PSI spoke with Dr. Niteesh K. Choudhry, a Professor of Medicine at Harvard Medical School, who recently completed his tenure on the PSI Board of Directors (2015 – 2021).
PSI: Please share with us your background and professional expertise.
Niteesh Choudhry: I’m a physician. Medicine informs my work and the problems that I seek to solve. I grew up in Canada, my mom was an academic and my dad was an econometrician who modeled the South Asian economy. As a result, we used to go to India almost every year and lived there for several. I trained initially in Montreal at McGill University, and when I was a first-year college student, I spent the summer at the Banting & Best Institute, which is where insulin was discovered. While I did dutifully run my experiments, I actually spent most of the summer doodling. And so, the head of the institute said to me, “You know, you seem like a very bright boy, but your future is not in basic science.”
That catapulted my career to more clinically applied topics. I started medical school in Toronto, was there for residency and chief residency. I was exposed to an interfaculty research program at Harvard, created by all the different graduate schools there that were interested in health. I was really drawn to this program because I am a generalist. I often call myself a shiny object researcher – things catch my attention, I find them interesting, and then I go think about them for a little while. Then I do that with something else and something else. The idea of being able to think about different things was immediately attractive to me and this PhD program enabled me to do that.
I had not applied for any jobs toward the end of my training at Harvard; I thought I would go back to Canada. The person who would become my boss said to me, “Why don’t you just hang out at Harvard for a year; you already have an office and if you don’t like it, then you can go back to Toronto. Make decisions for the next year, not the next 30.” This was very good advice. I felt that Harvard was the right place for me within three months of joining their faculty. By month four, however, I met the person who would become my wife in Toronto at a party, so I spent the next two years being in Toronto once or twice a week, as we commuted back and forth, until she moved here to Boston.
So fast forward, my work focuses on behavior – though I didn’t know it at first – and explores what I sometimes call the “know-do” gap. There’s a lot in medicine that we know and yet we don’t execute; we don’t provide services to patients in the right way, or patients don’t accept and use treatments in the right way. My particular interest in that gap relates to prescription medications. As I got interested in this problem of this know-do gap, I started asking questions. How do we get patients to take their medications? How do we get doctors to prescribe appropriately? The bias in my research is testing things that I know are scalable, and so I will sometimes sacrifice the perfection of the intervention for something that I know somebody will do something with in the future.
PSI: How did you come to know PSI?
NC: I came to know PSI through its behavior change work while collaborating with Punam Keller, a social marketing professor at Dartmouth who was on PSI’s Board. Punam introduced me to PSI’s CEO and President Karl Hofmann and to the then chairman of the Board, Frank Loy. At the time, I knew nothing about PSI, but I was intrigued by how PSI was doing public health behavior change at scale. PSI is an organization that’s impacted hundreds of millions of lives over 50+ years. I wanted to understand more about it.
To be perfectly honest, I didn’t have a specific interest in reproductive health; most of my work is in non-communicable disease and I continue to think that is an area that PSI should move toward. However, in addition to being motivated by the behavior change work, I saw how PSI’s role in integrating with the national healthcare systems will become increasingly important. As someone with a PhD in health policy, I knew that PSI was an interesting place to be.
PSI: What role did you play on PSI’s Board?
NC: At first, I’m not sure that Frank or Karl knew what to make of me, as I may be the most clinically active person who’s worked with the Board in recent history! I think the perspective of frontline healthcare workers is very important to have on the PSI Board. As I got involved with the Board, it became obvious to me just how many synergies there were between the Board, PSI and my own life.
I am a behavioral scientist; I have large NIH grants that are based in behavioral science, that’s the closest analogue of my work to what PSI does. My expertise is in implementation research, looking at how we get people to do things, that’s what PSI does. I am a father of two daughters, the child of a very strong woman, and a partner to an equally strong woman. I’ve been very fortunate to be amongst women who are strong and able to make choices, my daughters were born just before my Board tenure began, and their autonomy in making health choices became very important to me.
Given my own interests in things related to metrics and how we measure health care, I’ve seen my personal role on PSI’s Board as supporting leadership’s decision-making by providing concrete advice and asking questions. I think the PSI corporate structure and its leadership are as good as any large corporate organization anyplace in the world. But truly, I think I have learned far more from PSI than I have given back to it, and so I am humbled to have been part of the Board.
I’ve Chaired PSI’s Nomination and Governance Committee for the past several years. And I feel proud that I was in some way responsible for getting to know most of the Board members who will remain after my tenure finished in December 2021, for telling them the wonderful things about PSI and then convincing them to donate their skills to us. And in the last year, I’ve been lucky enough to be Vice Chair and support Board Chair Carolyn Brehm‘s leadership.
PSI: What are some of your fondest memories from your Board tenure?
NC: Every time I attend a Board meeting, I think, “What am I doing here? These are such amazingly talented people.” It has been quite an honor to have spent time on the Board. These were some of the most enjoyable times of my professional career.
Some specific highlights for me were from when we went on Board trips to the field.
Like our trip to Nairobi where we saw the Tunza clinics, a social business powered by PSI. Seeing the practice of healthcare in this environment was so important for understanding the last mile care that PSI offers in some of the most difficult places to operate around the world. In Cambodia, we went to a reproductive health lecture, where a community health worker was meeting with clients outdoors. And just listening to the delivery of essential services in that way, we could see that this is how healthcare actually gets delivered.
PSI: Now as you and Beverly Winikoff have rotated off the Board, four new members are joining. Do you have any advice for them?
NC: Listen and hold on.
There are so many things to learn. The Board trips gave insights but there are so many other ways to learn. PSI’s roots are as a reproductive health social marketing organization. The importance of these problems are as great now as they’ve ever been. At the same time, PSI has a lot of other work going on simultaneously, operating through a variety of business models, a variety of network relationships and variety of environments. There is not one PSI, there are many PSI’s. That is both the beauty and the challenge of the organization.
Get to know the staff; they are committed, inspiring, wonderful people who make PSI what it is. If you understand the culture, in addition to the substance of the work, then you’ll really get what PSI is about and what makes it special.
PSI: What reflections do you have on PSI’s consumer-powered healthcare approach?
NC: I credit PSI for helping evolve my own perspective on the role of patients, or consumers, in healthcare and what our role as healthcare workers are to them.
My work is about how I can engage patients to change their behaviors to do what is in their best interest. Building from patient engagement, the concept of “patient-centered care” gets a lot of buzz, as well as patient-empowered care, where patients are given power to make their own healthcare decisions.
What PSI has at the core of its mission is the recognition that it doesn’t empower its consumers. Rather, PSI recognizes and respects the inherent power within every person and seeks to remove the obstacles that prevent people from exercising it. Consumer-powered care, the difference of just two letters is massively significant for how we think about health, rights and respect that we owe to patients as autonomous individuals. Most of healthcare should be in a consumer’s own power. As individuals, we (should) have autonomy over most of our life, like our education, whether we vote, what jobs we pursue. Healthcare is another one of those core decision areas that we need to ensure patients have true power over.
Providers should give consumers the options, tell them the information and respect them to make their choices. And that’s what PSI does and what I credit PSI with having helped me appreciate over the past six years.
PSI: What are you going to do with all of your free time now that you’re no longer on the Board?
NC: It is bittersweet; I love PSI. This is a high-class organization and an effective Board. For now, I’m going to take a little bit of a break from Board service. When I do return to public service in a Board capacity, which I’m sure will be something in health and healthcare, PSI will be the gold standard.
Dr. Niteesh K. Choudhry, MD, PhD, is Professor of Medicine at Harvard Medical School, Professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health and Executive Director for the Center for Healthcare Delivery Sciences at Brigham and Women’s Hospital, where he also practices inpatient Internal Medicine. Much of Dr. Choudhry’s research deals with design and evaluation of novel strategies to increase the use of evidence-based therapies for common conditions such as heart disease and diabetes. He is particularly interested in changing patient and provider behavior and his work draws inspiration from a broad range of fields including clinical medicine, economics, cognitive psychology, epidemiology and biostatistics. His largest ongoing projects seek to combine approaches from behavioral science and machine learning in order to develop scalable solutions for health quality improvement. He and his research team are funded by a variety of public and private sources including the National Institutes of Health, health insurers, pharmaceutical manufactures and private foundations.
Dr. Choudhry attended McGill University, received his M.D. and completed his residency training in Internal Medicine at the University of Toronto and then served as Chief Medical Resident for the Toronto General and Toronto Western Hospitals. He earned his Ph.D. in Health Policy from Harvard University with a concentration in Statistics and the Evaluative Sciences. His research has been widely published in leading medical and policy journals and has won numerous awards for excellence in research, teaching and mentorship.
