EP227: Threads of Insight with Dr. Hensin Tsao

Dr. Hensin Tsao on Mentorship, Writing, and Defining Success Beyond Titles

Christine welcomes Dr. Hensin Tsao, Harvard Dermatology Professor and Director of melanoma programs at Mass General, who shares a pivotal early-career moment: stepping in for a WHO Melanoma Congress talk on genetics that led to new opportunities and reinforced the value of serendipity and mentorship. He advises giving every talk full effort regardless of audience size, focusing on turning “light bulbs” on for learners, and building an academic career through continual writing and strong communication, which he argues AI cannot fully replace in crafting persuasive, poetic narrative. Tsao reflects that titles are responsibilities, not validation, and warns that career moves can carry disruptive family costs. He discusses leadership lessons about recognizing differing goals in trainees, and describes his identities as explorer, clinician-guide using evidence to reduce suffering, and youth soccer coach. He closes by urging listeners to choose their own “destination” in life and work.

00:00 Welcome and Guest Intro

01:44 Serendipity Breakthrough Story

04:16 Give Every Talk Your Best

06:18 Write to Thrive in Academia

08:29 Titles Versus Responsibility

13:31 Identity as Explorer Clinician Coach

17:27 Final Advice Pick Your Destination

Transcript

Christine Ko: [00:00:00] Welcome back to The Girl Doc Survival Guide. Today, I'm very pleased to be with Dr. Hensin Tsao. Dr. Hensin Tsao, MD, PhD, is Professor of Dermatology at Harvard Medical School and Director of the Mass General Hospital Melanoma and Pigmented Lesion Center and the MGH Melanoma Genetics Program at Mass General Hospital, where he also leads the Skin Cancer Genetics Laboratory at the Wellman Center for Photomedicine. A magna cum laude graduate of Brown University, he earned his MD (AOA), and PhD from Columbia University and completed training in internal medicine, dermatology, melanoma fellowship, and oncology at Harvard-affiliated hospitals. Since joining MGH in 2001, he has built a continuously NIH and foundation-funded research program focused on the molecular genetics of melanoma predisposition, progression, and therapeutic response while directing the nation's oldest multidisciplinary melanoma unit. An author of more than [00:01:00] 270 publications and over 300 invited lectures worldwide, Dr. Tsao has received numerous national and international honors, has been repeatedly named one of Boston's top doctors, and has held major leadership roles in the American Academy of Dermatology, the American Board of Dermatology, serving as president in 2021, the American Dermatological Association, and multiple leading journals and advisory boards.

Welcome to Hensin. 

Hensin Tsao: Hi, Christine. Thank you so much. Man, that sounds like a great guy. You should get him on your podcast. 

Christine Ko: I know. I often will ask people to share a personal anecdote to start off with because a bio such as yours just does make it seem like you are not a real person. So can you share something? 

Hensin Tsao: There are all sorts of personal anecdotes, all the way from growing up in Taiwan, all the way through professional. But back about 2005 or '6 or so, my mentor, Dr. Arthur Sober, which many of you may know, came up to me and said, "Hey, listen, I've got an opportunity," which [00:02:00] often in academics means I've got work for you, and I'm gonna couch it as an opportunity. Someone at the WHO, the World Health Organization Congress for Melanoma, which occurs every four to five years, had dropped out of giving a talk. And he did say, "I have an opportunity for you. Would you like to step in?" And I'm like, "Oh my God, that is so terrifying," because up to then, I was lecturing at Wellesley High School or something. But I said, "Sure, why not?" And I took on the task and put a talk together about genetics. Since the kickoff of the Human Genome Project, probably about the end of the 1990s, it was still a very topical area, and its influence on melanoma and cancer was just beginning. I must have done a good job 'cause I got a lot more invites after that. It was a really pivotal moment because I think we often don't embrace serendipity and view it as opportunity. Serendipity is very important. If you look at Lenny Bernstein when [00:03:00] Bruno Walter stepped out, or you look at Tom Brady when Drew Bledsoe got injured. Not that I put myself in that category, but I just remember, take a chance, do something maybe out of your comfort zone. Someone is asking you, and you never quite know if it's just a task they want you to do or it does become an opportunity for career growth. So that has always stuck in my mind as being really critical 'cause again, it allowed me to meet some people in the melanoma world that I would not have been introduced to. And when he introduced me, he said I was his academic son 'cause I was training under him, and that also felt amazingly good. It's always taught me how important close mentorship is. So if anything, I think you should remember the kindness and generosity of your mentors and colleagues. And in this business, just very quickly forget the hubris and aggression of some of your peers and competitors, because you will ultimately lead a much [00:04:00] more fulfilling kind of academic life. Everyone listening out there, whether you're young or old, will either know of a pivotal moment or can expect to have one at some point. It's just recognizing when that sort of happens. 

Christine Ko: I like that story. You are very humble. But really, I just also wanna emphasize the point where you said that you worked hard, you put a lecture together, and you must have done a good job because then you got more invitations. And I would say, yes, it sounds like you definitely did do a good job. And one thing that one of my mentors has said is that when you get an invitation, really do the best that you can because then usually more will often come from that. Your story is a good example of that as well. 

Hensin Tsao: Definitely. The other thing is what I would recommend, 'cause again, it's your reputation out there. Even if you're talking to 10 people, give it 110% like you're talking to 1,000. Because I think the minute you feel that your [00:05:00] value as an educator, as a teacher, is directly correlated with the number of people in the audience, then I think your own sense of worth starts undergoing attrition. So no matter what, if you're talking a small focus at the AAD, and you've got a small number of people, or you're giving a big plenary, or whatever it is, always attack it with the same vigor and energy in either situation. Don't judge the value of what you're speaking to by the sheer size of the audience. 

Christine Ko: Yes, that's true. Is it Margaret Mead that says, "Never underestimate the power of one person to change the world"? But I think also if you even just change one person, even if it's yourself, I think that counts for a lot. 

Hensin Tsao: Yeah, absolutely. And Christine, you know this, if you could turn a light bulb on in one person in the audience, it's fantastic because that light bulb is gonna turn on more light bulbs and so forth. Usually the ones in the front row of my talks are asleep, but starting in rows two or three, there's always someone whose light bulb goes off. It's a [00:06:00] catalytic process over time, and that's really just an amazing feeling. 

Christine Ko: Yeah. So you've already given some tips for thriving. Do a really good job when you have an opportunity. Close mentorship. Do you have other tips for thriving over a career? 

Hensin Tsao: Yeah. Very simply, write, and write. They say writing is the lifeblood of an academic life, and it really is. Enjoy it. Now, I was a terrible writer graduating from high school. I ended up majoring in English. It's a very Asian idea, like you pay so much for college, you might as well get the training of what you're really bad at because that's what you're supposed to do. So I ended up majoring in English and falling in love with it, and a lot of that is writing a paper every week, right? So I think one of the skills I developed over that time period is, how do you create an argument? How do you make it coherent? How do you make it cogent? How do you communicate it? All those sort of [00:07:00] skills become ever so important when you're a scientist. I don't do plasmid preps in the lab. I don't even spend much time at the bench anymore. I spend most of my time writing. It's about reviews or it's about papers or it's about grants, and so much of that granting or that manuscript is developing an argument and selling it in a very basic way. So whenever postdocs or students come to me and they say, "What should I learn about genetics, about changes?" Way back when I was in college, CRISPR wasn't even discovered then, and my son in 12th grade was studying CRISPR. So the science changes, and it should. It shouldn't be static. It should be dynamic. But the ability to communicate is very important, and I think a lot of people think that AI is going to replace that now. I think AI is good at searching the literature and coming back with some answers for you, but it's still not great at developing a really nice argument. There are formulaic [00:08:00] ways to express yourself, and then there are more poetic ways. Everything AI ever writes is pretty formulaic because it's a statistical model. But the most beautiful sort of writing and narrative is poetic, and I think not to understand that is to undersell the value of language and communication. So in short, write and write. The more you write, the better you get at it, and the more success you have in life.

Christine Ko: That's cool. Is there anything you wish you had known earlier? 

Hensin Tsao: Yeah, when I was younger, I had all these sort of ideas how one day I was gonna take over the world. When you're in academics, I'm sure you've come across this, like when should you be a chair or when should you do something big? And I think I finally realized as I've gotten older, titles like that are about responsibility. No one wants to have kids just to be called Dad. "Oh, I wanna have kids so I can be called Dad." No, when you have kids, it's about that responsibility. It's not about the title, right? And I think when you have people who work under you and your [00:09:00] subordinates, you treat them like your children, so you're responsible for them. You're not exercising power over them. So it's not like you have kids just so you can have them work the fields or mow the lawn because you got that power to tell them to do something. It's really a lot more than that. And I think when you're young, really young, people spend a lot of time looking at these titles thinking that they'll validate them in some ways.

When I was young, I spent a lot of time thinking, "Should I be a chair or not?" And looking back now, I'm really happy where I am. I've never had to disrupt my family's life. Often the intangible losses are far greater than the tangible gains. And you don't realize how disruptive pulling kids out of their community is. You don't realize how your spouse's practice or workplace, if you were to just leave, how disruptive that could be. And I think in looking at it in balance, I've been totally ecstatic where I am. If I were to meet my [00:10:00] younger self, I don't know if I would believe my older self if I said that, but I spend a lot of time coaching the kids, and I see many of them like, "Oh, just because you didn't make it, I'm gonna make it," kind of thing. But there is some truth to understanding what responsibility means and how you can value the success of your entire family and network as opposed to just your own success in life. The other thing I wish I'd known earlier is that you and I, we're surrounded by people who want to succeed. It's easy to be the cheerleader when they really want to do well. But I think as you start meeting more and more people, especially if you run a lab or a clinical department or a company as a CEO, not everyone is Type A. And I think one of the lessons that I've had to learn over the years is sometimes they want other things besides what you wish for them And it's hard, but sometimes you need to let those people go. Fundamentally I've always viewed if I can't make them like a superstar, then it was my failure. Recognize [00:11:00] that what they wanna do may be different than what you want them to do. Letting those people go is also, I think something that you learn as you get older and as you start having more and more responsibilities. Those two things are things that I would tell myself if I met myself earlier.

Christine Ko: I just wanna go back to something you said, though. You said if someone's not a chair at some point in their career, they didn't make it? 

Hensin Tsao: People so addicted to these objective things. You can find value in what you do without those. There are people out there who view that having that title is the end all. And every stage, rather than seeing "What can I do in the world, in the circle I'm in?" They're thinking, this is a stepping stone to the next kinda level. There's always something more. Once they've become chair, then they can be the dean, and once they become dean, they can be head of the hos- ... In looking at what I have done, there are a lot of things that I haven't done in life, and you realize that you've done exactly what you want to do, and you're happy where you are. That's what I [00:12:00] was trying to say. 

Christine Ko: Yeah. I wanted to just go back to that point because you have so many accomplishments, and actually you have many titles that are important. Titles that not very many people will hold.

Hensin Tsao: Oh, you're very kind. And I do approach each one very seriously. Christine, most people have those temporarily. Most of mine are a year or two. It's not like a pope job, right? What you wanna do is just make sure you leave it slightly better than you found it, no matter what it is. That delta is really important because it makes you feel like you've done something. 'Cause most of them are also unpaid, thankless jobs. I think you should tackle it with all the energy that you've got. Because when you're given a responsibility like that, whether it's being on a board, whether you're president or something like that, I think you wanna, again, leave it better than you found it, and that delta is important to feel like you have created that delta.

Christine Ko: Yeah. I really like what you're saying, the [00:13:00] perspective that you're giving on it, and I feel like it is slightly poetic the way that you're saying it, just like when you were saying about writing.

Because when you said you don't wanna just have a kid just so you can be called Dad or Mom or whatever; to me, it comes down a little bit to identity. That is your identity becoming a chair or becoming a professor or becoming a president of something versus is your identity really something else? It's not just because someone calls you something 

Hensin Tsao: Yeah. I have different components of my identity. One is that of an explorer. And I think there are different kinds of explorers or investigators. There are those who find beauty in the big picture. There are those that find comfort in the details. I'm much more of a big picture person. So one of my identities is, if you can imagine me as a mountain climber I'm lousy with details up to a certain point, [00:14:00] but I try to see the big picture as much as I can. I reflect on things. I enjoy the view from the top of the mountain and I just wanna see how things relate. There are much better mechanistic people who deal in details all day. So in terms of an identity at the workplace, that's what I see. In terms of as a clinician, it's interesting. How do I view myself? Well- there's this Greek myth about how Theseus, I think, had a thread that Ariadne created to lead him into the maze. That's how he ultimately killed the Minotaur and was able to get out, 'cause technically speaking, you don't come out of the maze. So my role as a clinician, 'cause often what we do is not necessarily curable, I see the role of a clinician as being that person with the thread to go down to the deepest recesses of someone's fears, of someone's anxiety, [00:15:00] of the sort of tragic news of having had, say, a melanoma, and kinda taking them and leading them out of that space, all right? You and I have both been in places with family, where you're just in a terribly dark, fearful place. As a clinician, you can't always cure them, right? You can't always give them a drug and make things go away, but you can always reduce their suffering. You can always lead them to a better place. And that thread that I talk about, that's the scientific evidence that you have to hold onto. But with that in one hand, you also go down to the depths of those recesses and mazes to take them by the other hand and lead them out. So in some ways, as a clinician, you are that guide, that metaphoric guide that kinda takes them to that better place. It gets away from this idea that you have to be a miracle worker to be a great doctor, or the idea that you have to know everything. Because you do have that thread that is the evidence, and that is the literature, and that is the data that you should lean into to try to make those [00:16:00] decisions of which corner to round or do you go straight, do you go left. You kinda always need that connection back to science to do that.

And I think the one identity I have at home is really an anecdote. I'd never played soccer in my life. I actually didn't do much but study for the SATs all day. But, with my kids, I was a soccer coach for years, and over time, in the top sort of most rewarding things I've ever done in my life, that probably has to rank up there, more so than a lot of the stuff you were just talking about. I knew nothing about soccer. All I did was have an Excel spreadsheet that counted the number of minutes they played for each player. That's like the geek's approach to being a soccer coach, right? Just make sure you analyze the number of minutes exactly. That is the identity I had, with the kids growing up, which is really their coach. There to encourage them to succeed. And I hope they viewed me in that way. I'm not there to have some power trip to tell them what to do because that's [00:17:00] not how they grow into things. They're wonderful kids, and they are older now. I think we all have different identities into different communities, into different circles we belong in, and it's how you see yourself and what your role is in there,

Christine Ko: That was beautiful. I really loved what you said about being a clinician and having that thread and just bringing the patient to hopefully just even a little better place, because as you said, we definitely can't cure everyone. It's been really fun to hear your thoughts on things. Do you have any final thoughts? 

Hensin Tsao: First of all, this is really fun, and thank you so much for the invitation. I don't think I've ever done a podcast. I should just grow up and enter the 20th century for a change. But if there's anything I tell people, it's like deciding on a vacation. You have to pick the destination, and you have to decide how to get there. And you pack as much as you can to try to make the trip, but it's okay if you don't, 'cause at least you pursued what you felt to be the right destination, right? I think sometimes people [00:18:00] don't have that sense, and they just go somewhere 'cause other people say they should, and it comes with a free gas and free car. That is the wrong way to go through life. There are times I've seen people pursue research that they're not interested just for funding or now they're called chair. I've always said, how long do I wanna do research? I have questions I wanna answer. The hardest thing and probably most important thing in life, it's like any trip you plan, it's initially picking the right destination. Everything else, especially now with all the tools you have, becomes secondary to the fact that you have to decide that yourself. So that would be my final thought to anyone listening out there. 

Christine Ko: I love it. 

Hensin Tsao: Christine, it's so wonderful to chat in your space here. 

Christine Ko: Thank you so much, Hensin. 

Hensin Tsao: You're very welcome.