Stanley J. Robboy, MD

June 2012

Stanley J. Robboy, MD

Core of prime program: communication

Last month, I attended the three-day CAP Policy Meeting in Washington, DC, and then traveled to Lexington, Ky., for a two-day immersion in pathology as practiced at the University of Kentucky Chandler Medical Center.

At the policy meeting, keynote speakers included Ezekiel Emanuel, MD, PhD, one of the architects of president Obama’s Patient Protection and Affordable Care Act, and Rep. Tom Price, MD, who has introduced health care legislation. We discussed at length national and pathology-centric legislative priorities. On day three, we visited Capitol Hill, where we did our best to share our beliefs with legislators and their staff.

This was useful, educational, and necessary, but even more stimulating was the second meeting at the University of Kentucky (UK), where I spent intensive time with faculty and pathology trainees in a program that embodies everything we had been working to promote and protect in Washington the day before.

The CAP president’s tour takes the premise that visiting training programs will confer a better grasp of what most concerns our residents and fellows and how we can help them launch a satisfying career. I came to UK for the tour and as the department’s Bluegrass Visiting Professor.

I find that a slide seminar intended for residents and focused on my specialty, gynecologic pathology, is a reliable ice-breaker. From there, we had a brown-bag lunch, where pathology trainees helped me understand what is on their minds. Many are concerned about paying off their loans, about whether to subspecialize, and about how they will build a career in an evolving health care system. I encouraged them to create their own opportunities. I do feel that those who take the initiative to provide a service—teaching a seminar for medical students or becoming an active mentor, for example—are best positioned to show what they can do.

After lunch, I gave a talk on transformation for the entire department and then enjoyed several one-on-one meetings with members of their faculty, much like our peer-to-peer program. As expected, several of the faculty taught me something.

Paul Bachner, MD, has been professor and chair of the Department of Pathology and Laboratory Medicine for 15 years. Paul was a highly effective CAP president (1999–2001), founding the Council on Education, for example, and shepherding the first CAP cancer protocols, which were still new and controversial then. He will step down as department chair this month, take a sabbatical in bone pathology at the Hospital for Special Surgery in New York, and then return to the faculty, as he says, “to do some honest work.”

Dr. Bachner is a master communicator both when he’s talking and when he’s not. One thing that gets communicated up and down the line in that program is a persistent emphasis on communication and collegiality, including what he believes is the most often forgotten part of communication: listening.

Nearly seven years ago, Dr. Bachner recruited Gregory Davis, MD, a professor of pathology and laboratory medicine who was then associate chief medical examiner for the state to take over as director of their autopsy service and their pathology residency training program. They have since built an impressive forensic and medical-legal consulting practice around Dr. Davis. The forensic consult service, for which there has never been advertising, did 28 consults in the first six months (2005) and 253 in 2011, providing a major service to the community and the state.

Dr. Davis encourages his residents to follow up on a misunderstanding by knocking on the colleague’s door and saying, “Let’s get a cup of coffee and talk about this.” It seems that there are a lot of doctors having coffee with one another at UK. They make time to listen. It shows in the mood of the place.

Six years ago, Dr. Davis was doing his routine volunteer stint for the local National Public Radio pledge drive when the program director pulled him aside and asked if he might be willing to do a radio program. A one-minute commentary quickly turned into four minutes per week. For “Dr. Greg Davis on Medicine,” he interviews experts on everything from concussion and contact sports to all-terrain vehicle safety. Andrew Bernard, MD, an associate professor of surgery and director of acute care surgery, trauma, and surgical critical care at UK Chandler, has been on the show several times.

Dr. Bernard works closely with Leonard Boral, MD, MBA, professor of pathology and laboratory medicine and medical director of the UK blood bank, which processes 14,000 units of red cells every year. The two recently collaborated with emergency medicine physicians, nurses, medical technologists, and anesthesiologists to resolve difficulties with their massive transfusion protocol. Each time the protocol didn’t work perfectly they had another meeting to figure out why. The solutions were almost always communication related, Dr. Boral says, a product of the many individuals and telephone calls required to get the right blood to the right place at the right time. Now they have it down.

Eight pathology residents and 12 anesthesiology residents spend a month in the blood bank each year. Dr. Boral sees to it that everyone who completes that rotation is familiar with two randomized controlled studies, one in adult critically ill patients (N Engl J Med. 1999;340:409–417) and another in nonpremature babies in pediatric intensive care units (N Engl J Med. 2007;356:1609–1619) that established the benefits of a lower red-cell transfusion threshold: a hemoglobin of seven. By charging his pathology residents—and his anesthesiology residents—with carrying that message, Dr. Boral has successfully conserved red-cell transfusion resources.

The energy, initiative, excellence, and collaboration that I saw at the University of Kentucky embodied everything that the CAP Policy Meeting seeks to preserve. In Washington and in Lexington, I took great satisfaction in seeing so many talented, purposeful pathologists working together in so many ways to do all the right things right.