ASRA Pain Medicine Update

Cite as: Nanda, M.  Interview with 2024 Chronic Pain Distinguished Service Award Recipient: Dr. Hariharan Shankar. ASRA Pain Medicine News 2024;49. https://doi.org/10.52211/asra110124.004.

Hariharan Shankar, MD, is a professor of anesthesiology at the Medical College of Wisconsin (MCW) in Milwaukee. He is board-certified in anesthesiology and pain medicine. He is currently the vice chair of the American Board of Anesthesiology's (ABA) Pain Medicine examination committee. He is an associate editor for Regional Anesthesia & Pain Medicine and an ad hoc reviewer for multiple journals. He is one of the pioneers in the use of ultrasound imaging and lectures nationally and internationally about the use of ultrasound imaging in pain medicine. He has many peer-reviewed publications, abstracts, and book chapters to his credit.

Monika Nanda: Dr. Shankar, could you share the story of your career trajectory and the key milestones that led you to focus on pain medicine and anesthesiology?

Hariharan Shankar: My interest in anesthesiology started at Bangalore Medical College, India, primarily because of the encouragement from the then chair, Prof. Dr. B.S. Sudha, and other anesthesiology faculty. For personal reasons, I could not pursue further specialization immediately and entered the private practice of anesthesiology. I realized that I enjoyed teaching while helping a couple of interns prepare for the residency selection exam. As further training options were not available in India then, I sought opportunities outside India to further my learning, which landed me in Milwaukee. Having done family practice for a few years in India, I missed the patient interaction in anesthesiology. By offering more patient interaction, the subspecialty of pain medicine had the right mix when combined with anesthesiology.

MN: Reflecting on your journey from a private anesthesiologist in India to a professor in the United States, what were some leadership lessons you learned during this transition?

HS: One of the initial challenges to learning new techniques and acquiring knowledge is to erase or be willing to start with a "clean slate" and an open mind. This attitude change and plenty of support and encouragement from Prof. Saeed Dhamee, former vice chair at MCW, and other senior faculty helped me in my second anesthesiology residency at MCW.

Starting an academic career later in life requires careful planning to attain achievable goals and career advancement. Volunteering in national societies furthered my networking and collaboration. This also facilitated my transition to being a guide/mentor for enthusiastic young physicians, which I enjoy immensely.

MN: Throughout your diverse career, what personal qualities do you believe have been essential to your success in both clinical and academic settings?

HS: I believe that taking constructive criticism and being willing to learn or acquire knowledge, irrespective of who it comes from, is important for growth.

MN: How do you define success within your professional life, and how has this definition guided your career choices?

HS: Success is highly individualized and depends on the role. As a teacher, I succeed when my trainees receive acclaim; as a pain physician, I see my patients' smiles after I provide care; as an ultrasound imaging enthusiast, I succeed when others ask me to show them different ultrasound images in the human body.

MN: What has been your most rewarding accomplishment to date in the context of your work in pain medicine?

HS: Becoming the vice chair of the ABA's Pain Medicine examination committee has been the most rewarding compliment as it validates me as an educator and, of course, getting the Distinguished Service Award from ASRA Pain Medicine.

MN: Who have been your journey's most significant mentors or collaborators, and how have they impacted your professional development?

HS: There have been several mentors/guides/well-wishers on my journey. Dr. Marc Huntoon (former editor-in-chief of RAPM) encouraged me to submit my first poster on ultrasound use in the pain clinic to the ASA's annual meeting in 2006, and that set the ball rolling for further advancements in my career. Dr. Samer Narouze (former president of ASRA Pain Medicine) invited me to the SIG on ultrasound in pain medicine as a founding member.

MN: As someone who has received multiple awards for teaching, what key elements make an influential mentor in the medical field?

HS: A mentor should be willing to guide, expecting nothing in return.

Every teacher learns more by teaching. There is no end or limit to learning in life.

MN: What lessons have you learned from your international teaching and workshops that could benefit emerging leaders in anesthesiology?

HS: In many countries, people are enthusiastic and curious to learn and incorporate newer advances into their practice. Another notable feature is the kindness and respect for teachers. Teaching at various workshops has greatly improved my knowledge of anatomy.

MN: How has your involvement in professional societies like ASRA Pain Medicine shaped your career, and what roles have you found most fulfilling?

HS: Volunteering in national societies has been instrumental in my career advancement, both in terms of collaboration and learning. Some roles have facilitated this and provided great satisfaction, including my stint as faculty advisor for the resident section component and my role on the CME committee. Networking makes attendance at national meetings more of a "family" gathering.

MN: Can you discuss a particularly challenging moment in your career and how you navigated it to emerge stronger?

HS: The most challenging experience would be my move to the United States to start my training again after more than a decade of being an anesthesiologist. Resilience and support from some senior faculty is probably what got me through.

MN: How do you prioritize clinical duties, research, and teaching responsibilities to ensure excellence in all areas?

HS: Every patient encounter is both a learning opportunity, a teaching moment, and a potential research topic in that listening to patients teaches us more about various conditions, and our interaction and management style should be a teachable moment for our trainees. The uniqueness in some conditions prompts further inquiry and thus leads to potential research of the unknowns in that topic.

MN: What continues to drive your professional curiosity and commitment to advancing the field of pain medicine?

HS: Pain medicine involves much to understand, from the experience of pain to its ultimate management. We are also responsible for making the pain medicine certification process fair, valid, and current.

MN: What is your view on how artificial intelligence will shape the future of pain medicine?

HS: It has its advantages and disadvantages. There will come a time when the hand-holding and TLC that we are used to in our field will become AI-generated, and so will wellness checks. Pain medicine still has a lot to be discovered, so the applications are only likely to grow. 

MN: Looking ahead, what areas of research in pain medicine do you believe hold the most promise for transformative advances?

HS: I believe there is a possibility that we may be able to use objective tools to identify, assess, and grade pain better, and that is likely to be the game changer in providing better-validated pain management.

MN: Finally, what advice would you offer to trainees or early career professionals who are eager to make significant contributions to pain medicine?

HS: Pain medicine has a lot of opportunities for research and inventions. Younger physicians often ask me, "How do I find my passion?". According to Merriam-Webster, passion is "a strong feeling of enthusiasm or excitement for something or about doing something." In medicine, everything is interesting. When people have their eyes widened with curiosity and interest when encountering a medical topic, a condition, a procedure, or a device, they have found their passion. Spending more time investigating their passion would ultimately create a niche for them.