Gastroenterologist Linda Nguyen Selected as 2021 Master Clinician
Growing up in southern California, Linda Nguyen, MD, considered several career choices: marine biologist; astronaut; physician. Fortunately for the thousands of patients she’s treated over the course of her career, she chose the last one.
This year, she was selected to receive the Stanford Medicine Master Clinician Award, which honors a Department of Medicine physician for their commitment to patient care. The award also recognizes the uniform support of peers in viewing the master clinician as a physician who possesses exceptional competence, knowledge, skill, diligence, doggedness and expertise.
Nguyen was nominated by two colleagues: Leila Neshatian, MD, clinical associate professor of gastroenterology & hepatology, and nephrologist Glenn Chertow, MD, the Norman S. Coplon/Satellite Healthcare Professor of Medicine. In his nomination letter, Chertow commented that “despite being extremely busy and very much in demand, Dr. Nguyen has always found a way to see patients who need her guidance. She never fails to give them the time and attention that patients with motility disorders require.”
On learning that she had been chosen as the Master Clinician for 2021, Nguyen said she was “deeply moved and grateful to receive such a distinguished honor. It felt like receiving a lifetime achievement award, which reinforced to me that choosing the difficult path does lead to priceless rewards.”
Curiosity inspired a career
When Nguyen was in high school, she told her father that she wanted to become a physician. He asked her why. “It’s a hard life,” she recalled him saying. He advised her to pursue an “easier career.” “But easy isn’t for me,” she said. “I’ve always been drawn to challenges. More importantly, I wanted to make a difference in peoples’ lives.” The results speak for themselves.
Nguyen attended a combined Bachelor of Science and Medicine degree program at UC-Riverside and UCLA, completing her training in 1999. She did her residency and fellowship training in gastroenterology at California Pacific Medical Center in San Francisco. She is currently a clinical professor of medicine and vice chief of clinical operations for the division of gastroenterology. She also serves as clinic chief of the Digestive Health Center.
Nguyen, who is of Vietnamese heritage, never aspired to become an academic physician. “Throughout my education and training,” she said, “I never encountered any professors who looked like me, so I didn’t grow up seeing myself in academia. My plan was to go back to southern California, open a GI practice and be a very good clinician.” But during her fellowship years, she began to delve into the field of gastroparesis, a chronic condition in which the stomach inexplicably cannot empty properly. She was hooked by the mysteries of the digestive system.
In 2008, Stanford Medicine recruited her to direct the neurogastroenterology program, a position she held until stepping down in 2021 as she transitioned into her current positions. “Neurogastroenterology is the arena where the gut and the brain intersect,” she commented. “It is a very challenging field, since the currently available tests are often inadequate to diagnose the underlying cause of patients’ symptoms. This often leads to delays in diagnoses.”
She counts developing the program as one of her career highlights. “In the beginning, I was the director of one person: me. Today, we have a multidisciplinary team of 10 full-time faculty, a GI psychologist, three advanced practice providers, dietitians, and social workers, who provide state of the art clinical care and conduct cutting edge research that spans the entire spectrum of neurogastroenterology disorders.”
And this past year, her division established an advanced fellowship in neurogastroenterology -- the first in the country. It is a joint fellowship in collaboration with the autonomic neurology group at Stanford, to train the next generation of neurogastroenterologists.
For the love of food and quality of life
Gastroparesis and motility disorders are Nguyen’s area of specialty. These chronic conditions are often difficult to treat because there is a lack of reliable diagnostic tests and effective therapies. Patients may experience a variety of GI symptoms such as nausea, vomiting, abdominal pain and/or constipation for years, with significant impairment in their quality of life, especially in relation to food and eating.
“Food is so much more than what to eat,” Nguyen commented. “We are all social beings who gather with friends and families to connect around food.” Imagine how it must feel to be someone who has a chronic digestive disorder who can’t eat. That person’s ability to socialize and enjoy being with people can be severely limited.
“I saw my mother go through this when she had stomach cancer,” she said. “After most of her stomach was removed, she was not able to eat. I vividly recall her going through the motions while sitting at the dining room table with our family so we could all be together.” This motivated Nguyen to help patients return to some semblance of eating real food so they can participate in the rituals of eating and socializing.
Her research endeavors spring from observing her patients and questioning what she sees. For example, a few years ago she began noticing that many of her gastroparesis patients also suffered from migraine, and they were seeking treatment in both gastroenterology and in neurology. This prompted an inquiry into how the autonomic nervous system was triggering both events and a clinical trial of a vagal nerve stimulator to mitigate both conditions. In that trial, 40% of a small group of patients responded positively to the treatment.
She is grateful to the mentors, patients, and philanthropists who have supported her research over the years. “I want to thank them for their generosity and trust in my vision. Without them, my research would not be successful,” she said.
What does it take?
“My patients are tough,” noted Nguyen. “They usually come to me after years of symptoms and seeing multiple physicians without a clear diagnosis. Others have been diagnosed with disorders such as gastroparesis but haven’t found an effective treatment. In addition to their physical symptoms, they are often anxious and depressed – but that’s not unexpected after such discouraging experiences.”
“I look at the whole patient,” she continued, “and try to think like a crime scene investigator collecting evidence: What are your symptoms? When did they start? What triggers them? What is going on in your life? What tests have been done? Do you have other conditions such as migraine or other neurologic disorders, chronic fatigue, disordered sleep, allergic or autoimmune disorders, or others? Answers to all these questions help narrow the diagnosis and guide treatment decisions.”
This process taps into Nguyen’s affinity for problem solving. “Until there is a cure, my goal is to partner with patients to manage symptoms that can at least restore some of the patients’ dignity and quality of life. This often requires repurposing therapies that are FDA approved for different conditions but can have a beneficial impact on GI physiology and symptoms.”
It’s the people
Gastroparesis and other GI motility disorders are chronic conditions that require ongoing treatment, often for years. Nguyen has enjoyed hearing about many of her patients’ life events, including graduations, marriages, retirements, and births of children and grandchildren. One of her proudest moments was attending a patient’s PhD thesis defense.
“In addition to my patients and their resilience, it’s my family and the people I work with who inspire me the most,” she commented. That includes many women colleagues who have broken through glass and bamboo ceilings to achieve great things. “Celebrating their successes is just as rewarding as celebrating my own,” Nguyen said. She also noted that the environment at Stanford enables people of different backgrounds and origins to thrive and succeed. “I like to think I’ve played a small role in that, too,” she commented.
What's next?
“I couldn’t be more content than I am right now. This is the first time in my career when I’m not looking for the next big thing. I’m doing everything I love and want to stay present in this moment.”
What is next on her career horizon? “Absolutely nothing,” she said. “I couldn’t be more content than I am right now. This is the first time in my career when I’m not looking for the next big thing. I’m doing everything I love and want to stay present in this moment.”
“I’d also like to have the time to enjoy my kids before they go off and find someone else to hang out with,” she said with a smile.
But she would like to step back and dream big about how to take what she’s been doing clinically and replicate it on a larger scale to have a greater impact on more patients. She’d like to change how the medical profession approaches chronic illness, and teach that earlier in the medical training process.
She has this advice for the next generation of physicians: “Stay curious, continuously evolve, and remain patient centric. How I practice medicine today is much different from how I practiced even a year or two ago, which is one of the secrets to my success.”
Master Clinician Award Recognizes Extraordinary Physicians
The Stanford Department of Medicine Master Clinician Award was established in 2019, with cardiologist Randall Vagelos, MD, as the inaugural recipient. “We already had a Master Teacher Award, but we wanted to acknowledge those extraordinary physicians whose clinical skills made them the go-to people for their peers – the sort of physician you would want caring for you or a family member,” said Abraham Verghese, MD, the Linda R. Meier and Joan F. Lane Provostial Professor and Vice Chair for the Theory and Practice of Medicine. “The COVID-19 pandemic prompted a pause in the annual award, but it was instituted again for the year 2021,” said Dr. Verghese.
The seven-member Master Clinician Award selection committee requests recommendations for the award from division chiefs and other Stanford Department of Medicine leaders. The committee votes on the nominating letters that come in to select the master clinician for a given year and sends its selection to the chair of the Department of Medicine for approval. The clinician may only win once, and then becomes a part of the award selection committee. The winner is presented with a trophy and a gift of $2,500.