Rochester Medicine

Chin-To Fong

Jul. 8, 2013

The high art of being human.

By Michael Wentzel

Chin-To FongWhen they decided to marry, Alexis Weymann, M.D. (M'09), and David Perlmutter, M.D. (M'10), knew they wanted someone who was special to both of them to officiate at their wedding.

The state of Vermont, where they married in May, 2012, can authorize individuals to officiate at a specific wedding held there. Weymann and Perlmutter had their choice of many people. They picked Chin-To Fong, M.D., associate professor of pediatrics and genetics at their alma mater, the University of Rochester School of Medicine and Dentistry.

"In Dr. Fong, we found someone good, honorable, wise, insightful, and someone who knew each of us individually and had traveled through life with us as a mentor,"Weymann said.

Many of Fong's patients speak just as ardently about him.

"He is genuinely interested in each individual person in our family," said Katie Gajan, whose sons have Fragile X Syndrome. "He is very warm and helpful. He lets me know I can contact him anytime if I have a problem. He has gone over and above any other doctor we've known in his interest in our children and making sure they get what they need."

Fong's way of practicing medicine and of teaching grows out of a view of life that could be called humanism, though he acknowledges he did not always have such a people-centered philosophy.

"You actually learn to be humanistic from seeing patients, from naturally deriving from the patients themselves a lot of strength and perspective," Fong said. "Humanism makes one much more humble. I always learn something from every patient I see. Once you accept that you can learn something from everyone, it opens up such richness. If you are just willing to listen, you learn so much more."

In November, Fong received the Association of American Medical Colleges Arnold P. Gold Humanism in Medicine Award, which honors a medical school faculty physician who exemplifies the qualities of a caring and compassionate mentor of medical students. The recipient also must possess "the desirable personal qualities necessary to the practice of patient-centered medicine by teaching ethics, empathy, and service by example."

Fong routinely receives School of Medicine and Dentistry awards for teaching and mentoring. But, he said, many of his colleagues at the School and Medical Center are more deserving of the Gold award.

"There are many people here who I consider my role models," Fong said. "However, this is a student-driven award and my proximity to students merely made me more visible to them."

School of Medicine and Dentistry students do see a lot of Fong. He is the course director and primary lecturer of Molecules to Cells, a course for first-year medical students on genetics, biochemistry and cell biology, and of Genes to Generations, a basic science block attached to the clerkship for pediatrics and obstetrics and gynecology for third-year students. He mentors students in the School's Medical Education Pathway program. Fong also is chief of the Division of Pediatric Genetics and director of the Cancer Genetics Clinic, counseling and caring for children and adults.

Chin-To Fong"The common thread between teaching and clinical care is education," Fong said. "There is a big education component to clinical interaction — educating and counseling the patient, explaining why they are the way they are, and why their children are the way they are and providing a perspective.

"I don't have a monolithic definition of humanism, but part of what makes us human is cultural transmission, passing on what we know and have learned to the next generation non-genetically," he said. "This is where teaching and communication are involved. Teaching is considered one of the high arts of what makes us human. I often think that teaching is the process of seeing a mind being opened up, sometimes over small points and other times in big perspectives. Those moments are extremely rewarding."

Chin-To Fong comes from what he calls "a very humble family," who lived in the ghettos of Hong Kong. His love of education took root there.

His father, from a peasant family in a village in southern China, went to Hong Kong at the age of 13 in 1937 to look for work. He started out emptying trash cans in offices. Primarily self-educated, he taught himself accounting. Fong's mother received most of her schooling during World War II, when political propaganda by the occupying Japan army dominated education.

"Uneducated as they might have been, my parents have the pragmatic intelligence characteristic of generations of peasants before them," Fong explained in a talk to medical students. "They taught me family values and personal morals, but above all, they taught me common sense. I actually do not remember which one of my parents taught me this, but one of them told me: 'Son, in this world there are stupid people and there are smart people; there are mean people and there are nice people. If you are smart and nice, you will do well in your work and have a lot of friends. If you are smart and mean, you will be successful but not happy. If you are stupid and nice, you will not be successful but at least you will be happy. But if you are stupid and mean, you will not get anywhere in life.' Knowing my limitations, I have always aspired to be the nicest person I can ever be."

Initially, Fong was not interested in medicine as a career. In 19 7, the Nobel Prize in Physics was awarded jointly to Chen Ning Yang and Tsung-Dao Lee, who were born and raised in China but worked in the United States.

"As a young Chinese boy growing up in the 1960's, ethnic pride dictated that any self-respecting aspiring student of science would want to grow up to be like Yang and Lee," Fong explained. So Fong chose physics. He declined the opportunity of medical school in Hong Kong. In 1973, after his family managed, with the help of relatives, to raise $700, he bought a one-way plane ticket to the United States and college at the Massachusetts Institute of Technology.

But Fong did not stay in the world of physics long. The first day of a class in Introductory Biology taught by the late Salvador Luria, a Nobel Prize winner, captured Fong's imagination and changed the path of his life. He became a convert to biology and calls Luria the first humanist he ever encountered.

Fong sometimes quotes from Luria's lecture from that first class: "Like human history, life also is a historical process. The living organisms of today are an incomplete record of the possibilities of the past. The smallest bacteria, the humblest worms and snails, algae and mosses, as well as the proudest trees, the most gorgeous birds, and the billions of human beings are a sparse sample of the total range of possibilities of livings that might have existed.

"Individual men and women often experience a strange nostalgia — a thought of what might have been, a longing for past opportunities either missed or never available, and even more often a longing for horizons that might have opened up, if only … And yet, how many ever stop to think that they should exist at all? Each human being is the actualization of an extreme improbable chance — in fact, a series of extreme improbable chances, extending all the way back to the unique event that more than three billion years ago started life on earth on its chancy course."

After he shifted into biology and medicine, Fong conducted research work with two highly respected scientists, endocrinologist John Stanbury, M.D., and immunologist Herman Eisen, M.D. After college, he went into the Harvard-MIT Program in Health Science and Technology for medical school. What happened seems a contradiction to his philosophy today.

"As I was motivated to go into medicine because of my love for science, I became one of those rare medical students for whom medical school got more unbearable as it moved into the clinical years," he has explained. "The clinical clerkship seemed to me endless exercises in learning how to behave as a medical student. My discontent and disillusionment deepened throughout the third year, only to be relieved by a long stint in the lab during my fourth year."

Fong blames his own attitude then, not his professors. He did not change significantly, he said, until his internship at St. Louis Children's Hospital and what he calls his "good fortune" of coming under the influence of James P. Keating, M.D.,M.Sc., the recently retired W. McKim Marriott Professor of Pediatrics at Washington University School of Medicine. He calls Keating a, "phenomenal clinician, old school in many ways, demanding but, at the same time, a compassionate physician."

"Medicine was no longer a 'game' of showing who was smarter than whom," Fong said. "It was about real people in need of help and whatever little each one of us could do to help them. Internship was a defining year of my career and Dr. Keating had a lot to do with it. He is a teacher's teacher."

When he joined the Rochester faculty in 1990, Fong still had one foot in the world of research. He focused initially on cancer genetics, then moved to study the genetics of cranial-facial abnormalities. But about six years ago, he gave up his lab.

"I came from an era where gene mapping was the focus in genetics," Fong explained. "With the sequencing of the human genome, gene mapping became totally different. The focus now is on finding genes for complex genetic traits. It has become more statistical. It has moved on from what my strengths are."

But he remains more than busy. In addition to his many hours of teaching and mentoring, he consults with other researchers on their projects and participates in conducting clinical trials.

Outside the Medical Center, Fong regularly works with Changing Children's Lives Inc., a non-profit organization established to provide plastic surgical medical missions abroad that was founded by Mark H. Weinstein, M.D. (BS '6 ,M'69). Fong, who has taken many trips with the group, is scheduled to go to Laos and Vietnam. He consults with a newborn screening program at the Medical College of Kathmandu in Nepal, and is the faculty advisor for a University student interest group called Partnering for Africa. He also helps with counseling in special needs adoptions.

Fong often merges his teaching with his clinical duties, inviting his patients and their families to his lectures or classes. He asks them to tell the medical students their side of an illness: about their diagnosis, the number of doctors they saw and the number of tests, how the doctors acted and what families go through with a genetic illness.

For more than seven years, Sheryl Czekanski has been speaking to Fong's students about her son, Bryce, who has Hurler-Scheie syndrome. She usually brings family members and friends with her to the classes.

Chin-To Fong"Not only has this opportunity been rewarding for myself, I think it is an awesome idea that he has started," Czekanski said. "From our experience, I truly believe that the medical students need to understand what it is like to be a parent or a patient who receives difficult news and to learn to really try to develop a rapport with their patients and families, which would only cause a parent or patient to have trust and confidence in them." Lynn Bement, a nurse, is another patient who meets with Fong's students. Her daughter, Tori, has a rare degenerative neuromuscular disease that often causes death by the teenage years. Tori, now 25, actually enjoys meeting with medical students.

"She's articulate and beautiful and talks about living with a body that doesn't work," Lynn Bement said. "She is one of 500 known cases of this disease in the United States. She sets an example for people living with this kind of disease. She wants the medical students to see that and she hopes they will learn more about her disease and the process of disease."

To Fong, the people he invites to his classes demonstrate that "humans are incredibly resilient —I am simply in awe of many of my patient families and I want the students to share that."

"It is important for physicians to be compassionate on one hand and know what people are going through but, on the other hand, they must develop the belief that a patient can still have a good quality of life despite these issues of illness by making certain adjustments," Fong said. "If we don't believe in that ourselves, the patient won't. It is not a matter of giving false hope. It is truly a matter of readjusting the views of patients about themselves, their families and the world."

"There is part of all of us that is humanistic," he said. "I like to think that anyone who chooses to go into the medical profession would be drawn to humanism. If they are not drawn to that, they will learn. It will be part of their education and training so they will see that people are incredibly powerful in how they can take care of themselves in some sort of way and that you, as a physician, can draw strength from that. You have to realize there is tremendous diversity. Our job as physicians is not so much to judge but to accept and see how, given a certain perspective, a patient or family can achieve a higher quality of life."

Before the first exam in his Molecules to Cells course, Fong often e-mails his students to boost their spirits and urge them to look to the future. One e-mail stated:
"While I do want you all to do well on the exam, work reasonably hard, and carry forward the momentum you have gained so far, I think you should have a brief moment of reflection. Biochemistry and genetics are important in understanding human disease processes and treatment, which is why it is in your curriculum. However, the volume and degree of difficulty of the course can be overwhelming. Some of you may have doubts about whether the sacrifices you are making are worthwhile. Such self doubt is a normal sign of intelligence. For some of you, it will recur many times in the next couple of years.

"You need to realize that how well you do in this course will not determine how good of a physician you will become. This is humbling for me to say, but I think you deserve to know it. Thus, if you are struggling to keep your focus, and are in a moment of need, do not forget why you decided to become a physician and who has helped you get to where you are. Give them a call or a hug this weekend such that both you and they know that your struggles require teamwork. Health and support from family and friends are far more important for the remainder of your career and life pursuits than your knowledge in biochemical and genetic pathways. There are many wonderful rewards that lie ahead from being caretakers of your patients, and I hope you will do your best to hold on to that promise."