Dr. Robert C. Schenck, Jr.: Teaching by Example
July 01, 2002
Dr. Schenck is a Professor in the Department of Orthopaedics and Rehabilitation at the University of New Mexico. His current focus is directed towards a general orthopaedic sports practice including knee, shoulder and ankle injuries. His clinical research lies in multiple ligament injuries about the knee, recent work in ankle instability surgery, and continued work in orthopaedic rehabilitation and home rehab programs. Of his work, Dr. Schenck says, "One of my missions in life is to help those who don’t have access to medical care, and I work to provide outstanding care to those in need in our own country." I was born in South Texas, but was moved up to a little farming town on the Western Slope of Colorado in grade school. The town of Carbondale, Colorado is in a beautiful valley and was a great place to grow up in. We had doctors, but you didn't go to a doctor unless you absolutely needed to. So I guess I have always felt a need to, number one, help people that can't get care. But also I sometimes feel weird about taking money from people for doing surgery, because the value of the surgery is really dependent on how well they do. Obviously I charge for surgery but recognize the need to help others without insurance. At the first of my career, I was at [Johns Hopkins Hospital] for medical school and residency, and I took care of a large number of unfunded, inner-city patients and found that aspect of medicine very fulfilling. When I look back at the most positive aspects of my medical practice, it’s helping out the people who were injured in the middle of the night or the people with no insurance. Many people feel that that is a negative aspect of any surgical practice … but if approached properly and you have support from your university, which I have (from the University of New Mexico), then it really is a very extremely rewarding aspect of being a physician. Much of my volunteerism is done here in the US. From my perspective, when I do an ACL reconstruction on an un-funded high school student, that's a real special thing for me to do.
Knee1: What are your biggest experiences with your residents?
Dr. Schenck: Another important aspect in my life is activities where I have taught my residents. I have been a resident educator in pure academic programs ever since I finished my residency. I try to work as a human being, physician and also keep a good sense of humor, regardless of the situation or amount of work ahead of me. I had a resident last year say something that was pretty humorous, but also hit home as to how I try to practice medicine. He gave a little speech and … he said, "Dr. Schenck will go in and see a businessman with insurance with a shoulder problem and take care of him and treat him with respect. And then he'll go in and take care of some uninsured, alcoholic electrician who needs knee surgery, and he’ll treat him with equal respect." And then (my resident) said, "And that's because I think there's a little bit of both those people in Dr. Schenck." As a physician, you need to have empathy for all your patients regardless of their problem or social status. I try to teach by example and over the years have defined some important aspects of my philosophy as a physician and surgeon. I tell my residents three things: the first is taken from Spike Lee’s movie, "Do the right thing." I think that is one of the easiest ways to help me in making difficult decisions in my life. Secondly, treat patients like family. And thirdly, to try to live modestly. With medical students and residents, who are basically adults obtaining training, to borrow Jimmy Johnson’s statement after winning a Super Bowl with Dallas, you have to "walk the walk" with residents or it will have no effect on how they practice medicine. I do think that you really need to tell young people that they need to do the right thing. That is crucial. I think where I have the biggest input is example. I think that is important for them to see. The number one thing to teach a young person and to show by example is integrity. Do the right thing is the one thing you can say to a young person that quickly goes into their paradigm of how to look at decision-making for their future patients and in their own lives. Also, when you say, "Treat them like family," that's also a very good thing. I had a friend once ask me (when) we were talking about this youngster that needed surgery, and he said to me, "Bob, what would you do if it was (your son)?" I thought for a few minutes, and I said I would still operate on the youngster. With this goes a need to talk with your patients and teach them about their problems, answer questions, and show kindness. I tell my residents that you can pay your malpractice premium one day at a time–meaning you talk to your patents each day, explain everything to them and treat them like family–or you can pay it in one lump sum. To be able to operate with a young person and do a beautiful job on that patient, there is something special about that. Teaching someone surgery is a fascinating thing. When people say you are a teacher as an orthopedic surgeon, the layperson thinks of you at the chalkboard, but it really is basically in some ways having an apprentice working with you. Teaching residents is not, “You have to figure out and treat the problem on your own." It's really, "We're going to do this together." I was one time doing a really complex elbow fracture with an excellent surgeon and a resident. The reduction, I wasn't pleased with it. We considering our options and I simply could not accept the reduction for my own daughter. So I said, “We're going to change it." And we did. And that's where you teach people. Where someone sees that you have integrity and you accept and define certain things as good. And there are times where we have bad outcomes, but in my heart I know I have done everything I possibly can with what I have to make it better.
Knee1: You wanted to be a high school football coach. Is working with high school and college sports teams your way of living out part of that dream?
Dr. Schenck: I saw some high school athletes before me that went and played college football. A couple of them came back hurt, and they ended up working in the coal mine in Carbondale and that is a pretty tough life. And was like I know I can do well in college, but I knew the life of becoming a coal miner, so I didn't (play college football). I started taking care of some sports teams when I was a resident, and I enjoyed that activity quite a bit. And I thought maybe this will be a way to give back to athletics that I wasn't able to do in college. I am not living my life through my athletes, but having been someone who was able to function both on and off the field, I feel I can help student-athletes reach their goal both on the field and in life. Last year a parent asked me about his son after I fixed a both-bone forearm fracture from a kick off return injury; the parent said, "Dr. Schenck, I realize he is a great athlete, but his mother and I are concerned about his citizenship." In that manner, I focus on caring for athletes but also on promoting integrity and citizenship. I currently work with the [University of New Mexico] football team and it is amazing … (that) as a sports medicine physician you have to wear many hats. You have to be a good surgeon, but almost as importantly, you have to be a good communicator and have very good people skills. You have to talk with an athlete, an athlete's parents, the trainers–treat them all with respect. It is all part of my work at being a good team physician. Coaches have huge demands on them because they can lose their job if they don't win, so they have a lot of pressure. You want to make sure the coach knows you are going to do what's best for the athlete. Once you develop a good rapport with the athletes, trainers, coaches, and athletic and medical staff, then you become the "team" physician. I jokingly say that what you really are is a student council president with an M.D. after your name.
Knee1: What is the one patient who stands out in your mind?
Dr. Schenck: It would be two cases. One was a 14-year-old girl who was hit by a drunk driver. She had one of the most horrendous lower extremity injuries I had seen. I was fortunate enough to get everything back together right, and she did well and had a great result. But I have shown other physicians that case, the x-rays, and they have said, "Dr. Schenk, that was a save." This case brings up the point that I tell all my patients that I get them to 80% and their attitude and rehabilitation efforts go from either 80% up or 80% down. I say you were 100% before the injury. There's no way I can make you to 100%, but attitude gets (you) from 80 to 100%. If you educate a patient in that, then they are empowered to do well and they really can improve themselves. The other patient was a very tremendous woman who was abused by her husband. Whenever you have a patient who (is) abused, it brings up huge emotions in a physician because that really brings you back to why you went in to being a doctor. (Her husband) caused a wreck, and … I had to amputate her arm. We had to put her in a prosthesis. This young lady came back about five or six months after I operated on her, and I said, "I feel terrible about the fact that you lost your arm." Because no matter how important you think your treatment is and what you did for someone, if a patient doesn't recognize that you care … and she looked at me and told me not to worry about a thing. She said, It's OK. And my children think it's kind of fun that I have (a prosthesis.)" So that taught (me) a lesson. Here was an amazing person who accepted her fate positively and made the best of it. I tell my residents that I continue to learn each day. It’s not like I have all the answers. I realize that wisdom is a thing that you gain with experience. I'm not there yet, but I now recognize how important wisdom is in terms of your life decisions and taking care of patients, athletes and living your life.
Last updated: 01-Jul-02