Subscribe
Share
Share
Embed
The Clinical Excellent Podcast, sponsored by the Bucksbaum Institute for Clinical Excellence is a biweekly podcast hosted by Drs. Adam Cifu and Matthew Sorrentino. The podcast has three formats: discussions between doctors and patients, discussions with authors of research pertinent to improving clinical care and the doctor-patient relationship and discussions with physicians about challenges in the doctor-patient relationship or in the life of a physician.
[00:00:00] Dr. Cifu: On today's episode of The Clinical Excellence Podcast, we have Dr. Selwyn Rogers talking about trauma surgery.
[00:00:10] Dr. Rogers: Unfortunately, 40% of the victims of trauma at the University of Chicago Medicine, their mechanism of injury is penetrating, meaning unfortunately, that they've been shot at, and a bullet has traversed part or parts of their body.
[00:00:36] Dr. Cifu: We're back with another episode of The Clinical Excellence Podcast sponsored by the Bucksbaum Institute. During this podcast, we discuss, dissect, and promote clinical excellence. We review research pertinent to clinical excellence. We invite experts to discuss topics that often challenge the physician-patient relationship, and we host conversations between patients and doctors.
I'm Adam Cifu, and today I'm joined by Dr. Selwyn Rogers. Dr. Rogers is a widely respected surgeon and public health expert. As founding director of the University of Chicago Medicine Trauma Center, Dr. Rogers has built a stellar interdisciplinary team of specialists to treat patients who suffer from life-threatening events.
His team works with leaders in the city's trauma network to expand trauma care on the South side, and to develop a multidisciplinary approach to trauma care and health disparities. His work helps enhance the understanding of social factors that affect victims of violence and underserved populations, in addition to identifying approaches necessary to achieve better outcomes for trauma victims. Selwyn's research interests focus on understanding the healthcare needs of underserved populations. He has published extensively on health disparities and the impact of race and ethnicity on surgical outcomes.
Dr. Rogers, thanks so much for joining me.
[00:01:55] Dr. Rogers: Thank you so much, Dr. Cifu, for having me.
[00:01:57] Dr. Cifu: When I go through all that, I feel like I'm pulling you away from something more important than a podcast. Um, so I'm going to start with what's probably an easy question that you've been asked a thousand times, um, but sort of why trauma surgery, like how did you end up in this career?
[00:02:12] Dr. Rogers: It's a great question. I will have to go back to my origin story.
[00:02:16] Dr. Cifu: Okay.
[00:02:16] Dr. Rogers: So I'm a small-town boy who was born on the island of St. Thomas in the United States, Virgin Islands. And while growing up on... Born on St. Thomas, growing up on St. Croix, also one of the US Virgin Islands, I had the combination of the gift of understanding and the audacity of ignorance.
Now what does that all mean? So I, with respect to academics, I was quick to understand and quick to be able to teach others. I really enjoyed transferring the knowledge that I acquired to my classmates, and it may sound a little nerdy, but I liked teaching.
[00:03:00] Dr. Cifu: Yeah.
[00:03:01] Dr. Rogers: But I also had the audacity of ignorance. I had no one in my family who had gone to college, or grad school for that matter. And so when I was growing up, knowing that I liked science more than I liked English, for example, as a subject matter, I gravitated to thinking that I wanted to be a high school science teacher. That was my first calling if you will.
Um, however, back in the day, and some of the audience may know what an encyclopedia is, Encyclopedia Botanica was in our home and I opened up the M section. And on the M there was medical school and there were two medical schools listed, Harvard Medical School and Johns Hopkins Medical School and I said, if I'm going to go to medical school, I guess I have to go to college first. Again, not having a clear path in terms of how you get there. So long story short, I applied to both, was accepted to both and the rest of my career has been defined by making the most of opportunities, a combination of hard work as well as mentorship.
I chose a career in trauma surgery because when I came to the field of medicine, I wanted to take care of whole people. I didn't really want to take care of parts of people or had any significant predilection to cancer or endocrinology or diabetes. And so, as I went through all of my clerkships, you know, these rotations where you try something on for a month or eight weeks and you decide if it's going to be a fit.
Medicine, too slow, pediatrics, too many children, OB/GYN, all women, pathology, they're all dead, radiology, room too dark, kept falling asleep, and my surgical rotation was my very last one. And when I did surgery, I got bitten by the bug of fixing problems in a definitive way, and because I came to medicine to take care of whole people, not parts of people, general surgery is what appealed to me. And when I was doing my general surgery training at the Brigham in Boston, I kept coming back to this idea that despite rotations on the breast service or the endocrine service, or the surgical oncology service, trauma and critical care provided the best opportunities to take care of whole people, not just parts of them, in the context of the fact that people, when they're traumatically injured from a gunshot wound or stabbing or an assault, they bring all the baggage with them, right? They don't leave the baggage at the door. Whatever the social factors that led them to be traumatized in the first place are also part of how you care for them and care about them. So that's my case for why I chose a career in trauma surgery.
[00:06:02] Dr. Cifu: Got two questions or comments that come from this, one, as a proud generalist, I totally, kind of, I don't know, recognize or hear you as you talk about how you get into that and sort of what you imagine is yourself, you know, when you come into medicine, and I always find it interesting that you sort of find generalists everywhere and sometimes in places that you don't expect them. And then one question about your past, and I may be kind of making assumptions here, you know, I have a totally different background where like, you know, college and medical school and everything was sort of like, oh yeah, this is one of the things you do, my wife has a very different background whereas someone going from her high school to college, she was a very, very, very small minority. Were there people around you who sort of, you know, could kind of show you the path of look, if you want to, you know, achieve more than maybe people around you, this is how you do it?
[00:06:58] Dr. Rogers: The closest um, mentorship that I received with respect to the aspiration of doing more than going to the United States Virgin Islands, at the time it was college, UVI, was University of Virgin Islands college or now it's a university, was from my high school teachers.
[00:07:23] Dr. Cifu: Okay.
[00:07:24] Dr. Rogers: Um, you know, I didn't really have anyone in my family that was a college graduate, certainly not my parents. And so in the context of thinking about a career that would require a college degree, the thing that first struck me was being a high school science teacher, that's the thing that I saw the most, particularly my science teacher, Mr. Woods, my Math teacher, Mrs. Olive Walcott. Mr. Woods has since passed, Mrs. Olive Walcott I still stay in contact with. They inspired me about what was possible, and so the pathway to college though was a somewhat blind one, you know, I mentioned the encyclopedia, I guess I had to take a standardized test. Okay, I prepared for that. My classes were not AP, the highest Math in my public school on St. Croix was pre-calculus, there were no calculus classes.
[00:08:25] Dr. Cifu: Yeah, yeah, yeah.
[00:08:26] Dr. Rogers: And so, this gets back to the audacity of ignorance, didn't know what I didn't know, so I happened to be a good test taker, and I guess my scores and my GPA, which you can imagine was outstanding, 'cause I wasn't ever really challenged in high school. I mean, my challenge in high school was, can I teach what I knew?
[00:08:47] Dr. Cifu: Yeah.
[00:08:47] Dr. Rogers: That's the challenge.
[00:08:48] Dr. Cifu: Yeah.
[00:08:48] Dr. Rogers: But in many ways that practice of teaching what I knew or what I had learned, set me up to become a physician.
[00:08:57] Dr. Cifu: Okay. So, so far we've appealed to generalists and high school teachers, which I think are the most important people in the world, so we're in good stead. So this talking like is a total outsider to trauma surgery and especially, you know, trauma surgery and really trauma care here at the University of Chicago is, I find it very exciting both, you know, seeing and my interaction with you all on the wards and also reading some of your writings are the kind of breadth and diversity of the team that you've brought together here to help trauma victims.
And so outside, you know, the doctors and nurses, which to some extent are kind of obvious, who are the other people who you sort of really rely on to help with the care of trauma patients?
[00:09:43] Dr. Rogers: That's a great question, Dr. Cifu, very intentionally I have brought together a very diverse team of physicians, trauma surgeons to start but they're the, if you will, the floor. You can't do trauma care without trauma surgeons, and obviously one of the things that I often have to dispel is the conflicting of ER or emergency medicine with trauma care, they're not the same. The emergency department is a place, trauma care is a system of care that requires interdisciplinary engagement by a diverse set of, I hate using the term providers...
[00:10:29] Dr. Cifu: Yeah, yeah, yeah.
[00:10:29] Dr. Rogers: ...I'm going to use actually instead, specialists. And these specialists we often think of as the nurses in the intensive care unit, the nurses in the operating room, the nurses in the emergency department. We think about the anesthesiologist, we think about orthopedic trauma surgeons, so i.e., the normal quote-unquote "floor."
You can't do trauma care without those folks, and you can't do it well without those folks working well together. Having said that, I mentioned earlier that I chose trauma because, as you just said, I'm a generalist. I love the idea of taking care of whole people and in the context of the fact that traumatic injuries affect rich people, poor people, Black people, white people, Asian people, um, people who have agency, people who don't have agency, people who have means, people who have Bachelor's degrees, advanced degrees, and people who haven't gotten past sixth grade. You have to meet people where they are, especially if you're committed to providing the highest level of care. So with that context, if you are committed to restoring people to their best functioning, following a traumatic injury, you have to engage all aspects of the healing process.
So what does that look like? That means not just the floor.
[00:11:54] Dr. Cifu: Right.
[00:11:54] Dr. Rogers: It means social workers, and it means psychologists, and it means psychiatrists, and it means case managers, and I'm going to go there deeply in a second because a particular type of patient care requires a more intentional approach. So let me share with the audience that unfortunately, 40% of the victims of trauma at the University of Chicago Medicine, their mechanism of injury is penetrating, meaning unfortunately, that they've been shot at, and a bullet has traversed part or parts of their body. With that reality as the number one cause, reason for coming to the University of Chicago Medicine's Trauma Center is having been the victim of intentional gun violence.
We also know that to change the arc of those people's lives with respect to getting in the path of a bullet, that it was by design when I strategized about what would it take to stand up at a level one trauma center on the South side of Chicago that we embedded what we call the Violence Recovery Program.
So the Violence Recovery Program is actually folks who have a lived experience, either community members who know someone who's been the victim of violence or themselves have been the victims of violence or just involved, some of our folks have actually spent time in the carceral system. And so in the context of that lived experience, I like to say that they have a PhD in violence. Um, and they've used that lived experience, that life experience to help inform everybody else who doesn't have that lived experience because it's really through that combination of experience and translation of that experience to those who don't have that shared experience that we can provide the highest level of care.
[00:14:11] Dr. Cifu: It's really neat to hear because it is what we all do in medicine sort of raised to a whole 'nother level, right? It's that we're interacting with whoever comes in the door, right? No matter what you do. And all those people have different backgrounds, have different sort of levels of knowledge, and have different experiences, but you are having to provide this at what's often, you know, the worst time in people's lives. Um, and so it seems like this expertise that people bring is even more necessary, even more important.
[00:14:50] Dr. Rogers: You couldn't have said it better, um, because I do think that without it, there's a lot lost in translation.
[00:14:58] Dr. Cifu: Yeah.
[00:14:59] Dr. Rogers: You take, for example, an 18-year-old who is shot in the chest, survives both transfusions and operation, ICU stay, it's now two weeks later, and the lots of questions that an 18-year-old will be asking.
[00:15:18] Dr. Cifu: Right.
[00:15:19] Dr. Rogers: "What's my life going to be like? Am I safe? What does my future hold?" Even if they don't really think about the future beyond one day.
[00:15:27] Dr. Cifu: Yeah.
[00:15:28] Dr. Rogers: If you have never been shot yourself, and if this is such a foreign part of other people's lived experience, I challenge any of the audience to think about how they could quote-unquote "relate."
[00:15:44] Dr. Cifu: Yeah.
[00:15:45] Dr. Rogers: Especially if the 18-year-old boy, that's a boy, 'cause I have three sons who are 27, 23, and 20, and my 27-year-old is still my boy...
[00:16:00] Dr. Cifu: Yeah, sure.
[00:16:00] Dr. Rogers: ...still my child. And, um, in the context of the 18-year-old, adapting to a loss of control, feeling unsafe, if he or she swears at you or gets upset with you for seemingly no reason, why would you take that personally? And I will share, staff and nurses have taken it personally, instead of giving people the space and grace to say, if I were in that situation, how would I behave? How would I react? Not absolving anyone from creating an unsafe environment for the people taking care of them, but one of the things that our violence recovery specialists do artfully is, they diffuse these situations before they become problematic and going almost five years of the trauma center's existence, there has not been a lack of conflict.
[00:17:06] Dr. Cifu: Hmm.
[00:17:06] Dr. Rogers: However, there's been a lot of mediation and a lot of conflict resolution and we're certainly in a better place overall with respect to the end-grafting of the trauma center to the University of Chicago Medicine, if I'm going to use a transplantation analogy.
[00:17:23] Dr. Cifu: Yeah. Yeah. I'm thinking about, and this is probably a conversation for us to have after the podcast, about since we see that in every part of medicine where people who are sick, people who maybe have diseases who actually change the way they think, that often make those people when they're patients just more difficult for caregivers to deal with. And when I talk about caregivers really broadly, whether it's doctors or nurses, or actually family members, and I wonder how much, you know, I'll call them your specialists, you know, could teach the rest of us in, look, you know, this is a hard thing to have empathy for, whether it's a gunshot wound or whether it's dementia, but this sort of understanding where, I don't know, the behavior, the interactions come from, because that's, I mean, that's certainly something that, you know, medical students and residents have problems with, but boy, I still have problems with this, and I've been doing this for 30 years.
[00:18:23] Dr. Rogers: As do I, you know, similarly, 30 years. I do... May I give an example without...
[00:18:30] Dr. Cifu: Absolutely.
[00:18:31] Dr. Rogers: ...without being too concrete? Um, 18-year-old male, Black male is in the hospital and he's in the hospital with a feeding tube in place because he can't eat. Pain is an issue and he has an IV in, and his IV falls out and he's upset that he has to be stuck again for another IV. And in the midst of being upset, he yells and the nurse taking care of him, yells back at him. And that becomes a tennis match back and forth. And then there's an escalation to call security because he says an F word and a B word. Did that have to happen? And given the fact that the 18-year-old boy, I'm not going to call him a young man 'cause again, I have a 27, 23, and 20, and it can be viewed as derogatory to call a Black person a boy, but he's a teenager. He still has a teen in his 18-year age, and if you are ill in the hospital and I'm going to say, I'm 56. When I'm ill at home, I become a child. My wife can't stand it. I actually become very infantilized and I am not a good patient. But what does an 18-year-old do, has to? Regress.
[00:20:03] Dr. Cifu: Yeah.
[00:20:04] Dr. Rogers: And so that manifests as lashing out and we can't forget that they can't eat and they have a tube in their nose and they're trying to make sense of the unsafe world in which they now live, and they've always lived potentially. How do you take care of that person in a trauma-informed way? I.e., you think about their lived experience and what you don't see because we're not in their home, we're not in their community. We're part of a larger community, but we're not part of their community. And how does that manifest when there's disease, trauma and illness.
[00:20:44] Dr. Cifu: I sometimes regress just after a bad clinic on my walk-up. So last question for you, illness and medicine always reflect the world we live in, right? Much of my time is dealt dealing with kind of consequences of obesity, poverty, inactivity, substance abuse, and I know that and often feel like what I'm doing is trivial because I'm not addressing, you know, everything that's out there. I think in your professional life, this fact is much, much, much more obvious than for most doctors, how do you kind of fight the feeling that like, you know, you can't cure all the ills of society, you're just patching up the ills of society?
[00:21:29] Dr. Rogers: It's a great question, Dr. Cifu, I actually, mentioned at the top of the podcast that I love to fix things.
[00:21:38] Dr. Cifu: Right.
[00:21:39] Dr. Rogers: One of the reasons why I got drawn to surgery is that no matter how long an operation it is, there's an indication for the operation, there are risks to the operation, there's a beginning, a middle, and an end to the operation, and there is an outcome, which is usually in the course of minutes, hours, days, weeks. And there may be a long-term outcome in terms of what's the impact on that person over the course of their life cycle, but you get feedback. Um, what you're talking about is the fact that health is not determined by those slivers of interactions in someone's clinic or someone's operating room. Obviously, something like cancer that requires surgical resection or trauma that requires operative intervention to stop bleeding has a defined path, but the bigger issue is how do people get back to their level of functioning because ultimately every interaction with the healthcare system is about maximizing their human potential and be it appendicitis, or be it trauma, or be it cancer that requires an operation, the person doesn't feel better just because you take out the cancer.
[00:23:03] Dr. Cifu: Right, right, right.
[00:23:04] Dr. Rogers: They don't feel better because you take out the appendix or don't feel better because you're sawing up the blood vessel. It's about their recovery and what that recovery means for their ongoing both rehabilitation, but reintegration into the things that matter to them.
[00:23:22] Dr. Cifu: Yeah.
[00:23:23] Dr. Rogers: And if that is not healthcare delivery, I'm not sure what is. And if we can't commit as a profession to doing that in a holistic way, then we're probably falling short and we probably are not primum non nocere, we probably are doing harm, which requires a reconceptualization of what we do in healthcare delivery.
[00:23:50] Dr. Cifu: Absolutely. That's a really, I think, productive way of thinking about it which I'll keep in mind actually. Selwyn, thanks so much for taking time out of your ridiculously busy life to sit down, talk to me for half an hour, it's really terrific, I'll probably call on you again sometime.
[00:24:09] Dr. Rogers: I'm happy to do so, Dr. Cifu. It's been a pleasure.
[00:24:12] Dr. Cifu: Thanks for joining us for this episode of The Clinical Excellence Podcast. We're sponsored by the Bucksbaum Institute for Clinical Excellence at the University of Chicago. Please feel free to reach out to us with your thoughts and ideas on the Bucksbaum Institute Twitter page. The music for The Clinical Excellence Podcast is courtesy of Dr. Maylyn Martinez.