OR and our brain kind of wanders off trying to think about solving a problem. It would be great. 

Eva Sheie (22:08):
It's not like you know where you're going and you know how to drive so you can think about something else while you're driving. It's not, it's too intense to, 

Dr. Foppiani (22:17):
I would say that it is a little bit different from that. I'm sure that some surgeons, I've had years of experience may be able to do that, but something else I can tell you from seeing surgeons I've worked for 20 or 30 years, it's never an automatic, right? Even though you know exactly what you're doing, even though they may have done this procedure 200 times, you still have to be extremely focused because they're anatomical variation, and at the end of the day, you have a patient's lives in your hand and that is the priority. So we are always really focused on the task at hand. Our heads don't wander off. There may be moments in the surgery where it's less critical, where we're still performing and we may be discussing the patient. We may be discussing, huh, we did this time that was a little bit different. Let's try to research this. Let's try to look it up, or let's try to pay attention to this next time. Maybe we can be faster. Maybe we can be safer.

Eva Sheie (23:09):
You can't really have three things that you're thinking about at the same time. 

Dr. Foppiani (23:12):
No. 

Eva Sheie (23:13):
Even if you can have two, and so what I wonder maybe is I've wondered about this for a long time. The things happening in the room and the patient are the two things, which is why there isn't space for a second thing because you're managing all of these people and processes and technologies, and then you're also dealing with the patient.

Dr. Foppiani (23:35):
Exactly.

Eva Sheie (23:36):
Thank you for thinking through that with me. Well, what do you like to do outside of work?

Dr. Foppiani (23:43):
Well, first of all, we're all fairly workaholic. We do love what we're doing, which is a good thing. At the end of the day, it makes work very enjoyable when you love to do what you do. When I am here in the US or in Europe, I love to go play golf. I love to play squash as well. It's a lot of fun. I try to go skiing. I haven't skied in a long time, but I do love mountain skiing. I have to try to go to Colorado at some point, ski down those slopes. Something I definitely want to do, and when I'm back home in Africa, I do love to go bush camping, so we effectively take a car and we go three hours away from civilization. There is usually not a living soul around, or you have people that have been living in small villages close to the river the same way for probably a hundred, 200,000 years.

(24:30)
No technology, no electricity, no running water, and you're just there with your tent and a fire, and I can tell you that you're never going to have better coffee than at 5:00 AM in the morning on the side of the riverbank, just watching a sunrise on one of the rivers that goes through the Congo. It's absolutely magical and it's probably the worst coffee you could buy. It's like instant coffee. It's awful coffee if you were to have it right now, we'd be like, what are we drinking this for? But at that 5:00 AM in the morning, which peace, silence, no lights. No noise, just the sunrise. It's really a moment that stays with you and that coffee is the best coffee you're ever going to have.

Eva Sheie (25:13):
I could smell it.

Dr. Foppiani (25:14):
Oh, I'm sure you can.

Eva Sheie (25:16):
Are you on Instagram?

Dr. Foppiani (25:18):
I am. I'm not as active as I probably should be. I'm working on that. I'm fairly tech savvy on a lot of things, but social media is something I need to work on a little bit.

Eva Sheie (25:27):
You have to have time.

Dr. Foppiani (25:27):
You do. You do. It's very time consuming. I'll try to take a couple of pictures next time I go in the Congo and just share down social media. I feel like would be a way to show people what the Congo looks like.

Eva Sheie (25:40):
I'd like that. I mean, I'd actually like it on Instagram.

Dr. Foppiani (25:43):
Thank you. I appreciate it. Yeah, just one like. It's a place to start. One like, you know.

Eva Sheie (25:48):
You can count on me. 

Dr. Foppiani (25:49):
Cand count on you. I'm so grateful, Eva. I'm so grateful. That'll make me feel a bit better.

Eva Sheie (25:53):
Thank you for joining us today. Of course. It was really a pleasure hearing your story and I'm excited to see what you do next.

Dr. Foppiani (25:58):
Thank you so, so much for having, it was absolute pleasure spending time with you and well, we look forward to seeing you next time.

Eva Sheie (26:06):
Definitely. If you are considering making an appointment or are on your way to meet this doctor, be sure to let them know you heard them on the Meet the Doctor podcast. Check the show notes for links including the doctor's website and Instagram to learn more. Are you a doctor or do you know a doctor who'd like to be on the Meet the Doctor podcast? Book your free recording session at Meet the Doctor podcast.com. Meet the Doctor is Made with Love in Austin, Texas and is a production of The Axis, THE AXIS.io.