Mark Edward P.
Prince, MD, FRCS(C), FACS
Charles J. Krause
MD Collegiate Professor of Otolaryngology & Chair, Department of
Otolaryngology-Head and Neck Surgery
University of
Michigan
Dr Prince, you have a very
unique career pathway with a background in the armed forces and also in
engineering. So, my question for you is why did you end up choosing medicine
and otolaryngology in particular?
On a superficial
level, it's probably an easy question to answer but in reality, it's much more
difficult! I think that both of those experiences, engineering and the Navy, taught
me something pertinent to medicine. Engineering taught me a lot about how to
think and gave me some ideas about how to approach solving a problem. That was an
important set of skills I acquired and led me to a realization, that there was
a lot that an individual could contribute through an intentional problem-solving
approach. The armed forces experience came from a desire to serve my country,
but also to make a difference in the world. The combination of my education as
an engineer and my training in the navy gave me a great foundation to build on.
So how does that
lead to medicine? Well, I don't think it naturally leads to medicine
necessarily. It could lead almost anywhere. My story about how I got to
medicine is not so unique. One factor was my older brother who entered into the
field of medicine. I think hearing from him stories about what he was learning
in medical school, combined with some of the stories my mother told me - she
was a nurse at one point in her life - made me more interested in the human
condition. Staying in Halifax in Medical School also kept me close to my
girlfriend (now wife) and medicine seemed like a great place to make a
difference and maybe to apply some of the skills that I was collecting along
the way through these other things that I'd been doing. At this point in my
life, it's really hard to know exactly what I was thinking back then. Sometimes
I wonder if it just seemed like a pretty cool thing to be doing, medicine, with
a lot of opportunity, and maybe that's not a bad reason to choose to get into
something.
I see. That's a that's a really unique way to think about
it, I think. Now, I wonder, is there something that you do not like about the
specialty or the particular field of head and neck?
I didn't really
answer the second part of your first question. I'm thinking now, why did I end
up in otolaryngology? So, I'll just reflect on that a little bit because it's
perhaps pertinent to the second question about what I don't like in
otolaryngology. I was trained as a naval officer and as an engineer. Then I
went to medical school, and I switched my career path in the Navy to a Medical Officer.
I was what they call a General Duty Medical Officer, which is essentially a
primary care physician. I also was lucky to be able to specialize in hyperbaric
and diving medicine. When my time in the Navy started to come to an end, I was
looking for other opportunities. Otolaryngology, which is something I had some
exposure to in medical school, seemed like an interesting combination of clinical
work, procedural work, and had the continuity of care, which was something I
really loved about primary care.
I think that's what drew me to Otolaryngology
- It is a very unique combination medicine and surgery with continuity of care.
There are others that are similar, but none that has the same degree of
flexibility. You can be very clinical, you can be very procedural, you can be
somewhere in between. You can look after people for years and years or you can
see them for a short period of time. Otolaryngology has an amazing ability for
you to design the practice that you want.
To answer your
next question, whether there is anything that I would change. The obvious answer
is that it'd be great if the world didn't need people like me, right? I mean,
wouldn't it be wonderful if I could expend my energy, enthusiasm and my
training doing something else? Not that I don't enjoy what I'm doing now. I
love it because I do think I help people, but it would be an amazing world
where nobody suffered from head and neck cancer.
It seems like a
fanciful or superficial answer, but it's a truthful answer. If I were to give
you something that's a little more immediate to my daily life and that of my
patients, it would be to shorten our operating room turnover time.
Yeah, absolutely. And you said
that it might sound superficial, but I have to tell you, it doesn't sound
superficial at all to me. From an epidemiology or preventive medicine
perspective, it's very deep, right? Someone getting in the OR to receive a
procedure like that is a systemic failure on so many levels, prevention-wise.
So, it's really deep.
There is a
really neat book called “Upstream: The Quest to Solve Problems Before They
Happen”, by Dan Heath. The book really reminds us about how we should be
thinking about solving problems. In the United States, Canada and many other
places in the world, we are very good at spending a huge amount of effort and
energy to solve a problem when it becomes visible. Which is fabulous in one
sense; if we spent the same amount of energy effort upstream from where the
problem occurred, we might create even more remarkable results though.
I'll give you a non-head
neck cancer example: type 2 diabetes. We're inventing wonderful drugs, which
help people with their type 2 diabetes. I think that's incredibly valuable-
it’s really amazing that we have developed these remarkable new treatments and
we should keep doing that. At the same time, we should also think about providing
better nutrition, opportunities for people to get exercise, education and eradicating
inequities regarding nutrition and access to health care for less privileged
groups. That approach would also have an incredible impact on type 2 diabetes.
But it's a very different way of solving the problem than our typical approach.
It’s an approach to preventing the problem from occurring. Much harder to do, I
think, because sometimes the interventions required to solve the problem
upstream seem abstract ideas whereas once you see Type 2 diabetes develop it is
a concrete problem. How are you going to get fresh fruit and vegetables into an
inner city? I mean, that seems a lot more difficult than treating somebody with
type 2 diabetes with a new drug.
And it can probably have a
greater impact, like you said, than fixing the problem at the point that it
becomes really obvious. Now, I had the question actually here about how your
previous experiences and background affected your career and your leadership
style, but I think you have told me a lot about that already.
Let me tell you
one more thing. I think a lot of people have misconceptions about how the armed
forces and leadership work. I suspect that many people think that you get a
rank and then you can just tell people what to do, and they run off and do it.
That's really not how it works, though! I think the armed forces give really
great leadership training. The training focuses on educating you about how to
effectively work with teams, and how to give responsibility and authority at
the right level so that people are ready and able to make decisions. In the Armed
Forces, and in medicine, we need to train people to do their job at the highest
level possible and then give them the authority and the responsibility to make
decisions.
A leader in the Armed
forces must be a great manager of people. They have to be able to identify
strengths and weaknesses and work on those with the individuals they lead. In a
very real way, the goal is to develop each individuals’ skills to the highest
level possible. That's not hierarchical, that's no just telling somebody to do
something. The team must trust and respect each other enough to do whatever
they're asked to do. That trust is not easy to develop, right? That's not just
wearing a rank on your shoulder that does that. To be a good leader you have constantly
work to achieve the best for every member of your team. I am not saying you have to join the armed
forces to learn how to be a good leader. But people often ask me “How did being
in the Navy made you a good leader? You just wear a rank, and you tell people
what to do”. The answer is the Armed Forces has a focus on individual growth
and teamwork that works very well in most circumstances. Importantly they do
not think that excellent leadership skills come with a rank and the invest in
developing those skills.
In my mind, at least, what
you're describing is a very progressive leadership style. And it's really
important that you explained how the Navy background led to that. I can
definitely see that now. And it's good that we are having this in medicine as
well today, at least in some places! Now, moving back to the Department, it is
consistently ranked among the top in the country every year, maybe for decades.
What did you do, personally and as a team in general, to first achieve, and
then retain this distinction?
Well, the two
questions are very much linked, because the first thing that comes to mind is
the culture that is present, not just in my department, but at the University
of Michigan, in general. That culture is a culture of great generosity and
collaboration. I think that people here really are interested in success as it
relates to the team and the members of the team, not solely individual success.
The generosity piece refers to the fact that I've seen people here sharing all
kinds of information, knowledge, new techniques, and even new thoughts that
they have, about how to solve current problems or future problems. People here
are willing to do that, because they recruit a lot of really good people,
decent people who want to do the best, but also because the success of the team
is seen as at least equal, if not more important than the success of any one
individual.
I think our department
reflects that culture, perhaps at a level that's even a little bit higher than
the general level at Michigan. We don't measure value just on the amount of
money somebody makes in their clinic or the number of R01s that somebody has in
their lab, or the number of papers written. We believe that our people all
bring value in many different ways to the department, and we believe that everybody
comes here, with the intention of trying to do their best and to make things
work.
Culture is
really something that makes Michigan unique. I have benefited from that culture!
If you look at my CV and the things that I've done, I've been fortunate to be
in a place that's been so supportive and with people who've really helped me achieve
the things that I have done with the members of my team.
Now as far as
what have I done to retain this distinction for our department- what I have
done really is what prior Chairs have done: tried to sustain and grow the best culture.
We focus a lot on our culture here. We have a 360-degree evaluation around the
values that our department has: civility, inclusion, engagement,
accountability. We're asking people to evaluate each other and to judge their
performance simply based on how they adhere to those values and demonstrate
those values. It's part of our effort to have not only the most inclusive
environment possible, but also one that's very supportive and behaves in the
right way in every situation.
Thank you! My next question is
somewhat related to this one. And it is about what makes a good surgeon. What
makes a good surgeon? Is it talent or is it character that's most important in
your opinion?
A lot of times students will ask
me “what are you looking for in a in a resident” or, faculty members might ask
me “what are you looking for in a faculty member?”. My answer is that what
makes a good surgeon is the same things that make a good person. What makes a
good surgeon is the same thing that makes a decent person, somebody that is
always going to try to do their best and do the best for the people around
them, whether that's for patients or other members of their team or whomever.
My dad used to
like to use the word decent. I think what he meant by that, was just to treat
people the very best way you can. One of the really important factors to being
a decent person is not being afraid to say, “I don't know” or “somebody else
does it better than me” or “I need help”. I believe that to be a really good
surgeon, you need to have the humility to say those things. They're often true
and if you can't ask for help or you can't send a patient to somebody else that,
does it better than you or is more experienced, then you're probably not going
to be the very best surgeon you can be.
Is it character
or talent? I think, having trained a lot of residents and worked with a lot of
medical students, most people can be trained to be technically good surgeons.
It's a technical skill! There are some people that may have issues that make it
difficult for them to acquire those skills, but even those individuals in the
right environment can acquire them. So, to me, the technical aspects of being a
surgeon, which is where talent can often make surgery look easier are not as
important as the character. I really do think having the right approach to
patient care and working with others is the really critical piece to being a
great surgeon.
I see. Now, you obviously you
have trained a lot of residents, and you said that you get asked a lot what are
you looking for in a resident? My question will be slightly different. What is
the difference between a good and a great resident?
I think, Jason,
a lot of what makes a good resident is what I just reflected on. That, the
resident who is really committed to always doing the right thing in every
aspect of their training is going to be a great resident and doctor. When I say
doing the right thing, I mean, for example that if you don't know something, you
won’t be afraid to say so and you'll go and learn it. I believe that the drive
to always do the very best, and do the right thing, that leads to a lot of
wonderful things. Because you'll never take on something you shouldn't. You're
never going to not keep up with your continuing education. You're never going to
treat people poorly. We all make mistakes, and we do things that we regret, but
if ultimately, your goal is to really try to do the right thing, you'll fix
those things as well. And you will apologize and do whatever else needs to be
done to fix things. We spend a lot of time trying to identify the students that
have this quality in them.
Thank you! Now, I can't avoid
asking you about research- you're doing cancer stem cell research, which is
honestly amazing, and you have produced an incredible amount of work in this
field. How and when did research become a part of your career? We talked about engineering,
and we talked about your career in the Army before. But when did you start
becoming interested in research as well?
Not until quite
late, I’d say. In medical school we were asked to do some projects and not
necessarily publish. I can't say that I was particularly interested in doing
something very novel or very innovative and committing a lot of time to that. I
was mostly focused on learning how to be a good doctor.
Interestingly, a
couple of things happened once I started working as a General Duty Medical
Officer and in hyperbaric medicine. I became aware that there was a lot of
opportunity in diving medicine for advancement and new learning, and that got
me interested in reading a little bit more of the literature and really trying
to understand some of the science behind hyperbaric medicine.
I was fortunate
I had a chance to go to the Defense and Civil Institute of Environmental
Medicine, in Toronto where some really cool stuff is being done in aerospace
and diving medicine. I didn't actually start doing anything then, but when I
joined my Otolaryngology training program in Halifax, at Dalhousie University I
was interested in trying to do learn something about research and doing
something unique. I was very fortunate to run into one of my very first
research mentors, Joseph Nasser. Dr Nasser, was interested in craniofacial
growth and development. I won't go into the details of the project, but I spent
a significant part of my time as a resident -all fitted in around clinical work
because we didn't have a research block- doing some basic research.
When I finished
my residency, I came to Michigan for my fellowship. And I was very lucky there
to bump into Dr Tom Carey, who's quite well known in the field of head neck
cancer. He had some really interesting perspectives on biology and how it might
affect response to cancer treatment. So, I ended up dabbling in his lab. He was
very generous, and I learned about basic science research from him. That
experience in Michigan really made me very excited about biology, cancer, and
basic science research. In retrospect it wasn't so purposeful- it was just an
opportunity that came up that I took advantage of. Then there was some
intentionality on my part about learning more about it and getting engaged. That
led to an interest in cancer research. That's how it started: with me as a
resident with a mentor who was very excited about science and then a
fellowship, that gave me some opportunity to learn a lot more.
I know you have at least some
ongoing research projects, if I'm not mistaken. How are you able to balance
your clinical and admin duties today, along with your research projects?
Well, first of
all, I don't balance them in the sense that they're not equal! The amount of
effort that I have put into different things throughout my whole career has
varied depending upon the needs of whatever was going on, the amount of time I
had, and what was happening in my personal life. So, I manage them by working
hard, and by being intentional about understanding how much effort I can apply
to various things. Then the part that's great fun and makes it all possible is engaging
with great colleagues, collaborators and teammates so you don't have to do it
all yourself! I think that anybody that feels that they do it all themselves is
probably misguided. For me, I've been very intentional through my life, to make
sure that I that I'm a great team member and work hard as part of a team.
There are times
when the rest of the team is focusing a lot more on the lab. Right now, a
couple of my partners do all of that, while I'm spending a lot of time running
the Department and trying to continue my clinical practice. It's really the
team that will allow you to do a tremendous amount, much more than you could
ever do on your own. Developing meaningful relationships, where you share the
triumphs and sometimes the failures is what leads to success!
My final question is a more personal one. How would you -as
an academic surgeon- would like to be remembered? What would you like to be
remembered for?
For me, it's a very simple question
to answer. If a few people thought that Mark Prince did his best to help others,
and it made a difference to them then I would be very happy with that. If more
than a few were able to say that, I'd be ecstatic!
Thank you for sharing these, Dr Prince!
No comments:
Post a Comment