Dr. Joseph El-Khoury, MD, MRCPsych, is an assistant professor of clinical psychiatry at the American University of Beirut (AUB). He began his medical studies at St. George’s University in 1998 and, after qualifying as a medical doctor in London in 2002, he trained at Oxford University and St. George’s, University of London, in the UK, obtaining Membership of the Royal College of Psychiatrists (MRCPsych) in 2006. He has held a Certificate of Completion of Training (CCT) in adult and substance misuse psychiatry since 2010. In that same year, he was appointed as a consultant psychiatrist in the UK National Health Service. In 2012 and after 14 years abroad, Dr. El-Khoury returned to Lebanon to continue his medical career.

Dr. El-Khoury directs the newly created Psychosis Recovery Outreach Program and is responsible for the residency training program at AUB. He also acts as the Global Mental Health Scholar for the Arab region for a joint program by Columbia University and the World Health Organization.

He is enrolled in the Master of Science in War and Psychiatry track at King’s College London with an emphasis on trauma and political psychology. His current research and academic interests include addiction, severe mental disorders, health services development, the socio-political interface of psychiatry, conflict medicine, and cross-cultural psychiatry.

You grew up in Lebanon, so what attracted you to medical studies at St. George’s University?

I wanted a different experience and I saw an advertisement for SGU in my local newspaper. I liked what it offered, and my family was very encouraging about me traveling as part of my education. SGU also very generously offered me a 50 percent scholarship so it was a terrific opportunity for me.

What made you want to follow a career in psychiatry?

I was always interested in medicine but I enjoyed humanities as well. The mind impacts everything we do and this inspired me to learn more about it. I knew I wanted to be a psychiatrist from the start of my medical studies and I’ve never regretted my choice of specialism.

What would you say to other students who are thinking of enrolling at a medical school in another country?

I’ve benefited from studying and working in a number of different countries. I began my pre-clinical studies in Grenada and St. Vincent and the Grenadines in the Caribbean as part of the SGU course. I then had the opportunity to take part in an exchange program with Guy’s Hospital in London and ended up achieving a double degree from SGU and the Society of Apothecaries in the UK. After qualifying as a medical doctor, I trained at Oxford University and St. George’s, University of London and ended up working as consultant psychiatrist in the NHS for two years. The experience of working and studying in other countries and health systems was invaluable. I would encourage any student to seek out diverse experiences as part of their education.

How would you describe your experiences at SGU?

SGU was an important and solid stepping stone for me. It was an incredible mix of a studious and serious academic environment alongside Caribbean sunsets, wonderful food, and beautiful scenery. I took great pleasure in learning from the SGU professors who had so much knowledge to share. It was a stimulating educational experience surrounded by peers who became lifelong friends and it’s great to see how successful they’ve all become. I have very fond memories of my time there.

What was it like to come back to Lebanon after 14 years abroad?

I came back to Lebanon in 2012 because the country was, and still is, in need of psychiatrists. I took up a position at the American University of Beirut where I direct the Psychosis Recovery Outreach Program and I’m responsible for the University’s residence training program which is the biggest of its kind in Lebanon. I have a combined clinical and academic role which means I run a daily clinic and take part in advocacy work as well as research.

The principles of psychiatry are the same wherever you practice. Once the cultural layer is removed, you see similarities in human experiences and that what we have in common is more than what separates us. If you’re well trained, then you’re ready for anything.

Much of your research has a focus on the Middle East. How do you hope psychiatric care will change in the region in the coming years?

I’m currently working towards a master’s degree in war and psychiatry at King’s College London with an emphasis on trauma and political psychology. I’m focusing my research on Lebanon, Syria, and Iraq because there hasn’t been a lot written about this in the Middle East. I was born during the civil war in Lebanon and I’ve also found that there isn’t a lot of data from this conflict, so I’m conducting a study to look into the mental health of people who lived and fought in it.

I’m also researching psychosis service development in this region alongside addiction and its impact on mental health.

I hope to see the standards of mental healthcare in Lebanon improve the level of wealthier countries. It’s going to take a lot of collective work and strong leadership. This is what I’ll aim for.

What has been your career highlight?

It has been hugely satisfying to travel the world and then return to my home country and teach at the university where I was previously a student.

 

Published February 2019 

Undergrad: Integrated Sciences (Physiology/Evolutionary Ecology) and Arts (Religious Studies/Ancient Art and Architecture), University of British Columbia

Residency: Family Medicine, Dalhousie University

You grew up just a short drive from where you’re practicing. Was that the plan all along?

I am currently working in two outpatient clinics in Surrey, BC, but I also have an interest in dementia care/long-term care. I am the medical director of The Village in Langley, which is an innovative long-term care/assisted living facility for people with dementia. All these endeavors are within a 10- to 15-kilometer radius of the neighborhood where I grew up.

The goal the entire way through medical school was to come back to Canada. I knew it was going to be difficult, but whether it was finding rotations in Canada, doing research, or working on ways to improve my resume for when it came time to apply to match, I was so determined for it to happen.

I had gone on a number of interviews in the US, including at Ivy League schools, and also at schools in Ontario, Saskatchewan and throughout Canada. Thankfully I was accepted to do family medicine at Dalhousie University, which was my first-choice program here in Canada in part because they spoke French at that site.

It was an uphill battle for sure, and there were so many other obstacles in my life during school, including my dad passing away and some financial struggles, that I wasn’t sure if I could continue. But I was able to work through everything, and now I go to work every day and am so grateful.

How did St. George’s University come into view for you?

When I was applying to medical school, truthfully, I didn’t even know where Grenada was. I had seen a poster on the wall during my undergrad years at UBC. I had applied to schools here in Canada and also to SGU because I didn’t know what the future held. I hadn’t heard back from Canadian schools when I received a scholarship to join the January 2009 class at SGU, so I said yes. Then during my first term, I got called for an interview at UBC, and went back for it, so even if I had gotten accepted there, I really loved SGU by that time so I probably would have declined.

How well prepared did you feel for each hurdle along the path back to Canada?

If you’re determined and have the goal of becoming a physician, you will be able to reach it by going to St. George’s University. It has anything and everything you’d need to do it. At the same time, independently, you have to go and do it. At some places, you may be spoon-fed, and even if you aren’t determined you will probably still get through it. The SGU experience is not like that. I went to class, studied hard, did my rotations, and as a result, I was more than prepared for the USMLEs and for the MCCEE in Canada. In fact, I don’t think I even got one question wrong on the MCCEE. So I felt very prepared.

You also spent time in New York. How different was the experience there as a person from western Canada?

Living and working in New York is an experience like no other. When I was there, I actually thought that I should have grown up there. I really felt at home.

The diversity at SGU and during my rotations made me so much more well-rounded as a person, and that spilled over into my work as a physician. Having that perspective has allowed me to understand some of the situations that patients are going through and to help them make better decisions as their doctor.

What prompted you to include academic medicine among your focuses?

Currently I’m a clinical instructor with the faculty of medicine at UBC, and I’m hoping to create other affiliations that would allow for SGU students to come to my clinic  for rotations. I am also the communications/clinical skills director for MEDD 411 course at the Vancouver-Fraser Medical Program at UBC as well as the site co-lead for assessment and evaluation at the Surrey Site UBC Family Practice Residency Program. Additionally, I am enrolled in the Centre of Health Education Scholarship fellowship/master’s degree to become better equipped to contribute to the medical education community. 

That’s my passion: helping someone who was in the same position as I was and is seeking guidance on how to return to Canada, especially if they too are interested in teaching and education. Even during my time in Grenada and when doing rotations in New York, I enjoyed teaching the other students as well as nursing students at the various hospitals. Even now, when I know that I have a medical student working with me, it motivates me because I remember being in their shoes and it is so rewarding to help them learn.

Undergrad: Chemistry and Psychology, Boston University

Residency: Internal Medicine, SUNY Downstate Medical Center

Chief Residency: Internal Medicine, SUNY Downstate Medical Center

Fellowship: Cardiology/Interventional Cardiology, North Shore University Hospital

 

Last summer, you completed your interventional cardiology fellowship at North Shore University Hospital and began at Peconic Bay as an attending. How do you look back on the journey?

“It’s a little surreal. Each step along the way, you’re so focused on the next step in the process—residency, chief residency, fellowship, getting a job, another step exam, another board exam. Now I look back, I am so thankful for where it’s taken me and for those who have helped along the way.

“It’s really my dream job. I see patients in the office three days a week, and then I do procedures like angiograms, catheterizations, stents, and valve replacements the other two days. Some days I’ll round at the hospitals, I’ll read EKGs, or go where I’m needed.”

PBMC opened its new cardiac cath lab in October 2017. How has that changed the landscape of medicine in the region?

“Before the cath lab opened, patients would have to be transferred from here or Southampton Hospital all the way to Stony Brook University Hospital, which is an hour away give or take. It was an underserved population as far as Long Island goes. The new facility has already made such a difference.

“Recently there was an elderly gentleman who lived on Shelter Island—about 30 minutes east of here and even farther away from Stony Brook. He was driving back from a holiday trip when he began to experience chest pains. He stopped in the parking lot of our hospital, he was helped in, and we had him on the table within a half hour to open up his artery. If he had waited or gone back home, there’s a chance he might not be with us right now. The community has been very grateful, and we’re grateful for the opportunity to help.”

What initially prompted you to pursue cardiology?

“It had been my dream to be a doctor since I was 2 or 3 years old. One of my best friends growing up had open heart surgery twice, and seeing him go through that, with several trips to the hospital at such a young age, it’s one of those things that drew me toward cardiology.

“As an undergrad, I did some research through the Pediatric Cardiomyopathy Registry, which tracks children who inherited conditions that led to heart failure. I worked under Dr. Daphne Hsu, who was with Columbia at the time and is at Montefiore Medical Center, sitting in on procedures and consulting with patients.

“Then at SGU, I spent all of my first clinical year at Maimonides Medical Center, which is where I was born. When I was there—in addition to meeting the doctor who delivered me—I saw just how much cardiology factored into just about everything that went on there. We saw a wide array of patients of different ages and ethnic backgrounds.

“I really enjoy it. To open someone’s artery, to put in a stent, and to see them get better and go on to live a long, healthy life afterward, it doesn’t get much better than that as a doctor.”

How would you describe your experience at St. George’s University?

“I got an absolutely awesome education from SGU. I went to Grenada and made some very close friends. We were all going through something that only we could understand. Our parents can’t. Our friends from home can’t. We all went to SGU with the same ultimate goal—to become a physician. We knew that we were in the trenches together to make that happen for everyone. We all worked hard and we made it happen.”

In what ways did SGU’s support services help you during your time as a student?

“I received tutoring in anatomy and histology, which I hadn’t done much of in undergrad. Medical school is completely different from anything you’ve done before just because of the sheer volume of material that there is. At first, you don’t even know where to begin. The support and tutoring at SGU really help you focus your attention and give you the confidence that you can get through it. I’m very grateful for the help.

“Of my circle of friends, we all ended up in the specialties that we wanted, whether it’s interventional radiology, emergency medicine, anesthesiology, hematology and oncology, trauma surgery, pediatric dermatology, or for me, interventional cardiology. We all felt very prepared for the step exams, we did our clinical rotations in some terrific hospitals, and we learned how to become physicians.”

 

Published January 2019

Undergrad: Binghamton University

Residency/Chief Resident: Anatomic and Clinical Pathology, Westchester Medical Center

Fellowship: Molecular Genetic Pathology, Cedars-Sinai Medical Center

 

You grew up in New York. What prompted you to move out west?

Molecular pathology is a very small specialty, and it just so happened that the spots in New York were filled by the time I was applying. After that, I really wanted to live in Los Angeles over some of the other cities on the west coast, and I thought the training at Cedars-Sinai would be great not just in terms of academics but the practical, on-the-ground education that really propelled me into the position that I’m in now. By the end of fellowship, I was fully confident that I would be able to run a lab.

I met my wife, Selina Vail, during first term at SGU. She’s now a family medicine physician. We live two blocks away from the hospital, and she works at an urgent care center four blocks in the other direction, so it works out.

What type of personality does it take to be a pathologist?

Everyone says a pathologist has to be reserved and antisocial, but I think that’s a really poor way of looking at it. I’m the exact opposite. Even though I’m not dealing with patients, we’re dealing with the rest of the patient care team, whether they’re oncologists, radiologists, or other clinicians. Essentially, we help to formulate the basis for which patients get treated. Almost every patient in the hospital has labs, so the way I see it, we’re treating every single patient in the hospital even if we’re not directly seeing them.

In the lab, you mentioned that you have limited patient interaction. What are the pros and cons of that setup?

Pathologists are the doctors’ doctor. You’re the one that, in the end, everyone comes to, and it’s your job to say, “this is the diagnosis; this is the answer.” There’s a mystery there, a puzzle to be solved, and pathologists get to be the final arbiter on most diagnoses. It’s immensely rewarding. I definitely miss patient interaction, which is something that I enjoyed a lot during medical school, but it’s one of those things where you close one door and open another. I think the benefits of this specialty, in a professional and intellectual sense, far outweigh the negatives.

In addition to your work in the lab, you’ve been active in academia. What has drawn you to that role?

I’ve been an instructor for both small-group and large-group sessions since residency, and expect appointment as an assistant professor here shortly. My feeling is, what’s the use of having all of this information if you don’t pass it on to the next generation? It’s amazing to see when something just clicks with someone. You start talking about something and you can see the gears going, and then all of a sudden they just light up. It’s a great feeling.

How has the SGU experience prepared you to be a successful physician?

When you go down to the island, you’re faced with a situation that you’re not used to. You’re on your own, yet you make new friends and your success is based on your own skill and work ethic. You need to be able to perform and to do it in a way that is acceptable for everyone. The experience really sharpens your teeth and hones your drive.

But you can’t make a diamond without pressure. You need that sort of pressure to push forward. With all the pressure that comes with medical school—any medical school—there was ample opportunity to relieve stress if you could. I lived in Lance aux Epines and looked out at Prickly Bay. It was pretty ideal. That said, another great quality that that taught us was restraint, the ability to moderate both your work and your play. You can’t succeed by just working. You need to compartmentalize your life. Learning to do that makes you a better doctor and a better person.

My group of friends at SGU included some of the best, brightest, and hardest-working people who also knew how to relax when they weren’t under the gun. That sort of balance led every single one of them to be immensely successful. There’s nothing better than working hard all day, finishing up, and going on a sunset cruise. No American school can compete with that.

My experience at SGU was fantastic. I look back on the entire experience with nothing but tremendous fondness.

You were an environmental sciences major at Syracuse University. What prompted you to transition to a career in pediatrics?

“One summer, I started volunteering at a local children’s hospital. I saw how the nurses and doctors interacted with the children, and at times, I felt there was a minimal to no interaction at all with the actual patients but solely with the parents. I understand that children may be too young to fully understand what is happening and do not even have choice in the matter, but it doesn’t mean they should be left out of the loop. They are the ones that everything is happening to. It made a big difference once you explained in simple terms to the children what is happening and what will happen. I decided I wanted to change that mentality, that children should be part of the discussion.

In pediatrics especially, it is incredibly rewarding to know that your hard work is going to change a person’s life, to see a child who’s knocking on death’s door recuperate and grow into a normal child that no one would even know the troubles they went through. I don’t know if there is a greater sense of personal satisfaction. The beauty of pediatrics is that you get to see your patient grow through life. You may have started to see them when they were just born and continue to see them until they are 18 or even over 21. You create a much stronger bond with the child and family.”

You became a mother recently. How did having a child of your own change your perspective?

“It has changed everything. It’s really been a total 180 for me. In the NICU, you know a woman has been preparing this child for 40 weeks, and if they end up in my unit we all know this wasn’t the way it was supposed to unfold. The version that has been building up for months is not in shambles. Fortunately for me, I never experienced what it was like for my daughter to be in the NICU, but I can only imagine how I would feel. The most joyous time in someone’s life becomes one of the worst. As a mother, it’s very difficult to be able to compare these women and what they are going through to yourself. You now can empathize with them, thinking of your little one in the position that theirs is in.

It can be difficult to disengage at the end of the day, constantly thinking about the babies and parents. I feel a very deep connection now that I am a parent. It changes your perspective on the entire world, not just medicine.”

Can you elaborate further on the kind of relationships that you form with the families you see?

“Since I work in the NICU, you develop a very personal and deep connection with the families, and especially mothers. You are in the trenches with them, helping them through possibly the worst moments of their lives. Here in Hawaii the word ‘Ohana’ means family and togetherness, and ‘Aloha’ means love and unity, both words run very deep here. The Hawaiian culture is very family centered, which can make your job easier or more difficult. But once you have entered that sacred bond with the families, you become Ohana, a part of their family. I know this is very different when compared to other parts of the United States.

Truthfully, everything you learn in medical school or during residency doesn’t adequately prepare you for the personal connection you need to make with families and patients. You learn how to read people very quickly and well, and that something that might work for one patient could be considered offensive to the next.

My job is to help these babies come out of the NICU and live the most normal life they can, but also to give the family hope, patience, and love.”

Do you have a story from your time in the NICU that stands out in your mind?

“There was one scenario where we had a full-term baby who had hypoxic ischemic encelopathy (HIE). The directors of the NICU, PICU, and all of our specialists had thought it was a lost cause, that damage was too severe to continue on. After multiple discussions with the parents to withdraw care, they persisted to fight. Since Ohana and Aloha are big components of life here, this isn’t that uncommon. We all were convinced this was a lost cause and the child would never leave the hospital alive. That was a year and a half ago. After a few months of intense treatment, ECMO, dialysis, she was finally discharged at eight months. That same baby came back two months ago, and you would never have guessed the complications that she went through. There were delayed milestones and some other issues with vision, but otherwise as healthy as can be. You never would have guessed that this is the child that everyone almost gave up on. This situation showed us the true miracle of medicine and that we, even though we think we do, don’t know how the human body can respond. I see the miracle of modern medicine every day.”

Hawaii’s only your latest stop. You were born in Poland, and grew up in Canada and Syracuse, NY. How would you describe your experience as a student in Grenada?

“I loved it. I’m pretty adventurous and love to travel, so I had a great time exploring the island and the surrounding islands. Weekend getaways to different parts of the island were the norm, Fish Friday in Gouyave every other Friday, snorkeling, sailing, hiking, and the hashes. Grenada holds a very special place in my heart. I even met my husband there (Gautham Kanagaraj, MD SGU ’12), who recently finished up his cardiovascular disease fellowship at the University of Hawaii. I hope to take my daughter there one day and show her where it all began.”

 

Published September 2018