Chairman's Corner

Spring 2018

While activity on the Stanford campus begins to wind down in preparation for the lull of the summer months, at our Department, late spring is a time for reflection, renewal, and transition. In a few short weeks, I will once again bid farewell and good luck to our graduating residents, and reflect on the accomplishments of our faculty over the past academic year.

Our graduating residents, Dr. Linda Xu and Dr. Kai Miller, are preparing for their new adventures. Both accomplished students and excellent surgeons, Dr. Xu will join the team at Allegheny General Hospital in Pittsburgh as an attending neurosurgeon and the director of Brain Tumor Research, and Dr. Miller will travel to Utrecht University Medical Center in The Netherlands to complete his Van Wagenen Fellowship. I wish them both the best in their future endeavors. At the same time, I welcome a new cohort of trainees to our Program. Our new first-year residents – Dr. Adela Wu from Johns Hopkins, Dr. Ryan Jamiolkowski from University of Pennsylvania, and Dr. Dan Herrick from Tufts University -  will each add their unique interests and perspectives to what is an already talented group of residents. Our Residency Program continues to recruit the best and brightest, and I am looking forward to another year of teaching and mentoring our trainees.

The past academic year has also been filled with many faculty and resident accolades, from large grants for stem cell and head injury research, travel fellowships and research awards for our residents, faculty promotions that made history, to the many recognitions of our faculty’s research and clinical work by outside institutions and governing bodies, we all have much to be proud of. Despite the hectic and transitional feel of the end of the academic year, I hope you all also have a chance to enjoy the mild spring weather as you reflect on your past accomplishments and the many new adventures that await you.  

Physician Burnout

For 40 years, I survived on very little sleep. And it was just survival, no one thrives on four hours of sleep a night. As I was going through training and became a practicing surgeon, the general thinking was that sacrificing one’s own basic needs – sleep and rest, proper nutrition and exercise – was what good surgeons did to commit fully to the profession. But attitudes about self-care and wellness, especially for physicians are changing quickly, for the better.

Nationally, physician burnout has reached an all-time high. Over the past decade, national surveys indicate doctors suffering from emotional exhaustion, loss of meaning in their work, or a sense of ineffectiveness and lack of engagement with patients, affects more than 50% of those surveyed. This trend is bad for doctors and it’s bad for patients. At Stanford, leadership took notice of these trends and in response, implemented the WellMD Center, and became the first academic medical center in the country to hire a Chief Physician Wellness Officer.

In our own department, we want to ensure our residents and faculty feel supported and are encouraged to take good care of themselves too. We do our best to create a balanced on-call schedule that provides enough nights and weekends off for each surgeon to have time with family or for activities outside of work. We encourage our faculty to take time to travel or pursue educational and research efforts that expand their skill set, but also contribute to higher levels of engagement in their work. We provide individualized mentorship, and even offer regular Pilates classes for our residents. Our efforts are working. In the latest Stanford physician wellness survey, our Department reported a 25% burnout rate, as compared to 49% reported across neurosurgery departments nationally. In addition, our neurosurgeons reported a 35% professional fulfillment rate, as compared to only 18% nationally, and we ranked second highest in that category among Stanford School of Medicine departments.  

I’d like to see our Department’s burnout rates continue to decline, and our fulfillment rates continue to improve. But saying that I support these efforts isn’t enough. I’ve taken serious steps over the past year to change my own lifestyle. I now insist on 7-8 hours of sleep per night. I’m exercising more regularly, and making more nutritious food choices. Despite having spent most of my career neglecting in some ways my own wellness, being in a leadership position means I can teach others not to make mistakes I made. I want to set the example for the next generation of surgeons that taking care of one’s self doesn’t have to come at the cost of professional success. In fact, according to the data, and my personal experience, when doctors are well rested and enjoy their work, they end up taking far better care of their patients. We don’t want doctors who are just surviving; we want doctors who are thriving in all aspects of their lives. Their wellness is the key to our patients’ wellness and to fostering a leading neurosurgical program.

Rare Disease Day

What makes Stanford unique isn’t just its beautiful and sunny campus, or its proximity to Silicon Valley, it’s also our faculty’s commitment to tackle the most complicated, unusual or mysterious medical cases, and their determination to find solutions. Sometimes this means developing treatments and cures, but more often it entails years of spreading awareness, engaging the community, and affecting policy changes, in hopes of expanding resources for some of the rarest conditions. When I first became a neurosurgeon, I did not think that much of my career would be spent treating patients with a rare disease. While we didn’t know as much as we know now about the nervous system, and more specifically diseases that affect the nervous system and how to treat them, I certainly didn’t imagine a rare disease like Moyamoya would be central to my research and clinical care. But, it turns out, rare diseases affect many of us, not just those of us in healthcare.

According to the NIH, there are approximately 7,000 identified rare diseases in the U.S., defined as a disease affecting less than 200,000 people. While individual rare diseases affect small portions of the population, the combined total of people living with a rare disease in the United States is estimated at 25-30 million. So, it seems a fair assumption that at some point in your life you, or someone you know, will face dealing with a rare disease, and will likely find that little information is available and that few medical centers treat it.

One of the greatest problems with rare diseases is that there is so little awareness and education about them, that even specialists do not identify their symptoms right away, or sometimes they remain undiagnosed or untreated all-together. At Stanford, everything we do is based on a drive to discover answers, particularly for those with the most complex or rare disorders. In addition to my research in Moyamoya, many of our faculty focus their research and clinical efforts on rare diseases. For example, Dr. Gerald Grant is collaborating with experts at Nicklaus Children’s Hospital in Miami to conduct a trial using focused ultrasound for children with tuberous sclerosis, a rare genetic disease that causes tumors throughout the body. Several of our specialists across the Stanford campus are joining forces to create a comprehensive skull base surgery program that pioneers the least invasive, most effective treatments for rare disorders such as adenoid cystic carcinoma. In our new Neurosurgical Anatomy Lab, veteran surgeons are teaching residents how to perform complicated and nuanced surgical procedures for treatment of rare aneurysms. Next month, Dr. Steven Chang is hosting Stanford’s first Facial Pain Association Conference, aimed at bringing together clinical experts and patients to develop new solutions for those affected by the rare and painful disease, Trigeminal Neuralgia.

Many of our patients come to us because they have a rare disease and so few other places have answers for them. World Rare Disease Day is recognized just once a year, but in my line of work, we think about rare diseases every day, and we’re working hard to ensure all patients, no matter how rare their neurological disease, can find answers and therapies that will extend and improve their lives.

Happy New Year

I’m incredibly proud of our department’s accomplishments over the past year, and am confident the work we are doing continues to improve the quality of our patients’ lives.

In 2017 we welcomed four new faculty to the department, including two translational scientists, a new pediatric neurosurgeon, and a peripheral nerve surgical specialist. Our scientists and surgeons continued to push the boundaries of translational research and refining surgical techniques; integrating pioneering use of robotics in surgery, implementing the use of virtual reality in the operating room, and publishing results from a wide variety of studies focused on everything from epilepsy to brain tumors.

This past year our team worked with California legislatures to pass a new resolution declaring May 6 Moyamoya Awareness Day in California, an important step in spreading awareness for this relatively unknown disease. We also saw a renewed public interest in, and a great deal of media coverage about our stem cell therapy for stroke studies - culminating in a special ceremony where I was honored by the Smithsonian Institution with their Annual American Ingenuity Award for Life Sciences. I was surprised and humbled by the recognition!

I’m pleased to kick off the new year with the launch of our Department’s first e-newsletter, which will provide insights and the latest news to anyone interested in staying up-to-date with our Department. I am also looking forward to continuing to expand our department in 2018 with the hiring of new faculty specializing in skull base and pituitary tumors, complex spine surgery, and stem cell research. I’m eager to see what new scientific discoveries and clinical advances our researchers and clinicians will develop in the coming year, and am looking forward to sharing many more of our upcoming achievements with all of you. Happy New Year!