Michael Szego, Clinical Ethicist, Centre for Clinical Ethics reflects on his journey from completing his PhD with Prof. Roderick McInnes to earning a Master of Health Science in Bioethics and launching his career that brings together clinical consultations, policy development, education, and research. Michael highlights eureka moments in his career trajectory, the power of PhD training, and the importance of following your heart in career planning.
Can you describe your current position as a Clinical Ethicist?
Clinical ethicists help clinicians, patients and their families identify, analyze and resolve ethical issues in medicine. Clinical consultations, policy development, education and research are the four main aspects of my job.
Clinical consultations are an interesting part of my job as I am brought into difficult clinical cases often involving disagreements among healthcare providers and/or patients and their families about what the right course of action should be. A classic example would be when there is a disagreement about whether life support should be withdrawn from a patient in the intensive care unit. I try and provide a structured approach and help work towards a resolution while keeping patient values/wishes at the forefront of the discussion. I value this part of my job as it marries the theoretical with the practical and gives me an opportunity to help patients/families make difficult decisions.
The goal of writing good hospital policies is to engage in “preventative ethics” to enable teams with the necessary tools to make good decisions. For example, in the beginning of the year, I had several clinical cases involving patients who were suspected victims of elder abuse. During the consult we realized that the existing hospital policy was missing some key elements. Following the consult, we re-wrote the hospital policy that will hopefully result in the earlier identification and reporting of suspected elder abuse cases in the future.
I also do a lot of teaching both at U of T and in the hospital setting. At U of T, I guest lecture in a variety of undergrad and graduate courses. In the hospital, I engage clinical staff in a variety of different forums from grand rounds to in-services on hot issues such as physician assisted death, or core concepts such as informed consent. These teaching opportunities keep me up to date on research, clinical cases and changes in the health system, enabling me to translate leading practice into the clinic but also help prepare the next generation of clinicians for the issues of the future.
Finally, I also enjoy spending time engaged in research and research ethics. I regularly review protocols as a member of two research ethics boards whose mandate is to oversee research involving human subjects. I also perform some research of my own on a range of topics including: improving clinical ethics practice and the ethical implications resulting from returning whole genome sequencing results to patients.
Why did you choose the University of Toronto and the department of Molecular Genetics for your graduate studies?
I did my undergrad at McGill in the Department of Biology and wanted to pursue a career in science. Several graduate students at McGill told me about the Department of Molecular and Medical Genetics at the University of Toronto. After doing some research of my own I was impressed by the high caliber research coming out of the Department and since I didn't know any of the PIs I also liked the idea of the rotation system.
What are your most exciting memories from the Department of Molecular Genetics?
Meeting my wife, who was a graduate student in John Dick’s lab, certainly tops the list. A close second are some really incredible people I met in the Department many of whom will be lifelong friends. There were also those incredible ‘Aha’ moments. They don’t happen often, but when you’re struggling through an experiment and it finally works or you’ve explained an unexpected result or your hypothesis was proven, those amazing times were certainly some of my best memories.
What was the most important thing that you learned in graduate school?
There were a couple of important things that I learned. One was how to write. I don’t think that enough emphasis is placed on developing communication skills as part of a science undergraduate education. Shortly after starting graduate school I was asked to do a lot of writing, from grant proposals and scholarship applications to academic papers. It was definitely a steep learning curve. Critical thinking was another important skill I learned in grad school. I still remember just before I reclassified, I was at my parent’s cottage and their boat had broken down. Two neighbors, both decent amateur mechanics, were in the boat trying to figure out why it wouldn't start. I know very little about mechanics but by process of elimination I was the first one to figure out the problem. So grad school made me a better boat mechanic! But seriously, graduate school taught me how to break down a problem into manageable (and ideally testable) components. I’ve been able to translate these problem-solving skills that I developed through the many twists and turn in my PhD project to my current job. Although this might not sound ‘exciting’ it’s amazing in hindsight how the mind changes through this rigorous graduate program and despite cursing the process at the time, I feel fortunate in the end that I received much more than just a degree.
You decided to pursue a Masters of Health Sciences in Bioethics after the completion of your PhD. How did you come about this decision?
My intention at the start of graduate school was to eventually run my own academic lab. However, towards the second half of my PhD, while I still enjoyed my project, I began to feel like I wasn’t on the right career path. It took some time to work through, but in the end, I came to the conclusion that I wanted to be a clinical ethicist and I knew the way to do that was to get more training.
My window into ethics was through the life sciences graduate seminar series. I heard Kerry Bowman, the clinical ethicist at Mount Sinai Hospital, speak and I was intrigued by his job and the diversity of activities he was engaged in. I approached him afterwards and he offered me a volunteer position. After working with Kerry for a few months I knew I found the perfect career for me as I was able to combine my passion for people, research, science, and teaching into one job!
Did having a PhD help you later in your career?
I can’t underscore this enough. Yes. Absolutely. A PhD is a valuable credential in my line of work. First, I interact frequently with physicians and having a PhD gives me credibility. Secondly, I was able to get a faculty appointment so I could teach my own course and apply for grants. Finally, even though I am still quite junior, I have already been invited to participate in discussions at several different levels of government in relation to genetic testing and forensic biobanking. It is hard to know, but I am not sure so many doors would be open if I graduated with a Masters degree in science.
What was the most difficult aspect of transitioning from doing bench science to your current job?
I guess the realization that I would need more training after a long and difficult PhD. Then there was (and sometimes still is) the feeling of Imposter Syndrome. I felt like I knew how to do lab work very well and I knew what that entailed, but when I switched careers, I sometimes felt like I didn't belong because my background was so different compared to my colleagues.
Luckily, during my Bioethics training, I did a project with Steve Scherer in which I looked at the ethics of setting up a public genomics project in Canada. We are still collaborating on the Personal Genome Project Canada and several other projects so I still get to indulge in my first love of science.
What was the best advice you received when you were preparing to graduate?
After I decided not to do a post-doc, I arranged appointments to talk to all my committee members. I remember there was a range of responses. They were all very supportive, but I remember one committee member shared his experience in how he got to the position he was in. As a trainee, he described the difficulty he had in deciding what path to take. In the end his advice was to find a career that invigorates you. I realized that science wasn't fulfilling for me anymore. Currently, I work longer hours now than I ever did before, but it’s exciting work and I love what I do every day.
What advice would you give to students who are looking for career options outside of academia?
My thesis supervisor’s favorite quote was from Louis Pasteur and the translation goes something like: “Chance favours the prepared mind”. In science, flashes of insight don't just happen, they are the product of preparation. I think the same can be said for career planning. Opportunities will come up, but unless you are prepared and looking to the future you may not benefit when opportunity knocks. Do the same due diligence that you’re doing for your project. Do the necessary research. Go to career seminars. If something looks interesting to you, explore it. Volunteer. However, don’t let your career search be so distracting that you lose focus on your thesis project. But if you know that you don’t want to do a post-doc, then try to figure out the skills you need to develop or education required to make a jump from an academic scientific career (yes, in addition to a PhD) to set you up on road that excites you.