I became a doctor to help people. I had not considered a medical career until I was twenty-three years old and enrolled in a master's program in Health Policy and Management at Harvard School of Public Health (HSPH). This happened during the mid 1970s, a time when political leaders daringly mentioned national health insurance and the reformers' call pulled me. But at HSPH I met several wonderful physicians, committed to global policy issues but also to doing well for individual patients. They urged me to change directions and consider going to medical school. Given my minimal science background, this had significant practical implications. I would have to return to the classroom, taking a pre-medical curriculum. Training would be expensive and lengthy. But these physicians made the compelling argument: If I really wanted to help, becoming a practicing physician was the absolute best way.

With her book Risk Adjustment for Measuring Health Care Outcomes, Dr. Lisa Iezzoni is recognized as a leading authority on measuring the severity of illness. She was the first woman to be promoted to professor of medicine in the department of medicine at Beth Israel Hospital in Boston, Massachusetts, and has based her career on answering the big questions in medicine today—questions of equality, efficiency, and ethics.

Dr. Iezzoni never planned on a career in medicine, so when she completed her graduate degree in health policy from the Harvard School of Public Health, her science background was inadequate for medical school. Thanks to her strong academic record, however, she was accepted into Harvard's special student premedical curriculum.

To fill in the academic gaps, she took inorganic chemistry in an intensive summer program, then calculus, organic chemistry, physics, and biology. During her first year of medical school, the "spooky sensations" in her legs that she'd originally attributed to stress grew more severe. In January of that year she was diagnosed with MS, multiple sclerosis.

Iezzoni's diagnosis of MS in the 1980s brought down its own glass ceiling. "Early on I received frequent hints that my medical career was in jeopardy," she said. Once at a student dinner she asked a leading physician if his hospital might make some accommodations in her residency training, as the all-night hours required of residents would exacerbate MS. He replied, "There are too many doctors in the country right now for us to worry about training handicapped physicians. If that means certain people get left by the wayside, that's too bad." After great internal debate, Dr. Iezzoni decided to go directly into research rather than battle for an internship.

Dr. Iezzoni's graduate training in health policy was a great entrée into research, and she spent the next six years as a researcher in the Health Care Research Unit and as an assistant professor of Health Services at Boston University School of Medicine (BU). From BU she moved into her teaching and research positions at Harvard and Beth Israel Deaconess Medical Center.

Dr. Iezzoni is recognized as a leading authority on measuring the severity of illness. Her book Risk Adjustment for Measuring Health Care Outcomes has had four editions. As professor in the department of medicine at Harvard Medical School and co-director of research in the division of general medicine and primary care at Beth Israel Deaconess Medical Center, Dr. Iezzoni finds the answers to overriding questions in health care management. What, for example, determines whether two patients with identical symptoms entering two different emergency rooms will receive the same battery of tests?

She has conducted numerous studies for the Agency for Health Care Policy and Research, the Health Care Financing Administration, and private foundations on a variety of topics. She has also studied the use of clinical data to predict hospitalization costs and patient outcomes, compared the severity of illness across teaching and non-teaching hospitals, and predicted patient outcomes by using information from hospital data systems. Dr. Iezzoni serves on the editorial boards of major medical and health services research journals and serves on the National Committee on Vital and Health Statistics as well as the board of directors of the National Forum for Health Care Quality Measurement and Reporting.

Since 1996 Dr. Iezzoni has investigated health policy issues relating to persons with disabilities, and the implications of disabling conditions for living daily lives. Dr. Iezzoni is a member of the Institute of Medicine, and was the 1996 recipient of the Investigator Award in Health Policy Research sponsored by The Robert Wood Johnson Foundation.

What was my biggest obstacle?

My response here concentrates on my biggest obstacle to achieving the goal for which I had pursued medical training: helping people. In my original, perhaps naive view, that involved direct, hands-on contact with patients. I never attained that goal, because I never completed post-graduate medical training and therefore never became licensed to practice. The sole obstacle there was my diagnosis with multiple sclerosis (MS) during my first semester at Harvard Medical School.

This was years before the 1990 Americans with Disabilities Act, and from early on, I received frequent hints that my medical career was in jeopardy. Confronting the physical limitations and uncertainly of MS was only one step. I also had to deal with people's reactions to me—the "me" they equated with my disease. At that time, Harvard Medical School was a tough place to absorb these lessons. From four years at medical school, I left with one overwhelming lesson: never, ever talk about "it," the MS! It can't be cured, so don't mention it. For fifteen years, I almost never did.

How do I make a difference?

As noted earlier, my initial view was that I could only make a difference working with individual patients. But life had taken one of its ironic turns. I had left HSPH intending to become a practicing physician; because of the MS, I left medical school returning to the activities for which I was trained in HSPH. That's how things go. I often felt it was better that MS had happened to me than to one of my classmates who had prepared for a medical career since an early age. At least my HSPH education gave me options. Now I hoped to make a difference at that more global level. My research focuses primarily on two themes: methods to measure quality of care, and ways to improve fairness of payment. I have also participated in designing the method now used to set capitation payment rates for Medicare managed care organizations, with the goal of encouraging plans to enroll disabled patients and those with chronic illness.

More recently, I have conducted research about disability. Over time, I came to realize that silence carries consequences. For instance, I could have spared my caring colleagues their fears about my health when I purchased my scooter wheelchair if I had told them why I had bought it and how the restoration of mobility thrilled me. Silence reinforces the stigmatization of disabling conditions, the sense of shame and guilt that becoming less able to walk is something to hide, although of course, we can't.

Most importantly, strangers began asking my advice. In my scooter wheelchair, I have become a sort of "rolling focus group," attracting unsolicited questions from strangers about themselves, and their relatives and their difficulties walking. They describe bad knees, bad backs, heart and lung problems, and many other complications slowing them down. They want advice about restoring mobility or compensating for its loss. The research and writing I do on this topic addresses both primary care doctors and the general community. My colleagues now sometimes ask my advice about their patients with mobility problems and other disabling conditions. I am trying to break down the barriers people with disabilities face within our health care system and communities.

Who was my mentor?

First, during my job right after medical school, I met two wonderful colleagues with whom I have worked ever since: Arlene Ash and Michael Schwartz. Even though we are now at different institutions, we formed a tight little multidisciplinary team. I could never have accomplished what I have without them.

Second, at certain key points, individuals have provided invaluable assistance, even if fleetingly. For example, while looking for post-medical school jobs, two incidents solidified fears that my career—any career—was in jeopardy. One potential employer, an academic researcher, asserted, "Even if you work full-time, we wouldn't give you a full-time salary. Full-time here is eighty hours per week, and I'm sure you'd only work forty hours. So we'll pay you half a salary." A second possible employer, a medical educator, mused aloud, "I see three options: I could hire you because I feel sorry for you; or I could not hire you because I don't want to deal with your disease; or I could try pretending you're not sick and look at your qualifications." I rejected his job offer. Finally, the former dean of the Harvard School of Public Health stepped in and pulled a few strings. With his generous recommendation and assurances, Boston University hired me for a research job which, over the next six years, offered many opportunities.

Finally, in my current position, I have had division chiefs and department chairs that have truly been my advocates. Although they have not provided a mentoring role (e.g. sitting down explicitly to discuss my career) they have recognized what I have accomplished and worked to ensure that I attain the academic and other benefits from those accomplishments. My now-former division chief, in particular, ensured that my physical surroundings accommodated my disability.

How has my career evolved over time?

Oddly enough (and stated with acknowledged irony), perhaps because of my disability, I did not have the "distractions" other people face to build a career (e.g. a young and growing family, active leisure-time activities). I spend much of my time working, which for me means writing and thinking—both activities I tremendously enjoy. Although my career was non-traditional, I therefore have met many of the more traditional measures of success.