I arrived back from my week away just in time to attend the fifth annual Donald D. Trunkey Lecture this morning, held as part of the OHSU Dept. of Surgery's Grand Rounds. The yearly Trunkey lecture is dedicated to the "history and humanities of surgery," and this morning's talk was a fine example of that strain of scholarship.
Dr. Haile Debas, currently executive director of Global Health Sciences at UCSF, presented his talk on "The influence of surgery in the 21st century." Department chair John Hunter, M.D., outlined some of the similarities between Trunkey and Debas in his introduction, which include not only year of birth (1937) but distinguished careers at UCSF and even time spent here at the Medical School. Debas confessed that he had spent the summer between his second and third years of medical school in Portland, partly at UOMS and partly at St. Vincent Hospital; from that experience, Debas told the audience, he "knew that God lives here."
Debas began by noting that while surgery is one of the oldest professions in the world, it -- like another of the "oldest professions" -- got very little respect for most of its history. It has only been in the last century that surgeons have gained prominence as skilled practitioners of the healing arts; Debas went on to share his thoughts on how surgery can build on its past success and maintain its influence in the coming century.
Key to maintaining surgery's prominent place in medicine is education of medical students, who, according to Debas, should be introduced to surgery in the preclinical years (years 1 and 2 of medical school), before they are told that surgery is difficult and uninteresting. Debas believes that the younger students would be more receptive to the notion that "the definitive treatment is surgical treatment," and that more would be recruited into the field. Surgery must also become more flexible, Debas noted, so that women, among others, would be more willing to commit to surgical careers.
While surgical leaders have, to date, generally been chosen according to the Peter Principle, Debas urged the audience to consider proactive and structured development of the surgical leaders of tomorrow. Those leaders should focus on maintaining surgery's strengths in robotics and digital imaging technologies; leverage the new developments in stem cell and regenerative medicine; and pioneer new advances in tissue engineering. These efforts will require interdisciplinary collaborations and team-based approaches, which surgeons should embrace and foster.
Debas' main interest, however, lies in surgery's role in global health initiatives. Emphasizing that surgery is a public health strategy, Debas outlined four areas in which surgery must contribute to global health: treatment of injuries (trauma), obstetrics, emergency medicine, and major types of elective surgeries (such as cataract surgery). The "unprecedented" groundswell of interest in global health is coming from students, residents, and established faculty alike, who see it as a major trend in healthcare. Medical education in developing countries, medical tourism, and impending global conflicts over the effects of global warming are all major components of the global health movements in American medicine.
Here at OHSU, the Global Health Alliance is a student group that focuses on global health equity. Much of the philosophy and ethic behind this current interest in global health recalls an earlier era of medicine, especially the international efforts of Dr. Esther Pohl Lovejoy and her colleagues in progressive Portland and across the world to establish institutions and organizations dedicated to universal health care and global health equity. Many of Lovejoy's writings continue to resonate today; let us hope that the renewed spirit of cooperation is as persistent as the written word.