
Chapter 08: R. Lee Clark’s Vision and Changes in MD Anderson Culture
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Description
Dr. Keating begins this chapter with a brief description of his return to MD Anderson. He then describes MD Anderson as a unique place where it was as important to study the operation of cancer in humans as in the lab. He explains that the institution’s first president, Dr. R. Lee Clark, wanted to increase cross-fertilization between physicians and researchers. He also describes Dr. Clark’s “genius” for establishing a work structure that would relieve the faculty of worry so they could concentrate on cancer. He compares that environment to the situation today, in which health care is governed by corporate entities. He notes the problems with ethics that this can breed and the loss of a sense of altruism among physicians. Looking at MD Anderson, he notes the difference between the “luxury” of the public spaces, and the problems that faculty have getting basic material to support their work. He shares that he “prays for wisdom in our executive leadership.”
Identifier
KeatingM_01_20140513_C08
Publication Date
5-13-2014
City
Houston, Texas
Interview Session
Topics Covered
The University of Texas MD Anderson Cancer Center - Critical Evaluation; MD Anderson History; Growth and/or Change; MD Anderson Culture; Critical Perspectives on MD Anderson; Ethics; The Life and Dedication of Clinicians and Researchers; Faith
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey Ann Rosolowski, PhD:
So when you came back to MD Anderson, I’m curious, when you left, did you just say, “I’m leaving. I have no intention of coming back,” or was there the possibility left open? How did that all work, and how did you end up coming back?
Michael Keating, MD:
I ended up coming back because Dr. Ken McCreadie, who was the chief of the Leukemia Service, he’s a big, rough, tough New Zealander, [Redacted] and I thought, “You know, there really is no one else there,” because I’d sort of become his right-hand man. And it dawned on me that this was the most important leukemia program in the world and that perhaps if Ken couldn’t do it all, that I should perhaps consider coming back, that it was the responsibility to take what I’d learned and come back. And there was always a sense, “Well, you’ve learned a whole lot of stuff and you’re not going to be able to practice it at that level in Australia,” and this one institution, the MD Anderson, was the only place in the world that I thought could take people that weren’t lab investigators to become clinical research people. And it’s been a unique part of what distinguishes MD Anderson from other places, that it was as important to study the disease in humans as it was to have the test tubes and the cell cultures and the mice and the rats and all these things along the way. When R. Lee Clark set up the Anderson, it was the MD Anderson Hospital and Tumor Research Institute, and they were separated in the mind, that there were the doctors that were looking at the cancer in the hospital and then there were the researchers, and in many ways they were separate, but there was increasing cross-fertilization as the people that were working in research, if they stopped and thought about it, they would say, “Okay, I’m doing research in cancer because human beings have cancer,” so that they would drift towards, “How are my observations being applied in the human condition?” You know, it’s terrific to cure mice, but does that lead to the cure of one human being? So that I think Clark was a genius in the structure that he put in place, to have full-time salaried people, with a terrific retirement package, etc., so that you didn’t have to worry about whether you were going to die and leave your family bankrupt or whatever. There was also a special deal that you had; if your children went to the University of Texas, they could get massively discounted education, etc. So it took away all the anxieties, or many of the anxieties that people have when they are growing up and starting their careers, and just said, “Look, I just want you to concentrate on cancer. And the fact that even up until very recently, it didn’t matter how many patients you saw or how much lab work you did, as long as your department chair thought that you were an important, integral part of the department, that what you did was important to the whole structure of it. The department chair was the person that had far and away the biggest input into whether you got promoted or you didn’t get promoted. Nowadays, people are measuring all these relative value units and how many patients you see and how much revenue you bring in, and this is a tremendous change in our culture in a relatively short period of time. Not all of it, by any stretch of the imagination, is imposed upon us from within, because there are all these external forces. The healthcare industry has just become a corporate entity, and it’s not pretty, and they’re eating people alive; doctors, patients, whatever. Pharmaceutical companies use to have the term “ethical companies,” but you increasingly find it difficult to find the ethics in a lot of the things that go on. And I think that there’s a lot of discontent among physicians because the sense of altruism that they went into medicine with is now under siege. We’re no longer doctors and patients; we’re providers and clients. And now concierge medicine is alive and well. You know, if you go around the clinic buildings, we have these wonderful chairs and we have the fish and all this sort of stuff, and if you go into the examination rooms, we have these metal desks that face the wrong way, and there’s no place that you can put anything because they’re all shared facilities, and we have the most antiquated computer screens that you could ever imagine. I said, “Why don’t we get new ones?” And they said, “It’s not in the budget.” Well, the budget for one of the chairs there would be able to replace with a good-size computer screen. So the question is, what is the most important thing? Is it more important that the patients and the relatives have somewhere comfortable, or is it more important that the doctor and the patient have a facility that can optimize their chance of being cured or treated well? And it’s these balances that I think are part of the nodal consideration of where MD Anderson goes from now on. It’s going to be a challenge. I actually pray for wisdom and statesmanship in our executives. My prayers are unanswered so far. So far. We’ll see how it goes.
Tacey Ann Rosolowski, PhD:
Well, shall we leave it there for today?
Michael Keating, MD:
Sounds okay to me.
Tacey Ann Rosolowski, PhD:
Thank you for your time and for your commentary.
Michael Keating, MD:
Oh, I am enjoying it.
Tacey Ann Rosolowski, PhD:
Good. I am too. It’s very interesting. I’m turning off the recorder at four p.m. (end of audio session one)
Recommended Citation
Keating, Michael MD and Rosolowski, Tacey A. PhD, "Chapter 08: R. Lee Clark’s Vision and Changes in MD Anderson Culture" (2014). Interview Chapters. 1176.
https://openworks.mdanderson.org/mchv_interviewchapters/1176
Conditions Governing Access
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