One Step at a Time
When Dr. Dennis R. Roy discusses his work as orthopedic surgeon and the director of the hip deformity service at Shriners Hospital for Children Portland, he uses a model of a hip joint to demonstrate what he is talking about. Dr. Roy specializes in hip deformities, skeletal dysplasiasand deformities of the feet. As the director of education at Shriners Hospital, Dr. Roy also organizes the teaching program, engages in research projects and publishes regularly.
Before coming to Shriners Hospital Portland 11 years ago, Dr. Roy was an associate director of pediatric orthopedics and director of the hip deformity service at Children’s Hospital Medical Center, Cincinnati, Ohio and professor of orthopedic surgery at University Cincinnati.
Dr. Roy has completed fellowships in pediatric orthopedics at the Scottish Rite Hospital in Atlanta, Georgia and the DuPont Institute in Wilmington, Delaware.
Shriners Hospitals for Children are dedicated to providing specialty medical care in the fields of orthopedics, spinal cord injury rehabilitation, cleft lip and palate care, and burn care, at no cost to the patient. The 22 hospitals are a project of the Shriner’s, a branch of Freemasons dedicated to fellowship, fun and community, widely known for their trademark fez hats. The family-centered Shriners Hospitals are warm, welcoming and engaging environments with every possible step taken to reduce the fear and anxiety associated with surgery or extensive treatments.
What led you to become an orthopedic surgeon at Shriners Hospital?
Being a surgeon at Shriners Hospital is about taking care of children, as well as teaching residents and fellows and spending some time doing clinical research. I like that there’s a readily definable problem, and that you can solve it, see the result, and follow that result to completion hopefully the results will follow a child through life.
I went to medical school to be a researcher in marine pharmacology. My dad was a Navy corpsman for 30 years, and that was my only exposure to medicine. My undergraduate degree from Georgia Tech was in chemistry and applied biology. When I got to medical school, I learned that it was a mistake that I could approach marine pharmacology this way. I wasn’t going to be collecting specimens like I wanted to. I was going to be in a laboratory the majority of the time. So I shifted my thinking and said “what else draws me about medical school?” And the answer was: kids! My pediatric rotations were in cardiology and pulmonary diseases – a lot of kids were dying or were really sick, and I decided it wasn’t good for me mentally to be around kids who were dying or suffering. I fell in love with orthopedics and decided that was the route I wanted to go.
My goal is to postpone the need for an artificial joint as long as possible. I want to give the hip every opportunity to function well into adulthood. If a hip can’t be salvaged that is an unfortunate situation but I try to prevent that as much as possible.
Shriners Hospital also helps children to build their self-esteem and feel more empowered, correct?
Yes, in our rehab department we have therapists who help children recover from their surgeries and therapists who work with patients with cerebral palsy and developmental disabilities, and speech/communication therapists. One of our therapists has had some Google glasses on loan to see how they could help some of our patients. All of these services help to increase the child’s ability to function, therefore empowering them.
That must be very inspiring to be around!
Yes. There have been dramatic changes in the industry through research since I was a student. But if I started over, knowing what I know now, I can honestly say that I wouldn’t do anything differently; I would always do pediatric orthopedics. My desk is a mess, but I am very happy coming to work. I enjoy my time off, but I also really enjoy coming to work here.
We have the best view from our operating room – maybe in the whole country! On a clear day you can see Mt. St. Helens and Mt. Hood. A lot of the patient rooms are also East-facing, so patients can benefit from the beautiful view as well. We have an x-ray machine that emits only 10 percent of the normal levels of radiation a person typically gets exposed to during an x-ray, which is most beneficial for children who need multiple x-rays over a period of time. There are rooms for the families to stay in while patients are receiving treatment, physical therapy rooms, an in-house prosthetics lab, and on the top floor there is a playground. Everything is so kid-centric here, it’s great.
Other than working with Shriners Hospital, what brings joy to your life?
Travel! I have been to many countries including Egypt, Italy, Poland. And family. I have a wife and an 11-year-old son, and I have two grandchildren who live in Cincinnati. And I love to scuba dive.
What do you love about scuba diving?
Seeing what’s under there. I have also done a lot of underwater photography. When I was an undergrad at Georgia Tech, we would go diving in the Florida Keys each spring to catch fish for pet stores. Now I go back to the Caribbean or the Pacific on dive boats. We wake up and go diving. Then we eat breakfast as the boat goes to a different location. Then we go for another dive. Then we eat lunch, and then go for a dive, then dinner, then a dive…
Is that something you share with your patients?
Sometimes. I try to share a little of myself with them when they come in, and it helps them to relax and not be intimidated or scared. Mostly, I like to engage with the kids about why they think they are here. I tell them about my son and what he is involved in. We sometimes talk about what they have in common. Now, it’s what video games they are playing!
What are you teaching now?
The teaching I do personally is related to hip deformities and foot deformities. Additionally, I am the director of education. We have a lecture every Wednesday morning. I act as a liaison with OHSU and its education system. We have a combined conference once a month on pediatric orthopedics.
We also have an annual hospital event on April 25 and 26 – The 53rd annual Dillehunt Memorial Lecture. Dr. Richard Dillehunt played a major role in establishing Shriners Hospital for Crippled Children, Portland Unit, and served as chief surgeon from 1924 to 1943. His legacy continues through this yearly event, with a gathering of distinguished orthopedic surgeons from around the world.
In addition to trainings and events, we also require our residents and fellows to prepare lectures; it is part of their education to learn how to give a quality presentation to other doctors. It’s designed so that they will know how to organize their thought process. It’s not something you can improvise – there is a method to presenting a scientific paper, and our students need to learn how to do that.
We also have journal clubs, where we take an article from The Journal of Pediatric Orthopedics, and the students have to read the article and extract what is important. Oftentimes what is most important is the process of the research. A statement may be made without a study being well-run, so we want our students to be able to analyze that. A study may say: “I have eaten a bar of chocolate every day for 30 years, and I am healthy, therefore chocolate has made me healthy.” That’s not a controlled study! There was no control group, and maybe other factors were involved, like genetics.
When someone publishes their research, the message of that research is only as good as the research process. Is something based on fact, or on a poorly run study? Does a conclusion match the results? The deduction of a study might be expanded to a conclusion that is broader than the actual results of the study – that is overselling. We want our students to be able to question what they read, and not take everything that is published at face value.
What is your philosophy regarding helping patients decide on treatment options?
A lot of talking. A lot of answering questions. I think people have not always been aware that medicine has a lot of gray areas, but that’s really changing. Parents are doing a lot of research before they come see us. I always like to explain that there are numerous options, and numerous factors involved in deciding on a treatment option. I tell them what I feel is best, but after that it’s really their decision.
I encourage people to seek different opinions. At Shriners Hospital, the doctors are on salary, so it’s set up to support that. I try not to bias the decision-making process by sending my patients to other doctors who will recommend a treatment option that is similar to mine. I think it is best when the doctor’s ego is taken out of the equation.
I recommend families go home and compile a list of questions. I am old-school – I use paper, or stacks of 3 x 5 cards that I have around. I use them to make notes or write down questions, and I encourage my patients’ families to do the same. I ask them to come back and we talk it over again. I also try to let them know that they cannot make a wrong decision. Go with your best feeling. It’s important to not get paralyzed by all the choices.
How do you work through the mental and emotional challenges involved in doing this work?
There is a delicate balance between caring too little and too much. I think most of our doctors constantly look at what we do and question how we could do it better. Then, we follow the results. Always trying to improve, do it better. Focusing on what’s coming next helps, too.
It’s important for surgeons to strike a balance between personal and professional life. I try to pass that on to the doctors I am training: put your professional life in the context of your personal life. I wish I’d learned that earlier.
Lastly, lots of teamwork. There are seven full-time pediatric orthopedic surgeons here, each with a different sub-specialty. Surgeons are out front, but taking care of our patients is a team effort, with a lot of different people involved. There is a system of knowledge at this hospital to help these kids. From the child life counselors to the physical therapists to the transportation people, to the greeters (mostly volunteers), to the fundraising people, we are all a team. The care coordinators are the true liaisons with the families. We also have an excellent cadre of translators who are so good with the families. They have been here so long, they can almost give the lectures that we give the patients themselves! Yes, we have good surgeons here, but that is 30 to 40 percent of what will be important.
What are some of the most interesting research projects you have been involved in?
Mostly they have dealt with hip deformities in children. I was fortunate enough to get very interested in hip arthroscopes in children in 1998. I was one of the first pioneers of doing it consistently in children. We take a telescope and enter a joint and look around and do work. The hip joint is a deep joint and we have to distract the joint so we can negotiate inside (takes model and shows how that works). The research is asking: Is what we are doing here helpful? What treatments will make the most sense?
Is there a person in your life who inspired you, mentored you or helped you along your path?
My partner in Cincinnati was the first African American to go through the University of Tennessee, and the first African American physician to work in that hospital. He had trained in the Navy as well. He was extremely gifted and bright, and had a photographic memory. He could remember everything he read! Even still, he read about a surgery he was about to perform the night before, no matter how many times he had performed that surgery. He reviewed the anatomy. If someone didn’t know the anatomy and didn’t read about the surgery beforehand, he would kick a resident out of the operating room. I don’t believe in that method of teaching, but I still admired that. Now I always go over a surgery the night before.
It’s all about constant learning. If we do a case 100 times and we get a good result, we are happy. If we do that procedure the 101st time and we don’t get the result we expected, we think about what we can do different, better. That is the best mindset. We are always searching for perfection.
Historically, you haven’t had to deal with insurance at Shriners Hospital, correct?
We didn’t have to, up until recently. Proceeds from the Shriners endowment and various fundraisers run the hospital. Recently, with the costs of medicine going up, it has been necessary to start dipping into the principal of the endowment. And so, three years ago the Shriners made the decision that if a patient has insurance, we will bill their insurance company. But up until that time it was totally free care – for 90 years! If you don’t have insurance today, you will still receive free care at Shriners Hospital. Many times when a patient goes back to school after they have received care here, they believe in the hospital so much that they will hold a Shriners fundraiser at their school. Some people think of Shriners Hospital as a hospital for people who don’t have insurance, but that is not necessarily the case. This is a hospital for children who have a problem that needs to be solved, regardless of whether they have insurance or not.
What is your proudest moment to date?
When I left Cincinnati my partner got my clinic list for the last three years from my nurse and secretary, and they invited all of those patients to my going-away reception. One of the proudest, happiest, most emotional moments I had was when some of the kids came to say goodbye – kids who took time off from college classes – kids I had treated for 15 years. I still get emails from some of them. One young lady invited me to her wedding! It makes what we do so satisfying. I am getting a little emotional just thinking about it.
What would you like for the future?
For the field of medicine, I like the idea of free access to medical care, philosophically. We still need to figure some things out about that – the finances, the timeliness of care, the expertise. I don’t know the solution, but conceptually, I like the idea.
For me personally, I would like to just keep doing this – for a long, long time. My son is not even in college, I have lots of time!
Even after 36 years?
Something like that. By the time we are ready to retire, we almost have it down.