Multicultural experiences helped shape leadership perspective
Foad Nahai, MD, Atlanta, is a living legend of the specialty and a long-time recognized leader in plastic surgery. Having just completed his two-year term as president of the International Society of Aesthetic Plastic Surgery (ISAPS), Dr. Nahai has also served as president of ASAPS, chair of the Plastic Surgery Research Council, secretary of ASRM and as a director of the ABPS.
A true innovator who has applied vast reconstructive experiences to become a pioneer of aesthetic techniques, Dr. Nahai has found success in both academia and private practice. He was a professor of plastic surgery at Emory's School of Medicine before entering private practice 12 years ago at Paces Plastic Surgery in Atlanta. A prolific author, he has published more than 130 scientific articles and authored or co-authored seven books, most recently The Art of Aesthetic Surgery in 2005. He also serves as editor in chief of the Aesthetic Surgery Journal - an impressive feat for a boy whose teachers felt had "no affinity" for the English language.
Born in Tehran, Iran, Dr. Nahai was educated in England and became a surgeon in the United States. His diverse background has given him unique insights into leadership and the value of approaching plastic surgery as a whole rather than as the sum of its many subspecialty parts. Dr. Nahai and I spoke about what he's like to work with, his perspective on health care reform - and what he sees for the future of plastic surgery.
PSNextra: What are some experiences that were most formative for you?
Dr. Nahai: I was born in Iran, and as a child I lived a privileged life. We had a very close family. My father was a successful businessman. My grandmother lived with us. She was born in the 19th century, and as was the custom for women in Persia at that time, she didn't have the benefit of an education. She couldn't read, and I would go up to her room and read the newspaper to her. In turn, she would teach me about morality and my own background, about opportunities I had that my father didn't have. She would tell me that he sat with a candle at his desk to learn how to read and write.
At age 11, I was packed-off to an English boarding school. This experience strongly influenced the rest of my life. I had to make my own bed, polish my own shoes - I learned real self-discipline and self-sufficiency. Sports is compulsory in English boarding school - cricket, soccer, track and field. I was obviously disadvantaged in track and field - I learned that the only way I could compete well with tall guys was to move my little legs faster than theirs; I'd have to take three strides for their single stride to stay even. This helped me compete in track and field, swimming, soccer - and in life. The only way to be successful is to use your talent to the maximum, and you have to be self-reliant. I loved biology - and by the way, my English teacher would roll over in his grave if he knew I was editor of the Aesthetic Surgery Journal, since my teachers believed I had no affinity for the English language.
Life was relatively easy in medical school in England. It was there I learned how to be a real doctor and look at patients, put my hands on them and use my skills in history-taking to come to a diagnosis. First and foremost, I'm an English doctor. Training was at a more relaxed pace there. I was on call one night per week during my year as a house officer in England, and that night, I'd usually sleep through the night.
It was a culture shock coming to Baltimore for surgical internship at Johns Hopkins and affiliated hospitals - hardly sleeping, pre- rounding at 5 a.m. How I spent my days as an intern is a habit that has stayed with me. I now come into the office before 6 a.m., when it is really quiet, and I get a lot of work done before I go to mark the first patient for the O.R. Blending my nurturing childhood in Iran with my parents and grandparents; English boarding school with its strict code of behavior, discipline and self reliance; the American work ethic that is second to none - with unfailing support from my wife - has made me who I am today.
PSNextra: What are the most important leadership lessons you learned?
Dr. Nahai: I learned leadership from my father and mother, how they treated everyone with respect and dignity. My father would shake the hand of the office doorman, he would stand up when he was brought tea, and he would always ask after the families of his employees. My mother helped support the domestic help who needed care for their families. This is how my family dealt with people they worked with.
At English boarding school, I was taught that you don't send your troops ahead of you into battle; you must lead by example. I also learned sportsmanship in England. In Iran and in this country, there is too much emphasis on competition on the playing field and the need to win or score a goal. In England, it was more about enjoying the game rather than winning at any cost. I learned to be a good sport.
I learned from Dr. Bostwick how to be a friend to your peers and juniors, yet that at times, you need to be firm. Dr. Jurkiewicz taught me to set high standards for myself and make sure those around me understood my expectations.
PSN Extra: How has your leadership style evolved?
Dr. Nahai: I expect no less of myself than I do of others - and I'm my toughest critic. Part of my success with ISAPS I attribute to my background, having grown up in Iran where the culture is different. I'm able to understand different cultures and anticipate how someone from certain parts of the world will interact with me. In the Middle East, they may first say "no," but they want you to keep pushing until they say "yes." In England they think about consequences, and you know they will say "no." In this country, we are more direct.
The ability to know a culture and the style of individuals within that culture - I deal with that to convince them to see my point of view. ISAPS represents a lot of different backgrounds, work ethics, cultures and values - I have been very careful to not enforce the American way on the international society. Building consensus and knowing how to build a consensus - Japan, Latin America, England, and U.S. styles, for example, are very different.
When I was president of ASAPS, secretary of ASRM and chair of the Plastic Surgery Research Council, I like to think my style was to do what was best for the Society and specialty. I've never been one to concentrate on one subspecialty, but rather on plastic surgery at large - not just aesthetics, not just microsurgery, not just reconstructive surgery. I've always relied on consensus-building to achieve what's best in the interest of the group rather than force anything.
PSNextra: What are some aspects of traditional plastic surgery that you miss? What do think has improved?
Dr. Nahai: I miss the challenge of inheriting the tough problems from our colleagues, the challenging wounds. At the end of a Friday afternoon, they would call: The gynecologist with the huge irradiated pelvic wound, the cardiac surgeon requiring reconstruction of a chest, the orthopedic surgeon needing to fix a leg. I enjoyed helping them and, more importantly, enjoyed resolving the patients' complications. Where have the cases gone? A combination of things: Some of it has gone away because many of these surgeons are doing their own flaps now. We are in very real danger of losing breast reconstruction, too, as some breast oncological surgeons are doing their own reconstructions. The other reason I'm not seeing these cases is that I'm not hospital-based anymore.
What has improved is our knowledge of flaps - specifically the perforator flaps, which spare muscle.
PSNextra: What's it like to work for you?
Dr. Nahai: I'm fair. I don't expect anything more from other people than I expect from myself. You work with me, not for me. I won't expect you to do anything that I wouldn't expect of myself.
PSNextra: What are qualities that you find difficult to tolerate?
Dr. Nahai: I don't tolerate a poor work ethic. I cannot stand mediocrity, nor those who blame others for their own lack of success. Take responsibility!
PSNextra: What do you think are three of the next, big innovations in plastic surgery?
Dr. Nahai: We're just scratching the surface with fat grafting, making the fat work consistently and evaluating what happens 10-15 years from now. We don't know how the grafts will behave over the course of time. The whole stem cell question puts us in the center of reconstructive and regenerative surgery.
Looking at aesthetic surgery, we don't have a "facelift in a box." There's no technology that can tighten collagen and skin, that can render a facelift obsolete. I know that's what will eventually happen.
Cancer treatments are changing. That will change the way we do things with reconstructive surgery following cancer extirpation.
PSNextra: Tell us about your training.
Dr. Nahai: After my internship and one year of residency at Johns Hopkins, I went to Emory University in Atlanta for general and plastic surgery residency. My plastic surgery residency in the mid- to late-1970s at Emory fell in the midst of an incredibly busy time in the evolution of reconstructive surgery. I was lucky to have been around so many bright people - John Bostwick, MD; Stephen Mathes, MD; P.G. Arnold, MD; and professors Luis Vasconez, MD, and Maurice Jurkiewicz, MD. We were immersed in the evolving field of microsurgery, muscle flaps and fasciocutaneous flaps. Ultimately, that provided me the right background to succeed in aesthetic surgery.
For example, I have intimate knowledge of the anatomy of the facial nerve from radical neck dissections and parotidectomies, so I enjoy facelifts. I confidently know what's there and how to handle mishaps.
PSNextra: Is the horse out of the barn when it comes to health care reform?
Dr. Nahai: It's very sad that we don't look at lessons learned with the nationalized health service with a single-payor health system. Canadians are trying to get away from that. All my classmates in England are amazed the United States is emulating a system that doesn't work. This nation has been a leader in medicine based on the free enterprise system, on the independence of doctors and patients, on having the choice of where to go and who will treat them. We will lose our independence, and I fear with it our edge, as innovators and world leaders in plastic surgery.
PSNextra: Who are your personal mentors?
Dr. Nahai: I'm one of the few people who went through school not saying, "I want to grow up and be like [him]."
I have had role models, individuals who I looked up to and who helped me along in my career. My boarding school biology teacher encouraged me and provided me extra work to do, suggesting special reading to fan my enthusiasm. I had a medical school professor of anatomy whom I joined in the lab to do research on bone marrow stem cells. When I look at what's going on now with stem cells, I'm amazed by how forward-thinking he was.
Alan Reed, MD, professor of medicine at the University of Bristol, England, convinced me that the science of medicine was learned in class and in books - while the art of medicine was mastered at the bedside, examining patients. He would emphasize that patients help you make the diagnosis at bedside, and you don't need expensive tests. This was a time and place in England when medico-legal concerns were unheard of. This professor had an incredible influence on me, including suggesting that I go to Johns Hopkins over the summer as a visiting medical student. I returned to him after my trip and told him that I wanted to be surgeon. I was afraid I would disappoint him, but he was incredibly supportive; he helped me secure a position there.
Gardner Smith, MD, at Johns Hopkins helped me with a surgery position at Emory. Dr. Mathes and I bonded on the trauma service at Grady because we had so much in common, particularly our work ethic and way of taking care of patients. My co-residents and Dr. Mathes influenced me - I took a little from all of them. I made up my mind about strong points of my mentors and peers, and decided to adopt those, but in my own style. And I saw what I didn't like, and made sure I didn't emulate that behavior.
PSNextra: What are some of your favorite pastimes outside of work?
Dr. Nahai: I love working out. This goes back to boarding school, where one hour of physical activity was scheduled every day. I love to ride my bike, but it's very difficult in Atlanta. The static bike is a blessing: I can multi-task exercising, reading and editing manuscripts simultaneously. The thing that keeps me sane and calms me down is working in our backyard, and this also goes back to boarding school when in the summer months we were given a plot of land on which to grow vegetables. I love music, especially classical music. I love traveling. Flying is not as much fun as it used to be, with security and the crowded planes, and it's now mostly work-related. I still like to see new places, learn about new cultures - and I always learn from my colleagues.
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