Q&A with Timothy Meyer

"The Desire to Teach is a Strange Instinct"

Timothy Meyer, MD, with his colleague and research partner Tammy Sirich, MD

Timothy Meyer, MD, professor of nephrology, has been faculty at Stanford since 1984, and has taught generations of Stanford faculty and fellows. He’s published numerous articles and was associate editor of the Journal of the American Society of Nephrology. And he shows no signs of slowing down: currently he and his research partner Tammy Sirich, MD, assistant professor of nephrology are working on a cell phone app to help physicians determine the proper duration and frequency of dialysis treatments.

Sirich says, “I have never met anyone with such a passion for teaching. I remember as a brand new nephrology fellow, I had no idea how to analyze a research article, let alone present it for our Division’s journal club. Dr. Meyer must have spent three hours going over the article with me so that I could present it with confidence.  Now ten years later, he still teaches me something new every time we interact.”

Errol Ozdalga, MD, clinical associate professor of medicine and himself a recipient of a divisional teaching award in 2019, also remembers Meyer’s teaching with fondness: “I remember over 10 years ago at the VA rounding as a resident with Dr. Meyer, I remember it like it was yesterday—such a great teacher and an amazing person.”

Speaking to Meyer is as fun as taking his class (or learning from him during clinical rounds) must be: he’s charming, funny, and (as with any great teacher) always ready with a great example to help illustrate his point.  As he explains it, “The desire to teach is a strange instinct, almost like an appetite for drink or playing tennis.”

The following is an edited excerpt of our conversation.

Q: Tell me a little bit about the background of your career.  When did you start teaching?

Well, it’s a long time.  I'm an old man.  I graduated from medical school in 1975, was an intern and resident at Stanford for a couple years and then after a year in Australia spent six years in Boston training in nephrology.  Came back to Stanford in 84 and have been on the faculty ever since.  When I came to Stanford I became co-director of the renal physiology course for what was then second year medical students and did that for most of twenty years.  I now teach mostly in the clinical setting, with fellows and residents who rotate through nephrology.   

Q: What made you want to become a teacher?

My grandfather was one of the first faculty members at the Stanford Medical School, and I believe he was hired because of his ability to teach anatomy.  That was all he did.  He didn’t practice medicine, but teaching future doctors was a crucial responsibility.  He was hired in 1909, when Stanford moved down from San Francisco.  I live in his house and think that he had an important influence on me. I grew up thinking that a career teaching medicine was something worthy and respectable.  

You have to have the teaching appetite.  It’s difficult to sustain and promote medical teaching, particularly now, but the desire to teach is a strange instinct.  It's sort of like bird watching.  Some people will stare at a bird and figure out what kind it is.  Other people say, oh yeah, that's a nice fluttery thing in the sky.  

Q: What do you think makes a great teacher?

In some ways, teaching's kind of like murder. You need motive, you need opportunity, and you need method.  

Let’s say you’re my cousin.  I've got nothing particular against you but there's a hundred million dollar estate and you're first in line and I'm second. So there’s a motive.  You won't get rich teaching, so you need another motive.  And that's the strange instinct to teach, the teaching appetite we've been discussing.   

Now the second thing you need (and this is a growing problem) is the opportunity.  As the hospitals have become busier and faculty lives have become busier, people struggle to get through the day. Even if you had the desire, that is the motive, you might not have the opportunity.  It's like if you were the cousin I wanted to murder, but you lived somewhere in rural New Zealand and I couldn't get at you.  

And finally there's method.  I think if they have the motive and the opportunity most people come up with method.   

Q: Can you think of a moment that illustrates great teaching for you?

I’ll give an example of great teaching: my daughter teaches French, she taught high school French and now teaches college.  When she started teaching high school French in southern Connecticut the little boys she taught were New York Giants fans, and she knew nothing about football, but she wanted to motivate them.  So she would get the paper and find out what happened to the Giants and then she would insult them in French the next day in her class.

The rules of the class were that the kids had to reply in French.  They're ninth grade boys. Their faces would turn almost purple as they tried to stammer out responses to her insults against the New York Giants fullback, then a man named Tiki Barber.  You know, she would say, "oh, poor Mr. Barber," in French, "He has fallen in the dirt. He cannot run very fast." And they had to answer her in French in order to defend their idol.  You get the idea.  She is really good.

Q: Do you prefer classroom teaching or teaching fellows in clinical settings?

TM: I taught the renal physiology class for 20 years.  It's difficult.  I think the clinical setting is better with again the caveat that time pressure has made teaching more difficult.  The electronic medical record made things harder because the old reward for teaching was that the trainee would go around and hunt up all the data.  The trainee had to go to the X-ray department to get the X-ray reading and look up labs in a paper chart.  That's not true anymore.  Now a good Stanford attending can get the data faster than the trainee can. It used to be that if I spent half an hour telling a student or fellow why the plasma sodium was low the tradeoff was that the student had spent an hour chasing the medical chart. And now I can do it quicker than they can.  So the payoff for teaching is reduced.

Q: What do you see as some of the challenges for medical teaching going forward?

I sympathize with the difficulties that modern university medical faculty face.  As the pace of hospital work increases, the time for explanation and teaching tends to get squeezed.  I see this as a continuing challenge for the future.

Q: Looking forward, what’s on the horizon for you?  Any current projects?

I'm working with Dr. Sirich, my partner, trying to make dialysis prescriptions easier to write and understand by moving them on to the mobile phone.  Most of the credit on that project is hers.  The app is in development, being tested by us before it’s released to anybody else.  But hopefully it'll eventually be used by trainees and renal physicians to improve the efficiency and understanding of dialysis prescriptions; how often people need to get dialyzed and for how long.

Q: Finally, what's your favorite part of teaching?  

It's fun.  You yourself learn so much better when you're trying to teach. I sometimes review the fellows' grand rounds with them and I learn so much more from that, going back and forth, than I would if you had given me the same hour and said, "Tim, read these three journal articles." I mean, it's like this conversation. It's fun.  And the things you learn from teaching go into your brain and stay there.  Whereas if you just sit and stare at a piece of paper and hope that the information will get lodged in your brain— for me it just doesn't.