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About Our Guest
Dr Ruan Qing Zhao (@qzruan.md) is a Singaporean physician whose career has taken him from Singapore to the UK and now the United States. After studying medicine at University College London (UCL), he completed his residency in anesthesiology at Brown University before pursuing subspecialty training in interventional pain medicine.
He currently practises at the Providence Veterans Affairs Medical Center, where he helps patients manage chronic pain through minimally invasive procedures.
Synopsis
In this second part of our conversation with interventional pain specialist Dr Ruan Qing Zhao, we step outside the hospital and into everything that happens around it — the marriage that keeps him grounded, the home-cooked feasts, and the spontaneous decision to sign up for Hyrox. We geek out over VO2 max, and why it might matter more than your cholesterol panel.
We also get into the harder stuff: treating veterans carrying both physical and psychological trauma, what it’s like to genuinely feel a patient’s pain after one very bad 24-hour stretch with his own back, and how “Dr. Google” has quietly become “Dr. GPT.” Along the way,
Qing Zhao doesn’t hold back on what studying for exams during a six-day surgical work week actually looked like — three hours of sleep, an alarm set to wake up and read, then straight back into a 12-hour shift.
We close on something we think a lot of our listeners will sit with: his advice to any Singaporean on the edge of a decision to go overseas. It’s less “just do it” and more “know yourself well enough to know if this want is even real.” A conversation about fitness, pain, burnout, and the cost of ambition, from someone who’s actually lived it.
Episode Transcript
Isaac
Hello, I’m Isaac.
Faith
And I’m Faith.
Isaac
And welcome to the We Didn’t Plan This podcast. So this is our second episode with Dr Ruan Qing Zhao, our guest from Boston who does interventional pain and made his way from Singapore, to the UK, all the way across the pond to the US. And you know we spend so much time talking about your clinical journey and much of what went into the medical side of things last episode and today in very in keeping with the theme of what we’ve been doing on our podcast so far, we want to talk about the life outside of medicine as well
Because there’s, you know, there’s so much of it as you mentioned the last time that impacts the decisions we make about our jobs, our professional growth and I think most, most people in the medical field, actually a lot of them have very interesting things going on outside, you being no exception. So my first question is, paint us a picture of what life outside medicine looks like for you or has looked like across the years?
Qing Zhao
Right. Actually, I have to admit to the fact that I’m not a very interesting person outside of medicine. A lot of it is driven by my wife. So it’s a good thing that we got married. Yeah, my wife likes exploring, you know, the cities that we live in, because most of the time when you’re in residency programs, unfortunately, you don’t get a lot of time outside of the hospitals, right? So all the exploring, you kind of have to sort of push it to the back of your mind. But if there’s someone else exploring on your behalf, I think that helps.
So she’ll know exactly what to do, where to go for meals, especially for the year that we spent in New York. It’s a very interesting place, I would say, very colorful. Some people like it, some people don’t. But it’s a very vibrant place, right? So outside of medicine, what we do a lot of the time is that we’ll go out. If we’re in the right cities, like Boston, New York, we’re just a little bigger. We’ll go exploring, looking for places to eat, to hopefully find things that don’t cost a lot of money to give us entertainment. There’s lots of places, museums that you can go to. If you register your address as a resident, they’re not going to force you to pay. So that’s the other trick.
My wife is a real foodie. So what she does is that she’ll select the restaurants to go to. And she’s a great chef and a cook. And the next time, she’ll mimic the kind of food that we’ve eaten at home. And so I played a supportive role by paying for the ingredients. And sometimes, initially, with the cutting and having to put my surgical skills to good use. But after a while, she kind of assumed that part of the responsibility herself. So my role really diminishes. So we do that in our free time. We do have friends coming over, she’ll lay out a feast for them. So it’s fun for her to do, and it’s nice for me to watch. And to taste. Yeah, exactly.
We do exercise quite a bit, and that’s just something that we continue to keep to. Even when we were in the UK, that’s when we first picked it up, actually. Aside from just going to the gym, we got a little bored doing that. So we started joining classes and I think F45, which is also, you know, this growing phenomenon here that became, you know, a very central part of our lives in the UK. Even after moving to the US, we tried, you know, joining those classes. But because the US is a lot bigger, so you have to travel a little further. We kind of gave up on that now that we’re in a much smaller town.
And I think what Isaac and Faith have been alluding to is this Hyrox thing that’s been really growing in Asia and beyond, which is also filtered through from the West. So we set our eyes on that now that we’re older. And apparently, I was told that when you hit hit your 30s and your 40s, you either run a marathon, you know, do triathlon or Hyrox. So, you know, we, I think we picked the lesser evil out of the three because, you know, there’s no way. Yeah, right. I don’t think we could have done either of those. Yeah, Isaac probably has more stories for you regarding long distance running and swimming. So yeah, that’s how we kind of divide our time and keep ourselves, you know, entertained.
Isaac
It sounds like I like a lot of, A lot of other physicians, you do put a lot of time into keeping it up here. You know, the secret to looking that good at this age.
Qing Zhao
Oh, thank you.
Isaac
It’s going to be Hyrox.
Qing Zhao
What you cannot see is all the white hair that’s, you know, hidden all over the place.
Isaac
So I guess one of the questions I had also, because, you know, you guys seem to have a pretty good social life as well. You have your friends over and the food is always a great draw. It’s very easy to incentivize people to come over with that. How does your social life look like in the States right now? I mean, you weren’t always there for that long a period. You weren’t there either. How was that like? Maybe not just in the US, but in your time in the UK as well.
Qing Zhao
Right, right. I think, you know, I would like to say that I think both my wife and I were not, you know, your typical extroverts. You know, we don’t seek out social events to go to. The regular hangouts we have are usually, you know, with a fixed group of friends. and like I said she’s definitely closer to the spectrum of an extrovert within that scale of introverts so she definitely helps me out a lot the group of people that we hang out with a lot more now initially came from the medical field but then they kind of branched out and they introduced other people to us and now we have sort of a fixed group of people that we regularly interact with in New York although we’ve moved away now, I think the little trips that we take from where we live going to New York almost feels like a little vacation every couple of weeks. So that does also kind of mitigate the stress of working as a physician. So I would say we’re not super social, but we do have regular people that we regularly hang out with. nice. I guess it’s just because the US is geographically large. Any little trip you take, I think mentally, it’s almost like you’re on vacation. So I guess that helps. Even taking a slightly longer train ride, it’s like three hours going to New York, it feels like you’ve left the country. So that definitely helps.
Isaac
Wow, I mean, it sounds like a decent amount is going on. It’s And I also then wanted to segue a little bit back into the fitness and health sort of thing. Sure. And part of this, two reasons why. So when Faith was helping to plan this episode, she has a sentence in capital letters that says, “Must ask him about recent Hyrox.”
Faith
Yeah, because I was like, this is all I’ve been seeing on his Instagram. So I was like, wow, it seems that the trend is in the US and here, and he can be an ambassador to talk about it.
Isaac
Yeah, no, I’m sure that they have a very good franchising and ambassador model. But I don’t know. I don’t know. And I guess the other thing is that Faith herself was in the longevity space, right? And I think growing here in the past few years, as well as mainly in primary care, there’s a lot of talk about holistic wellness, preventative care, and things like that, of which health and fitness is a very big part. So we were curious, for you at least, what your relationship with fitness and I think exercise or anything, sleep, caffeine, whatever, how has that evolved across the past few years?
Qing Zhao
I don’t think there has been a huge amount of change until maybe I would say six months ago when we did decide to enter ourselves into Hyrox. Before that, we were just trying to keep ourselves active. me personally, I started going to the gym, I think, right about, I think when most guys in Singapore became a little more aware of having to keep active and fit, right? Right before NS, I was like, oh no, I have to survive this for two years. So I think I started around the same time. And it was initially, I just regularly go into the gym, which is what people usually do. And when I was in the UK, we joined this functional F45 training group. And that kind of essentially kept going until we went to the US where we picked out another one of these franchises to enter ourselves in.
So that was pretty much always in the background, but it didn’t really take a front seat to what we were doing. I think recently, as I have pointed out, longevity, health and wellness, it’s really a big deal. I think everyone has probably read one of these books. Interestingly, I did also within the last six months by one of these authors that’s now unfortunately disgraced because of everything that’s going on in the US. You probably know who I’m talking about. So that’s when we really started looking at, oh, okay, although we go for our health screening every year, we look at these blood tests, is there something more that we should be exploring? if HDL and LDL are within normal range, is it enough? And I think Faith is going to be able to tell me more about what ApoB and Lp(a) and all these things mean.
Faith
All the biohacking and trying not to die.
Qing Zhao
Right, exactly. So obviously this has become more mainstream. And I don’t know whether it was a conscious or unconscious effort on how to do a little bit more for ourselves that we kind of started looking at other things that could both keep us active. Because I think for Hyrox, if you do want to go into the nitty-gritty, the difference between something like that and obviously marathon and long-distance swimming and things like that, compared to just going to the gym, is your VO₂ max, right? I think that’s the big thing that’s sort of behind Hyrox because VO₂ max is really the index that directly reflects on longevity. So you’re not going to be able to achieve that without a significant amount of cardiovascular input.
And Hyrox seems to be one of those things that bridges, you know, gym bros and others, right? Which I think Isaac probably has a VO₂ max of 70 running marathons. So Hyrox is somewhere in the middle and it kind of forces you to do a little more in terms of your cardiovascular health. And when we started training six months ago, we kind of realized that, hey, you know, this is how uncomfortable you can get. We’re trying to just, you know, pushing your VO₂ max up by 0.1 or something like that. So then it became quite different. We tried to sort of integrate that into our daily lives. It doesn’t mean that you have to spend more time at the gym, but we’re sort of a little more pivoted towards trying to achieve that cardiovascular health. and that sort of snowballed and accumulated. And when Hyrox did happen in Hong Kong, like, you know, just this past weekend, last week, yeah, that’s when, you know, it kind of culminated to this, to this end point of us being able to finish our race and not dying. So, yeah, so that’s our fitness journey, I guess.
Isaac
So that was an anesthesiologist’s take on cardiovascular fitness.
Qing Zhao
Yeah, and the importance of exercising.
Isaac
Yeah, exactly. Then that actually brought an interesting thought to mind, which was you work with a lot of patients who I suppose have acute pain, chronic pain. And I suppose before you go around shoving things into their spine, there’s a lot of lifestyle factors and a lot of those other biomechanical factors that come into play as well. And I think the other interesting factor is that they are all vets who’ve been through certain experiences. So I’m actually quite interested in how this sort of lifestyle exercise movement, how do those come into play in your daily practice, if at all?
Qing Zhao
Yeah, in my field, definitely. You would think that we would want to be as interventional as possible to make our lives interesting. I mean, it’s just like how surgeons always want to operate and how orthopedic surgeons always see a fracture bone somewhere right because you know that’s what drives our interest um but you know in the pain field the pain is a little more complex in the sense that you know it’s obviously physiological it comes from you know you know the the pathology you know locally from the area where you know the issue is and at the same time, a lot of it is mental, which is the reason why it’s so complex and difficult to measure pain.
It’s difficult to treat pain and the reason that pain requires multiple specialties to be involved or at the same time. So believe it or not, what I believe in is that patients should probably, or hopefully, get the best outcome with the least invasive intervention. Pain alone, with the strategic injections and even with neuromodulation, is really hopefully to try to prevent them from from having surgery, right? Or to try to salvage the pain that’s left over, unfortunately, from like a spine surgery.
And what I like to tell my patients is that, the best injections have a lifespan too, right? Because that’s just how long the steroids will last, which is four to five months. So even the most strategic and the most precise injection has a lifespan. So what do you do during that period of time? You should move more, right? You should move in a way where it’s healthy for you. And you should be aiming to build up the core muscle bulk so that wherever your pain is coming from, have the muscles take over the function of a joint, which is no longer there. Have the muscles take over this really osteophytic spine in the back, build up your muscles in the back.
And the story is really that if you do that sufficiently, then you don’t really need to rely on these four or five-month injections from us anymore. And that’s what we want to see. we want to continue to see you every four to five months. These veterans, unfortunately, they’ve been subjected to a lot of trauma. I mean, it’s both mental and physical. And it’s not only just cumulative, but they all kind of pile on top of each other, right?
And exponentially, they become exponentially difficult to treat if one of them kind of lags behind. I mean, I don’t have the ability to take away the mental trauma and the PTSD, But if we’re able to downgrade your pain score from a nine to a seven or a six, and then have you take over the responsibility and continue to move, build your function, and hopefully never rely on us anymore, I think that’s really the end goal, the objective. I don’t want to intervene on you and continue to put more and more devices into your back. That’s not really our end goal.
Isaac
And it definitely helps that you walk the talk as well, right?
Qing Zhao
Right, yeah, I try. And to be very honest, yeah, I keep saying this, but now that I’m getting older, I do feel how intense these pain and these burdens on your back and on your spine can be. I did something very stupid. I mean, it wasn’t even intense. I was sitting, not moving in a chair for about four hours. I think I was trying to do… I’m trying to get myself a discount or a good deal. And I just got too absorbed doing that thing. And I just didn’t move in the chair for four hours. And when I got up, I had like the worst back pain in my life, which hung around for over 24 hours. And over that 24 hours, I was the worst patient. I was screaming, I was shouting, I was having this really bad attack. And for that 24 hours, I completely understood what those patients were feeling. So, yes, I was really empathetic after the first 24 hours. I was like, oh, okay, all right, this is what they’re going through.
So, yeah, it could happen to anyone. It could happen to a perfectly healthy, fit and young person. I don’t belong to that category. So, you know, it’s a good, I think it’s a good concept to have at the back of your mind that, you know, health, longevity, wellness, that’s something that you can carry forth. And you should be more aware of that when you’re young, especially now when there’s so much information available, right? You know, I’m sure Faith knows that, you know, all these indices that we can measure, like Apolipoprotein A and B. But we have all this information now and it’s up to you to decide what you want to do with it, right? But make an informed choice. There’s no right or wrong. I think a lot of cardiologists still can’t tell you, you know, how low your LDL should be, right? And things like that. How should you like taste that in to make it super low? Is that a good thing to do? I don’t think anyone can tell you or, you know, define for you what’s good. But now that you have all the information available, just take the responsibility and decide.
Isaac
Yeah, it’s a huge toolbox of information out there. And I think in this day and age, everyone from Dr. Claude and Dr. GPT qualified cardiologist. There’s something a little bit different to say. It’s so much more than, you know, the simple things that you would go through. Like, I don’t know, when I first got my MD and a little bit of time before, then my friends will ask me, like, you know, my knee hurts. Do I have an ACL pair? Right? And then when my friend says it hurts when I squat, I tell them, then don’t squat. Don’t provoke it.
And so, you know, there’s this whole coming together of what you see in the clinic and what you see in the theatre and what you do in your daily life as well. In much more literal terms, coming back to the whole work-life balance idea, one thing that a lot of doctors have to do behind the scenes that more medical people often don’t realise is the studying, the extra hours, right? And especially in your formative training as you must have went through a lot of exams from both sides of the ocean. And how did you manage that along the way? Did you feel like it crept into your existence a lot? And how did you get around it? My worst nightmares.
Qing Zhao
Yeah, and following up on that, I think I finished the very last of my specialty exams like a year and a half ago. So that’s technically the very last exam, hopefully. And I’m like, you know, in my 40s now. So unfortunately for physicians, that’s the amount of rigor that you kind of have to endure along the way. So yes, I was never a very good candidate when it comes to taking exams. And when it comes to medical knowledge, it’s pure memory work, right? And it’s a lot of memory work. It’s difficult to fit that in, especially when you’re doing a residency training.
And it was pretty crazy what I did initially when I went to the US. I did mention on the last episode that when I went over to the US for the first time, I really did see that knowledge gap between a UK candidate like me going to the US system, where people have picked up certain traits when it comes to working with questions and things like that since they’re at medical school. It’s a very different kind of learning and questioning and answering that they really got used to. It’s part of the daily lives.
But for me, already, I wasn’t a good test taker. Going there, that really crushed me. I remember coming back after a 12-hour shift, going to sleep for three hours and setting a timer on so that I can wake up after three hours to read for half an hour or for an hour before going back to sleep. Surgical training was really intense. So that was the kind of studying that I was trying to fit into my life because at that time, There’s really no, that you don’t have any extra additional time because the surgical schedule at that time was, you know, a fixed six day working week. And, you know, they don’t take any sort of public holidays into account. That’s just how much time you got. And on that one last day that you have, you’re just in bed for 24 hours, trying to recover and trying to live. So that was the kind of studying I was doing.
But as you kind of progress and became more senior, you kind of find your own way to adapt yourself to that kind of examination model. So I cannot say, you know, on behalf of my colleagues here in Singapore, you know, what sort of exams, what sort of questions they’re going to ask you, you know, whether it’s multiple choice, whether it’s someone sitting right across from you asking questions during board exams, right? Because they’re all very different in terms of format and the kind of confidence you need to have to pass.
But I would say at the early stage of your training, when you set up yourself for success, so understand yourself, what’s the easiest way for you to retain information, especially in medicine where there’s no tricks. It’s not like if you’re a math whiz, you can close your eyes and come up with formulas. But in medicine, it’s pure memory. It’s pure memory. So find out a good way, because it doesn’t work for everyone, whether it’s writing notes, giving yourself questions. Because I have friends that just write questions for themselves, just to give them little tips and they read it along the way when they’re going to work, just to keep their minds active. Other people, now with AI, you can build all kinds of little apps to test yourself all the time, because you have to figure out your own way in jolting your memories. the amount of knowledge that you’re consuming as you’re getting more senior, that only increases.
The type of knowledge might change because now, as Isaac has pointed out, with AI, with everything being online in the cloud and with journals being, I would say, the primary source of new medical information as opposed to the old school way of reading textbooks. A lot of things have changed and you just have to adapt to it, unfortunately. Hopefully, AI makes it easier, both in terms of them summarizing the important things that you need to remember, and also you being able to utilize apps or things that you built yourself to just continue to remind yourself of those important information. So, yeah, I don’t think there’s going to be a formula that fits everyone, but it’s tough, but you will find a way through it, right? I think every physician will tell you at the end of the day that they made it, but everyone did it a little differently.
Isaac
It’s a really nice tour through the academic tornado that is your 20s and 30s. And so to tie up everything, do you have any words of advice for someone who’s 18, 19, on the cusp of their medical career? And they might think of going abroad, they might think of doing something. I think for most people here at least, even doing half the good plotting that you did is ambitious, right? And what kind of words would you want to say to them about someone who might want to take a step out, take a step to really go and pursue something somewhere that they really wanted to?
Qing Zhao
Right, right, right. Yes, I think that’s a great question. And it’s difficult to answer because I would say as Singaporeans, we’re in a very unique position in the world in terms of, you know, where you could potentially, you know, go to this really, you know, you’re good in English, you know, there’s no real language barrier. And, you know, to be honest, potentially you could go wherever you want, right?
The most important thing is, you know, how much do you want it and how much do you know yourself, whether, you know, whether this want that you’re feeling now is genuine, right? I think that’s the most important thing because when you’re 17, 18 years old, you don’t really know yourself that well, right? And it’s only, you know, now that I’m old, I look back and I was like, phew, okay, I think I got some of it right. Maybe, you know, 30, 40%. And I’m, you know, I’m pretty happy that I got that 30 or 40%, right? So you have to know yourself to a certain degree and to know your demands and your wants and your desires to a certain degree to really, you know, go into medicine.
Because medicine is not, unfortunately, it’s not just an occupation, right? It’s a way of life. You know, once you’re a physician, you’re a physician for life, right? I would say, being in your position, uniquely positioned as a Singaporean, I would say, keep your mind very open because it’s good and bad growing up in Singapore because everything is pretty much predefined for you. If you go through the checkpoints right and get all your boxes checked off, you’re going to do pretty well. You’re not going to veer off and become unemployed or something like that, which is not possible.
However, also unfortunately, limits your vision a little bit. And because Singapore is such a great environment to be living and working in, that you don’t really see the potential elsewhere. But obviously the caveat is that going elsewhere comes with its own challenges, right? And that’s the reason why I said you need to know yourself well enough to then decide whether those are worthwhile for you. Everything that I went through, a lot of people would say it’s probably not worth it. And Singapore is a great place.
I might end up coming back here to retire. And I’m actively looking at that possibility right now. So I might end up coming back anyway. But what’s the difference, having spent 20, 30 years overseas, going through all those challenges and eventually coming back and ending up in Singapore? I would say those are the questions that you have to ask yourself, right? whether all of those struggles will be, at the end of the day, valuable enough for you to actually take that first step.
But I would say don’t shut off all these potentials and possibilities early on. Have a look around, find out from those people who’ve done all these things that you haven’t heard about, and look into it and ask yourself the question, do you think this is potentially what you could do right or mimic is this something that interests you right do you want to look at how you know medicine is practiced overseas right you want to look at something that’s you know that’s that could potentially be very different um and could be you know potentially hugely rewarding um because you know it’s it’s just so medicine is just so multifaceted that there’s all these other you know
Isaac
Those are very wise words. I think the world is so big, right? There’s so many options. And I think as you pointed out, how well do we really know ourselves? One thing you said in the earlier episode, which was that for you, it took talking to just a different group of people to make you realize that maybe the first group of people was what was the greatest thing. So I think those are things that I’ll bring into my own career hunt as well. And I think you probably go see where it is, right? So thank you everyone for listening in. And thank you again, Qing Zhao, for coming and embracing our, gracing us with your presence. Have a very, very well deserved vacation. Thank you. And see you next time.
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