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- Greetings, Will Mobley for the Compassion Forum.
This is a production of the
Sanford Institute for Empathy and Compassion and
in this series, I'm trying to really show
you the very human, very real side of our leadership
that's working so hard during this pandemic
to bring health and wellbeing to our UCSD community
but beyond UCSD, to San Diego and beyond.
So I'm very pleased to be here today with David Brenner,
Vice Chancellor for Health Sciences.
David, a real leader, a person who's transformed
in the last many years
our health sciences efforts in our campus and
really can be so proud of his role as leader
through so many interesting times.
David, everybody knows your name
but let's hear about David Brenner, the human being
and tell us about your background
and a little bit about yourself.
- Okay.
I don't know if anyone else will be interested in this
other than my children, but I'm happy to do this.
Anyway, so I, as you can pick up from my accent,
originally from New York and
I spent most of my education on the East Coast and
I trained at Yale and then the National Institutes of Health
and I was always very research oriented.
I mean, the appeal of medicine to a large extent
was the appeal of unknown problems
and trying to solve problems and prove even health
through research.
Then on a dare,
I moved west of the Hudson River
for the first time to do my fellowship at UC San Diego
in 1985.
My youngest child is the only
native Californian in the group.
He was born at UC San Diego, Hillcrest
and then I completed my fellowship,
I started doing research in liver disease.
I loved this place but I was interested also
in leadership and development programs
so I did what many academic physicians do and
when it was time after four years on the faculty here,
I moved to University of North Carolina at Chapel Hill,
become a professor and chief of gastroenterology.
That was also very different from New York and La Jolla.
(laughs loudly)
The joke about Chapel Hill is
any direction you leave Chapel Hill, you're going south.
It was a very sophisticated academic health system
university surrounded by tobacco farms
and agriculture.
But it was a great place to raise the children.
They would run to the forest with their dog,
no one ever locked their houses
and it was a very collegial academic medical center
where there was a lot of collaboration, support and
interest in student development, faculty development
and I first got interested
in this through the fellowship through the
NIH funded Digestive Disease Center
and I sort of got some ideas about
what you can do at a bigger scale,
how you could use
my basic understanding of research and clinical care
to leverage into asking the bigger problems.
So,
the joke is that after
in Chapel Hill for 10 years, my youngest went to college
and my dog died and it was time to move.
I did get a new dog, so don't worry about that,
and we moved to New York where I was
Chairman of Medicine and Physician Chief at
Columbia in NewYork-Presbyterian Hospital,
which is enormous academic medical center, very complicated,
amazing people working super hard, but not very
collaborative.
I mean, it was very much siloed
and the people were,
one of my favorite expressions about Columbia is
that Columbia is a great place, its just not an easy place,
because everyone works super hard to get
the same amount of things done.
And I picked up on that, that there should be ways of
creating synergies and making the academic medical center
more collegial , more collaborative,
leveraging the three missions
and that was hard to do at Columbia.
It's the oldest medical school in the United States,
it's pretty set in its ways, it's very successful,
but it's landlocked and it has limits to
what you can do in building programs.
So I was quite happy there, but out of the blue
the chancellor, Mary Anne Fox, at UC San Diego
said, "If you behave this time,
"you can come back to UC San Diego."
I said I would do my very best,
and I would say I probably knew two thirds of the people
from when I was there as a fellow and junior faculty member,
'cause very few people leave San Diego.
But I saw the opportunity with
open footprints and
the hospital situation and the clinical activities
to really really make a difference
to use what I learnt at Yale and Columbia and UNC and NIH
and try to apply all that too as vice chancellor.
So the upside was enormous.
- Yeah, so, I mean, the themes that I'm hearing there are
understanding, scale and synergy,
and making those two line up.
And do it in a place where the is an open footprint
where that kind of growth and that kind of synergy
may have been easier to pull together.
- Yeah, I think that's pretty unique to UC San Diego.
I mean, I think the quality of patient care
at Columbia is just sky high.
The physicians are just amazing.
I thought the collegiality at UNC was amazing.
There are all these things, but they did not have
all the opportunities that UC San Diego did.
And when I came back,
some things had changed, but a lot of things hadn't.
And one of the things that hadn't
was the academic medical center.
When I was a fellow here in 1985,
I was told completely straight face,
that, "David, we have enough patients
"to teach you how to do endoscopy".
It was not an academic medical center
that was a destination,
it was not an academic medical center
that was quite enough to care after the community
and that sophisticated patients in San Diego
would leave and go to LA,
or go to MD Anderson or go to Austin
but it was not felt that the university
provided that kind of academic health system
nor patient opportunities.
So one of the mantras I developed was that
I didn't want anyone to have to leave San Diego
for their healthcare.
I thought that was a reasonable goal that we could do.
And another mantra was that
the research and the clinical programs are not conflicting,
they are actually complementary.
There was a big concern
that if you put more resources into clinical care,
the research would suffer.
Because the idea was the pie was only so big
and depending on how you split it up,
you get different results.
And I had to convince people, which I think is right,
that the pie can grow.
That you are actually bringing in more resources.
You are not competing for the fixed amount of resources,
you are actually bringing in more.
- And the data shows that, right?
I mean, there's more than enough evidence
to prove that you're right.
- Yeah, I mean,
so, the clinical activity has more doubled,
but the research activity has also increased tremendously.
So you would think that you can do one or the other
and a lot of places have decided to do one or the other.
There are places that are just pure research places,
very low clinical activity, and then there places
that are world renowned for their clinical care
and they've fairy limited research program.
So I think that to do this
took a lot of
convincing and leadership and buy-in from the faculty,
and there was a lot of concern at the beginning.
We started thinking about building Jacobs Medical Center,
you know, over a billion dollar beautiful, state of the art
inpatient facility, they would say, "Why are you doing this?
"Are we not gonna build any new labs."
But then we built the Biomedical Research Facility II,
we built the Altman Clinical
and Translational Research Institute,
we built all these research buildings.
And then there was a concern that,
"Well, is the teaching going to suffer?"
Because we always took a lot of pride
in teaching medical students, particularly being colleagues
and the medical students engaging with the faculty.
And yet, we are able to do a completely new curriculum,
we are able to build a beautiful,
Sanford Medical Education and Telemedicine building.
You know, it is just,
everyone from all the country comes to visit
the simulation center.
So I really think that we are able to do all three missions
in a very interactive collegial way
that the training is better 'cause the hospital is better.
The the hospital is better
'cause there is a great Clinical
and Translational Research program.
The basic research is better
'cause now you can get clinical materials
to study and understand.
So I really think that has been an enormous improvement.
And the other thing that was very different
from Yale and Columbia and even UNC compared to UCSD,
was this idea of philanthropy and community engagement.
There was very little philanthropy
when I was a junior faculty member here in 1985.
And there was
very little, (chuckles)
not that much more when I came back,
there was a campaign,
but if you look at the health sciences,
we were doing about
45 million dollars a year in philanthropy,
which is okay, but this year was our best year,
fast forward and its 180 million.
So, its a completely different order magnitude.
I mean its completely different.
And what you can do,
if you can raise that amount of money to build programs,
to build clinical activities, to educate students,
is completely different than what you can do
when you are functioning at a lower level.
- Yes, so the story then has David coming here,
there's scale up, there's synergy,
and there's the sense of community
that allows these donors to understand
how building a stronger UCSD,
really builds a stronger San Diego
and it builds a stronger environment for
not just discovery but for care.
So, now that would have been enough, right?
Those challenges were great enough
and now you are facing new ones.
Tell us how you are responding to this completely unexpected
and really difficult pandemic.
- So, I'm sure everyone has told you this,
that COVID-19 is completely different
than any of our experiences.
Yours or mine, the previous people you interviewed,
you know, Paddy Mason, Steve Garvay,
is completely different.
- Totally
- So you have to use what you know,
but then be willing to admit.
It is very good to know what you don't know.
I mean, it is very good to know
that you don't know things,
that you have to work them out and be flexible.
And sometimes, things are imposed upon you,
and you just deal with what's imposed upon you,
but sometimes, you have an opportunity to initiate things
and decide to do things differently.
And that's where critical decisions are made.
So the things that were imposed upon us to a large extent,
was that we close
all non emergency clinical care,
we took our students off of the clinical activities,
off the wards, off the clinics,
we stopped giving lectures, with a larger group of students
and we scaled way back on our research programs.
So a couple months ago, it was an enormous screeching halt,
putting on the brakes on all three missions.
I never ever thought anything like that.
And that was to a large extent imposed.
We could use a little creativity, for example,
we have an amazing research portfolio, we are very dependent
upon timed experiments and certain things that we need to do
and I thought that our leadership,
including the chancellor and the vice chancellor research,
really were very rational
in saying, "We can do critical experiments
"as long as we continue to follow
"public health recommendations."
So in other words, we could maintain our alma colonies,
as long as only one person at a time was
in a mouse house room.
We could continue to do critical timed experiments,
as long as only a single person using PPE,
using social distancing was in the lab at one time.
That I thought was a very rational decision
based upon extreme circumstance.
Other institutions, took a very different tact.
They called their mouse colonies, they closed their labs,
they locked them up and they went home
and they're gonna have enormous difficulty
getting started again.
So I thought that was very rational, and
we are now discussing, as you and I can discuss going on,
how do you in a step wise fashion get back
to doing research, get back to doing patient care
and get back to teaching.
And so this is really an opportunity for us to be creative,
thoughtful, and show leadership to minimize the
damage to the Covid 19 pandemic
and also to be creative in coming up with solutions.
And some of the solutions we talked about is
there's silver lining here somewhere.
- Yeah.
- Some of the solutions might actually stick
even after this is long gone and we find that
we can do things better.
You know, Rahm Emanuel says, "Never waste a crisis,"
and this is a crisis, and there are things we're trying
that I bet will become part of our standard rapporteur
that we will not have done if we did not have a crisis.
- You know I think it's really that spirit that is
so important for us to hold on to.
First of all, the humility to know that we don't know stuff
and that we're gonna learn by
only if we listen carefully,
only if we ask the right questions.
And then the idea that,
look where we are headed, how crazy would it be
for us not to learn from this in a way that
allows us to innovate going forward.
So, David, we thank you for your leadership.
We know you are working hard.
We appreciate very much your efforts
and thanks for all you've for UCSD
and continue to do for us.
Thanks, David.
- Thank you for strong leadership
at Sanford Institute for Empathy and Compassion,
I think it's gonna become a vital part
of the UC San Diego community and beyond.
I think we're gonna really teach people the role
of empathy and compassion in healthcare
and just in general life.
So let me give you a paraphrase before we go.
Sir William Osler, the founder of modern American medicine,
said physicians should know three things.
Everyone gets the first two, which is skills and knowledge,
but people forget that the third thing
that he said every physician needs is compassion.
- Yeah.
- So he said without all three,
you'll never be a great physician.
So we're sort of rediscovering
what he taught us a century ago.
Anyway, thank you, Bill.
It's a pleasure. - We are, and thanks,
David so much.
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