Welcome to my new webpage. We surgeons spend most of our time in the operating room, or thinking about the skills that make us improve our surgical outcomes. Blogging isnt really up there in the top ten :) But having said that, we are in a new age of surgery, where patients are out partners in helping to navigate their many surgical options. We are leaving behing the idea of a paternalistic medical system in which Doctors " order" patients to do as they say. Today we are aware that a person's well being is actually multi-factorial and that most of the care that goes into having a good surgical outcome precedes the acutal time of surgery.
When we have to perform surgery, for whatever indication or reason, most often this is for end organ failure. So the basic tenants of good health and healthy living such as diet and excercise are very important and help us just as much as any surgical training and proper planning and technical execution of a procedure.
This page represents a big change for me and the way I have practiced medicine, reflecting the changing times in which we live. Specialists are no longer removed from direct patient access; social media has enabled us to connect directly with the people we serve. Moving forward, we plan to work directly with patients to provide the most up-to-date, personalized care aimed at achieving the best precision surgical outcomes. This is a huge shift for surgeons, as we have in the past lived behind a curtain of primary care providers, relying mainly on a referral pattern. Now, we are in the midst of a great paradigm shift, where the well-informed health care consumer can directly contact us to determine by whom they should be treated. I have seen surgeons who have spent a lifetime perfecting their skills in the academic setting turn to social media to communicate directly with patients.
Paradigm shifts are important and are inevitably a sign of progress. The last shift for me and for breast cancer treatment began in 2001. Not only did I complete my surgical training then, but I also was in New York as the events of 9/11 unfolded. On a more positive note, I was a member of the audience later that year when the landmark papers describing the novel concept of “intrinsic” subtypes of breast cancer were presented. This paper and subsequent thinking led to a dramatic shift in the way we think about and treat breast cancer today. “Molecular portraits” of breast cancer and the MammaPrint paper presented at the San Antonio Breast Cancer Symposium in 2001 were our first attempts to understand the heterogeneous biology that cancers exhibit in becoming malignant, often requiring us to treat with divergent paths to achieve a cure. We began to think of breast cancers according to this specific biology and treat them accordingly. Today, this means that often patients with a “basal” or “HER2,” like “intrinsic subtype,” will often be treated with chemotherapy first and then offered surgical or radiation therapy. Even more exciting has been the recent discovery of targeted therapy aimed at destroying cancer cells displaying specific genetic changes, recently resulting in the introduction of drugs that target or inhibit cells marked by the “program death ligand.” These PD-1 inhibitors have revolutionized our ability to treat aggressive lung and skin cancers with minimal side effects. Stay tuned as we see this arena grow to include other immunotherapy or immune system-boosting therapies to help treat more cancers. Exciting times are indeed ahead as we continue to make strides.