Vinayak Kottoor, M.D.
Vinayak Kottoor, Chief Resident
in the Institute of Genetic Medicine:
You’ve trained in both internal medicine and pediatrics in a multitude of settings— India, the United States and the Dominican Republic. With that rich and varied background, why then a residency in genetics?
KOTTOOR: It’s all a part of building a broad and sufficiently deep foundation of knowledge and awareness as I proceed with training in clinical genetics. It has to do with where I feel medicine, as a discipline, is heading, and how genetics, as a discipline but also as a way of thinking, is coming into its own as being basic to our understanding of human biology.
How does genetic medicine complement your already impressive educational and professional foundation?
KOTTOOR: Having trained in adult and pediatric medicine, I feel comfortable thinking about health and disease across the age spectrum. There are certainly ways in which children are not “small adults” and vice versa. However, they are, fundamentally, the same organism, and a more holistic view of the patient population is helped by understanding the common thread throughout their lives, which is their DNA as it interacts with the “environment,” a word with many meanings in biology.
What are your research interests?
KOTTOOR: As the late Dr. McKusick told me when I interviewed with him, “We are the last of the primary care providers.” In that vein, I hope to collaborate in research that establishes effective ways in which to take what is learned on the front lines of genetics research to its place of application: the primary care setting. The need for this is growing with time and scientific progress. Genetic findings are increasingly more “actionable” as our understanding and technology moves forward. Internists, pediatricians, family care physicians, nurse practitioners, physician assistants and nurses are the providers who can carry forth the benefits of this greater genetic understanding to patients. Our role, in the broader genetics community, is to engage this very necessary evolution in health care.
Why train at Johns Hopkins?
KOTTOOR: Before starting my chief year in pediatrics in Saint Louis, I gave myself six months to interview and decide on a program for genetics. I had the happy dilemma of choosing from among many excellent programs across the country. Each interview was exciting, and I came away contemplating a future at each of those programs. However, the excitement I felt about Hopkins did not fade over time and lasted even through subsequent interviews.
I was particularly impressed with the breadth of work being done within the IGM and via collaborations. The faculty was very genuine and sold me on the quality of work being done here. Many other programs compared themselves to Johns Hopkins by trying to tell me about the limitations of studying here. Meanwhile, the interviewers at Hopkins took the opposite approach; they filled me in on the strengths of the various programs I was looking at. For me, that was particularly refreshing and indicated a collegiality that I was intent on finding.
How do you envision life after residency?
KOTTOOR: I am a clinician. My place is in front of people, communicating with them, and teaching them as well as learning from them. My view of how to achieve that role has broadened since coming to Hopkins. Caring for patients will always have a place. Meanwhile, just as the patient-doctor encounter is in large part an educational experience, I have realized that education of and interaction with my colleagues in the health care profession regarding genetics is just as satisfying.
A combination of the two is my goal. That may sound like two jobs at once, but I like a challenge and am ready and willing. I tend to focus on the journey more than the destination.
What challenges have you faced during your genetics residency?
KOTTOOR: After my residencies in internal medicine and pediatrics, I can hardly complain about my current work schedule, even on the busiest days. I pushed the edge of restrictions on hours at work more as chief resident of pediatrics. Still, working on the clinical side of genetics, I have experienced the growing pains of the field: While we have much more than ever to offer in terms of diagnoses and management, we still have such a long way to go. There is a lot of “wait and see” still happening that is difficult to accept, sometimes, for a person trained to heal. Technology has outpaced our ability to understand what it tells us. While I am enthusiastic for its promise, I am also very worried about the impact of “half knowledge” on consumers of healthcare.
What is the best thing about this residency?
KOTTOOR: It’s the amazing access trainees have to the IGM faculty as well as other faculty and staff within the greater institution. Any meeting I have had with IGM faculty has ended with an invitation to return and discuss some more when I needed to. That is a very positive aspect that I hope to emulate.