Chapter 19: A Philosophy of Teaching –and Leadership
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Description
In this Chapter Dr. Pollock notes the range of situations in which he has taught and states that his philosophy of teaching is based on an informal model of mentoring. In the clinic, he explains, he finds it gratifying to demonstrate by how to build rapport and trust with a patient, how to handle difficult situations and deliver difficult news.
Dr. Pollock explains that he always gives his patients his cell phone number during a first meeting, and Dr. Pollock explains the significance of doing this for patients, and for fellows who see a physician offering support 24/7. He describes at length the importance of listening to patients and notes that this does influence the bottom line, increasing the number of patients who recommend MD Anderson as a caring institution.
As a teacher of researchers, Dr. Pollock explains that he had most impact in a support role, editing papers and teaching researchers how to express their ideas and develop skills in public speaking. He notes that he began to develop these skills while on a debate team in high school and by taking seminars as a history major in college. Dr. Pollock quotes St. Francis: “See yes to listen rather than to be listened to,” and makes the connection between his teaching philosophy and his preferred model of servant leadership.
Identifier
PollokRE_03_20121119-C19
Publication Date
11-19-2012
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, November 19, 2012
Topics Covered
The Interview Subject's Story - The EducatorThe LeaderThe MentorMentoringLeadershipEducationCharacter, Values, Beliefs, TalentsProfessional Values, Ethics, PurposeProfessional Practice The Professional at WorkPatientPatients, Treatment, SurvivorsHuman StoriesOffering Care, Compassion, HelpPatientsThis is MD AndersonInstitutional Mission and ValuesThe MD Anderson Ethos Healing, Hope, and the Promise of ResearchResearch, Care, and EducationPersonal Background
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:
I wanted to ask you, too, about teaching. It’s been a motif flowing through, but we haven’t really addressed it specifically, so maybe you could just begin by telling me about your philosophy of teaching and then maybe give me some examples from graduate school—you know—whatever you think might help understand how you approach that.
Raphael Pollock, MD:
In my thirty years at Anderson, I’ve been very, very fortunate to have the opportunity in a formal sense to teach medical students, residents, fellows, predoctoral graduate students as well as post-doctoral fellows, and in even a broader sense, teaching other faculty who come to me for help with one or another issue on a less formal basis. I suppose that the embodiment of that is a philosophy about the centrality of mentoring—how important that activity is. I have participated in formal lecture series in medical school and the graduate school and continue to do so, but the teaching that I find the most gratifying is the teaching that is less formal, where there are less barriers. So for example, every month on our surgical oncology service we have a new group of fellows who sometimes bring with a resident or a medical student, so one of the things that I do is I bring those people to my office. I have a standard talk that I’m asked to give when I go as a visiting professor to other institutions about this area that I’m interested in—sarcoma—multidisciplinary sarcoma care. So we just sit in this office and we go through the talk. It’s about a two-hour process. The talk itself is about an hour. But I ask questions of them as we go through, and I try to encourage questions of me so it’s not a lecture, it’s a conversation that is triggered by a PowerPoint presentation that we all are looking at on my computer display. That, to me, is very, very gratifying because you can see how areas of lack of knowledge are being eradicated right in front of your eyes—sort of the eureka. “Oh, that’s why they do such.” It’s very, very gratifying to see younger people coming to an understanding of why something happens. Our planning conferences on Tuesday and Thursday afternoon, where new sarcoma patients are presented to develop and articulate multidisciplinary treatment programs, is another remarkable teaching opportunity that’s very hands-on. CLIP A: The Mentor C: Mentoring C: Leadership B: Education A: Character, Values, Beliefs, Talents A: Professional Values, Ethics, Purpose C: Professional Practice C: The Professional at Work C: Patient C: Patients, Treatment, Survivors C: Human Stories C: Offering Care, Compassion, Help C: Patients C: This is MD Anderson B: Institutional Mission and Values “Modeling Patient Care”
Raphael Pollock, MD:
+ Teaching in the clinic is also a very gratifying part of what I do, and frequently it’s not just pointing out the manifestations of disease but the clinic. And to some extent rounds on inpatients is a remarkable opportunity in which to demonstrate by example how important it is to engage patients, to listen to patients, to come to how to build trust in a doctor/patient relationship, the importance of trust in that relationship, the importance of the relationship itself, and how to handle difficult situations, how to be a bearer of bad news, how to counsel someone who needs a radical surgical procedure which will change their quality of life, how to help them adjust to this new reality set point, how to do this with dignity and with respect so that the patient is not diminished, so the patient feels that they have participated in the decision. And some of these things are so straightforward that it almost boggles the imagination. I give my cell phone number to all my patients, without fail, in the first visit, and I make sure that they write it down somewhere and give it to them electronically, whatever. The impact that that has—patients knowing that they can find you if they need you and that you’re giving them permission to find you if they need you, 24/7, 365—as an example—not only the care but as an example to the trainees who are also in the room. They come away stunned because of something that apparently most people don’t do. The people who are my heroes who practiced in the era before cell phone numbers—I know Dr. Martin would have done that. There’s no question about it. It’s the right thing to do. And then do the same thing with patients who are going to see me in the clinic. If there’s more than a week delay in their getting to me, I have the clinic staff give the patients my cell phone number so at least they can call me and talk about their disease and their issues. I want to make those connections. People and students and trainees come back to me and say, “You’re a glutton for punishment. People must be calling you all the time.” I say, “No, actually not. People are very respectful of your need for downtime yourself—that you have a private life.” But it takes the worry out of the relationship. Can I find my doctor? Can I find the person who is responsible if I really, really have a problem? And so just as an educational process by doing. Other sort of little tricks of the trade—giving a patient your totally undivided attention, making that eye contact with a patient even in the middle of a busy clinic. Patients will say, “I don’t want to take much of your time,” and just telling them, eye contact, heart-to-heart, “My time is your time. If I have to work through lunch so we can have the talk that we need now, my belly can stand it.” It’s a way of engaging people that does not necessarily, unfortunately, translate to more money on the bottom line. In an ultimate sense, I think it actually does, because the word of mouth is unbelievable, particularly through the patient advocacy groups and Facebook and things like that, which has been a tremendous source of patient referral independent of the institution. Probably about half of my patients come to me from the Internet rather than through the front door of MD Anderson. I route them through the front door, but the initial contact is through the Internet. But these are important lessons for trainees to learn. And what ends up happening is that five minutes of undivided attention—and when I’m talking to the patient in that period of time, I don’t care how many times my beeper goes off, I’m not answering it—that tells something to the patient. Your concern right now is the most important thing, it occupies my total attention, and you have my total attention, and you can have as much of it as you need. It’s a very powerful message to someone that you’re going to be well cared for here. And this is how you build trust. These are not things that are taught in textbooks unfortunately. I think, in this day and age—and I’m not saying this to be self-congratulatory, because I know there’s lots of other people that practice medicine that way here as well—it’s the way that it should be because it’s the way that you’d want to be cared for or you’d want someone in your family cared for. So setting that as a positive example with the caveat to a trainee, you can learn a lot both from positive as well as negative examples as you formulate your own philosophy and approach. I also strongly believe in touch—that holding someone’s hand while you’re talking to them, particularly about bad news, enables you to add credence to the statement that at the end of the day it’s one person trying to help another person. And it’s truly amazing what people will accept if the information is brought to them with compassion and with hope, because there’s always things that can be done—always things. When you’ve run out of standard therapies there are Phase Ones. People do respond to Phase Ones. If you get a response, absolutely we will reconsider you as a surgical candidate. And I tell patients when it’s really clear that they’re moving towards the end of life, I say, “There’s two things I will promise you: You will not be in pain, and you will not be alone.” And that’s so important for patients to hear and to see and for trainees in the room to be able to witness this interaction with patients. And if I’ve been able to impact on the younger people who work with me in the clinics and see this and that they’ve been able to extract some of these lessons, then for sure this will not have been for naught. I mean, I know it’s not been for naught, but I’m just saying that of all the educational baton passing activities, to me that’s one of the most important. Shifting gears for a second, talking about training in the research arena. This is something that I have been engaged in, although probably not with the same direct impact as in the clinical arena. One of the problems in my own career is that I became chairman of surgical oncology at age forty-two, when I was still an associate professor, which is a very young age, as these things go—probably somewhere between ten to fifteen years ahead of when I would otherwise potentially have been selected for that role. And it required that I make certain choices in my career, and I really had to move, in some ways, away from the direct line of fire in the lab. I couldn’t do it in the same way and still provide the same attention that the position mandated. I was very fortunate to be supported by other people who could, in some ways, surrogate for me in that point person role in the lab that I had enjoyed up to that point, but I no longer was able to do it myself with the same passion, commitment, and knowledge. And my role, perhaps because of my writing abilities and editing abilities, in some ways changed from being the person who was providing the direct scientific corpus of knowledge—here’s how you do Western blot technique type training—to more what is the philosophy of science. How do you set up controls for experiments? And even more recently, helping younger people editing their manuscripts, editing their grants, not just in a passive copyediting way but for science, does this make sense? Then particularly helping the younger people put together their talks for national meetings and reviewing their talks with them, training them in public speaking and effective slidesmanship, if you will. Those are important academic skills—how to write and abstract by editing and working with trainees and doing that and talking the process through and then sitting with them on a Monday. “Okay, Tuesday afternoon we’re going to get together and you will make these changes and you will—” simple little things about public speaking that if you’re in a large audience and you have stage fright, pick out two people—one in the second row and one all the way in the back—make eye contact with them and just shift back and forth and back and forth. Everyone in the audience will feel like you’re talking to them. These are not things that are intuitively obvious.
Tacey Ann Rosolowski, PhD:
How did you learn them?
Raphael Pollock, MD:
I was a high school debater, and that was part of where I learned a lot about the skills and how to think on your feet and be articulate and stay on track and be focused and precise in your use of language. I had some marvelous debate coaches. We enjoyed some—at that point, when you’re a sixteen-year-old—some major successes in that arena, so that was a very gratifying thing. That, and then in graduate school, where I was a history student, writing an honors thesis and having a very scientifically weak but history top-heavy course load my last two years. Many of the courses I had were research seminars, where you were expected to write a ten-page manuscript every week for fourteen weeks. I had a seminar on the French Revolution from someone who was a genuine expert in the area. Our final exam for that entire year’s seminar, we came into this room and he had written up on the blackboard. It was a three-hour exam, and the question was, ‘The French Revolution-Discuss.’ So you really have to know how to organize your thoughts. And being able to take some of that knowledge that has been accrued, and, again, helping younger people and seeing their pleasure and excitement when they give that paper at their first big national meeting and it goes over really well because they have prepared very well for it is extremely gratifying.
Tacey Ann Rosolowski, PhD:
Well, there’s no point to creating knowledge if you can’t share it.
Raphael Pollock, MD:
That’s right.
Tacey Ann Rosolowski, PhD:
So getting students to understand, first of all, what is the pleasure of creating knowledge and then what’s the great joy of having a community suddenly that you’re sharing it with—those are two important things you can do in the classroom. So you’ve kind of shifted into more—I mean—not exactly a facilitative role but kind of a facilitative role.
Raphael Pollock, MD:
Yeah. It’s more of a facilitator role, and in terms of the Sarcoma Research Center, I have a number of very grateful patients who have been remarkable philanthropists in helping us underwrite some of the activities of the center that are not covered by the research grants, where we’ve also enjoyed a lot of success. But the grants tend to be very circumscribed in what their budgets will allow you do, both because of the amount of budget as well as the stipulations about what it can and can’t be used for. So donors have been very, very helpful to us in that regard.
Tacey Ann Rosolowski, PhD:
Is there anything else that you wanted to say about teaching?
Raphael Pollock, MD:
I don’t think so, other than that I’m so grateful that in so many different venues that I’ve had this opportunity to be a personal teacher, working with small numbers of people. I can give the big lecture, but I don’t, in some ways, enjoy it as much as the smaller group or even the one-on-one.
Tacey Ann Rosolowski, PhD:
As you were talking, I was recalling a conversation I had recently with someone in Faculty Development who was talking about how they’ve actually begun talking to junior faculty about what’s called either target mentoring or spot mentoring, because people have so little time that junior faculty have to know specifically what they need help in and go for that five-minute window when they can get advice on that one particular topic. And that’s so far away from the kind of mentoring situation you were talking about.
Raphael Pollock, MD:
Well, it’s kind of like speed dating, I suppose. The problem is that most young faculty don’t really know what they really need help with.
Tacey Ann Rosolowski, PhD:
Yeah, you don’t know what you don’t know.
Raphael Pollock, MD:
And some of it just emerges if someone can just spend a little bit of unstructured time and observe you as you go about your activities. Then they can come back and say, “How did you know to say such-and-such or ask such-and-such? What was your thought process?” Then you can sort of debrief, and that’s a great way. So I’ll tell a trainee, “This patient, we’re going to have a very difficult conversation. I want you to observe. I don’t want you to interrupt me as I’m talking to the patient. She needs my undivided attention. But I do want you to ask questions afterwards about what you’ve seen so you can extract from this whatever pearls there are to be extracted.” That works very well. It’s one of the very best things about academic medicine. Maybe it’s the best, actually, because it’s what has given me the most thrills in my life.
Tacey Ann Rosolowski, PhD:
It sounds like you’re a born teacher.
Raphael Pollock, MD:
I don’t know if it how born it was, but it— I think that a lot of it is—and this is true in so many different realms of activity, not even limited to medicine—you know—I’m Jewish, so quoting St Francis is a really good thing. St. Francis says, “Seek ye to listen rather than to be listened to,” which I think is the most powerful leadership precept of anything that I’ve ever read. I’ve read a lot of books about leadership. As soon as you are seeking to listen, you’re opening yourself up to empathy—empathizing with someone else. Can you put yourself in their shoes? Can you look through their eyes and see what the horizon looks like? Can you remember back to when you were a first-year assistant professor and it looked like there were these giants walking the earth who could crush you with a single step? Can you think about how terrified you were about taking on new things that you didn’t know how to do yet with mentorship available? Can you think about that? Are you able to still recreate that in your mind? As soon as you make the commitment to listening, you open yourself up to empathy and you open your mind up to someone else. If you’re going to be a leader, particularly if you’re going to practice servant leadership, you have to think about this from the perspective of what does someone else want to accomplish. And that includes people who may not have as much insight or experience or native talent or whatever. And Dr. Martin was masterful at that. I gave you the eulogy. One of his remarkable strengths was he could always see something special in someone else. When someone else was under assault, if you will, he was very quick to point out, yes, that may be true, but you have to keep in mind this part of this person, to the point at times of almost being self-effacing himself. But that’s remarkable. So I think that listening is really where this all comes from, and being patient. Letting someone struggle to express their idea rather than just imposing your idea if they can’t get the idea out quick enough is really important, because that ultimately builds trust. You become reliable, and that’s what so many people are looking for in this day and age. What they so often don’t find is reliability, empathy, the willingness to listen, the willingness to think about someone else’s issue selflessly. It’s very, very important. It has to be genuine because people will smell out when it’s not genuine—patients and trainees and colleagues alike. It goes with having to be able to say no when no is the right answer, but saying no in a way that doesn’t destroy someone. That’s an important skill set that, again, I think is all too often overlooked in our helter-skelter, busy, busy environments that we’re working in—taking the time to smell the roses.
Recommended Citation
Pollock, Raphael E. MD and Rosolowski, Tacey A. PhD, "Chapter 19: A Philosophy of Teaching –and Leadership" (2012). Interview Chapters. 1331.
https://openworks.mdanderson.org/mchv_interviewchapters/1331
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