Chapter 13: Chair of the Section of Head and Neck Surgery
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Description
In this Segment, Dr. Goepfert talks about his leadership of the Head and Neck Surgery from 1982 until 2003. His primary goal on assuming the role was to facilitate multi-disciplinary care practices. He notes that all head and neck patients at MD Anderson came through Head and Neck Surgery, whether they ultimately needed surgery or not, and the Department followed each patient through treatment and aftercare. Dr. Goepfert notes again his role in establishing the Thursday Conferences where thirty or thirty five individuals from different specialties and services would gather to plan multidisciplinary treatment. These sessions served as a model eventually implemented by everyone at MD Anderson. Dr. Goepfert also says that he wanted to train physician-scientists, following the model of Dr. J Freireich in Developmental Therapeutics. He talks about the qualities needed to succeed as a physician-scientist, the need for proper mentors in both the clinical and laboratory science fields, and other requirements to support translational research. Dr. Goepfert sketches the evolution of the physician-scientist role at MD Anderson, and what he did to support this growth.
Identifier
GeopfertH_02_20120828_C13
Publication Date
8-28-2012
City
Houston, Texas
Interview Session
Helmuth Goepfert, MD, Oral History Interview, August 28, 2012
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the Institution; Building/Transforming the Institution; Multi-disciplinary Approaches; Institutional Processes
Transcript
Tacey Ann Rosolowski, PhD:
Now, you became the full-time Deputy Head of the Department of Head and Neck Surgery in ’79 and then became chair of the department in ’82.
Helmuth Goepfert, MD:
Yeah, Dr. Jesse died in ’81. And they asked him in ’79 to name a deputy chairman.
Tacey Ann Rosolowski, PhD:
So what were your goals and first steps when you assumed that position?
Helmuth Goepfert, MD:
Number one was to create a forum that allowed for the discussion of new patients with other specialties, and it has mushroomed into a very significant endeavor nowadays. It needs to be said that traditionally, at this institution—and it still is like that—the head and neck surgeon sees all head and neck cancer patients, so it’s very few of them that come in just straight to radiation therapy. The patient that is referred to head and neck surgery comes through head and neck cancer, comes to head and neck surgery, we do the initial evaluation, we do the local history and physical and make sure that the patient is discussed once we have some basic elements of the history and physical and possibly some of the radiologic studies and other studies that are necessary. Often the medical oncologists see the patient for the purpose of making a joint decision of how this is going to be handled. Is there protocol that the patient can fit in, in the sense of a research protocol? Is this a patient that would predominantly be treated by one modality of treatment? The Head and Neck Department has assumed that responsibility and has always done it that way. In addition to that, we follow the patient through their treatment, in addition to whoever is treating the patient, and we have assumed the role of the follow-up, which became a little bit of a burden as the number of patients increased, so we had to create a survivor clinic. The Survivor Clinic exists now for patients who have been, the past five years, post treatment and still want to come here. There is a survivor clinic that is basically run by a physician assistant. Most of us have a physician assistant. In Head and Neck, we don’t have any advanced practitioner nurses.
Tacey Ann Rosolowski, PhD:
How did it happen that Head and Neck took on such a broad role with patients even who would not require surgery?
Helmuth Goepfert, MD:
Because we had the means of examining the patient, and we comprehend the function of the different sites better than somebody else. It was established because we would not control the management of the patient, as we discussed yesterday, at this institution. We wouldn’t gain by operating on a patient. Yes, there was a time in which physicians sort of leaned a little bit in one or the other direction that caused some turmoil between some members of the department and radiation oncology. I wanted to preempt that by establishing an interdisciplinary forum where patients could be discussed, and these issues brought out into the open in order to make the right decision—what we felt was the right decision.
Tacey Ann Rosolowski, PhD:
What were some of the other initiatives you took up? Before I ask you that, was there any kind of discussion or argument about setting up this kind of responsibility?
Helmuth Goepfert, MD:
No.
Tacey Ann Rosolowski, PhD:
So people really—it was really the MD Anderson practice?
Helmuth Goepfert, MD:
Yes, it was supported by everybody. We made it in such a way that it was—at the end of the day it became Thursday because usually new patients were seen Monday, Tuesday, Wednesday. So, we created it to be done on Thursdays, so the patients were still untreated. Over time, Diagnostic Imaging participates in it now, and they bring the studies and communicate everything over a cable. They don’t need to lug around the x-rays. That, over time, has become better. The oncologic dentists, they give their opinion if a patient needs dental extractions or whatever. The prosthodontics are there in case a major resection is necessary, and they’ll need rehabilitation. Speech Pathology is there, the nutritionists are usually there, and of course all the trainees are there. What used to be a limited group of maybe fifteen people now is at least thirty to thirty-five sometimes filling the ranks. It has become a very—I would say it has served as an example that later was implemented by everybody else in the hospital, and now it’s sort of the hallmark of MD Anderson multidisciplinary care. So that is how that started. The other thing I wanted to do as soon as possible was to create or duplicate the efforts that Dr. Freireich had done in training physicians to become physician-scientists. That is a very hard-to-follow project because these people really have to have a passion for doing it. You cannot do it away from the clinical level. You need to still participate in the clinical care of patients. You need to have a mentor that understands what you’re doing on the clinical side, and certainly a training mentorship on the basic science side, so that whatever project they want to study or evaluate or participate in has the proper mentors on both ends. I mean, there was the effort—one of the early efforts was in the study of natural killer cells.
Tacey Ann Rosolowski, PhD:
That was in Head and Neck?
Helmuth Goepfert, MD:
In Head and Neck and the man that was in charge of that then was Dr. Stim Schantz. Elizabeth Grimm was the scientist. You may have heard from her. Elizabeth Grimm was the scientist who was sort of doing this on the basic science side, and Dr. Schantz sort of got into this and he created his program of physician scientists on this subject and followed through with it for a long time. Dr. Clayman, for example, who came later—Dr. Clayman came in the ‘90s, and he did his main work on p53. He did the initial studies of p53 and did even a national protocol to develop p53 by local injections, so there’s a long history on that. So you always had to have a sponsorship, and you had to have a mentorship, and you had to let the team of scientists help this person to become the translator from the clinical side to the basic science side. In order to train fellows in that, that’s the difficult part, because it demands that a fellow give up, for a year, his clinical training and spend time in the lab studying the language of the basic scientists, because you use a different language. I mean, all of this is—pure science is basically a language that most of it I don’t understand. That is something that they have to do in order to become really adept in what they want to do in the basic science.
Tacey Ann Rosolowski, PhD:
Can you give me kind of a sense of how those languages differ? You said you don’t understand it yourself, but I’m sure you understand it much better than I do.
Helmuth Goepfert, MD:
They talk at the submicroscopic level—the ultrastructure of something, the proteins, the genes, and the DNA and then the p53 and all the different elements that—what do you call it?—the targeted therapy is totally Chinese for me, because all of these new elements that are brought about that you have to understand—the pictures of how the epidermal growth factor interacts with antigens and antibodies and what the cascade is and what the down effect is and so forth. All of these things are unknown at the level of the clinical medicine.
Tacey Ann Rosolowski, PhD:
So it’s immersion in the special language of that science?
Helmuth Goepfert, MD:
Yeah. And people at this institution have the availability of these scientists next door, which really is there. And then you have to credit Dr. Freireich because he started this in leukemia, and leukemia has remained—the progress in leukemia has been fundamentally guided by physician-scientists. Yes, they can have access to their specimens very easily; they draw blood or take a bone marrow, which is usually much easier than what the solid tumors give for the purpose of studying the ultra-microscopy or the structure of any of these cells that they want to target with any of the therapies. So it is something that requires dedication.
Tacey Ann Rosolowski, PhD:
And it impresses me that it requires not only dedication but a really special kind of mind.
Helmuth Goepfert, MD:
Oh, yeah.
Tacey Ann Rosolowski, PhD:
And very different skill sets—on one hand, having all of those interactive skills and diagnostic skills, but then a whole other kind of intellectual apparatus.
Helmuth Goepfert, MD:
The intellectual apparatus is very different.
Tacey Ann Rosolowski, PhD:
Yep. Interesting—very interesting.
Helmuth Goepfert, MD:
That came about, as I said, in this time after Dr. Jesse. Dr. Jesse already thought that it was necessary to create an individual that would help advance the science by knowing both sides of the street, so to speak. It has become much more important now and much more complex, and it is something that the institution is trying to get more focused by doing all the things that [Ronald A.] DePinho wants to do now, which may or may not pan out. But, as I say, that is what it is.
Tacey Ann Rosolowski, PhD:
Now, before we turned on the recorder you said that you wanted to give more about your perspective on the physician-scientist. What else did you want to share about the evolution of that role at this institution?
Helmuth Goepfert, MD:
The evolution at the institution has been very favorable, and many people have sort of retooled that were still young in their mind—you have a flexible mind. After you are sixty you don’t have enough flexibility in your mind anymore to learn these things. That needs to be said. The people who have the flexibility in their minds that can capture this and can formulate it and use it for the purpose of creating something new is what is so remarkable and what can be done in an environment like this institution that has sort of, hopefully, for most of them, an open door. So that is the important part of physician-scientists. They sort of form a very important bridge in bringing the knowledge from the bench to the bedside.
Tacey Ann Rosolowski, PhD:
What do you feel you were able to do administratively to support the—?
Helmuth Goepfert, MD:
I selected people to come on the faculty that had an interest in doing that and had shown, at least in the fellowship or by some other means, an ability to work along that line.
Tacey Ann Rosolowski, PhD:
Who did you bring on board that you felt was particularly successful or exemplary?
Helmuth Goepfert, MD:
Dr. Clayman, Dr. Myers—those are the two primarily that I have. I had Dr. Schantz way back when, but Schantz then left for New York, and he’s still a physician-scientist at the present time. Those are basically the ones I remember right now offhand. Then I trained Dr. Weber, but Dr. Weber followed more the trend of being an expert clinician, an outstanding surgeon, a very great communicator, and educator, and, at the same time, focused on the issue of quality of care. That has been the hallmark of his tenure as Chairman at the present time. He expanded more on the clinical side. He did not venture into translational. Now, there are others that left the institution then, but they left after their fellowship or after a year in addition to their fellowship. I forgot the name; there is one. [Dr. Douglas] Frank—Frank is his last name. He is in New York, and he still pursues that. But people come in different shapes and with different interests. The fellowship is there, and not only the way we set it up. We brought this through the society that credits our fellowship. The fellowship was not only to teach them how to handle head and neck cancer but to get exposed to an environment of physician-scientists and get exposed to the language of the basic scientist. And that goes along with that, and it goes along, too, with so-called clinical research or protocol research, where it again is becoming much more complicated. And again, it requires a specific mind and a set of skills that have to be acquired beyond what medical school or medical books can offer.
Tacey Ann Rosolowski, PhD:
Now, I read that you established both basic science and clinical research sections in the department. Am I understanding that correctly?
Helmuth Goepfert, MD:
No. I didn’t, really. Yes, we had some basic— There was a basic science, and we have a basic science laboratory, but it never was really totally separated from clinical care. Yes, there was a basic science laboratory. I forget the name of the people that were in there. It is over fifteen years ago now, because it later became much more affiliated to a physician-scientist.
Recommended Citation
Goepfert, Helmuth MD and Rosolowski, Tacey A. PhD, "Chapter 13: Chair of the Section of Head and Neck Surgery" (2012). Interview Chapters. 1012.
https://openworks.mdanderson.org/mchv_interviewchapters/1012
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