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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. Dee Fenner, the first-ever recipient of the Bucksbaum National Award for Clinical Excellence.
[00:00:14] Dr. Fenner: You know, I'm at the point in my career where I'm, you know, thinking about, well, I've established my legacy. I think my mentees and those I've trained really are, you know, what I'm the most proud of. And so I think making sure that when I do step back that my department and folks are in good shape. And that's the thing I think that's probably most important for me.
[00:00:45] Dr. Cifu: We're back with another episode of The Clinical Excellence Podcast, sponsored by the Bucksbaum Institute for Clinical Excellence. On this podcast, we speak to patients and doctors about all aspects of excellence in clinical medicine. I'm Adam Cifu and today I'm joined by Dr. Dee Fenner. Dr. Fenner is the Chair of the Department of Obstetrics and Gynecology and the Bates Professor of Diseases of Women and Children at the University of Michigan.
She holds a joint appointment as Professor of Urology. She is nationally recognized as an expert in defecation disorders, surgical education, and reconstructive surgery. Working with a multidisciplinary team, her major contributions have been on understanding how birth injuries impact pelvic floor disorders and developing new and novel treatments for accidental bowel leakage.
This year we are thrilled to recognize her with the Bucksbaum Institute Clinical Excellence Award. This award recognizes physicians who have displayed exceptional dedication to clinical excellence and the advancement of the doctor-patient relationship. Dr. Fenner, congratulations, and thank you so much for joining me today.
I am wearing you out here because you just gave a lecture, and then I ran you over to my office for this podcast, so I hope you can stick with me for a little bit longer.
[00:02:01] Dr. Fenner: We're all good.
[00:02:02] Dr. Cifu: So I wanted to start just by getting a sense of sort of how you ended up here. Kind of what first attracted you to obstetrics and gynecology, and then how did you end up kind of being, I don't know, an expert in pelvic floor pathology?
[00:02:16] Dr. Fenner: Yeah. Well, thank you again. I'm so pleased to be here and the recipient of the first Bucksbaum Institute Clinical Excellence Award. You know, I went to medical school back in the mid-80s and it was such a different time, in terms of 20 percent of my medical school class was female. I was very interested in surgery. I enjoyed surgery. I liked the patient interactions. I think sort of the ability to sort of cut and cure, if you will but I also enjoyed the obstetrics piece and... Which is nothing better than delivering a baby, and I think just attracted to as a woman having female patients was you know, something that I enjoyed as well.
You know, as I say, back in that time, I didn't know any women that were surgeons that weren't obstetricians, gynecologists and so... And also, I will say, that there were... I didn't think that women were always treated well by some of the physicians that I worked with as a medical student.
[00:03:26] Dr. Cifu: Women patients?
[00:03:27] Dr. Fenner: Yeah. And that I wanted to provide really patient-centered care and so OB/GYN was a perfect fit. So I did my residency and was fortunate to train at the University of Michigan, and there were some really excellent pelvic surgeons there. And the field of what we call now urogynecology sort of was just coming into itself. There were only one or two non, and we weren't certainly ACG-accredited, non-approved fellowships at the time. And so I liked surgery. I liked doing GYN oncology surgery, but I just didn't think that I wanted to deal with the oncology and the patients. And so urogynecology is a great field because it's really quality of life.
And so that's how I got into it. It was a great field because it was just beginning and growing. And so I got to do that and to really lead nationally and to help grow the field and to advance the science and the care. And so I've been very, very fortunate. It's been a great, great career.
[00:04:43] Dr. Cifu: How exciting. What was the gender breakdown in OB/GYN when you first started?
[00:04:48] Dr. Fenner: It was still probably at that time even 80-20.
[00:04:54] Dr. Cifu: Wow.
[00:04:55] Dr. Fenner: It was mostly men. Yeah.
[00:04:56] Dr. Cifu: Yeah. So you've seen amazing transitions both in what the specialty looks like and in, obviously, given what you do, sort of the field itself and what the clinical practice is like.
[00:05:07] Dr. Fenner: Yeah.
[00:05:08] Dr. Cifu: That's exciting. So you work in a space with patients who can be, I think, particularly vulnerable, right? Thinking about new mothers, thinking about older women. And they can present with problems which I think many of us would find difficult to talk about. So it almost seems like, you know, two things together which could make the visits very difficult.
I imagine that creating space for your patients to be comfortable and confident is kind of key to the medicine itself. Just, I don't know, reflecting on, you know, what your day is in practice like, what's worked for you? How do you do that?
[00:05:47] Dr. Fenner: Yeah, I think first you have to try and, you know, dispel some of the myths that women have heard. You know, whether they... You know, well, "I was, you know, I'm just getting old and this is part of it." I frequently say, "Well, you know, people have heart attacks in their seventies, but we don't, you know, say it's just getting old. We try to help them. And we need to think of your, you know, urinary incontinence or bowel control issues or prolapse of your organs in a similar fashion."
So I think trying to normalize it in a way that they shouldn't be embarrassed and also to reassure them we have lots of options for them and then we have options that we can tailor to what their specific needs are. And so making sure that you have a sense of what are their goals, what do they want to do and what is it that their visit is there for. I think the thing, you know, they can write something on a piece of paper or a questionnaire, but yeah, I really find that I just need to talk with them and say, you know, "What matters most to you and what brought you to see me today?" And so, I think that, you know, fortunately, whether, you know, commercials on TV now show things that we didn't even think about 25-30 years ago. So it's certainly out there, but it's still very uncomfortable seeing women who have symptoms or problems, pain, incontinence right after delivery is, you know, something that frequently they have no idea what happened. And so for them, it really is a lot of education and trying to explain to them, you know, their own anatomy and what happened with delivery and what we can do, again, to help them and to try and make them feel safe and reassured. And I think that's the key is to listen to them and to follow what their needs are.
[00:07:39] Dr. Cifu: Do you still see patients who have you know, suffered with the problems they're seeing you for for a long time, or do you think people are... You know, something's changed that people are more apt to see you early at the beginning of their problems?
[00:07:56] Dr. Fenner: I think it really depends on the woman and you know, it depends too on her financial situation, and her priorities, you know, I think if depending on her health issues, you know she has to you know, focus on, you know. If she's just worrying about, you know, trying to work enough to feed her family, she'll probably not come and take care of herself.
I see a lot of that, women who have put off caring for themselves because they may be caring for a mother or father or they have a disabled child or, you know, their husband and until some... You know, they're taking care of someone. So you know, women are caretakers of the family. So I would say now it's not that they're not aware, it's just that they don't put themselves first in those circumstances so that they... I can tell you the number of times, "Well, you know, my mother's gone now, and so now I can focus on me," that type of a response.
[00:09:01] Dr. Cifu: Right, right. I know that very well, too. This is a little bit off-topic, but you sort of mentioned direct-to-consumer advertising that I think, you know, every day I struggle with, you know, what's the balance of the benefit and harm of direct-to-consumer advertising.
You know, sometimes it does let people know that there are possible solutions to their problems. Some people... Sometimes it actually educates people that what they're experiencing could be considered a problem that they could see a doctor about. And then of course, there are people who are freaked out by things that they shouldn't be freaked out by because people are just trying to sell them something.
Is that something you hear, whether it's, you know, incontinence supplies or drug advertisements that bring people in to you?
[00:09:49] Dr. Fenner: Um, not very often. I'll be honest, I'm not sure how effective those commercials are. Some of the medications, when they go list the complications and side effects, I think they drive people away.
So I do think, you know, sometimes if, you know, if we have a new therapy, we might do some advertising or, you know, more just awareness for, you know, to try and let people know we might have something that could be helpful for them but I haven't found that those advertisements... I think I'd be shocked how much good they must have research on it, or they wouldn't spend money, but it's hard for me to imagine. I don't hear that.
[00:10:27] Dr. Cifu: Right. That's exactly how I look at those ads. I listen to them like this can't be effective. I'm like, you know what? They know what they're doing.
[00:10:33] Dr. Fenner: Yeah, they wouldn't spend the money. Right?
[00:10:37] Dr. Cifu: So, besides, you know, excelling over your career in clinical work and research, one of the other reasons that we recognized you was that you are known as such a dedicated teacher and mentor.
A lot has changed over the course of your career, and I think, you know, this is true for all of us. I think it's especially true in the surgical practices. What are the kind of challenges you see in either teaching trainees at every level today or maybe supporting those trainees, junior faculty as they kind of come through the ranks?
[00:11:18] Dr. Fenner: It certainly has changed. I think that, you know, I think we always provided excellent care and things were good, but we certainly monitor our quality and our complications and patient expectations differently than we did 30 years ago. And so I do think that, you know, allowing the young surgeons and the trainees to have some independence in the OR is a lot more difficult but counter to that is, you know, I'm so experienced now that there's not... I wouldn't say fix anything or that I monitor and I can... I think I've become such a good teacher and can explain things better that I can be more hands-off than I would have been earlier in my career. So I'm hopeful that balances, but I do think that we try to use simulation and things, but there's no experience like being there and having to make decisions in the operating room as things go and having... You know, I want to say, every patient's a little different.
And so, I do think that being able to support and to have surgical coaching and to think about how, you know, you make that transition from a resident to an independent practitioner that we see as, you know, those first couple of years making sure that we have people available or in the room at least so that we can make sure that they feel the confidence and that they're able to, you know, progress and take good care of the patients.
[00:13:00] Dr. Cifu: I like the idea that you can see problems or mistakes before they happen at this time in your career.
[00:13:06] Dr. Fenner: Right. Yeah.
[00:13:07] Dr. Cifu: To draw a parallel between sort of what you do and what I do and, you know, this will stereotype a little bit, but I wanted to see if you've kind of had the same experience. I feel that recently, because for me, it's I think people in medical school coming to residency, for you it might be later trainees, I think that because a lot of the sort of responsibility and really clinical engagement gets delayed these days, you know, one can argue if that's appropriate or not. I often feel that trainees are a little bit less likely to sort of take responsibility to jump in when I first meet them. And something which has changed for me is almost need to motivate people to be like, "Okay, this is yours, you know, these are your decisions to make."
Maybe for you, you know, these are the cuts to make. You think that's true?
[00:14:08] Dr. Fenner: I do. And I don't know 100 percent why, but I do feel like that whether we haven't made our expectations clear and that they should do that but, or that we are, I don't... You know, I think, my mentors, they seem to... I know they're a lot more intimidating than I am, but I don't know.
I think it's just a different expectation. And I think, yeah. And I think for some, especially taking that leap from being a medical student and being the resident, where you do have to make decisions that you see some doctors, some can do it well, and others have a real hard time. And you really have to say, "You're the doctor now, you have to do this." And... Yeah.
[00:14:55] Dr. Cifu: A question. I hate to take something that you sort of say as an aside, sort of funny, and make it into something more, but I'm struck. Let's say, you know, later in my career of, you know, the way maybe I'm viewed as a teacher and educator later. Where I hear people saying like, "Oh, you know, you're really intimidating," or something like that where much like I think we all feel like we're still 18 and then we look at ourselves in the mirror and we're shocked. Have you sort of experienced that over your career as you've been, you know, really a committed educator for decades?
[00:15:35] Dr. Fenner: Yeah, because I think I've always had high expectations. And so I think that, you know, when the residents were coming to my clinic or the OR making rounds, I expected them to have read, to know what was going on.
And so I do think yes, and certainly now as the chair, because you know, I have this high title. So that makes people be, you know, they're much more nervous and feel, you know, and just because, and I don't think that I've changed that much since I was a division director or a regular faculty, but that is the title. I think it brings different fears from the learners. Yeah.
[00:16:15] Dr. Cifu: You do wear a crown too.
[00:16:17] Dr. Fenner: Of course. That, too.
[00:16:19] Dr. Cifu: What is sort of next for you in your career? What are you sort of interested in, I don't want to say the final years, but in like, you know, the final stages of your career, I guess? What are the challenges that most excite you?
[00:16:34] Dr. Fenner: Yeah, you know, I think one of the things that's happening so rapidly is data science, AI, what's going to be happening and how that's going to impact us both in education and patient care. And so I'm fascinated, I'm terrified, I'm, you know, worried, but I'm also, you know, optimistic but I think the power in certain areas is going to really, I think, help patients with personalization and being able to come up with, you know, what's the novel therapy that would work for their particular disease.
At the same time, I do think, you know, what excites me, I think, you know, I'm at the point in my career where I'm, you know, thinking about, well, I've established my legacy. I think my mentees and those I've trained really are, you know, what I'm the most proud of. And so I think making sure that when I do step back, that my department and folks are in good shape. And that's the thing I think that's probably most important for me. You know, I still have been getting more involved with some global health, and I think there will be, you know, opportunities there to do some things to continue to give but I don't want to be one of those folks that meddles. I just want to make sure that if needed or if I could help. Yeah, I do think, going back, that AI is going to be a huge disruptor too, and hopefully in a positive way. As I said, I'm excited, but I'm also terrified.
[00:18:12] Dr. Cifu: Yeah, yeah. The only thing that brings me optimism, which hopefully is not misplaced, is I feel like we have learned something from the way we've succeeded and failed with the electronic medical record. And so we're going into kind of this era of a new technology, maybe with our eyes a little bit wider open than we did the first time?
[00:18:33] Dr. Fenner: I hope so. I hope that we're not as... Maybe some ways gullible. I think we all thought this was going to be fantastic. It's going to make our life easier. And we'll have all this information. And then we realized that that can be overwhelming and not useful. And so I do hope that we have learned something, yeah.
[00:18:56] Dr. Cifu: We're not going into this saying what could possibly go wrong.
[00:18:59] Dr. Fenner: Right. Exactly. Yeah.
[00:19:02] Dr. Cifu: Well, Dr. Fenner, I wanted to thank you again for taking all the time, both in giving your talk today and in taking time for the podcast, and again, a real congratulation to winning the first Annual Bucksbaum National Award for Clinical Excellence.
[00:19:17] Dr. Fenner: Thank you so much. I feel so honored and I appreciate your time.
[00:19:21] Dr. Cifu: Before we finish up today, a quick addition about this year's National Clinical Excellence Award. As you know, the Bucksbaum-Siegler Institute for Clinical Excellence at the University of Chicago is dedicated to fostering compassionate doctor-patient relationships and advancing clinical care.
Each year, the Institute recognizes extraordinary healthcare professionals through the National Clinical Excellence Award. To learn more about the award, and nominate a deserving clinician, please visit the Bucksbaum Institute webpage, that's bucksbauminstitute.uchicago.edu.
Thanks for joining us for this episode of The Clinical Excellence Podcast. We are 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 via the Bucksbaum Institute webpage.
The music for The Clinical Excellence Podcast is courtesy of Dr. Maylyn Martinez.