Jonathan H Chen MD PhD Profile picture
Nov 24, 2022 27 tweets 5 min read Read on X
When any given day in academic medicine can feel like a thankless grind on a relentless hamster wheel, it's worth having gratitude for any and all support along the way. 🧵(Image: Belle Kim, Zachary Elgar, and A Prolific Source, 2015) Image
As a classical overachiever, it's typical to project a public persona of infallibility and effortless success.
Inspired by "CV of failures," I ironically find it more inspiring to see that success is often only achieved in the face of frequent setbacks and disappointments.…
Grateful for @DorisDukeFdn and @StanfordMed institutional support to even acknowledge the context of challenges while striving to achieve results for early career scientists faced with caregiving responsibilities amidst the pandemic.…
When I met the other awardees from the last cycle, I saw that all of others were ambitious woman scientists, likely with young children at home.
It perhaps seemed odd then, what I was doing there?
Sharing below the essay I wrote as part of my application. May it offer a helpful perspective to others trying their best to do some good in the world, grinding away through life marathons.…
"While I was making excellent progress in my clinical informatics research program as a new junior faculty, the COVID-19 pandemic outbreak disrupted that momentum in large part due to increased caregiving responsibilities for both my school age children and elderly parents.
As the pandemic broke over two years ago, I was glad and prepared to jump into the front lines against a menacing societal threat as a practicing hospital physician.
I have continued clinical care even during peak surges in holiday weeks, responding to hospital calls for assistance to keep up with the needs of our patients.
What I was NOT prepared for was to effectively become a homeschool teacher for my 5 and 9 year old children. With my wife a full-time physician-scientist in the hospital herself, no family in the area, and all schools and daycare shut down, all research time had to move in home.
Between March to October 2020, I supervised my children every day, prodding them to engage in “Zoom school” and preparing lunch. Of course, “Zoom kindergarten” was ludicrous and required constant support for 5 hours a day, making continued work extremely inefficient.
Many of my colleagues and collaborators can attest to the not uncommon appearance of a then 6 year old enjoying running through the house naked in the background of my research Zoom calls.
Our institution’s offers for additional childcare credits through agency services was well appreciated and intended, but unfortunately not necessarily effective. The very nature of a pandemic surge is that all infrastructure breaks down.
Thus, even when I had booked extra home daycare services for a weekend where I was on service in the middle of the Omicron surge (and my wife was gone for a conference), the daycare service canceled on us the day before.
We were thus pressed for the first time to leave a 7 and 11 year old home alone, while I frantically completed morning rounds in the hospital before returning home to provide childcare. Luckily, the house was not burned down nor any other major disasters while I was gone.
On Christmas Eve of 2020, I received a call from my widowed mother living in the Los Angeles area. I offered “Merry Christmas,” but she was tearful, revealing that she had just gotten COVID-19.
This was especially frustrating as we were mere weeks away from vaccine availability, and it was still not practical for anyone to travel.
While she made it through to New Year’s, she strangely became progressively debilitated. She called me from an emergency department visit where a scan found that she now also had a recurrence of metastatic cancer that was not treatable given how debilitated she had become.
Through January 2021, I finally got the first course of vaccinations (while also completing *another* R01 grant submission), and spent every other week traveling to LA, managing months of unopened mail and unpaid bills, and arranging medical, home hospice and caregiver support.
I was still attempting to conduct research meetings in LA via Zoom, even as I had to provide direct medical supervision and counseling as family members hid my mother’s morphine, believing it to be “poison” while she moaned in pain just days away from her death in March 2021.
The loss of a beloved and lifelong advocate parent is of course tragic, but natural and inevitable. What I was not prepared for was months of toil in the aftermath as I became the executor to settle her affairs with many ugly business and personal issues left up in the air.
This likely disrupted my research productivity more than any other challenge, as I had to dedicate many daytime business hours calling funeral arrangers, accountants, banks, insurance companies, real estate agents, lawyers, police, and even private investigators.
A couple months after my mother’s death, I was invited as a keynote speaker at the @MayoClinic @hongfangliu @jhalamka Artificial Intelligence Symposium. It was refreshing there to lead a discussion about my optimistic hopes to advance the science of medicine and improve lives.
Despite all of the challenges during the pandemic, I strove to remain as effective and productive as I could towards serving our larger mission in medical research.
Respectively, I continued to support a vibrant team of trainees and collaborators towards publications in venues ranging from JAMA, JAMA Network Open, JAMIA, Annals of Internal Medicine, Nature Digital Medicine, and The Lancet.
While I was able to attract R56 bridge funding from the @NLM_NIH, the @MooreFound, and an @NSF sponsored industry collaboration among others, my progress and enthusiasm for sustaining a demanding physician-scientist career is not what it could be with additional support."
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More from @jonc101x

Nov 1, 2023
Never got around to this, but fulfilling a standard self-congratulatory announcement of my first fully funded NIH R01 grant.…
Much of this was built off the work of star graduate student @conorkcorbin. Glad to collaborate across sites with @IDInformaticsMD @SanjatKanjilal and with Stanford experts @StephenMaMDPhD @AmyChangMD @StanDeresinski @robtibshirani @steveaschmd and Mary Goldstein
When I started as faculty, I was told this was a critical benchmark for success I had to hit. I figured I'd try 3 times. If it still didn't happen, this academic track wasn't for me, and I'd move on to other jobs I'm more than capable of (and would probably pay better).
Read 11 tweets
Mar 31, 2023
Slides to to engage clinical + informatics communities across multiple forums.

For the two people who have not already heard about and tried using #ChatGPT, over 100 million other people already have. The fastest growing internet application in history. #MedAI Image
Good or bad, ready or not, these tools are out there and are being used in all imaginable and some unimaginable ways.
Even LAST quarter, Stanford students are using ChatGPT on the class assignments, including straight up submitting ChatGPT generated answers without any edits. Image
Overly simplified breakdown on how these systems work. Auto-complete on steroids. How to guess the next word you enter? Learning parameters on how often those words have appeared together in prior examples. Image
Read 24 tweets
Mar 30, 2023
#ChatGPT #AI performance on *open-ended, free-response,* clinical reasoning exams intended for human medical trainees. #LLMs are passing medical licensing exams, but artificial multiple choice designs do not reflect realistic clinical reasoning.…
From describing diagnostic schema, generating differential diagnoses and problem lists, to suggesting and interpreting tests, ChatGPT is already demonstrating the surprising ability to often reach a 70% passing threshold on multiple cases.
For simple recall style questions ("describe the typical symptoms of a patient with heart failure,") it will knock those questions out of the park, while showing wide variability and struggling with deeper analytical questions.
Read 5 tweets
Oct 21, 2018
Closing the loop on #Diagnostics #Tweetorial with example #AppleWatch #AFib #Screening. From a company website: "Atrial fibrillation is a silent killer. The heart arrhythmia causes more life-threatening strokes than any other chronic condition, and will affect 1 in 4 of us."
"But the sad fact is that atrial fibrillation often goes unnoticed: It is estimated that 40% of those who experience the heart condition are completely unaware of it."
Using #AppleWatch technology and #DeepLearning #AI #ML, a device algorithm can reportedly detect atrial fibrillation with high accuracy (c-statistic 93%).
Read 44 tweets
Oct 5, 2018
#Tweetorial on #Diagnostics and #Screening interpretation.
An otherwise healthy 40 year old woman comes to you after reading on the internet about a terrible disease that one in a thousand women get, and a highly accurate test that can save her life.
The test is over 99% accurate in people with the disease. For those without disease, the test is only wrong 5% of the time.

You order this test and it comes back positive. The woman anxiously asks you, do I have the disease? What is the chance this woman has the disease?
Assuming they weren't immediately fooled by the "test is only wrong 5 % of the time," most I've asked correctly recognize the stats provided are Sensitivity = 99% and Specificity = 95%, and that the objective is to determine the Positive Predictive Value.
Read 21 tweets

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