The Man Behind the Medicine
At the opening of the Duke Cancer Institute in February, Dr. Victor Dzau, who heads Duke Medicine, stood on the second floor at the building’s ribbon cutting ceremony and looked over the glass ledge at the crowd seated below.
Dzau believes the new building will revolutionize care for cancer patients. Instead of emphasizing impersonal procedures, the lobby feels more like a home, featuring a fireplace and a café. When patients lose their hair, they can visit a boutique in the lobby that provides wigs and head scarves at no charge. If patients and their families need time to be alone, there is a “quiet room” designed for meditation that offers customizable mellow music. The institute is more than just a hospital. “We have renewed our promise to our patients that they come first and that they are always at the center of everything that we do,” Dzau said shortly before introducing Gov. Bev Perdue, who sat behind him and next to President Richard Brodhead.
As chancellor for health affairs and CEO of the Duke University Health System, Dzau is responsible for everything from the clinics where patients are treated to the classrooms where medical and nursing students learn and research. In his mid-60s, his black hair is now mostly white. A doctor’s white coat hangs in his office closet, though he often works in a suit. At the building opening, he wore dark pants, a white shirt and a patterned blue tie. Before he took the stage, he found his wife, Ruth, who he has been married to for nearly four decades. Ruth Dzau serves on the boards of Planned Parenthood of Central North Carolina and the Center for Child and Family Health, a local organization that cares for children and families affected by trauma, abuse and adversity. One of the Dzau’s two daughters, Jacqueline, works in Duke’s ophthalmology department.
Victor Dzau’s days begin early and end late. He begins working at his desk by 7 a.m. and continues until around 7:30 p.m., when he usually attends dinner meetings or events. When he finally gets home, Dzau catches up on email and makes his way through a color-coded packet of work his staff puts together for him. The yellow folder contains documents to review and sign, the blue folder calendar requests to consider, the black folder items to read and the red folder his mail. On a typical night, he sleeps just four or five hours. “That’s one of the, I guess you can call it, gifts,” Dzau said, his voice accented from his childhood in Shanghai and Hong Kong. “That’s my biology, I can do this, and it gives me extra hours to work or have fun.”
With a stressful schedule and little downtime, Dzau is very engaged and moves between calendar items quickly. Celeste Lee, who was his chief of staff from 2007 to 2010, likened the experience to scenes from the former hit NBC drama “The West Wing.” Sometimes he would pass by Lee’s desk and ask her to walk with him, and then he would walk so fast that she would have to run with a notepad in hand to keep up. Dzau and his personal assistant Edwin Stephen first met when Stephen was a concierge at the Washington Duke Inn, when Dzau was first being recruited by the University.
Now, Stephen’s responsibilities range from managing the mail room to driving Dzau to the airport. He has earned the chancellor’s trust by never repeating the details of confidential meetings and phone calls, and he knows Dzau’s calendar by heart. “People have to keep up—he walks fast. You ever walk with him?” Stephen asked me with a laugh. “[Dzau says,] ‘Let’s walk! You go to the gym every day, keep up!’”
Dzau invited me to shadow him for two days to get a sense of how he spends his time. He opened all the meetings on his calendar including an executive committee session reviewing an information technology project and patient satisfaction scores at Duke hospitals and clinics as well as his working lunch with the head of the Duke Global Health Institute.
Dzau, now approaching eight years as the figurehead of Duke Medicine, said the satisfaction he gets from his work makes the long days more meaningful than draining. As a child he saw firsthand how medicine can serve communities, and it became his passion. Born in Shanghai, China, Dzau and his family fled the country in the 1950s when the communist regime took power. Dzau’s father, who owned a soap factory in China, moved his family of five to Hong Kong. The Dzaus were not poor in Shanghai, but in Hong Kong they had to start over with nothing. For a year, the family shared a single room before re-establishing themselves. As a child growing up in Hong Kong, Dzau witnessed overwhelming poverty and inadequate healthcare. Not far from his family’s apartment, people lived in squalor on the hillside with no heat and limited access to water. Tuberculosis was rampant in the area, and several members of Dzau’s immediate family suffered complications from the disease and other serious medical emergencies, like strokes. At the time, treatments that would be standard in the U.S. today were not accessible to many families. “As a child, you can never forget those kinds of things,” Dzau said.
While still in Hong Kong, Dzau learned how he could make a difference, inspired by a friend’s father, who was a doctor. Once he finished his primary education in Hong Kong, he moved to Canada to attend McGill University and become a doctor himself. He spent his career at Stanford and Harvard Universities where his research focused on cardiovascular disease before he was recruited by Duke.
Given his background, one of Dzau’s most cherished causes is providing medical care to all members of the local community, regardless of their ability to pay. Although this comes at a cost to Duke’s bottom line, Dzau believes it is part of the University’s medical mission just as research and teaching are.
Five or six years ago, Dzau helped overcome a serious obstacle to community care. Some Durham patients with complex medical issues struggled to get the speciality treatment they needed because they were intimidated by either the cost or Duke’s high patient volumes. To address these problems, community leaders with medical expertise met in the basement of a Durham church in order to find a way to care for these patients. The effort included nongovernmental organizations, county commissioners, heads of hospitals and doctors who worked in the community but not directly for Duke, and Dzau pledged the University’s support. The group’s efforts resulted in a system of health care called Project Access of Durham County. The leaders first estimated the number of Durham residents who were not receiving the specialty care they needed and then agreed to each care for some of those patients even if they could not pay. “This was really a breakthrough,” Dzau said of the cooperation between the various private and public entities that contributed to the solution.
In this sense, even the Duke Cancer Institute is a part of what Dzau considers to be the community care system. Community care provides basic medical services but ideally includes highly specialized treatment because patients without insurance require this sort of care as well. The idea is that care should be given in the community for the community, Dzau said.
The University’s efforts address local needs, but combining private and public entities to improve health care remains a national issue. The Institute of Medicine, an organization that provides national medical advice, just completed a 21-month study about the relationship between primary care and public health. The committee’s March report used Durham as one of three examples of successful community care and noted the range of community participants that contribute to this effort as well as Durham’s collaborative financing structure for providing that attention. “Duke has given an example of how primary care is working with public health to improve health,” Dzau said.
Health care reform, debate over the National Institutes of Health budget and uncertain economic conditions pose substantial challenges for Duke Medicine in the coming years. With this in mind, Dzau launched an initiative called Enterprise-Wide Planning, which will reconsider fundamental questions about the vision for Duke’s health system, including considering issues such as how revenues from clinical care can continue to support the University’s educational mission. As Congress and the Supreme Court consider the future of American health care, four subcommittees at Duke are compiling information and drafting recommendations that are set to be completed by June.
“What we are doing right now is going through a planning period, getting prepared and beginning to make changes that will enable us to be ready and succeed in the future,” Dzau said. “Whatever happens, we will be a better organization.”
On the first morning I followed Dzau, he arrived at a meeting with the project leaders of the various Enterprise-Wide Planning committees wearing a black pinstripe suit, a pink and blue tie and glasses. The group discussed the challenges ahead, which range from reducing certain expenses in the medical center over the next five years to defining the role of the consultants Duke hired for this strategy project.
In meetings like these, a pattern of Dzau’s behavior emerged. In order to let those who work for him voice their opinions, Dzau listened first and followed with a series of probing questions. Then, he would finally speak his mind, incorporating the ideas of his team and the shortcomings of the analysis thus far. The following afternoon, when I asked Dzau about this method, he smiled. “And if I feel strongly, I’ll say it more than once,” he said. Members of Dzau’s staff said instead of rejecting ideas, he encourages others to consider solutions from all possible perspectives.
Many of Dzau’s appointments take place in his office, which has blue carpet and white walls covered with photos, degrees and articles. His desk is covered by neat stacks of papers, and the room has more than a dozen chairs. This space is just one of the rooms in the larger chancellor’s suite, which is located at the top of the academic quad and not far from the Old Chemistry and Social Psychology buildings. It has its own boardroom and workspace for the six employees who help with everything from planning annual events to booking travel. Sarah Braman, for example, is the executive assistant who manages Dzau’s calendar. Most days, the chancellor has back-to-back meetings all day, she said. Members of the staff said Dzau’s work ethic pushes those who work near him to keep up. “He expects a lot from you, and so you expect a lot from yourself,” said Celeste Lee, his former chief of staff.
In a given day, Dzau has the responsibilities of a CEO, a scientist and a professor. At one moment, Dzau is focused on the numbers, the quality of the hospital’s care and the costs associated with those treatments. In his next appointment, he turns his focus to academic research and the importance of discovery. Then Ph.D candidates or undergraduates arrive, and there’s a complete transformation again, said Edwin Stephen, his special assistant. “It’s like he’s taking his tie off,” he said. “It’s completely different, and sometimes, when I want to please him or ask him a favor, I don’t call him doctor. No, I call him Professor Dzau. That, you know, gets his attention.”
It will take the business acumen of the CEO, the analytic approach of an academic and the care of a doctor for Dzau to lead Duke Medicine to continued success. The business model for medicine in the United States is changing, and the sources of national funding that have allowed doctors at academic medical institutions to devote part of their efforts to conducting research and improving care are not guaranteed.
Sunday mornings, the chancellor will sometimes play a round of golf. He enjoys theater, music, movies and travel. Dzau does not escape for long, however, because medicine is his passion. When his week is complete and his schedule is free—in particular, Saturday mornings—Dzau ventures to campus to work in his lab, which focuses on cardiovascular translational research. He studies the heart, trying to improve patient care so that people do not have to suffer as he saw in Hong Kong.
“I want to say one thing,” Dzau said. “For me, I’m not making a distinction between work and pleasure. If people make the equivalent that work is pain and pleasure is not work, I actually find a lot of gratification and satisfaction in doing what I do. So I don’t find it onerous, per se, work.”