SELWYN ROGERS Interviewed by Peter Tishler, MD, 2011 I am Selwyn Rogers. I am actually a Junior. I have the pleasure of having a young Selwyn Rogers the third in the family. I am an Associate Professor of Surgery at BWH and the Division Chief of TBSCC. Thank you very much. I will start by asking you some questions of a personal or a professional nature. You have been in the Brigham s department of surgery since graduating from HMS in 1991. Why did you choose surgery? It s an odyssey of where I started. I am a small town boy from the United States Virgin Islands, and St. Croix specifically and actually I thought I was going to be a primary care doctor. I was going to go off to college and medical school and go back to the Virgin Islands and take care of people who look like me, talk like me, are me. And I got inspired by the surgery bug largely around the very visceral nature of surgery. Surgery is about seeing, doing, feeling disease. There is a broken blood vessel. There is a cancer; it s very palpable; it s very concrete. And it turns out that even though I was never the tinkerer as a child, I actually loved the idea of having a problem and working through bringing hands and mind to work through that problem and surgery captured that creativity in terms of taking disease and transforming it through the impact of surgical principles to cure, comfort and heal patients. Very nice. What are your clinical and research specialities? My primary focus has actually been the no do gap. I ve actually had a very strong interest in trying to sort out the difference between what we know in surgery and what we do in surgery and how can we lessen that gap. So in many aspects of medicine, for example, be it cardiology or infectious disease, we ve had very good clinical research and/or randomized clinical studies that support one approach or another. And historically in surgery we ve been more of an apprenticeship model. You do what you were trained to do, be it 5 years ago, 10 years ago, or 1
30 years ago. And people become very wedded to their way - The Brigham way or the Mass General way or whatever institution way. That is actually a very useful construct because if something works, why change it. Particularly something as invasive as surgery. Having said that there were various instructors in my training at the Brigham that there were maybe two ways we d do something, or 20 ways we d do something, but 20,000 ways of doing the same thing? And that variation and processes of care led me to think through how could we better understand the link between those individual steps or processes or things that we do to provide care to the surgical patient and the link of variation in outcomes, and trying to bridge that link has largely been the research work and the clinical work that I ve done. That s actually extended a bit as I thought beyond the individual surgeon- patient diag to think about population health, particularly populations who are disadvantaged in terms of access to surgical care. I presume that says something about your being a member of the Center for Surgery in Public Health, which is a creation of your department. Tell us more about your focus in relation to surgery at the Center. Certainly. So classically in a biomedical model we talk about disease in the context of molecules, proteins, receptors and how alterations of DNA or signal nucleotide peptide morphosis lead to disease. However if you go one subfolder up using as you know a windows analogy, there are all these other component parts of health. The social determinants of disease if you will poverty, socioeconomic status, race and ethnicity how do those social factors, that some of us control and some of us don t control, impact disease. Now certainly in the broader context of medical care, there has been increasing focus on the social determinants of disease but in surgery that has somewhat been lagging. And in the context of that reality a number of surgeons at the Brigham, who are kind of these young surgeons who wanted to think about population health in the context of surgery, worked with Dr. Zinner to conceive the CSPH. And the CSPH was conceived in the context of what is the intersection between surgery, public health and public policy and how can surgeons actively engage in health services research and clinical research to improve the quality and access to surgical care both in the United States and globally. Is this a phenomenon that is at other academic medical centers too? The Brigham has been at the forefront and we are proud to say that we have been a model for other centers that have sprung up, at University of Wisconsin for example with one of our graduates, Caprice Greenberg, who was the third director of the center who is now running that center. And we continue to recruit the best and the brightest who actually want to be part of the Brigham and Women s Hospital in the context of the leadership that we have taken with respect to linking those two concepts of surgery and public health. 2
Do you have any mentors as you developed your career in surgery? I ve been blessed to have tremendous mentors over the course of my entire surgical training but I would even go back to being a 10 th grade high school student in the Virgin Islands, Mrs. Olive Wolcott, who was my math teacher and she inspired me to realize that I had the gift of understanding. I didn t know what that was but it largely was around this idea that I actually learned things but I was very encouraged and inspired to transfer that knowledge to others. So I spent a fair bit of time not only acquiring knowledge but trying to share knowledge and that s what she actually meant by my gift of understanding. The understanding that I had, I wanted to transfer it to others. So my mentor/mentee relationship - I have always had a dual perspective of the role of mentor/mentee and that being very active. Over the course of my training I have been incredibly blessed to have just dynamic mentorship all the way through. So I reflect back to having matched at the Brigham and actually carving the letters BWH in the back of my head. My barber did that. I can look back and I think boy that was a long time ago June 21, 1991 was when I started my internship. When I think back to that time, I was walking in the door, and I heard - the question was posed to me - Did I know Dick Wilson? And I kind of shrugged my shoulders and said no. It turns out that Dr. Wilson had passed away the year before of melanoma but we had a connection here. He had a summer home on St. Croix and I was from St. Croix so people were asking me if I knew Dick Wilson. Now the island of St. Croix is pretty darn small you know 84 sq. miles, population 45,000 - so the odds of me bumping into Dick Wilson is not zero but low. So I didn t have a chance to meet him in life but I certainly met him in death and he continues to be memorialized with the Dick Wilson Teaching Award. From that, a person I never met, but whose legacy lives on at the Brigham, I was an intern who was taking care of Dr. Francis Moore Sr. where I at one time had to put an IV into him. So this was in the days before there was all the ancillary services that we have and it was a Sunday afternoon and Dr. Moore is having an operation. And I had to put in an IV. I started shaving his arm. He was something hirsute in the arm so I shaved across the grain if you will and he scolded me profusely and took the razor out of my hand and said you always shave along the long axis side. I remember that because it resonated because it was about a principle that if you are going to make an incision or make an intervention, you have to think about every step. And that was actually a very valuable lesson that I learned, not in the operating room but learned on the 6 th floor of the Brigham and Women s Hospital. From there I ve actually been blessed to have a whole cadre of mentors, most notably Dr. Zinner who has pushed me and challenged me to look at what impact I could make in surgery. And I would say humbly at the beginning of my training all I want to do is to get through the day. I mean you are doing every other night call, every other weekend. You d walk in Saturday morning at 5 a.m. and you walk out 10 p.m. on Monday night. All you are trying to do is survive. And Dr. Zinner was one of the first of my mentors to encourage me to actually look up and think through what impact was I going to make in my career. You know I went to the lab of Dr. Tim Eberlein who is now a chair 3
at Washington University in St. Louis and that was phenomenal experience. I look through the pantheon of Brigham chiefs - Dr. Cohn, Dr. Sugarbaker, and Dr. Bertagnolli - it s just a remarkable statement of the power, of the accomplishments and the passion that BWH has made throughout the world. I remember asking Dr. Joe Murray once, and this is a comment about how you, by being in a certain space, get to interact with people that you otherwise may not and the Brigham is one of those spaces that are very special. I asked Dr. Murray at a function at the Country Club in Brookline once, I said Dr. Murray I mean you have been vastly successful. I mean, a Nobel Laureate, the last surgeon to win the Nobel Laureate in 1980, just phenomenal. And I am sure that you could, at any point have moved on from the Brigham and been a chair of a department somewhere else in the world. And Dr. Murray said well I could have, but the Brigham was such a special place that I didn t want to be any place but here. And that has resonated in my mind over the past 21 years that I have been at the Brigham and as I am about to make this jump from the Brigham to my unique form of leadership as the chair of surgery at Temple in Philadelphia. It s tugged at my heart a little bit. It s tugged with the context that over the course of the past two decades, I have been struck by the power of the individuals that have walked through the portals of the BWH. I have been struck by the contributions that the BWH has made to the field of medicine and the field of humanity, but most importantly I have been struck by the people. And those people that you touched, those people that you mentor, those people that touched you, that mentored you and you end up making not just lifelong friends but actually lifelong comrades in this battle in human disease and suffering. Thank you so much. Now I am going on to another topic which concerns the role on the status of minority physicians here at the Brigham. As a member of the surgical staff, have you experienced any discrimination here at the Brigham? So you know I have a great history and perspective on issues of diversity. I think one of the challenges that I will face is that just because you walk into the four walls called a hospital, that does not change the broadest of the context in which we live. Which is the world is a place that discriminates people by race, ethnicity, height, socioeconomic status, the color of their eyes, what shoes they wear, what clothes they wear, what car they drive. And so just because you walk through the portals of the hospital doesn t mean that people leave their own selves at that door. And so to answer your question, yes, I remember vividly as an intern a white man with swastikas tattooed on his chest who came in as a trauma patient. He was a victim of a trauma and I was the intern in the emergency department and as an intern, the little person on the totem pole, you get to intervene with every patient who walked in the door who has a surgical problem. And I walked in and said I am Dr. Rogers and I am here to take care of you. You know the usual introductory commentary. And his response immediately was I don t want any nigger taking care of me. And I said okay, this is going to be a tough night. It didn t 4
get necessarily any better except for when my chief resident came to take care of him. The response that was given is well if you can t let him take care of you, then no one here will take care of you. And that was an awesome experience that resonated. It was about the principle Thomas Jefferson was quoted as saying In matters of style, swim with the current. In matters of principle, stand like a rock. I think that in the contexts of those moments that are very painful, we all have an opportunity to make an impact. And it s those small decisions that are actually lasting impressions. And in the context of the question do I experience discrimination?, the answer is yes. It s every day. I am an African American male predominantly in a white field. So I am a black face in a white place. Well, by definition, as we sit in my office right now, I can tell you that if you look around the walls, there are pictures of my three sons, right? African American male, pretty obvious, right? Yes. In the context of that reality I have had people walk into my office, sit in this chair, scan the room before I walk in and still look surprised. And they are not surprised at how tall I am 6 4. They are surprised that I am black. And then that s actually when I use that opportunity to shock them that, yeah, black and excellent, and I am here because I am your doctor. Has there been any evolution at this institution of issues of recruitment, training, staff appointment or academic advancement for minority physicians? I would honestly say that it has been mixed. I have been so thrilled particularly in the department of surgery and the department of medicine that from 1991 when I started as an intern where I could count on a single hand the number of nurses, the number of residents that were African American or Hispanic American. I ve been notably impressed by the sustained commitment to the diversifying the resident and fellow pool. Having said that, I have been starkingly disappointed with evolution over the past 20 years of that pool showing up in chairmen of departments or chairwomen of departments and division chiefs across the Brigham enterprise. And in 2012, if a place like the Brigham and Women s Hospital that stands for excellence, can t find a way to find the best and the brightest, wherever they may be, of whatever race and ethnicity to exemplify the fact that diversity is a core principle of excellence. It is through a diverse multicultural pluralistic society that we can actually achieve our best selves as Americans. And to answer that question who do we aspire to be and when we answer that question I think we will make a significant contribution to the world and potentially continue to be leaders in this domain as we are in so many others. When we look at the patients that we serve, because at the end of the day, medicine in all of its forms is about service. When we look at the patients that we serve, if we don t reflect on those patients that we serve, we are probably missing our best selves. 5
Are there any other comments you would like to make about this whole phenomenon? Well at some level there is discussion about pipeline. There is I go back to my three sons, 16, 13 and my youngest is about 10, and male if you look at it, they are doing very well. They are in a high socioeconomic status. They have incredible access to just about any resource they could need. They have supportive parents. They are in a superb public school system in the suburbs. They get to be exposed to educational offerings that actually stretch them. When I do a program called Doctors back to School where at the American College of Surgeons meetings which varies between San Francisco, New Orleans, Chicago, you go to some public schools in America, 8 th grade no labs, 8 th grade no computer labs, no science labs. So how can those kids actually compete? The playing field is not even level; it s actually crooked. And in the context of that reality I think that we have to focus on education as a fundamental pillar to achieve equity. So that is a pipeline problem. Yes But that doesn t address where we are today. I think a place like the Brigham can recruit the best and the brightest in a diverse workforce. But we have to actually open ourselves to that will. You know, we have to have a will that asks what is important to us. And there are many, many things that are important to an institution as great as the Brigham. There is commitment to excellence. There is a research enterprise which is outstanding. There is our patient care which is just superb and exemplary. Myself, I broke my hand in medical school. I got my care here by Dr. Simmons. I had open heart surgery here by Dr. Collins when I was a third year resident. All three of my kids were born here. You know I mean it s like Sy Sperling, I m not just the owner of the firm, actually I am a client; you know the bald headed guy who got a hair transplant. It s uncanny how if you make a commitment to something, you can make it happen. And the Brigham has made a commitment over the past 100 years to so many significant milestones. And for me the lasting one that I will take with me to Temple and by the way I learned from Dr. John Mannick, who was my first chair of surgery, don t go down there and say the way we do it at the Brigham. That is a sure way to get me run out of town. But what I will take with me is from a chairman that I didn t have the option to work for, Dr. Francis Moore Sr., who said that surgery is about responsibility. And that actually I take to my core because if you always do the responsible thing in the context of helping, healing, curing another, you will also do the right thing. 6