Chapter12: The Department of Surgical Oncology: Some History, Accomplishments, and Critical Evaluation
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Description
Dr. Pollock begins this Chapter by pointing out that acquiring resources was a challenge during his chairmanship, so he convinced established faculty members to set up a pool of their overage dollars to help young professors fund clinical trials –many of which have evolved into major lines of research.
Dr. Pollock reviews contributions of previous chairs: Dr. Richard Martin stressed the importance of excellent clinical care; Dr. Charles Balch understood that the group needed to transition from being a unit in the Texas System to being an academic unit; Dr. Pollock combined the two perspectives, emphasizing that one could do both research and clinical care, as he himself demonstrated by being only the second M.D. on faculty to complete a Ph.D. program at the Graduate School of Biomedical Sciences.
Dr. Pollock expresses his pleasure that his Department has emerged as “a dominant force in American Surgical Oncology.” He also notes that assuming the role of Chair as an assistant professor “short-circuited” his own research opportunities. He then talks about his evolution as a leader over his fifteen years as chair, giving examples of how he would handle situations differently now. He also expresses concern that the current MD Anderson administration is shifting focus away from collaboration between faculty. He tells an anecdote that stresses the value of interaction and collaboration among faculty.
Identifier
PollokRE_02_20121010-C12
Publication Date
10-10-2012
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Raphael Pollock, MD, Oral History Interview, October 10, 2012
Topics Covered
The University of Texas MD Anderson Cancer Center - An Institutional Unit The Administrator MD Anderson History Collaborations MD Anderson Culture Building/Transforming the Institution Growth and/or Change Obstacles, Challenges MD Anderson Impact Multi-disciplinary Approaches Business of Research Donations, Gifts, Contributions The Life and Dedication of Clinicians and Researchers The Leader On Leadership Professional Practice The Professional at Work Career and Accomplishments Critical Perspectives on MD Anderson
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:
That is amazing. So in that discussion you talked about the faculty, you talked about training, and then you talked about raising the profile of the department. It’s a really interesting way to approach that problem. Were there other issues that you had to deal with, such as resources and reshaping sort of elements of the mission of the department? What were some of the other challenges you had to take on?
Raphael Pollock, MD:
There was always a struggle for resources because there’s never enough resources. When you have really good people, the imagination and the ambition, which is not a dirty word, will always exceed what’s available. So part of the challenge there, which was sort of exemplified by how we approached research space, was to get people to see that through cooperation we could get more accomplished. So we were very fortunate, for example, there were some people who were very involved in clinical research and had been competitive for extramural funding, particularly from big pharma and things of that sort. I was able to convince people that we should set up a pool of dollars that was the overage and use that as a way of supporting the young assistant professors who were coming up who wanted to pursue a clinical trial but didn’t have the resources and the institution didn’t have the resources to give to us. So we had to do something; either tell that person you can’t do this trial or figure out some way of doing it ourselves. I was very, very fortunate that the more senior faculty who had such resources were willing to donate portions and put it in a common pot so that the younger people could prosper. They got the message. This is the germline DNA and we have to nurture it. And it was the same idea as we don’t have enough separate space to give everyone their own individual laboratories, so all the labs are common labs. And I did that myself by leadership by example. I tried to share everything that I had. I was, I think, very selfless.
Tacey Ann Rosolowski, PhD:
What happened with some of those projects that were funded out of that common pot of money? Where there some that really took off in interesting ways?
Raphael Pollock, MD:
It’s hard for me, in the retrospect of twenty years later, to be able to say this specific project came out of that, but certainly projects that were pursued in that era had a huge impact, and some of those had to have made use of some of these shared resources. The neoadjuvant use of chemoradiation in pancreas that Doug Evans and Jeff Lee pursued is a great example. The sentinel node biopsy projects in melanoma and breast, where Anderson was the strongest contributor nationally, much of the research nursing was paid for out of those shared opportunities. So those are just two examples of things where that was done.
Tacey Ann Rosolowski, PhD:
Was that an unusual thing for a department to do?
Raphael Pollock, MD:
It would be self-serving for me to say, yes, unusual in that I didn’t do a survey at the time. I was struggling trying to figure out how to pay the bills.
Tacey Ann Rosolowski, PhD:
Yeah, I’m not meaning to think of it that way. It just seems like—you know—it really speaks to the unusually supportive atmosphere in a department—that people were willing to kick in with—I mean—money always talks, big time, and if they were willing to kick in money, that’s amazing.
Raphael Pollock, MD:
I was very fortunate because I think that the people around me in the department understood what I thought we could accomplish as a group, and it made for a very strong esprit de corps. And I had a gut feeling—sort of a sixth sense—particularly if we were able to tip the SSO over in that first two or three years. So it went from us going to this meeting and listening to other people and sort of being atomized to everywhere you turned there was another Anderson paper and everyone was so surprised. It was like the buzz at the meeting. Where did all that come from? Well, it came from our hard work. It came from all those nights we spent together. So people came back from the meeting, they were invigorated. They saw this. Success begets success, and there was a sense that we are arriving. We do have— He was right; this really is that good a group. We really can compete for things, and we really can do things that take us beyond where we’ve been before.
Tacey Ann Rosolowski, PhD:
So were you really the vision maker when you took over? You were new into this. You stepped into the chairmanship, and you became the one who articulated and was sort of the booster for the department—that I know we can be the best. I know what’s going on here.
Raphael Pollock, MD:
Oh, I think that’s a fair statement. Under Dr. Martin’s chairmanship, the importance of clinical care was stressed and the importance of excellent clinical care and patient service. That was less important in a real, genuine, meaningful way to Dr. Balch, but Dr. Balch had an understanding that this group needed to migrate from where it was as the surgery department of the Texas State Cancer Hospital to becoming an academic unit, and he laid many of the seeds for that. But I had the benefit of both of their accomplishments, to be able to bring a number of these issues to fruition. The idea that the triple threat—outstanding clinical research person, or double threat, that that was not an extinct dinosaur—that you actually could do all of these things. And I think that I did, in some ways, set a personal example, from what I had done earlier. I was the second person to go through GSBS and get a PhD while a full-time assistant professor, so people knew that that could be done. I maintained continuous NIH funding from 1983 all the way to date, so people could see that that could be done. At the same time that someone was developing a strong clinical presence in a very demanding disease system, so that could be done. But the entire time that I was an assistant professor—that entire seven-year period of time—I worked easily 100 hours a week. I had the divorce at the end of that period of time to show for it. And that’s not something I’m happy about or proud about, and maybe a better person could have kept all of that together. I don’t know. But it certainly was something that could be done. But I think that the other part of this—I mean—people in the department would joke about it—that so-and-so worked almost as hard as Pollock. It was not derogatory of me, but it also wasn’t necessarily laudatory. God bless them that there’s someone who wants to work that hard around here and do that stuff. And I think the people appreciate that. Certainly my most recent change in status here has triggered hundreds of emails from people who have told me that this set in play a very powerful pattern and environment that they thrived in and really appreciated—that I’d had that impact on them and what was around them.
Tacey Ann Rosolowski, PhD:
As you look at the time—the fifteen years that you spent as chair of the department—what are you particularly pleased took place during your time in that role?
Raphael Pollock, MD:
I think the emergence of the group as such a dominant force in American surgery. We went from being the bridesmaid at best to being the dominant force. We colonized all of the major departments, and one of the things that we saw is that departments that did not have a history of surgical oncology would frequently take one of our fellows sort of on a fly—on a promissory note—and then in very short order, because they were so well trained and they understood the gospel according to Anderson, in very short order, twenty-four months later, they’d be calling back to the mother house, “I need a partner.” So there are any number of programs where the entire group ultimately—or the majority of people in that group—came out of our fellowship and just self-propagating. They’re traveling with the force. They got the message. They knew how to do it. Very, very powerful—very, very powerful.
Tacey Ann Rosolowski, PhD:
Is there something that you wished you had accomplished but were not able to?
Raphael Pollock, MD:
I think that coming to the chairmanship of that department at age forty-three, halfway through my associate professorship, short-circuited my own independent laboratory research career. I had to—and I was willing to—I wanted to—take on the agenda of the other people in the group as my personal agenda and top priority, but that made it impossible for me to pursue some of the research opportunities and certainly a more pure research trajectory. I had to step away from some things at a very, very early point and not only surrogate that but let other people run forward in being the idea germinal center. I don’t know how good a true, mature, independent investigator I could have become. Life is a series of choices. I don’t regret the choice in a deeply remorseful way, but I think that was a direction that was consciously short-circuited in the service of what I thought was a more important—and still think is a more important—larger goal. I’m very grateful that I was at least able to maintain enough of a presence that we could sustain a peer-reviewed program at the same time that I was doing the administrative things. And also, most pertinently, developing the clinical skills in this disease and maintaining them, which is very important—has been very important. That’s my touchstone. It goes right back to Dick Martin.
Tacey Ann Rosolowski, PhD:
Well, you mentioned that you aren’t sure what kind of a researcher—how you would have evolved as a researcher. How did you evolve as a leader during those fifteen years?
Raphael Pollock, MD:
You could probably get a more accurate and maybe even more honest answer by talking to some of the other people around me, but I think my own self perception is that I became progressively—I mellowed. I became even more flexible. I learned how to accomplish some goals without having to have them quite so much of a zero-sum proposition, where someone had to lose for someone else to win. Inherently, that’s who I was, but executing on that at times I found difficult. I will give you an example. There were two faculty members in the department who were both working in the same disease site and were very critical of each other. What ended up happening was they would make rounds on all of the patients that had the specific type of disease, including the patients of the other person, and then, in front of the fellows, they would criticize the management, which was very destructive. The way that I handled that—this was one of the early tasks—the way that I handled that was I pulled them both in my office and said, “This is going to stop immediately or else there will be repercussions. These are the tools that are at my beck and call—your salary, your tenure, your employment. What about that don’t you understand?” And they both left. Now, it accomplished the purpose, but I think in some ways it was very alienating for them to have been on the receiving end of that. I think it would have been much more constructive to have spoken to them individually and demonstrated how destructive their actions were and how much consternation it was causing the trainees who felt like they had to pick sides in this process and how unfair it was to them and detrimental to their education and that I really had higher expectations because I knew that they could do better. Yeah, I was going to have to monitor it now that this had come forward, but please let’s make this the last time that we have to talk about this. Now, that has a very different feel. And I learned more about that and more about public listening. You don’t always have to have the answer. You may be the chair, but that doesn’t mean you have to come up with the answer right then and there. It’s a very effective thing to say, “You know, I hadn’t thought about it from that point of view. I’m not totally sure I agree with you on this yet. I’m going to take forty-eight hours and chew on this and think about it.” Then I’m going to come back to the group or the individual and, “I’ll tell you what I think so we can pick up the thread of the dialog.” That’s very different than feeling that somehow you are being challenged, even though that’s what was going on, and feeling like you have to respond immediately—you know—show of force. “Listen, buddy, I’m the top dog here. I make that decision. No, you’re not going to pee in my swimming pool. This is not your call. This is my call.” So that type of behavior, which is sort of like posturing in response to posturing. I think that I was pretty effective in putting that aside and learning how to build cohesion and consensus, particularly in dealing with potentially adverse outcomes, how to buffer that, how to buy time, how to let people come to their own conclusions. Just a small contrast—when we went through the process of selecting our fellows under my predecessor, Charlie Balch intercalated himself strongly into that process, picking people sometimes outside of what the group wanted and imposing people on the group sometimes for very political reasons. And in contrast to that, we set this up so that we— And I studied the way that Sloan-Kettering did their interview process as well. The way that Sloan-Kettering did it is they had twenty-one to twenty-four people who would come through on a Saturday morning. The entire group would be interviewed, and then there was this very stilted, New York, wine and cheese cocktail party at the end of the thing. I thought, hmm. The feedback that I’d gotten was that it was very unrelaxed. You know that old New Yorker cartoon of the New York cocktail party where there were people in tuxedos, but instead of heads they have pistols pointing at you? That type. So I went to the group and said, “Listen, I think we should do this very, very differently. I think we should invite the trainees to come down the night before, and then let our fellows take the applicants out for barbecue and then go to Amy’s Ice Cream after that. Let them just talk to these people, and if they have any questions, let’s tell the trainees just to answer as honestly as possible.” When we interviewed the applicants the next day, it’s going to be intimidating enough for these kids. We have lots of different ways of finding out if they know what they’re doing. Let’s ask them questions that are though-provoking but don’t represent threats per se. So one of the questions that I would ask an applicant was, “Tell me about yourself five years from now. Tell me what you’re doing and what are going to be the key parts of your activities.” Then they would tell me and I’d say, “Now, I want to put a little twist on that question. I want you to tell me about the things that you think might be impediments to getting there and therefore what you’re going to do to avoid those impediments so you can achieve those goals.” If someone says, “I have no idea where I’m going to be five years from now,” the chances are pretty good they’re not going to be in an academic environment, because that takes a certain commitment to that. If they tell you, “Well, it’s hard for me to think of anything that will get in my way,” that’s not the right person either because they’re probably an egomaniac and aren’t going to be able to work well and sublimate themselves in the service of a larger group, and they’re going to be competitive with the other fellows. So we’re able to sort people out but in a way that wasn’t New York City-cocktail-party-type activity. And the way that we did the roundup after all of the interviews is we split it into two Saturdays, meaning we only interviewed twelve people each time, so it was a more in-depth interview process. We assembled around a big conference table. I said, “Now, we have twelve people to go through. Everyone is going to have a chance to speak.” Everyone interviewed all the applicants. “Everyone is going to have a chance to speak about each applicant. If you don’t have anything to add beyond what has already been said, all you have to say is ‘nothing more to add,’ because we’ve got twelve people and we have forty-five minutes to go through everyone.” Then I never said anything. I said I would only comment if people asked me. And it was amazing how that process built cohesion, built a sense of trust of each other, helped reinforce the core shared values, and it didn’t have me telling people what to do. Certainly I would never think of pulling rank and saying, “We have to take this person because his boss is on the Board of Surgery. This is for political purposes.” It took that absolutely out of the mix so that everyone could see that the process had integrity, and then they could believe in it. So, that was just part of what we tried to accomplish.
Tacey Ann Rosolowski, PhD:
Running meetings and having meetings be effective is just one of the single best things that people can contribute because it can be such an amazing time waster and such a drain of energy. It makes people dread them.
Raphael Pollock, MD:
Part of it, too, was I made a commitment that any meeting that I ran would have an agenda. The agenda would be open, it would be circulated in advance, and if we didn’t have an agenda, guess what? The meeting gets cancelled. Hooray! How many times have we spent just listening to someone droning on and on, hearing self-aggrandizing and self-promoting behavior? There was no need. So the meetings were very focused.
Tacey Ann Rosolowski, PhD:
So you found that the department, when you provided guidelines for basically changing the culture of meetings or changing the culture of whatever activity that department was taking up, that you really had buy-in. People didn’t violate the rules.
Raphael Pollock, MD:
No. Well, I can tell you one of the very first meetings that we had, one of the faculty members made a very disparaging remark about the other in the meeting. It was not these two people who had that fight, parenthetically. I slammed my fist down on the table and said, “Is this the type of meeting that we want?” And I just “let it hang there” sort of pregnant, counted to ten under my breath. No one said anything. They were so shocked that I slammed my fist down on the table. I said, “I thought not. Let’s move on to the next agenda item.” And for the next fifteen years that type of comment just never surfaced in the meetings again. That wasn’t the type of meeting they wanted.
Tacey Ann Rosolowski, PhD:
Well, it’s kind of amazing that— I worked briefly—sort of violating the rule, adding my own thing—I worked briefly with a community development facilitator when I lived in Madison, Wisconsin, and the communities that worked with him, the single thing they always mentioned was how much they appreciated the guidelines for running a civil meeting. How to behave in a civil way in a meeting—everyone’s frustrated by that. So that’s great. And that’s the one place where everybody tends to come together, and that good feeling and good activity there and productivity energizes the rest of the life of the department, I’m sure.
Raphael Pollock, MD:
Yeah, very much so. And I think that learning how to take yourself with a grain of salt. I was very quick—in a meeting context, for example—if there people were turning to me to come forth with an idea about something, I would say, “Well, okay.” Or they’d say, “What do you think about this?” deliberately pulling me into this, I would usually have some idea about it. I would say it, and then quickly add the phrase that this may be a winner or it may be yet another one of Pollock’s follies. Again, you can make fun of yourself. Your word is not so critical that it’s carved in stone. This is not the Ten Commandments. And I think that communicating that you’re a flexible person and that, yes, I recognize that I ultimately have the ultimate say so, and so I’m not going to use that. We’re not going to go there. I know who I am. You know who I am. We don’t have to go there. We can get much more accomplished if we’re just like-minded individuals trying to form allegiance to each other and around common strategies and goals—things we can pursue together. That’s a very powerful idea, because I think that people, particularly if you’re in the cancer field, understand that it’s a multidisciplinary treatment, and they want to be part of something that’s bigger than themselves. I think that is a key part of what MD Anderson has been. I don’t know if it’s sustained or sustainable. I have real concerns about the administration now, where so much seems to be focusing on individual recognition and my disease is a Moon Shot and your disease is a Moon Shot and your disease is not a Moon Shot and things of that sort. I think we lost some of that. But the heart of what Anderson is about is those things, and it ultimately comes back to the patients and treating the patients well. It, again, sort of flushes this out. The Division of Surgery used to be on the tenth floor of the Clark Clinic Building, and when they built the new faculty center, we were told, “You have to move across the street to there.” The powers that be have decided and so forth. I was very upset because it was a perfect set up. We could go from the operating room, take the elevator up to our offices up on the 10th floor, all in the same building, tame the desk monster for twenty minutes, and then go back down to the operating room. I said, “Well, this is going to be very, very disruptive.” And I talked to Mendelsohn about this. He said, “Look, what can we do to ameliorate the hit?” I said, “Well, one thing, it’s not going to be the same. We’re not not going to do it, John, but here’s one thing you can do. Set up a surgeon’s lounge that has computer terminals and opportunity to dictate memos and—not a human stenographer—access to dictations and people can make PowerPoint presentations—the stuff that we would do in the office between the cases.” And he said, “Okay.” So we moved and we set that up. The two things that came out of that that were totally unanticipated, one of which was that by no longer having the escape hatch going up the elevator silo to your own private office, but being in this much larger lounge with twenty or thirty other surgeons from all different departments, for the first time, the Division of Surgery had a venue where people could actually talk to each other. That was new. So that was a plus. The other thing that it did—it was before the time that we had both the bridges. It was just the one that connected the Rotary House, so to get to the operating rooms you had to come down the elevators from the faculty tower and walk across that bridge to get to the operating rooms. So every morning, as you did that, you got to see the families of the patients eating breakfast with the new patients, and it was such a dramatic reminder of why you were there, what the day was about. Someone once told me, “Your worst day as a faculty member here at MD Anderson is better than your best day as a patient.” This is why we’re here. And I hadn’t anticipated either of those two positive benefits that far outweighed the ability to just clear twenty minutes worth of work off your desk. And so again, there’s sort of this being more open to what other people might say, and I think that takes a certain measure—even more of a measure—of self-confidence that I had when this all started out. And accruing experiences that are additive so that you come to an every-increasing understanding of the utility of that approach.
Recommended Citation
Pollock, Raphael E. MD and Rosolowski, Tacey A. PhD, "Chapter12: The Department of Surgical Oncology: Some History, Accomplishments, and Critical Evaluation" (2012). Interview Chapters. 1324.
https://openworks.mdanderson.org/mchv_interviewchapters/1324
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