Chapter 03: Friction in the Evolving Field of Head and Neck Surgery
Files
Loading...
Description
In this chapter, Dr. Goepfert explains the debates in the 60s and afterward, over how to divide conditions of the head and neck between general surgeons and those trained in Otorhinolaryngology (Ear, Nose, and Throat). He talks about the friction between the Society of Head and Neck Surgeons (mostly general and plastic surgeons) and the American Society for Head and Neck Surgery, founded by ortolaryngolosts. He gives an example of the Mayo Clinic, where (in the 1080s) cancer was treated by a Head and Neck surgeon and a general surgeon performed necessary neck dissections. He also discusses the debates over which field should handle surgical reconstruction after procedures to address cancer –plastic surgeons or the head and neck surgeon. He notes that, at MD Anderson all plastic surgeons are trained in that specialty, not in head and neck surgery, then lists various plastic surgeons at the institution, beginning with Margaret Sinclair, the first reconstructive surgeon at MD Anderson.
Identifier
GeopfertH_01_20120827_C03
Publication Date
8-27-2012
City
Houston, Texas
Interview Session
Helmuth Goepfert, MD, Oral History Interview, August 27, 2012
Topics Covered
The Interview Subject's Story - Overview; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Controversies
Transcript
Helmuth Goepfert, MD:
So that’s how I got into “head and neck surgery.” Throughout this time, there still was very much friction between the two big societies of head and neck surgery. There was the Society of Head and Neck Surgeons, which was predominantly general surgeons and plastic surgeons. Then you had on the other side the American Society for Head and Neck Surgery, which had been founded by otolaryngologists about four years after the previous one. Now, even though they attempted to work together, there was animosity in the fields between surgery done by general surgeons, surgery done by otolaryngologists, but over time the pendulum swung towards otolaryngology. Nowadays, ninety-plus percent—almost 100 percent—of head and neck surgery is done by otolaryngology-trained physicians, and the two societies, again, eventually merged into one, which is the American Head and Neck Society—AHNS.
Tacey Ann Rosolowski, PhD:
What were the points of contention between these two societies after their founding? Dr. Helmuth Goepfert Ego. (laughs) Specialties evolve, and otolaryngology, from its beginning, had a certain interest in part of cancer of the head and neck, predominantly the larynx. The general surgeons sort of hung on to the rest of it—the neck dissections, the thyroid, the skin, and all the diseases that are surrounding the paranasal sinuses and the oral cavity and so forth. So, it was sort of they got training in it, the departments dealt with it, but gradually the general surgeons got away from that. On the other side, otolaryngology sort of lost due to the advent of antibiotics for all the infectious diseases of the head and neck. The ear infections became less, sinus infections became less. In general, anything that had to do with infectious disease became less prevalent and was treated medically now. That was an important event. And even in the ‘80s—early ‘80s—there still was a certain separation in some organizations. I’ll give you an example. In the Mayo Clinic, for example, until about that time, if there was a cancer of the larynx being treated, the otolaryngology took care of the treatment of the cancer of the larynx, but then the general surgeon came in to do the neck dissection. So, it was sort of a strange split. Now, there has always been friction between specialties. Another friction between specialties that is not quite resolved yet has to do with the surgical reconstruction of the defects we do in our operative procedures. There is a very strong move from otolaryngologists to do that. On the other side, there is an established rote that is done by plastic surgery. In this institution we follow the latter, so all our plastic surgeons here are trained in plastic surgery and come up. I’m partly responsible for that way back then.
Tacey Ann Rosolowski, PhD:
Why did you support that particular training track for plastic surgeons?
Helmuth Goepfert, MD:
Because we always felt the necessity to stay in touch with them. This is from the time that the first plastic surgeon at this institution, Dr. Margaret Sinclair—she sort of was a plastic surgeon that had been trained before the war in Germany. She came via Cleveland Clinic, or one of those clinics, to MD Anderson back in 1952 and was the first reconstructive surgeon here who was— Of course, the armamentarium then was very limited. Then, following her, there was another surgeon that was a plastic surgeon that was with us, Dr. Don Gard, and he retired recently from private practice here in Houston. When he left, a man who had been double trained in otolaryngology and plastic surgery, David Larson, took over, and he came as a plastic surgeon and developed certain techniques in plastic surgery that were used for many years. He basically set a tone for that. During his tenure we did the first attempt of getting a microvascular surgeon. That failed, and we sort of abandoned that. When David Larson left it became quite critical. There was one plastic surgeon whose name escapes me right now that in the interim covered the waterfront. I forgot his name. He committed suicide. You must remember that, possibly. And then we appointed Dr. Mark Schusterman, and Dr. Mark Schusterman was basically the one who started an independent department of plastic surgery at this institution, and that evolved into what it is today—probably the biggest surgical reconstruction unit in the country.
Tacey Ann Rosolowski, PhD:
And when did that happen? When was that department established?
Helmuth Goepfert, MD:
Dr. [Charles M.] Balch was the chairman of surgery. It was in the mid ‘80s.
Tacey Ann Rosolowski, PhD:
Mid ‘80s, wow.
Helmuth Goepfert, MD:
What was his name?
Tacey Ann Rosolowski, PhD:
Well, you’ll think of it. We can pop back and slide it in later.
Helmuth Goepfert, MD:
[Steve] Kroll—K-R-O-L-L.
Tacey Ann Rosolowski, PhD:
K-R-O-L-L, okay.
Helmuth Goepfert, MD:
The first name comes back soon—Steve.
Tacey Ann Rosolowski, PhD:
Steve Kroll. Okay, great. We’ve really covered a lot of territory. I’d like to go back and pick up some details of the evolution of your career. It’s interesting. As I was reading through your CV I thought, “Wow.” I was wondering how you maneuvered into this role, because it seems as though you did so many things. I had questions about how you got involved with chemotherapy and why and the ways in which you began to set up programs in that. Just the snapshot that you gave at the beginning of the interview—where you described all these specialties—it gave me a portrait of how very, very complicated this universe of treating this area of the human body really is.
Recommended Citation
Goepfert, Helmuth MD and Rosolowski, Tacey A. PhD, "Chapter 03: Friction in the Evolving Field of Head and Neck Surgery" (2012). Interview Chapters. 1002.
https://openworks.mdanderson.org/mchv_interviewchapters/1002
Conditions Governing Access
Open
