The Reason for Interplast

 

In 1968, the patients were few at Stanford Medical Center. The patients are the human pathology and are therefore the reason for which the medical school might be needed or founded. Patients were scarce, and few and far between; there was not sufficient pathology for a new medical school to operate.

The reason for this were twofold.

  1. PAMC Palo Alto medical clinic had the practice of caring for not only the regular paying patients but also the carriage trade. The upper class, of which there were quite enough.
  2. Stanford University had begun. The successful process of developing the medical school according to the well thought out design to make a highly productive highly regarded research oriented school consistent with the model in place for the other schools and departments across the University.

The school of medicine had therefore designed its hospital primarily as site to carry out the research for the faculty. Of the four tenets of a University medical school: research teaching patient care and community service, research the number one priority. The first recruits, the heads of the departments not only recognized this, but had designed the system.

The Stanford Hospital was for this reason, slightly at variance with the usual competition of an “hospital” being an across-the-board overall all clinical knocks and crannies delivering all types of surgical miracles the plan in the model that was being built in 1968 was based on the idea that research, both of bench basic and clinical, was the foundation for brilliant medical breakthroughs in medical practice.

The school of Law, the GSB (graduate school of business), and the departments of education, psychology, history, math and statistics, music, maintained that research was one of the main purposes of their existence. The purpose of human pathology  in the medical school was to provide sufficient research. It is clear to Stanford University that the “charter” of the medical school was that adequate clinical aspects for faculty research would exist.

It became obvious (for example, to me) that not all of the full-time faculty on the tenure track working in clinical subjects at a level below department head realized that there was a reason other than that the physicians in private practice and the volunteer clinical faculty were monopolizing the patient’s and the volunteer clinical faculty were monopolizing the patient’s and detracting from their clinical experience and from the pathology of available for the progress of teaching residents and students[1] which says students were in actuality of tertiary concern. not of primary concern, Residents were of secondary concern and research was of primary concern. Residents were of secondary concern and research was of primary concer. How will this full-time practice of medicine in an academic setting was without question the finest and most ideal system especially after acquisition of tenure. Tenure protects the physician from being impacted by external forces. For example government mandates religious movements, political ideas, legislative forces and from personal financial reasons for making decisions in their practice. The full-time system liberates the faculty member from the three “bosses” that tend to color their judgment in private practice. It is the bank loan that must be paid off, and business is the boss. That may direct, the physician, without tenure. The Dean may exert influence. Religious influence may tell you, what is right. However, the tenured cannot be fired because the application of tenure says that the faculty member knows more about his or her particular field than others, and the decisions made by the faculty person are untouchable.

The baseball analogy system probably is superior to the full–time system if practiced systematically. Those holding the lower-rank than departmental head felt anxiety that their personal income was being affected by the physicians in private practice. This feeling of inequity was not based on objective numbers but on comparison with their former peer’s incomes, with whome they were still friends, in social and professional associations and societies. Of course, some still gauge professional success by comparing basic  number of dollars from their work. What grew is a select segment of physicians who have signed on to the wonderful hospital with the very best system practice of medicine attached to a medical school and a fantastic university. But they were unable to hold her head up high to their professional brothers and sisters in that situation. Unfortunately, the differential between these segments (those in P.P. The retail practice of our profession, and the full-time salaried positions in the ideal application of medicine) increased over their own success in life was imperfect;  the first decades rather than decreased. The causes were mapped the value system upon which they determined their own success in life was imperfect; they head mistakenly perceived that the Hospital system was using the usual model. And these segments were then comparing physician practitioner and educator to physician scientist, the Stanford model.

In this Stanford model. Not everybody understood that all professional fees were controlled by the dean of the medical school – including speaking engagements and royalties, with the exception of expert witness in court and book earnings. The indirect costs to the central fund from grants for NIH and other research from pharmaceutical companies was at 57% of nominal grant amount in 1985. Salaries were negotiated on behalf of the members of the department by the department heads with the deans. Personal gifts and bequests to individual faculty members were legally and in fact part of the budget of the school of medicine.

Of course, benefits to the faculty members in the full-time system in medical school were enormous if they were calculated. Educaiton of children of the faculty was a very significant perk: 100% of the tuition to Stanford and 50% of tuition to other schools, expenses for clinical photography  and travel and art work for publication, visual art for papers and posters was 100%, a benefit. Faculty housing was a benefit for home was eligible for very favorable mortgage rates and conditions and a lot could be selected and least at next to nothing on the very long term. In my case this per was $350,000 and one year $450,000. Nevertheless, when all full-time faculty gathered at weekly luncheon with department head. The over arching conversations reflected the mind set of whining and complaining about actual salary number compared with PP.

The paucity of patient pathology and plastic reconstructive surgery in the early decades coupled with the lack of operating room capacity assigned to that division, coupled with the inability to bring in capable high-class faculty led to anxiety and being unable to move ahead to greatness in their fertile field, which lay uncultivated in front of them.

The solution to the discontent was to incorporate extramural resources. The jail, the VAH psychiatric domicile, and the juvenile rehabilitation units were interesting. Temporary Band-Aid addendum our curriculum.

The general perception on the part of the faculty and the local population was that Stanford Hospital was an across-the-board clinical Hospital to serve the taxpayer of the state and the tax district localoly. On the other hand, it was little known that Stanford was a research Hospital. My perception was that the research institution masquerading as a clinical service institution allowed for numberous niches to exist in their public service aspect as a hospital. There for plenty of “space and room” was available for clinical reserach, for teaching of residents with their student slaves, for community service programs, and for imnnovative ways to seek new avenues for patient care. The concern only for Stanford, and it’s community was throught to be narrow minded by me. In fact “extra mural” resources soon meant “international, and multiplier.” In answer to the question “where are the congenital anomalies cleft lip and palate and hypospadias?” Quite rapidly lead to the realization for the disparity in this area: the knowledge and skills in plastic and reconstructive surgery between the developing world and the developed world was quite large. In fact, this disparity was larger than the disparity in the fields of agriculture, education, research. The disparity was more than an imbalance in services; the disparity was a moral issue.

Simultaneous to this challenge, which appeared on our stage, on our side of the eqution accentuated the situation. These introcustions into our field, our body of knowledge, were the cause of the unquenchable desire to share these delicious items with those who did not have these on their menu.

  1. transplantation of organs – the kidney was transplanted from one identical twin to another
  2. homotransplantation from one individual to another person of organs as well as skin had become possibilities with proper reserach and intense clinical concentration
  3. microsurgery was able to transfer chunks of tissue from one part of an individual to another part
  4. CFA cranial facial anomaly surgery, was able now to change the grotesque child to a merely ugly one, and the not good-looking person into a regular person in the center of the bell shaped curve regarding appearances.

We also knew that some unsolved problems were challenges on the chopping block ready to become objects of discovery:

  • healing of the spinal cord and paraplegics and quads would surely be solved by the Army of noble laureates nominees in other schools and departments at Stanford.
  • the laser, the interactive use of computer (user computer interface) networking, and user conditioning on the computer were developed at PARC, Palo Alto reserach Center of Xerox Corporation but alas they were put “on the side.”

Dr. Chase hooked me up with his fellow dept. heads so that I could begin using these world-class incredible talents at Stanford in my projects:

  1. Founding the academic advisory Council: the purpose to interest recent graduates of plastic surgery training programs steering them to academic posts and providing them with recent reports and profiles of the players at those institutions.
  2. Introduction of the concept of Removal of tattoos from human skin using the Q switched ruby laser.
  3. Introduction of the “in service exam.” A test to compare individuals across all training programs. A committee composed of PhD.’s candidates from the top department of educaiton in the country assisted me on every question with statistical analysis of efficacy and validity.
  4. Histopathology assistance with the regeneration of the spinal cord project by putting the severed cord in contact with tissue rather than cerebral spinal fluid.

In the course of scrambling for funds to support our work in the developing countries found that an University-based medical school (another 501(c)3 nonprofit foundation) had 5 basic tenets in common: education, public interest, nonprofit, patient care. Community service had begun to be an objective of the University medical school during that era. Although several areas of state law cover the “ownership of donors and or patients,” a bit of fusion and some conflict and possible competition regarding donors of money occurs. An understanding between the two development offices may resolve th issue. It was also found a Foundation – University medical school synergy brings benefits to both. For example, the professional reputation of faculty members doing international work is increased. The ability of the department’s doing service work to attract the brightest applicants for residency is increased exponentially: students are included in the medical system in Latin America, whereas by and large students are not included in the U.S. Valuable patient experience particularly surgical operating experience, under supervision supports the medical curriculum of the University medical school. And “Air Force” and “Navy” and wide international contacts acquired by the foundation assist teaching research and patient care. The med school University — 501(c)(3) foundation synergy becomes a principle on which to build in the next decade.

An example of “necessity is the mother of successful innovation and unintended benefits” is demonstrated by the plastic surgery division developing ambitions in the Central Valley, and in northern Mexico. Monthly educational and patient care trips required repeated expenditure for tickets on commercial airline.

A DC3 – the safest airplane ever flown except 746 – was purchased for 25,000, and supported by retired commercial airline pilots, each with 20,000 hours multi-engine experience. Stanford self-insurance being cautious, prompted money being scrounged to purchase the insurance policies. The public Library how to form a fulmination book and one day visiting 14 desks in Sacramento yielded Mexico medical project to be synergistic with the University and teaching patient care research and community service. Fundraising for both institutions increased.

[1] countries with solid contact in patient care and education, and sustainability (long term professional relationships) Central Valley of California, Baja California, Tijuana, Mexicali, & Compeche and Oaxaca, Honduras, Nicaragua, Ecuador, Peru, Chile, Brazil, Cambodia, Nepal, Lesotho, Vietnam, Philippines, Thailand, all of these countries desire higher educational opportunity for their counterparts working with foundations, all of them are aware of the importance of global inter-relationship in education, and nonprofit organizations and intercultural aspects.

[2] Funding sources scrounged: walk for mankind, bake sale level fund-raising, lectures with slides to University contacts in trust departments of banks, courses given to train the pharmaceutical company representatives, transsexual surgery patient donations.

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