Daniel G. Deschler, MD, FACS
Professor and Vice-Chair
for Academic Affairs,
Department of
Otolaryngology- Head and Neck Surgery,
Massachusetts Eye
and Ear Infirmary,
Harvard Medical
School
Dr. Deschler
received his BA at Creighton University and received an Honors degree in
Medicine from Harvard Medical School. After concluding his Otolaryngology-Head
and Neck Surgery residency at the University of California, San Francisco, he
then completed an advanced fellowship in head and neck surgical oncology and
microvascular reconstruction with Richard Hayden, MD in 1996. Dr. Deschler
joined the Staff of the Massachusetts Eye and Ear Infirmary in 2000 and is
currently a Professor of Otolaryngology-Head and Neck Surgery at Harvard
Medical School and he is honored to be the Inaugural Dr. Eugene N. and Barbara
L. Myers Chair in Head and Neck Surgery at the Mass Eye and Ear. He and his
wife, Eileen Reynolds, MD are the Faculty Deans for Leverett House at Harvard
University.
He has authored
over 240 peer-reviewed publications, as well as numerous books, book chapters
and education reviews. He serves on the editorial boards of the Annals of
Otology, Rhinology and Laryngology, Head & Neck. Laryngoscope and UpToDate.
He has served as the Otolaryngology Section Editor for UpToDate since 2002 and
chairs the Thesis Committee of.
Triological Society. Dr. Deschler's
clinical interests cover the breadth of head and neck oncologic and
reconstructive surgery including advanced malignancies of the upper
aerodigestive tract, salivary gland diseases, microvascular reconstruction and
general head and neck reconstruction. His research interests overlap the
breadth of these areas including speech following pharyngeal/Laryngeal surgery
and reconstruction as well as management issues in the treatment of advanced
head and neck malignancies
Jason Tasoulas: Dr Deschler, I
recently read a bit about your story and was truly fascinated. I understand you
grew up in rural Illinois before becoming one of the world’s most accomplished
surgeons. I would love to hear more about your journey, if you’d be willing to
share some of it.
Daniel Deschler: I grew up in a
small town in Illinois. Neither of my parents went to college. My dad left home
when he was 17 and joined the army. My mom grew up in post-World War 2 Germany.
She actually met my dad when he was in the service, and they moved to the
States when my mom was 20 and I was born shortly after. I have a brother who's
8 years younger than me, and I had a really wonderful family. My parents really
valued education and what it could do for you.
So then I went to a Catholic High School and then I went to a Jesuit University in Omaha, Nebraska, and I really made some great friends there, and it allowed me a lot of time to grow as a person and explore whether I could do medicine and whether I might like it. And I really had a great 4 years there, and part of that time I went away, and spent 6 months studying in Vienna, at a time when people rarely studied abroad.
Jason
Tasoulas:
And you studied theater, if I'm not mistaken?
Daniel Deschler: I did! I was lucky that I did well in the sciences, and so that then gave me a lot of freedom about what I could do in college. So I was a history major and I did a part of that while I was studying in Vienna. I did a lot of theater but, because it wass a Jesuit university and has professional schools, including a medical school, if I wanted to take anatomy I went over to the Nursing School, and I took human anatomy rather than having to be in the biology department and do cat anatomy. And then, when I did Physiology, I did it through the Pharmacy School. I did Biochem through the graduate school. So it really gave me this great opportunity to get everything I needed done to graduate, but also take advantage of all the stuff that you can do at a really nice university. And like I said I made some great friends.
My family was supportive, and on a whim, I applied to Harvard Medical School. I got in, and that's what really changed things for me. Because when I came to Boston, all I wanted to do was go to medical school to be a doctor and take care of people, and I thought that that was cool.I was thinking that that was just going to be good enough for me. And then I saw what people were doing with medicine while doing that, and the way that they looked at questions and asked questions about everything. And it just forever changed the way I looked at this wonderful trade, medicine!
It let me evolve in a way that I get to do
both. I get to be someone's doctor and be an important part of their life and
let them be part of my life. And then yet I also get to teach, and answer these
questions, and advance the field and learn all the time. So that was really a
seminal thing for me.
I also
met my wife in the 1st week of medical school, and we dated all through
medical school, and we were engaged just before the match. I met my best friend
and my life partner! So you really can't ask for more from the medical school
than that- I don't think it was designed to be a dating service, but it worked
out for me! That's my pathway. And I've always just been really fortunate to
have good friends, have the supports, but also, push things and enjoy things.
Jason Tasoulas: That's
incredible. I'm impressed by the fact that several things that I was hoping to
touch upon during this interview you've already mentioned here! It’s very
fascinating to learn about your journey. To get there I'm sure that required a
lot of perseverance and persistence, and a lot of effort. So, I'm curious to
understand what kept you motivated during this journey.
Daniel Deschler: I think that I never really lacked motivation, because, there were always people around me who were doing it better, and doing more of it than I was at that time, and so they provided roadmaps of what the pathway would be if I chose to engage in that. And it's not that everybody needs to engage at one level- the ultimate level. If you wish to, then you're volitional about that. And it means that, for one thing, you need to practice. You just don't learn to tie well by only tying in the OR on the days you operate. You tie a thousand knots, so that when you're asked to tie one perfectly, you can. and that knot matters to that person at that time. And so, you watch your chief residents or senior residents who really are doing it well. And you're like, “What is it that they're doing that I want to do?”, and then you watch the ones that aren't doing it so well, and you say “Hey, how do I make sure that I don't fall into that trap” and “How do I do it better than that?”. Not that they're bad, but I want to do it better than that. What are the things to do? And then you expose yourself to great people out there, and let them teach you, and learn from them. “Steal” little things from them. If you watch one talk and you remember something in an operation 5 years later, it can let you make a difference in someone's life - what a great moment that is.
So I never really lacked motivation in it.
And I still think that I'm getting better at things. You know I've probably
done well over 2,000 parotidectomies, and I still feel like I'm getting better
at it. I still feel like I'm doing things that I couldn't have done 5 years
prior. That's really an exciting part of life.
Jason Tasoulas: I remember when
you published on your first 1000 parotids, several years back. That was already
an impressive number. It's now double! So that's even more impressive,
obviously!
Daniel Deschler: Well, the thing
about that paper is not that one guy did a lot of parotids. The thing about
that paper, the reason I wanted it out is that it controlled a major variable.
You had one person who does it the same way with the same set of standards. So if
you apply that methodology and that standard, then you can glean meaningful
data from that. You take out a key variable of different practitioners,
different times, and different things like that. So you know that paper to me
said that you can do these operations with residents and trainees, and you
don't have to be slow, and you don't have to sacrifice quality because every
one of those operations was done with a fellow or a resident. That's what that
paper is about to me. That's where this part of life is fun, because you can
start to apply all the things you've learned over time.
Jason
Tasoulas:
Dr. Deschler, what distinguishes a good from a great surgeon? What makes a
great surgeon for you?
Daniel Deschler: I think that a great surgeon is someone who knows when to operate and when not to operate and then knows how to operate and how not to operate. Someone who is always motivated by the central core tenet ofsurgery, which is to benefit a person in a time of need. And , if you have people like that, then by the sheer force of that mission, they acquire the technical skill to do that. Or if they don't specifically have it, they surround themselves with people who can do that. And I think that that's what really makes a great surgeon.
Technically, in my career, I probably
operated with, maybe 5 people that I thought were outstanding technical
surgeons. Two of them were in general surgery when I was an intern, and then
the others were in otolaryngology. They were exceedingly skilled, technically,
which was great to watch. I greatly
revered them, because of their ability to know when and when not to operate.
Not only how to take a patient through a procedure technically, but also take
them through it before and after because I think that's just as important.
Jason
Tasoulas:
Thank you for sharing that. I think it's a very unique perspective.
Daniel Deschler: This is the surgeon
part of it. And then you blend that with “what makes a great academic surgeon”,
and that's the person who's then able to take that component of being a great
surgeon, and blend that with asking questions, constantly doing it in a
critical manner, and doing it with the intent of moving the profession forward.
Jason Tasoulas: You make me
wonder if I already shared my questions with you, without me remembering!
Because my next question says “you have a legacy of training many excellent
surgeons and surgeon scientists. How does one become a surgeon, scientist? And
what should they do during residency, fellowship, and junior faculty years of
their career?”. You obviously already touched upon that, but I'm wondering if
you have more thoughts about this.
Daniel Deschler: I think that the key to being a great surgeon scientist is always being curious. You should always be asking questions. But you're marrying that with the discipline of how to evaluate and explore, and then also sharing the message. That involves seeing how people answer questions around you, looking at the machinery for answering questions and then doing it. So you need to do it from the beginning. Not just tell someone to do it. And I think that sometimes there's a gap in that.I think you need to know the all the steps in the production line. And that means you write a lot. The only way you get better at writing is by writing. I think some people bristle at that, but I think it's really important. And I've shared this with other people: I don't love to write, I don't! But I knew that in order to be impactful in this I needed to learn how to write, and then how to write efficiently, how to write well, how to advise other people how to write, and then from that how to edit. And those are all things. I think I do well now, but I do well, because I've done a lot of it!
I was the Associate Editor for the White Journal for head and neck surgery for over 8 years, and that made me good at that. Then I got this position with Up-To-Date. And so I've been an Associate Editor with Up-To-Date for over 20 years, and that taught me how to produce work for generalists, which my wife was very helpful with as an academic general medicine person. It also taught me how to teach other people how to write for generalists.
It's funny- I would ask people to write a piece for Up-To-Date, and and then they need to revise it, and they would bristle a little bit by the added work. And I would say to them “do you understand that in a given year 50,000 people will read your Up-To-Date chapter, and maybe 50 will read anything else you've ever written in otolaryngology? Your moment of impact is huge in that setting”. And sothat's a learning curve, too.
I think when you're a mentor for those
people you have to be very specific about what your expectations are and what
their expectations are. You need to know where they are on the curve of writing:
with a resident, you're at one level, with a fellow you're at another. You
really should set up goals and timelines. Then when you edit work, you need to explain
why you're doing it. You explain other ways of coming at the question. Little
things you can do. You demonstrate that every time your name's on a paper, there
has to be a reason your name is on that paper, right?
Jason Tasoulas: I think this is
a rare breed of people that would always review, always read, always provide
feedback. And it makes a big difference for someone that is on the other side
of this.
Daniel Deschler: It makes a huge difference. And you're going to do this, you'll do more and more of this, and then you'll start reviewing for journals, and then you'll have a lot of journals that'll ask you, and then you'll sort of find the ones that you do the most work for. It's okay to concentrate on those. Then, when you do that, those people at that journal will notice your work, and then they'll ask you to be on their editorial board, and then from there you'll develop that relationship, and then they may ask you to be an associate editor. But you can't do that for every journal right?
And because you do it for, let's say, Oral Oncology, it doesn't mean you never review for Laryngoscope again. But you just have to be consistent about your workload and how you balance that. That's the pathway.
But the biggest thing I tell folks is it
takes time, so don't be impatient! Do good work, do it for the right reason,
and it will be recognized, and that is how you can then be in a position to
make a difference. If people shoot too fast, too quickly, then the foundational
stuff isn't there, and things can go awry. But you have time! So it will all
come together.
Jason Tasoulas: This is really
great advice! You have held several leadership positions. You talked about your
editorial roles. But obviously you also had leadership roles at Harvard Medical
School, Harvard College, and AHNS to name a few. What are you looking for when
you're either hiring someone on different levels, or when you're starting to
collaborate with someone. What are some qualities that you're looking for?
Daniel Deschler: I think a way to
approach this is to say, you're building a team to succeed at a certain
project, whether it be the international meeting, or whether it be a division,
or whether it'd be a specific project within a organization like the Thesis
Committee for the Triological Society. You really want to look for people that
you think share the same goals, and will be on board with the mission of what
you're looking to do. You need to be able to clearly articulate that mission so
that people don’t wonder why they're doing something.
I think you really need to connect them to the product, connect them into the success of the entity when it happens, for it to continue to succeed. You need to have people connected to that, building success as it goes forward, so they can have the positive reinforcement of putting in the time, because many of these are voluntary. I look for people who are honest, curious, passionate, who aren't afraid of hard work. I think that there's nothing wrong with working hard and doing something good with that. I don't think you're a fool or being taken advantage of, or anything like that. I think that most success is built on hard work, and if you look at anyone out there that you probably interviewed, like Bob Ferris, worked extremely hard and he still does. Look at Greg Farwell, another really hardworking person. But they were able to build teams around them, build consensus, and then carry those teams to success by listening to them, building upon their strengths. I don't even think leadership is the word- I think that what they provided was guidance, so that people can be in their best position to succeed. And you know that's really rewarding when that happens!
Jason Tasoulas: It's been a
while since I did my interview with Dr. Ferris, but I remember he was still
back at Pitt, he wasn't at UNC yet. And I asked him at the time “How do you do all
three? You have a very successful lab. You're very busy there. You have a
leadership role at the cancer center, and you're also clinically active. How do
you do that?”. And he told me, and I still remember to this day “I'm 75%
clinical and I'm 75% research”.
Daniel Deschler: Exactly! I've
never had an academic day in my entire career. So I think what Bob is saying is
that you just blend these 2 entities. It's not that you're working twice as
much as everybody else, it’s that you're working on both things at a high level
and that they're inextricably bound. They're woven together like threads that
go this way, and threads that go that way: you need them both to have the
fabric, And Bob is amazingly successful at combining these.
Jason Tasoulas: And would you
say that those qualities that you described earlier apply to clinical work as
well?
Daniel Deschler: Yes, I think
that excellence is not an accident.. It
doesn't just happen. It happens because you are committed to it. If you have
some special skill, that's great, but that's not going to carry you for the
whole thing. Just because you're a little more manually dexterous, that's not
the thing. The decision of where to put the stitch, or when to put the stitch
is much more important than putting the stitch. And so I think that whether
you're in the OR, or sitting at a lab meeting, you just have the same
standards.
Now that can be really challenging to the people
around you, right? Because maybe some tasks don't need to be at that high
level. But this is what you are like- you
can't deliver at a lesser level. And so that's where I find that I have to
learn about my environment and say “Okay, you know, people are trying, and it's gonna be fine, we're
gonna do this right”.
You would much rather have somebody who
feels like they are functioning well,
than somebody who feels like they're failing, because you're never going to get
them to move forward. It's unfair to them to make them feel like that. So I
think that's the thing that it took time to for me to learn, and I and I'm
still learning, but it's very rewarding when it works out.
Jason Tasoulas: Thank you for
sharing that. So MEEI, near is obviously a very special place for
otolaryngology. It has been the driving force for many of the advances in our
field, and even the people that went on and created other legacy departments
are somehow related to MEEI. My question is what makes it unique for you.
Daniel Deschler: The thing that I
like the most about it is that it reminds me of being in a small town. When I
have a patient comes in from Maine, and they've driven 4 hours, and they have
something bad, and they need an FNA, and maybe a scan - I can walk to radiology,
or I can make a phone call and they can fit them in. If one of my patients comes
in and they've got a sinus issue that now needs to be addressed, I walk down 2
flights of stairs to the sinus clinic, and I say “Hey, I got this guy. He's got
this this and this. Could you see him to take care of his new sinus issue?”. That
means a lot to that person at that time. And that also allows you to connect
people to the core mission at key moments. So if somebody does a favor and does
an FNA for me, I can thank them, but I can also tell them how important it was
to the individual they took care of and so that they actually get some of the
positive feedback that patients give, that they might not otherwise get. That's
helpful to the people doing it and its much more possible when it's a smaller
place. So this is nurses week- and every
year, on Wednesday night of nurses week I go to Trader Joe's, and I buy
bouquets of flowers, and I drop them off to the OR, pre-op, PACU, the main
floor, etc.
Jason
Tasoulas:
That's just amazing.
Daniel Deschler: It's a little thing that says thank you. And I can do that because MEEI is containable- it's not a thousand bouquets. It's 8. So that's a totally doable thing. But you know it's a way of connecting with people in that way. So when things reach a challenging moment, a crescendo, you've got people on board who will want to step up, and they'll do it for the right reason. So that's what I really love about working in this place. I've had the same 2 amazing women work for me as my assistants for nearly 20 years, and they do a great job.
So today, because I'm away next week for the Trio/COSM, we saw a large number of people between 8am and 4pm. When I leave on a day like this I usually say “Thank you for helping these people today. Great job team!” and let them know they are appreciated.
The other part that's fun, is that you can treat this hospital like a laboratory because of the fact that it's
not multiple different services it is a smaller containable enterprise.. Around
2004, wwe really made a big effort towards trying to decrease the amount of
time it took to do free flap surgery and have it be a reasonable thing. So we
looked at critical issues of how we could carve time out here? Not just by making
people operate faster, but by making the whole enterprise work better. When you
have a small hospital and you're one of the bigger services in it, you can
treat it like a lab. You can pull one variable out and address that variable,
and you can see what happens. When laryngectomy tubes with HMEs were introduced,
we looked into that, and we worked with nursing to set up a protocol, and all
my patients got HMEs and all patients of another surgery did not get HMEs, and
we directly compared those groups. You
can't do that in a big hospital where patients are spread out over many floors..
I could negotiate for many more things with the hospital because I could
demonstrate downstream benefit for it. And so that that's been kind of a fun
aspect of improving clinical operation through leveraging the size and the
relationships within a small hospital.
Jason Tasoulas: Yes, it sounds
like it's a very unique environment. And it probably brings a very unique sense
of community with it, as well.
Daniel Deschler: Yes, but the
thing is, that it’s good, but it only becomes great if you take advantage of the
opportunities it affords. If you just go and say “Oh, I get to do more surgery”,
then that's kind of a level one way of approaching it. But if you say “okay, I
can do more. What are we going to do with the more we're doing?”, “Okay, that
gives us more tissue for bio-banking. That gives us more cases to look back on
for results, or that gives us more ways to look at how we're doing this to do
it better, faster, cheaper”, that's when it's great. It's good, but to make it
great you need to leverage that, to create things and make it better for others
who aren't in your position.
Jason Tasoulas: Thank you so
much for that. I'm thinking that what comes across through many of your answers
is the sense of big picture vision which I think is rather impressive. So thank
you for sharing this. Now I'm under the impression based on what I've what I've
read, and our interaction so far that you have other interests outside
medicine. And I'm curious to hear more about those. And how do you keep up with
those while maintaining a very busy professional life?
Daniel Deschler: I have a very fortunate life. I think that people talk about work-life, balance, but I never liked that model, because in my mind it puts the two on opposite ends of a spectrum. I've always felt that it's more like work-life integration. And I think that that's the better approach. What things are important in your life, how do you blend those together so that you can have each of them be rewarding and successful. Now, some days you're going to fail at work, and some days you're going to fail as a father. And you learn from those things and try to do it better the next time.
In my early career, the big drivers were my work, but also my family. I was very committed. My wife and I, both, as academic physicians, made very important decisions about how we would approach family life. We ate dinner as a family every night. Now that meant that we had to get home on time, and we had to learn how to cook a quick meal, but all 4 of us would sit down every night and have dinner, and then we would take care of the kids and get them to bed. Then around 9 o'clock is when your academic stuff starts. It wasn't while they were up. They had our time during that!
You learn how to construct your schedule so that they have consistency in their lives. So that may mean that there's a committee position you might have to say no to, or it may mean thatone of you does accept something that's seems really important, and the other one is on board to do that. So, my wife, was on the Resident Review Committee for Internal Medicine, which is a huge job, for 6 years: 4 trips a year, and so she could go, and we would work out.. And when I would have to go to the Academy or AHNS she'd cover for me etc. I I really enjoy my work. I take a lot of worth from my work, but also the family life is wonderful! I coached little league for 6 years when my boys were little, and I wouldn’t trade that for the world.
Back in the 2000s the talk I used to give was called “Making the Extraordinary Ordinary”, and it was the steps you do with free tissue reconstruction, that take it from a 16h operation to a 6 or 7h operation. People think it's just that surgeons get better at it. But that's not what it is. That does give you something, but when you then break down where the time loss is, what you can get by skilled teams working together, how much each component of it should take, what other forces play in the hospital - that's how you get it down to a 6 h operation. And then, if you do that, then your free flap surgeons aren't being burned out. They get home, and their families are happy, and then their kids know who they are, and then they can do it for a long time.
If you have people who do it for a long time, you go from competent to proficient to excellent, and then you go to mastery, and then, when you have mastery, you have people who can train people and skip the redundancy that often occurs. But if you don't do that, then what happens is people go from competent, to proficient, maybe excellent and then they quit, because other forces come to play. And then they keep cycling out like that.
But you have someone like Derrick Lin,), who’s still doing a ton of free tissue transfer. He's doing it because he can do it fast and well. And it's a manageable thing with his multiple other jobs. And that makes him a really important factor for the hospital, for patients, for academics, and so on. He is a master.
So I think that for me, you just have to
find out what's important in your life. What gives you joy. And it might be art,
it might beanything, maybe family and friends and loved ones, teaching, or
something else! And you find places for those, and you do them at a level that
keeps you going.
Jason Tasoulas: Dr Deschler, what
are you looking for in the future? Professionally.
Daniel Deschler: I don't know if
I'm really looking for anything right now. I think that I'm looking to continue
to have leadership roles that can allow me to grow, but also to benefit other
people. I'm looking for ways to make a positive difference. I think that's what
I'm looking for. I'm not really looking for titles, and I'm not looking for
accolades and things like that. I'd rather just say “Hey you know, where can I
make a difference?” and then you can do them at a small level, and you can do
them at a large level. Those are the things that I'm looking for right now, and
that's why my wife and I took this this Dean positions at the HarvardCollege, because it was really a
unigqie and amazing chance to have a positive effect on a whole new group of
people at an important part of their lives. We've been fortunate that those
opportunities have come up in our lives. For example, I wasn't looking to be
one of the people that led the International meeting. But then, something came
up and they needed somebody. So they asked if I would come in and help with
that, and it was a great experience!
Jason Tasoulas: Yeah, that must
have been an incredible experience!
Daniel Deschler: It was a rapid
learning curve for me, and I utilized my experience putting together previous meetings.. And then you have to
listen to people tell you what's important. And Bob Ferris was very helpful with that. Again, not
something I was actively seeking, but opportunities present themselves. And
then you can decide, you know, can you do a great job with this, and sometimes
you have to say no. For example yeasr ago I was asked to be a Chair, and it really was a
great opportunity. But ultimately it came down to not being the best time to
move my family, and I had a great job here, so I ultimately said no to that. It
would have been a career change for me, but I don't regret that in any way.
Jason Tasoulas: This part about
saying no reminds me of what you said earlier about being able to tell when to
operate and when not to operate, and how the latter is very important. I have a
last question for you. This is a question that I've previously asked Dr. David
Kennedy, and Dr. Carau. How would you like to be remembered? What would you
like your legacy to be?
Daniel Deschler: I would like to
be remembered as someone who really cared and tried to make a difference in any
way I could. And then, if people are able to name a few ways, and if few different
people name different ways, then I think I've been really successful. If that
were to be the case, I'd consider myself quite fortunate, and having done well.
Jason Tasoulas: Thank you so
much, Dr. Deschler.
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