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Physicians Update

 
Winter 2012

Field of Surgery Evolves as Advances Take Medicine in New Directions

Charles Brunicardi, M.D.After 16 years at Baylor College of Medicine in Houston, the last 12 of them as chairman of the Michael E. DeBakey Department of Surgery, Charles Brunicardi, M.D., has returned to UCLA - where he was on the faculty from 1989 to 1995 - to serve as chief of the General Surgery Group and vice chair for surgical services for the Department of Surgery at UCLA Medical Center, Santa Monica, as well as surgical director of the UCLA Center for Gastrointestinal Diseases. Dr. Brunicardi's clinical expertise includes gastrointestinal surgery and surgery of neuroendocrine tumors, and his research focuses on translational genomic medicine and surgery. The recipient of numerous honors for teaching and research, Dr. Brunicardi has served since 2002 as editor-in-chief of Schwartz's Principles of Surgery, considered the premier surgical textbook worldwide.

What drew you back to UCLA?
I believe in self-reinvention, and when Dr. Ronald Busuttil [chair of the Department of Surgery at the David Geffen School of Medicine at UCLA] called and offered me a chance to be part of building the general surgery academic programs in Santa Monica, I thought it was an incredible opportunity. UCLA has grown to become one of the predominant healthcare systems in the United States, and with the beautiful new full-service hospital opening up in Santa Monica, there has never been a more exciting time to be part of the leadership team. I am also very interested in personalized medicine - using patients' genomic profiles to guide decisions about their care. There is an organized movement at UCLA to build this, and I am thrilled to become part of that.

What is surgery's role in developing personalized medicine?
Surgeons will play a critical role, because they have access to the diseased tissue. We envision that all patients will be put on a protocol and their tissues will be placed in a biobank, with the information becoming part of databases that will help us come up with genomic profiles on the tissues we remove, guiding decisions about imaging as well as care. Using these profiles, we will be able to remove at-risk tissues as a prevention strategy, as well as deciding on surgical approaches. For example, does the cancer patient get chemotherapy prior to surgery? And then the Holy Grail is targeted therapy. Whereas surgery would remove the tissues at risk, targeted therapy based on the genomic profile of their cancer, for instance, has the potential to cure the patients for the long term.

How has the field of surgery changed since you were last at UCLA?
It's much more collaborative now. Historically, surgery was based on a command-and-control, top-down leadership approach. Now it's much more about using collective intellect. The multidisciplinary conference is an example, where we come together with other healthcare providers to decide what's best for the patient, as opposed to the surgeon alone saying what is going to happen. And there is a greater emphasis on measures to ensure safety and prevent surgical errors.

How about the surgery itself? What has changed and where do you see it headed?
When I was a new faculty member at UCLA in 1989, we were just learning how to do minimally invasive surgery, starting with laparoscopic cholocystectomy. Since then it's spread throughout general surgery. We've become a kinder and gentler craft, and it will continue moving in that direction. The use of robots in surgery is just in its infancy, but we are learning far more about how they can be employed to improve the quality of surgery. As that technology merges with molecular imaging, you can imagine the robot guiding the surgeon to do things like sparing nerves and determining the margins of the cancer. Advances in imaging have made a huge difference. When I was a medical student, we didn't have CT scans or MRIs. The change has been remarkable.

What makes you most optimistic about the field's future?
What's most exciting is how brilliant the medical students are, especially at UCLA. They are accomplished in multiple areas - in music, athletics - and they have grown up on computers, so they are using them in exciting ways - for everything from simulation to Web-based education. The future is bright because of the brilliance of these students.

You've been a big proponent of leadership-training programs for medical students and residents. What makes for a strong leader in surgery?
The key is creating a vision that your constituency can become part of fulfilling, and then having a willingness to lead, to learn, and to resolve conflict. There are, of course, different styles of leadership. There is command and control, based on fear and intimidation, and then there's the collaborative style of leadership, in which you build self-esteem using a collective intellect. That's the one I favor.

What is most rewarding about what you do?
I love teaching students and residents and continue to get great joy out of taking care of patients, even after approximately 8,000 operations over the past 22 years. I tell the students that I can't imagine a greater profession than being a physician, and having the privilege of pursuing a powerful vision at UCLA.





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