EP124: Life Lessons from a Dermatopathology Legend, Dr. Phillip McKee

A Conversation with Dr. Phillip McKee: Balancing Passion, Work, and Wellness
In this episode of SEE HEAR FEEL, I reconnect with Dr. Phillip McKee, a renowned dermatopathologist and author. We discuss Dr. McKee's career, his experiences with burnout, and the role his wife played in helping him manage his workload. Dr. McKee reflects on the challenges of saying no, the importance of giving 100% effort in one's work, and the impact of relationships on well-being. We also delve into handling misdiagnoses and staying updated in the medical field. Dr. McKee emphasizes the need for dedication and passion in one's profession while acknowledging the inevitability of human error.

00:00 Introduction and Guest Welcome

01:06 Discussing Burnout and Work-Life Balance

04:11 Challenges in Dermatopathology

09:50 Importance of Relationships and Personal Wellbeing

12:43 Final Thoughts and Advice

Dr. Philip McKee is a Fellow of the Royal College of Pathologists and received his medical degree from Queens University in Belfast, Northern Ireland.He trained in pathology at the Royal Victoria Hospital in Belfast and completed a dermatopathology fellowship at St. John's Hospital for Diseases of the Skin in London. He has authored and edited many books, including the amazing Pathology of the Skin. And that edition that I fell in love with won several medical book awards. He was awarded the Elson B Helwig Lecture Award in 2003 by the American Society of Dermatopathology. He is married to a retired cytopathologist, who was also a Professor at Harvard Medical School. She is now a full-time artist. He also has four adult children with very varied interests. 

Transcript

Christine Ko: [00:00:00] Welcome back to SEE HEAR FEEL. I'm very happy to be with Dr. Phillip McKee again, who was in conversation with me back in 2022, very early on when I first started this podcast. He is a lover of his wife, I'll put that first, a lover of Ferraris and a lover of dermatopathology. He is a fellow of the Royal College of Pathologists and received his medical degree from Queen's University in Belfast, Northern Ireland. He trained in pathology at the Royal Victoria Hospital in Belfast and did dermatopathology at St. John's Hospital for Diseases of the Skin in London. He has worked in London as well as the US at Brigham and Women's Hospital and he is currently sometimes in France. He has a very prolific and popular social media presence. In addition to all that, he is the well known author and editor of several books, including Pathology of the Skin. He's been awarded multiple awards, including the Elson B. Helwig Lecture Award by the American Society of [00:01:00] Dermatopathology.

Welcome to Phillip.

Phillip McKee: Thank you very much. And it's nice to be back. 

Christine Ko: Yeah. So I'm supposed to give a lecture at the American Society of Dermatopathology in the fall on various things like wellness, flourishing, emotional intelligence, avoiding burnout, work life balance, managing workload. Some of those things we touched on back in 2022. But I thought it would be nice to just touch base with you again.

Phillip McKee: Sure. Absolutely. Absolutely. 

Christine Ko: I remember last time you said that you did encounter some degree of burnout when you were writing your textbooks, maybe because you were writing more than one at the same time. And you were able to successfully hire Gracie, your wife as an editor, which helped you. Can you just talk a little bit about that? 

Phillip McKee: That's absolutely true. I don't know how I ended up doing it, but I was [00:02:00] working on three books simultaneously, and this was such a bad idea. It really was. But the trouble is, it's very hard to say no. I find in my life, that's the most difficult thing for me, is ever saying no. So when someone comes up with a suggestion, I think, oh, that sounds like a great idea. So I say yes. And then, of course, I come to regret it. And I was having a very tough time. I was working on those books and also had a consultation practice as well. And when you added all that up, it was a recipe for something to go very wrong. And fortunately I was able, as you put it nicely, I hired Gracie to become my editor. She took a lot of the burden from the book side of things off my shoulders, so I managed [00:03:00] to come through relatively unscathed at the end of it all. 

Christine Ko: Yes. I remember you mentioned last time we spoke about saying no, that it is very difficult for you. I think it's difficult for a lot of us, especially when we're very excited about what we do, and things sound fun and interesting, like you said. But do you have any ways that you have successfully said no? 

Phillip McKee: The answer to that is no, I haven't. I continue. I think you you hit the nail on the head. We all love what we do. It's not a job, it's a way of life. And I'm 76 now, and I'm as busy now as I was 20 years ago because I can't stop it because it's what I do. And It's why I get up in the mornings. It's the whole purpose of the day. If I didn't have a day with a chunk of derm path, it would seem [00:04:00] horrible.

And I don't know anybody who actually has a proper work balance either. 

Christine Ko: Yes. 

Phillip McKee: I mean it just doesn't really happen. I don't see how it could. The thing is this, how I view it is You're there to do a job, and you've all these patients get biopsies taken, and, to me, it's a tremendous honor. It really is an immense honor that you get that specimen and have the privilege of looking at it and deciding what you think the patient has got. I was very aware that when I looked down in the microscope that it was somebody, and that somebody was depending upon me. That puts pressure on you. It does take its toll because you can't let up your guard. You have to give 100 percent of yourself, [00:05:00] even if it's an epidermoid cyst. It might have a melanoma in the wall of it for all you know. Even if the first glance suggests it's nothing, you can't do that. And that makes life quite tough. 

Christine Ko: Yes. Another thing that I've been really interested in more recently is error and misdiagnosis and really seeing everything that is relevant to the patient in that slide. So if there's an epidermoid cyst and maybe a little bit of actinic keratosis on the surface, and you don't see the actinic keratosis, it doesn't matter. But as you just mentioned, if there's an epidermoid cyst and there is some melanoma in it, that is a big deal. It would be important to notice that and note and document that. But we're human and there is this big responsibility to the patient to do a hundred percent. How do you prevent yourself from slipping. Yeah. 

Phillip McKee: The trouble is, that's [00:06:00] a sort of an impossible question, because when you've made the mistake, you don't know you've made the mistake. I know of two cases where I was wrong. I'm sure there are hundreds of where I was wrong, but I don't know about them.

But I know of one, I'll tell you, it's a wonderful story actually. I was at St. John's at the time in London and there was a resident who she and I didn't get on very well. Put it that way. And she came up to me one day and she said, Dr. McKee, I'd like you to look at this case, and my heart sank, because I thought I don't know, I don't trust you, so there's bound to be a sting in the tail here.

So I looked at it, and I said that's a melanoma, And she said, oh, that's great, well done. Now would you like to look at the slide that you reported two years ago? So I looked at the slide I [00:07:00] reported two years ago and I called it a mitotically active compound nevus, which extended to margin. It was actually another, it was a nevoid melanoma that I'd missed. I didn't hear anything more about it other than I know I didn't get sued, which was a great relief. And then I had a case in Boston, and it was horrible. Actually, I reported this case as a compound nevus. It recurred shortly thereafter, and I saw the recurrence and it was melanoma and I looked at the previous biopsy and it was clearly melanoma and and then I looked at the cases on either side. Both either side were compound nevi, and so it became obvious to me that I'd lifted the wrong slide up. So I contacted the [00:08:00] clinician and told them what had happened, and I spoke to human resources and told them what had happened. But the patient was so nice, the patient got in contact and said, don't worry about it, it didn't make any difference because it was only a couple of months. It wouldn't have changed anything. So it was so nice that rather than ending up in court, the patient reassured me rather than the other way around. So those are my two experiences of misdiagnoses that I know of. 

Christine Ko: Yeah. You're absolutely right. We wouldn't make the error if we knew we were making it.

Phillip McKee: Yes. I think one of the problems that can arise is if there's an entity you've never heard of that looks awfully like what you call something, but it isn't that something, it's the thing you've never heard of. And that can be a problem. It's very hard to keep up to date with the literature. Very difficult, particularly as I'm retired [00:09:00] and I work hard trying to pick up stuff, but it's very difficult. 

Christine Ko: I agree. Knowledge itself is, doubling every couple of days. That was even maybe five years ago that I read that and medical knowledge, the same. I think I read something, in a medicine type journal, so it wasn't about dermatology or dermatopathology per se, but they were saying if they just chose 10 top journals or something and said they were going to read them cover to cover, it would take 22 hours or something per day.

Phillip McKee: You can't read everything. It would be very tedious too. Yes. 

Christine Ko: Yeah. 

Phillip McKee: I'll say I find social media is a great way of seeing things you've never heard of. There's a lot of stuff that people post and it's great. I think, wow, that's fantastic. 

Christine Ko: Absolutely. I agree. It can be longer, but it can be very small, short bites of information. 

You have such a wonderful relationship with your wife and she, edited for you when you [00:10:00] were working on those three books. And I know you said that you met her in the United Kingdom before you moved to Boston. I think relationships, probably late in my life, I'm coming to realize this, but they are so important to wellbeing and trying to have some sort of balance of the things that we love, the people versus, the work that we do. Do you have any comments on any of that?

Phillip McKee: Yeah absolutely.

 I think if you're going to survive, you have to have.... I can't imagine my life without Grace. She's been very much the rock upon which I've survived. And it works both ways. I'm a great supporter of hers. She's now a full time professional artist. So it works both ways, but lots of people aren't married or don't have partners or don't have relationships and manage very well, but I wouldn't want to [00:11:00] be one of them. Bernie wasn't married. Marty Mihm wasn't married. They were both immensely successful in their careers. I didn't know Bernie socially, but I knew Marty very well. He was godfather to, oh, to so many children. It was amazing. Rather than having a partner, he had all these children, running around him, demanding his time.

Christine Ko: You met Gracie a little later, you had told me before. 

Phillip McKee: Yes. We met when I moved, when I moved to London in 78, and we got together in the early 80s. We both had prior marriages, which we had to extract ourselves from, and which we did, obviously, and then we got married, and here we are, long time later, so we've been together for gosh, [00:12:00] over 40 years, anyway, 45 years, maybe. It's quite a long time. A lifetime...

Christine Ko: it's a lifetime, yeah. Gracie was a pathologist as well. And now she's an artist. 

Phillip McKee: The thing is, she was a cytopathologist. Which is all about color, rather than patterns that we're used to. I think cytopathology is more color. And so painting is a natural progression in a sort of a funny way, I think.

Christine Ko: I see. Yes. And I do think that's important to change, right? To progress, to use the word you just said, to not, even though you might be doing germ path for 60 years or something, you're not exactly doing the same thing. It's been so fun to talk to you. Do you have anything you want to end with? 

Phillip McKee: The only thing I think I can, is a [00:13:00] bit of advice to people. If you're going to do something, give 100 percent of yourself. Don't give anything less. Give what you'd expect, it's rather if you are in an airplane, you want the pilot to be focusing on whatever pilots do a hundred percent of the time and the same goes for surgery and the same goes for pathology, you can't give anything less.

So if that's not what, if that's not what you want in life, then get out quickly and do something else cause there's no shame in giving up and doing something else if you realize this is not for you because you could be very good at something else, couldn't you? 

Christine Ko: Absolutely. And maybe actually that's a way to say no, because if you think I can't give a hundred percent to this or even more, I don't want to give a hundred percent to this.

Phillip McKee: Yeah. If somebody asked me to do a book now, I would [00:14:00] say no. 

Christine Ko: Would you? 

Phillip McKee: Oh yes, I would. Absolutely. I would indeed.

Christine Ko: We are all better off for the books that you've done, and still better off for the active, work that you still do. So thank you for spending this time with me. 

Phillip McKee: Thank you very much. And it's been lovely to see you and take care. Bye. Bye.