EP194: Dr. Scott Binder: A Perspective on Pathology and Beyond

Dr. Scott Binder on Life Lessons and Medical Philosophy

Dr. Scott Binder, MD, shares his journey from a dermatopathology residency at UCLA to directing his own practice. He recounts challenges such as his first autopsy during the AIDS crisis and discusses overcoming prejudice, emphasizing the significance of resilience and putting patients first. Dr. Binder highlights the importance of moral integrity in medicine, continuous learning, and staying relevant through life's stages. He also touches on coping mechanisms like meditation, understanding the big picture, and the necessity of letting go of control. The conversation underscores the unique doctor-patient relationship and the enduring pursuit of purpose and passion in both personal and professional life.

00:00 Introduction to Dr. Scott Binder

01:04 A Personal Anecdote: First Autopsy Experience

02:44 Overcoming Challenges and Prejudice

04:22 The Importance of Putting Patients First

07:36 Balancing Career and Personal Life

09:05 Adapting to Different Career Stages

10:50 Finding Purpose and Fulfillment

13:39 Final Thoughts on Control and Resilience

Transcript

Christine Ko: [00:00:00] Dr. Scott Binder. MD is Director of his own dermatopathology practice after 25 years in academics, including almost 17 years at UCLA. While at UCLA, he held a longstanding leadership role at UCLA Health. He's the Founding Director of the UCLA Dermatopathology Fellowship and former Clinical Chief overseeing Anatomic and Clinical Pathology, Molecular Pathology, and multiple clinical labs. He established UCLA's outpatient pathology labs, and led innovative efforts including joint Path/Radiology reporting and sports drug testing. He's an internationally recognized educator and speaker with more than 150 invited talks worldwide and over 125 peer reviewed publications. Additionally, he's a pioneer in telepathology and digital pathology consulting, including collaborations with global institutions and industry leaders like Google. He is passionate about advancing diagnostics, training future leaders, and bridging [00:01:00] medicine with technology.

Welcome to Dr. Binder.

Scott Binder: It's a pleasure to be here. 

Christine Ko: Could we start off with you sharing a personal anecdote?

Scott Binder: For my pathology residency, my first rotation was autopsy. This was 1985. There were quite a few AIDS patients in the hospital, and there were quite a few AIDS autopsies. An AIDS autopsy came up as my first autopsy. This is my first autopsy, and my first experience clinically in pathology at UCLA. I go to talk to the attending about what we should be doing, what should we be concentrating on, which organ systems. I went through the chart beforehand, and he was a noted cardiac pathologist. He told me he had no interest in coming into the room with me and seeing the autopsy. He didn't wanna have anything to do with the [00:02:00] dead body. He basically left me wearing a hazmat outfit in a sequestered room that in previous years had been for active tuberculosis patients. It was just myself and the diener, Roy Bailey. I was expected to do an entire autopsy and come up with a cause of death all by myself. The first autopsy experience. It was after the HIV virus had been isolated, but the method of transmission was still unclear. There was still a lot of fear around it. I spent about 10 hours in that room. I'll never forget it because I was so scared. 

Christine Ko: How did you deal with that?

Scott Binder: It was very difficult. My whole life, I had been dealing with bullying and intolerance, and prejudice; hearing people constantly behind [00:03:00] my back talking about me being gay. There was always some degree of prejudice and intolerance. What kept me going was the big picture, wanting to become a doctor, wanting to be a pathologist, wanting to be a dermatopathologist, wanting to be the best I could be, wanting to teach, wanting to create services for patients through the UCLA system. Putting the patient first. The patient is always first. I always had a goal in front of me.

We all have hard lives. I don't think anybody has an easy life. Life is inherently difficult. We have illnesses. People die around us. We lose our parents, friends, children. People lose their money. Life is a series of challenges, and you have to be resilient. [00:04:00] Life is not just; there is no justice period. That doesn't mean you should be immoral. It means you should be moral.

The moral code. I'm not talking about people cheating on their income tax. I'm talking about putting the patient first. The patient is always first. Christine, you understand 'cause you're a dermatologist, too. Pathologists get removed from that, and they have to understand that they're an important part of the team that's treating the patient. The patient has to come first. You, as my dermatology client, come second, you come second. All the other factors, money and reimbursement and technology, that's in the background. When you make decisions in medicine, you should always think of what's best for the patient. Always. If you stick to [00:05:00] that, you'll be a good doctor, and people will respect you and start adopting that. I've always thought that was key.

If there's one thing I would tell you, the theme: You've got to put things in perspective, the big picture. 

Christine Ko: Yes. Life is hard for each one of us. We have different challenges. Ultimately it really is, for doctors, put the patient first. That's a certain perspective on how really to do the work.

Scott Binder: We have to try to do better. I try to do better, but I have tremendous faults. But a very good start is knowing your faults. You have to be resilient. You have to be mindful. You have to care more for people. It's our responsibility to help as many people as we can live a more [00:06:00] reasonable life. Not to get distracted by things that seem large, but aren't really large at all. Getting a diagnosis of cancer is undeniably large. Not getting a date, not winning, or not being athletic, or whatever. These are not big things, but when you're in the midst of 'em, they seem huge.

Christine Ko: Knowing ourselves, self-awareness, especially knowing our faults, is certainly really important. 

Scott Binder: What's even more important is letting go, giving us room to make mistakes, to be patient with ourselves. To be generous with ourselves. To allow for these faults. Not to blame.

Cognitive behavior therapy is extremely important and very useful. Meditation is extremely important and very useful, and I think exercise is extremely important and very useful. We need to focus [00:07:00] on things that make the soul soar: music and art and all of the talent that's out there. It's about creating a team, and having people you trust; having the smartest people who share your moral code, doing the things that they do best. I can't do everything, but I can pick knowledge experts. That's looking at the big picture. All of these being ways to help cope and to alleviate stress.

Christine Ko: Some people know, but maybe others don't. I did my dermatopathology fellowship with Dr. Binder, and ever since I have known you since fellowship, you've always seemed to really know your goals. And you have a strength of character and a good moral compass, aside from [00:08:00] being a wonderful dermatopathologist and a wonderful teacher and guide as a fellowship director. That's always been a blessing to me. After fellowship, life changes. You have oftentimes a new job, a first job, after all that training, in residency and then fellowship. And then, oftentimes, you have kids around that time if you haven't already. So new job and kids within a five year span; in retrospect, that's a lot.

Scott Binder: I believe women in medicine have a very difficult challenge. It was difficult for me as a gay man, but after a while people just saw me as a white man. The gay thing fell away. But the way women were treated all throughout my training is a tremendous injustice. Women in medicine have a very difficult time.

Christine Ko: Do you have thoughts on how the [00:09:00] pressures and desires we have change over a career as we pursue meaning?

Scott Binder: For many years you're so busy learning and growing and practicing, in terms of medicine. Training can be obviously many years. Finishing your residency and fellowships or your research. That keeps you going. There's always a goal. There's always a test. There's always a degree. That's very linear. It's very hierarchical, and it provides a strong structure, which makes life easier. It doesn't make those subjects easier or achievement easy. 

When it's over, you're thrust into the real world, whether academics or private practice, each has challenges. I've done all kinds of different jobs at very big places and small places. And I have to tell you, there is no perfect job. There is no perfect job. Judge your job by, [00:10:00] just like your relationships, big picture things. You just have to have the right job at the right time. Your needs change. When you're younger, you wanna be around for the children. So you have to have a job that's a little bit more flexible in terms of hours, particularly if you're the primary caretaker.

Your children are grown, and so now what do you do? Now you can look at maybe even bigger things to do or things that are more related to yourself. You can decide, I wanna be a Chair, if you're an academics, or I wanna be a Director of something, or I wanna start my own startup company. Or I want to increase the practice, increase my business.

Later in life, when you get to be older, over 60, 65, it depends on where you're at. We still want similar fulfillment that we [00:11:00] had when we were young. It may be continuing to work as I'm doing now. I'm still teaching, but not nearly as much, and I'm not producing papers and not going around the world giving talks, which I did for years. I've given all that up. Life is a series of compromises. But it doesn't mean you can't be useful and purposeful. You may decide you wanna learn to paint, that you've always wanted to paint, or that you wanted to learn Italian, or that you've wanted to see every national park. There are many different ways to stay purposeful. That's a huge part of growing old and not feeling old. You feel young because you still believe you're contributing. 

Christine Ko: I think it goes back to what you said you wanted to be the theme of perspective. To have a perspective on what still gives you meaning at whichever stage you're in.

Scott Binder: Absolutely. Having [00:12:00] perspective and understanding the big picture because the big picture changes, with different life growth cycle to the next life growth cycle. The big picture can change. Parts of it stay the same, but parts of it change. Life is very exciting. No one should tell anybody what they can and can't do.

Learning is very important in my life. Learning makes me feel young. There's always things to learn. I feel very intoxicated by all of the possibilities, still. It's important to feel that you're relevant.

Christine Ko: I like that. The ability to feel intoxicated by something, and whatever that is, it's an individual thing. That's very compelling and attractive to think about it that way.

Scott Binder: There's so much that's intangible. So much that's subjective [00:13:00] about the human interaction. It's such a special relationship, physician /patient. It's a very special relationship. Tough decisions require an understanding of the heart. 

Christine Ko: Understanding of the heart. Yes. I like that. Having an understanding of the heart, being intoxicated by something at every stage of your life. And as doctors remembering to put the patient first as part of a moral code. All of that I agree with wholeheartedly. Do you have any final thoughts?

Scott Binder: Final thoughts? One of the parts of having the big picture is letting go of control. We have very little control in our lives. We have free will, and we have the ability to cope with stress, and we have the ability to make better [00:14:00] choices. But a lot of things that happen we have no control over. The most important things that happen to us are usually not in our control. An accident, a disability, falling in love; when you're sick, you're suffering, all of these things. You have no control. Your mind can help you. If you're strong and resilient, you can get beyond feeling negative about the lack of control. Life is a tempestuous ocean, and you're up and down. But you do your best to hang on, move forward and stay afloat. And that's what I think we all need to do in life. We need to be looking forward, always with hope and excitement, eager for that intoxication, whatever it may be.

We have a trajectory. We've got to try to decrease the [00:15:00] turbulence by all of the things we discussed that are stress alleviators like meditation and yoga and exercise. But fundamentally, the best stress alleviator is just realizing we can only do our best. We have to think about the positives. Every day, I get up and I'm breathing is a good day.

Christine Ko: Thank you so much for spending time with me and talking to me about these various things. It's been lovely. 

Scott Binder: It was a joy.

Christine Ko: Thank you.