Ralph Snyderman, former chancellor for health affairs at Duke and dean of the School of Medicine from 1989 to 2004, is releasing a memoir Nov. 1 called "A Chancellor's Tale: Transforming Academic Medicine." The Chronicle spoke with Snyderman, who is also the James B. Duke professor of medicine, about his tenure as chancellor, the current state of health care and his advice for pre-med students.

The Chronicle: Why did you decide now to write about being chancellor?

Ralph Snyderman: I started writing the book probably a little over three years ago. Once I started writing it, it became obvious that what needed to be told was so important beyond the Duke audience. What happened during the 15 and a half years, not only greatly affected Duke, the Medical Center and the University, but also really changed the practice of medicine.

TC: What were Duke's major accomplishments during your tenure as chancellor?

RS: The first was the creation of the Duke Clinical Research Institute, which is now a national model for how clinical research should be done, particularly in academic institutions. It brought the importance of clinical research as a way to translate research discoveries into practice.

The second was the creation of the Duke University Health System. Duke, when I first came, consisted of Duke Hospital and the practice of physicians in Duke Hospital. That was it. Now we have a Duke University Health System that extends not only through North Carolina, but also through much of the Southeast, with a medical school in Singapore. It was the creation of a very large, integrated health system which was totally revolutionary for an academic medical center.

The third and the fourth are the concepts of integrative and personalized medicine. Medical care continues to be very heavily focused on an individual’s disease—not necessarily on that individual and all the things that the individual needs to care for their disease. For example, a patient with cancer seen at Duke 15 years ago would have been treated beautifully with surgery and radiation therapy to try to destroy their cancer. But what about their emotional well-being? A model for integrative medicine provides the individual all those other things, supports those things to master their disease, to get through the really tough part of it.  The concept of integrative medicine was to put the patient in the center and to humanize their care and to say that we have more responsibility to the patient than simply the treatment of their disease.

TC: What are the specific things that you did as chancellor and that you do now to balance your career with your family life?

RS: That’s probably one of the toughest challenges that I had or anyone in this type of leadership position has. Quite frankly, I think during the time I was moving up the ladder in my career, I did not give enough attention to my family. If I had to do it all over again, I think I would have more balance between my professional and personal career. I think one of the things I have focused on since I have stepped down is to understand that when you look at what’s truly meaningful in one’s life and one’s career, in addition to all the things one tries to accomplish, it is family and friends. So I focus on it a heck of a lot more now, but during that time I was chancellor, there wasn’t a heck of a lot of time for me to be anything other than chancellor.

TC: Hypothetically, would you have given up achieving one of the accomplishments we mentioned earlier to have spent more time with your family?

RS: That’s a good and sensitive question, and I frankly think no. I believe I could have done it even more effectively if I had at times been more grounded. I think that what was accomplished could have been accomplished and would have been accomplished. But I think that for one’s maximal effectiveness, one does not necessarily have to give up attention to what is very meaningful to the individual and their personal life. I don’t think you need to take more time to do it, but you need to make sure that you do it and you do it in a very meaningful way.

What I would have done are some of the things I actually learned to do during the latter part of my tenure as chancellor. One of the pillars of integrative medicine is mindfulness meditation—being in the moment and spending time every day to reflect on what really matters. I think what I would have done is spent the time to be very personal. Every day now, I spend at least 30 or 40 minutes or an hour with my wife when I come home. We call it our personal time. We just sit and talk. We talk about what our days were like and really getting into the touchstone of what’s important.

Looking back, the advice I would give anyone in a job like this or leadership in any way, is: don’t lose that touchstone of what makes you who you are and what gives you the strength to do the things that sometimes may be very difficult.

TC: What advice do you have for pre-med students?

RS: I would hope that pre-med students are strongly—at their core—driven because they want to be physicians. They should have this intuitive feeling that a physician is a healer, [someone] who gives themselves in service to other people in a very particular way with a tremendous amount of ability to help other people because of their training and resources. So if a student truly believes this, that is a great start. If they don’t truly believe this, then I have problems and concerns about them.

Second, I would say, no matter what you do, stay grounded in that. That ought to be front and center. There are an awful lot of things that one reaches out and tries to do. "If I do this, will this get me a better shot? If I do that, should I seem this way? Or should I seem that way?" It may be necessary to be aware of the touchstones needed to get you into an American medical school, but it ought not be the main drive. I think that the main drive ought to be passion and the curiosity, the wanting to learn and to really understand.

Duke students have so many opportunities to learn about all the different aspects of what’s going on in health care. [They can] see what they like, what they don’t like, whether it's really for them, [and they can] get involved in things they really do like to help them [grow] their own intellect. I think it also looks good on their record when they apply to medical school. But graduating from Duke with a good record and doing well on the MCAT, I cannot imagine that won’t be good enough to get students into some good medical school in the United States.

TC: What do you predict will be the major challenges facing our generation’s health care system?

RS: One of the greatest challenges in the health care system is to get people to understand how important their health is to them and how much of their health depends on what they do, what they eat, how they exercise, what substances they take, what risks, whether they have stress. All those things are much more dominant in one’s health than virtually anything else. So I think one of the greatest challenges is getting people to take their health personally.