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Focus on Ian Dorward, MD

Ian Dorward, MD, is an assistant professor of neurological surgery and orthopedic surgery. His areas of specialty are spinal deformity surgery, spinal cord tumors, neurovascular disorders, cervical spine surgery, orthopedic spine surgery, and neurological surgery.

Dr. Dorward sees patients at the Neurosurgical Cervical Spine Institute and Spine Center in the Center for Advanced Medicine. 4921 Parkview Place, 6th floor, Suite B.

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What happened in the course of schooling to influence you to choose your specialty of neurosurgery?

When I was a first year medical student, I interacted with a neurosurgery resident who helped teach our neuroscience course. Then during my 3rd year of medical school I rotated on the neurosurgery service, and that same physician was Chief Resident of neurosurgery -- I spent a lot of time with him and he became my mentor
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I’d always had an interest in neuroscience, and was attracted to the severity of the problems with which neurosurgeons deal. My exposure to this particular mentor in medical school helped me realize the pivotal role a neurosurgeon can play in someone’s life.

Neurosurgery is a commitment, both in terms of time and mental resources. On a daily basis, there is a huge quantity of knowledge you need to be able to assimilate and master. Patients’ lives are in your hands; it’s an enormous responsibility -- you have to be willing to accept that. Other elements of your life might have to be de-emphasized as a result.

What is your connection between neurological surgery and orthopedic surgery?

I’m a neurosurgeon who did spine training with orthopedic surgeons at Washington University. It’s an unusual combination, but I think it works. The surgeons here are world-renowned and skilled. Because I’m interested in spinal deformity, I wanted to get exposure to the orthopedic spine surgeons’ techniques – they have a different way of approaching problems than neurosurgeons.

Correcting spinal deformities is something I’m trying to develop in my practice, but this is one element of my practice. In addition to deformity corrections and other complex spinal surgeries, I perform cranial surgeries and aneurysm surgeries.

What brought you to Washington University?

After having carried out all of my medical education at Washington University, I knew as well as anyone how impressive this institution is—not just in neurosurgery, but in essentially every department. I feel very fortunate to have given the opportunity to work here, and to continue interacting with my mentors in both neurosurgery and orthopedic surgery.

Why was some of your medical training in Ireland?

Head of neurosurgery, Ralph Dacey, MD, has a relationship with senior surgeons at Beaumont Hospital in Dublin, Ireland. As part of our training, all neurosurgery residents spend six months there.

Ireland was a great experience. The health care system in Ireland is vastly different than in the United States. Here surgical residents only perform surgeries with the direct supervision of an attending surgeon.

This is not the case in Ireland, where many procedures are performed unsupervised by physicians-in-training. That leads to a tremendous operative experience for the physicians-in-training, which is why we continue to seek out that opportunity.

However, being immersed in that health care system really illustrates the unparalleled quality of care that is provided in this country. There is a reason the United States is the number one destination for medical tourism in the world.

Which aspect of your practice is most interesting?

At this point, having variety is most interesting to me. It is very appealing to take care of a patient with a cerebral vascular hemorrhage one day and another patient with a spine tumor the next day.

The diversity enables me to perfect new techniques and perspectives during one type of procedure, and apply them during another type of procedure. During the early phases of a doctor’s career, this cross-pollination can be very beneficial.

What new developments in your field are you most excited about?

I’m most excited about the research opportunities provided by “big data” – the use of large scale patient data bases and registries. We can utilize that information to determine what works best and what treatment options are most worthwhile in the real world, when applied across large numbers of patients.

Traditionally, within the framework of evidence-based medicine, randomized controlled trials have been the gold standard for determining what treatment is successful versus what treatment is unsuccessful. But these types of studies don’t work as well with surgical procedures because part of the design of randomized trial requires that the patients be free to cross-over from one group to the other group.

However, if this cross-over is too rampant—as frequently happens when patients want to have surgery despite being randomized to a non-surgical group—then you wind up comparing a group of patients who had surgery against another group of patients who also had surgery.

Of course there are no differences in outcome between the groups, but the comparison was not really fair to begin with. This problem has arisen in multiple recent randomized trials, particularly in spinal surgery.

A better way to evaluate how patients do with surgery is to look at results in the real world – not a controlled study. You can achieve a more efficient data capture by empirical methods -- collecting electronic medical records to obtain comprehensive results of patient outcomes and complications – with or without surgery.

Which particular award or achievement is most gratifying?

On a personal level, I would have to say my two sons. They are a pleasure to be around. When you see their little victories, like riding a bike for the first time, it’s so gratifying. Even though they are mini-accomplishments, you feel such a glow that you managed to bring a human being into the world.

I used to have a difficult time keeping a plant alive, but kids have this way of making sure you water them appropriately.

What is the best advice you’ve received?

I would maybe not use a piece of advice, but a quotation. I used to be a runner -- cross country and track. One of my running idols was American long distance runner, Steve Prefontaine. He once said, “To give anything less than your best is to sacrifice the gift.”

Unfortunately, he died in an automobile accident before he had a chance to accomplish everything he could have.

His statement meant a lot to me. I was fortunate to have certain aptitudes and was given the gift of a good education as well as the opportunity to train with some of the best surgeons in the world. And now I am working at a terrific academic institution.

Every time I take care of a patient, that’s a chance to give my absolute best. To give anything less would be sacrificing the many gifts given to me.

If you weren’t a doctor, what would you like to be doing?

If I weren’t a doctor, I would like to be a novelist. Writing and publishing short stories about medicine is something I’ve been doing for years. Because I encounter emotionally trying circumstances and stressful situations in neurosurgery, it’s very helpful to write about my experiences.

When a patient comes in with a severe illness, you need to take care of him or her immediately. In an ideal world, one would be able to pause, reflect and process what transpired.

But the reality is you don’t have the luxury of pondering the various emotional elements of the situation, so it’s put in the back of your mind and the door is closed on it. It’s very easy to push forward to your next patient and never open that door again.

I think if you leave all those doors closed, something happens to you as a person and as a surgeon; you might wind up not being able to care as much about your patients.

It’s vital to take the time, go back and open those doors to explore what you’ve encountered and the role you’ve played in your patients’ lives. And that’s what I’m striving to do when I’m writing about my experiences.

Dr. Dorward’s published short stories include:
“The Texture of a Word.” Reprinted in Body and Soul: Narratives of Healing from Ars Medica. University of Toronto Press, Jan 20, 2012.
“A Shot for the Pain.” In Real Life of a Surgeon, Kaplan Publishing, 2009.
“On the Watch.” Bellevue Literary Review – Abilities & Disabilities: The Range of Human Function. Fall 2008.
“A Silent Comfort.” The Lancet: 370(S20-5), Dec. 2007.