Chairman's Corner
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Diversity

In 1969 I was elected vice president of my high school class, and had to give that year’s commencement speech. It was a very tumultuous time, with the organization of the massive Vietnam Moratorium demonstration protesting the war and a year after Dr. Martin Luther King Jr. was assassinated. I felt strongly that our school should have done much more to commemorate Dr. King on Martin Luther King Day and what was happening with racism and civil rights in our country, and I criticized the school’s administration during my speech. When I was finished, many of the school’s staff did not applaud and it was clear that my criticism did not go over well. Nonetheless, I made a commitment then to continue to follow my beliefs, and while I did not go on to become a political activist, I’ve continued to carry those same beliefs throughout my life.

As a neurosurgeon and Chair at Stanford, I’ve been in a position that allows me the privilege and power to act on those beliefs by encouraging, mentoring, and hiring a diverse population of  surgeons, scientists and residents. When I first became Chair of the Department of Neurosurgery at Stanford in 1995 we had only 5 faculty members, all white, including  one woman. It was one of my priorities to increase the diversity of the department, and I’ve made a concerted effort to identify and train people who represent cultures and backgrounds different from my own, or who don’t look like me. Our faculty now comprises  33% women and other underrepresented minorities, and our residency program boasts 30% women and other underrepresented minorities. While I’m incredibly proud of those numbers, unfortunately, they both represent some of the most diverse populations at a neurosurgical program in the U.S. There’s still enormous room for others to catch up to our numbers, and for us to continue our progress in this area.

The past year has only increased my resolve to continue to push for a more diverse faculty and resident composition. With hate crimes on the rise and issues of diversity and gender equality in our everyday news streams, it seems a propitious time to talk again about the statistics and the importance of increasing diversity within our institutions. Issues of diversity in leadership, discrimination, and the wage pay-gap persist, and there is still considerable work to do.

A couple of months ago - 48 years after I gave that high school speech - I was giving another speech during a national neurosurgery conference to a group of young neurosurgeons, residents and medical school students. As I looked out at the room, I was deeply encouraged. The audience was different from the audiences I’ve seen during these conferences over the last few decades. No longer was the majority white men; the room represented a diverse population of ethnicities and races, and a high distribution of women. I spoke to the group about the rigors of a career in neurosurgery, the tough decisions that someone in leadership needs to make, and the surprising highlights and pitfalls of dedicating one’s life to research and medicine. At the end of the speech, many of the questions and comments from the audience focused on one thing: diversity. How can we ensure more women assume leadership positions? How do we encourage more underrepresented minorities to go into neurosurgery? How do we expand inclusivity within the field? It became clear to me that these issues are all just as important to the young people entering our beloved field as they have been to me - and that gives me great hope for the future.

Second Opinion

Most doctors, especially those who are considered renowned experts in their field, often get requests from family, friends, colleagues, and even strangers for medical advice. I am no exception. Whether it’s by phone, email, and most recently social media, I am often asked to review the medical history of people who are not my patients, and unfortunately, there really wasn’t an appropriate, legal, or streamlined way for me to accommodate those requests. Until now.

Starting this month, Stanford Health Care and Stanford Children’s Health launched a new program, called Online Second Opinion. The new program is a service provided by both hospitals for neurosurgery patients. If you or your loved one have recently received a diagnoses that may require brain surgery and are looking for a second opinion, this service may be right for you. Once you create an online account, my team will be able to review your previous health records and images, and provide a recommendation regarding whether surgery at Stanford is an appropriate option.

Our team of experts are available to review diagnoses for a variety of conditions that require surgical treatments, including cerebrovascular and spinal vascular surgery, aneurysms, Moyamoya disease, pituitary tumors, meningiomas, and more. Being able to provide this option to people around the world has been something I’ve been looking forward to for a long time. As I’ve mentioned in previous posts, I believe our expertise should not be limited to only those who live in the places we practice. The new online program is yet another way for us to increase our reach and make our years of experience, and our services at Stanford, available to many more people.

Global Health

International travel is incredibly beneficial, not just in terms of finding time to relax or spend quality time with family, but also as a means of learning about new cultures and people, and expanding our own perspectives about our world. If you’re lucky, your adventures will preclude any medical mishaps or emergencies, and you’ll travel through a country never needing the expertise of the local health care providers. In turn, many of us never consider that there are places in the world where medical care is not just lacking in quality, but is altogether scarce. While there are underserved, low-resource communities in the United States, lack of proper medical care in some parts of the world is chronic, and this is particularly true when it comes to neurosurgery.

Since neurosurgery is so highly specialized, incredibly competitive, and requires years of training, there just aren’t that many neurosurgeons in the world. The latest numbers available from the World Health Organization, as of 2004, indicate a total of just over 33,000 neurosurgeons in 103 countries. What is particularly problematic is the distribution of neurosurgeons is entirely unbalanced, with the majority residing in North America and Europe. For example, while in the United States, there is approximately 1 neurosurgeon available per 80,000 people, in some parts of the world, the distribution is 1 neurosurgeon for 10 million people. As the population grows and ages, the need for neurosurgeries will also grow. Simultaneously, our techniques and technologies for treating neurological conditions and diseases have dramatically improved in just the last couple of decades, but many people still do not have access to even the most basic surgeries we perform. These surgeries can save lives, and I feel, as do many of my colleagues, that these procedures, and our expertise, should not be limited to those who live in the places where neurosurgeons are most concentrated, but should be available globally.

At Stanford, we believe outreach medical work is not just important, but necessary. I’m a strong advocate of neurosurgeons spending at least some portion of their time traveling to countries where we’re desperately needed, working with local health care providers, and performing the surgeries that no one else can. For that reason, we created the Stanford Neurosurgery Global Health Initiative, an effort funded by grants from a variety of organizations, that allows our attendings, residents, nurses, and medical students, to travel and work internationally in areas with some of the greatest need for neurosurgeons. As part of our Initiative, our faculty, staff, and students have been traveling regularly to Uganda, Jamaica, and North Korea, where they help the local medical personnel with emergency treatment, pre- and post-operative care, neurosurgical training, and conducting research.

Traveling to remote places of the globe can make for memorable vacations, but international travel can also translate to meaningful work and helping others. In the case of neurosurgeons, it seems especially important to dedicate time to taking care of patients who have no access to treatments that make the difference between decrease in pain or greater independence, and oftentimes, the difference between life and death. I’m proud of the work we’re doing around the world, and encourage others in my field to consider spending some of their international travels working in places where people like us don’t yet exist.  

Spring 2018

While activity on the Stanford campus begins to wind down in preparation for the lull of the summer months, at our Department, late spring is a time for reflection, renewal, and transition. In a few short weeks, I will once again bid farewell and good luck to our graduating residents, and reflect on the accomplishments of our faculty over the past academic year.

Our graduating residents, Dr. Linda Xu and Dr. Kai Miller, are preparing for their new adventures. Both accomplished students and excellent surgeons, Dr. Xu will join the team at Allegheny General Hospital in Pittsburgh as an attending neurosurgeon and the director of Brain Tumor Research, and Dr. Miller will travel to Utrecht University Medical Center in The Netherlands to complete his Van Wagenen Fellowship. I wish them both the best in their future endeavors. At the same time, I welcome a new cohort of trainees to our Program. Our new first-year residents – Dr. Adela Wu from Johns Hopkins, Dr. Ryan Jamiolkowski from University of Pennsylvania, and Dr. Dan Herrick from Tufts University -  will each add their unique interests and perspectives to what is an already talented group of residents. Our Residency Program continues to recruit the best and brightest, and I am looking forward to another year of teaching and mentoring our trainees.

The past academic year has also been filled with many faculty and resident accolades, from large grants for stem cell and head injury research, travel fellowships and research awards for our residents, faculty promotions that made history, to the many recognitions of our faculty’s research and clinical work by outside institutions and governing bodies, we all have much to be proud of. Despite the hectic and transitional feel of the end of the academic year, I hope you all also have a chance to enjoy the mild spring weather as you reflect on your past accomplishments and the many new adventures that await you.  

Physician Burnout

For 40 years, I survived on very little sleep. And it was just survival, no one thrives on four hours of sleep a night. As I was going through training and became a practicing surgeon, the general thinking was that sacrificing one’s own basic needs – sleep and rest, proper nutrition and exercise – was what good surgeons did to commit fully to the profession. But attitudes about self-care and wellness, especially for physicians are changing quickly, for the better.

Nationally, physician burnout has reached an all-time high. Over the past decade, national surveys indicate doctors suffering from emotional exhaustion, loss of meaning in their work, or a sense of ineffectiveness and lack of engagement with patients, affects more than 50% of those surveyed. This trend is bad for doctors and it’s bad for patients. At Stanford, leadership took notice of these trends and in response, implemented the WellMD Center, and became the first academic medical center in the country to hire a Chief Physician Wellness Officer.

In our own department, we want to ensure our residents and faculty feel supported and are encouraged to take good care of themselves too. We do our best to create a balanced on-call schedule that provides enough nights and weekends off for each surgeon to have time with family or for activities outside of work. We encourage our faculty to take time to travel or pursue educational and research efforts that expand their skill set, but also contribute to higher levels of engagement in their work. We provide individualized mentorship, and even offer regular Pilates classes for our residents. Our efforts are working. In the latest Stanford physician wellness survey, our Department reported a 25% burnout rate, as compared to 49% reported across neurosurgery departments nationally. In addition, our neurosurgeons reported a 35% professional fulfillment rate, as compared to only 18% nationally, and we ranked second highest in that category among Stanford School of Medicine departments.  

I’d like to see our Department’s burnout rates continue to decline, and our fulfillment rates continue to improve. But saying that I support these efforts isn’t enough. I’ve taken serious steps over the past year to change my own lifestyle. I now insist on 7-8 hours of sleep per night. I’m exercising more regularly, and making more nutritious food choices. Despite having spent most of my career neglecting in some ways my own wellness, being in a leadership position means I can teach others not to make mistakes I made. I want to set the example for the next generation of surgeons that taking care of one’s self doesn’t have to come at the cost of professional success. In fact, according to the data, and my personal experience, when doctors are well rested and enjoy their work, they end up taking far better care of their patients. We don’t want doctors who are just surviving; we want doctors who are thriving in all aspects of their lives. Their wellness is the key to our patients’ wellness and to fostering a leading neurosurgical program.

Rare Disease Day

What makes Stanford unique isn’t just its beautiful and sunny campus, or its proximity to Silicon Valley, it’s also our faculty’s commitment to tackle the most complicated, unusual or mysterious medical cases, and their determination to find solutions. Sometimes this means developing treatments and cures, but more often it entails years of spreading awareness, engaging the community, and affecting policy changes, in hopes of expanding resources for some of the rarest conditions. When I first became a neurosurgeon, I did not think that much of my career would be spent treating patients with a rare disease. While we didn’t know as much as we know now about the nervous system, and more specifically diseases that affect the nervous system and how to treat them, I certainly didn’t imagine a rare disease like Moyamoya would be central to my research and clinical care. But, it turns out, rare diseases affect many of us, not just those of us in healthcare.

According to the NIH, there are approximately 7,000 identified rare diseases in the U.S., defined as a disease affecting less than 200,000 people. While individual rare diseases affect small portions of the population, the combined total of people living with a rare disease in the United States is estimated at 25-30 million. So, it seems a fair assumption that at some point in your life you, or someone you know, will face dealing with a rare disease, and will likely find that little information is available and that few medical centers treat it.

One of the greatest problems with rare diseases is that there is so little awareness and education about them, that even specialists do not identify their symptoms right away, or sometimes they remain undiagnosed or untreated all-together. At Stanford, everything we do is based on a drive to discover answers, particularly for those with the most complex or rare disorders. In addition to my research in Moyamoya, many of our faculty focus their research and clinical efforts on rare diseases. For example, Dr. Gerald Grant is collaborating with experts at Nicklaus Children’s Hospital in Miami to conduct a trial using focused ultrasound for children with tuberous sclerosis, a rare genetic disease that causes tumors throughout the body. Several of our specialists across the Stanford campus are joining forces to create a comprehensive skull base surgery program that pioneers the least invasive, most effective treatments for rare disorders such as adenoid cystic carcinoma. In our new Neurosurgical Anatomy Lab, veteran surgeons are teaching residents how to perform complicated and nuanced surgical procedures for treatment of rare aneurysms. Next month, Dr. Steven Chang is hosting Stanford’s first Facial Pain Association Conference, aimed at bringing together clinical experts and patients to develop new solutions for those affected by the rare and painful disease, Trigeminal Neuralgia.

Many of our patients come to us because they have a rare disease and so few other places have answers for them. World Rare Disease Day is recognized just once a year, but in my line of work, we think about rare diseases every day, and we’re working hard to ensure all patients, no matter how rare their neurological disease, can find answers and therapies that will extend and improve their lives.

Happy New Year

I’m incredibly proud of our department’s accomplishments over the past year, and am confident the work we are doing continues to improve the quality of our patients’ lives.

In 2017 we welcomed four new faculty to the department, including two translational scientists, a new pediatric neurosurgeon, and a peripheral nerve surgical specialist. Our scientists and surgeons continued to push the boundaries of translational research and refining surgical techniques; integrating pioneering use of robotics in surgery, implementing the use of virtual reality in the operating room, and publishing results from a wide variety of studies focused on everything from epilepsy to brain tumors.

This past year our team worked with California legislatures to pass a new resolution declaring May 6 Moyamoya Awareness Day in California, an important step in spreading awareness for this relatively unknown disease. We also saw a renewed public interest in, and a great deal of media coverage about our stem cell therapy for stroke studies - culminating in a special ceremony where I was honored by the Smithsonian Institution with their Annual American Ingenuity Award for Life Sciences. I was surprised and humbled by the recognition!

I’m pleased to kick off the new year with the launch of our Department’s first e-newsletter, which will provide insights and the latest news to anyone interested in staying up-to-date with our Department. I am also looking forward to continuing to expand our department in 2018 with the hiring of new faculty specializing in skull base and pituitary tumors, complex spine surgery, and stem cell research. I’m eager to see what new scientific discoveries and clinical advances our researchers and clinicians will develop in the coming year, and am looking forward to sharing many more of our upcoming achievements with all of you. Happy New Year!