Leaders in Medical Education

Dr. Deanna Attai, President of the American Society of Breast Surgeons

Uthraa Thambiran
Published on Aug 7, 2015. Updated on Invalid date.

Dr. Deanna J. Attai completed her undergraduate education at Vassar College, she graduated with honors from the Georgetown University School of Medicine, and then completed her General Surgery Residency at Georgetown University Hospital. Her surgical practice is limited to the care of patients with benign and malignant breast disease.

Dr. Attai is currently serving as President of the American Society of Breast Surgeons, and has served as President-Elect, Secretary / Treasurer, Chair of the Finance Committee, and Chair of the Communications Committee for the Society. She is also a Fellow of the American College of Surgeons. She is certified by the American Society of Breast Surgeons for the performance of breast ultrasound, and is an ultrasound instructor for the American College of Surgeons.

An ardent proponent for patient education and empowerment, Dr. Attai is frequently sought out by local and national media for her thoughts on breast disease, diagnosis and treatment. She is a regular contributor to social media sites and is a co-moderator for #BCSM – Breast Cancer Social Media – a popular breast cancer support community based on Twitter.

How did you first become interested in medicine? Medical education?
In elementary school and high school I was always interested in science. My father was a cardiothoracic surgeon and my mother was a nurse, so dinner conversations often revolved around medicine. As a high school student I accompanied my father on hospital rounds, seeing office patients, and observing surgery. At the time I don't recall being determined to be a physician, but once I went to college, I assumed that the next step would be medical school and I majored in biology. While I took a broad range of courses, the sciences are always what appealed to me.

As far as medical education, I think my interest was sparked early in medical school - I attended the Georgetown University School of Medicine in Washington, DC. We all have to start somewhere - and usually it's with a blank slate. I was fortunate to have incredible professors in medical school who clearly had a passion for teaching. When I rotated through the clinical clerkships as a third and fourth year student, I was also exposed to many attendings and senior residents, especially in surgery, that truly loved their work and enjoyed teaching. I also had a handful of attendings and senior residents in various specialties who didn't seem to enjoy their profession, and it carried over to their teaching style. It was a perfect example of how I did NOT want to be, and also probably influenced my decision to become a surgeon. It's important that we educate the next generation, but I also feel we need to do that in a way that conveys our love and passion for our chosen specialty.

Can you share your background on how you got to where you are right now?
When I finished my general surgery residency, also at Georgetown, I knew I wanted to go into clinical practice, and I joined a large general surgery practice in Northern Virginia. I was again fortunate to be surrounded by senior colleagues skilled at mentoring. I left that practice after 4 1/2 years to take a position with a general surgeon in Southern California, also in community practice. After 1 1/2 years, I went into solo practice. While my practice included the full range of general surgery, during each of the 3 different settings, my patient population evolved to about 60% breast. In 2002 in preparation for solo practice, I took courses in breast ultrasound and image-guided biopsy, and purchased an ultrasound machine. I joined the American Society of Breast Surgeons and learned how to better take care of patients with breast conditions and breast cancer. It was an exciting time - I was learning things that I was never exposed to in training, and was being educated about a completely different way of thinking about breast disease. By 2004 I decided that I wanted to practice breast surgery exclusively, and I stopped performing all other general surgery operations. I also became more involved in the American Society of Breast Surgeons, initially serving as a member of the Membership Committee. I then became Chair of the Communications Committee, and later earned a seat on the Board of Directors. During this time I also became faculty for the Breast Ultrasound courses and have had the opportunity to teach physicians how to incorporate a new skill into their practice. I am so honored by the fact that my first ultrasound instructor now calls on me to teach others. Later I was nominated to the Executive Committee, and currently am serving as ASBrS President. My clinical practice has evolved as well. In August 2014, after 19 years in private practice, I joined the faculty of the David Geffen School of Medicine at the University of California Los Angeles (UCLA). I remain in my same office in a community setting, but I again have the opportunity to teach and mentor medical students and residents, have more research opportunities, and have a large support network. I feel I have the best of both worlds - a community practice setting with academic responsibilities and support.

What are 2-3 changes you would like to see in the current medical education system? How about the healthcare system?
Medical education has changed quite a bit over the last 25 years! I finished medical school in 1990 and general surgery residency in 1995. Once I moved to California in 1999, I had limited exposure to medical students and residents, but since August 2014 I have become more involved in medical student and resident education. Students remain inquisitive and eager to learn, and personally I find that enthusiasm contagious. I think as educators, we need to always remember that we were once students (and in medicine, you remain a student your entire career) - wide eyed and ready to soak up information. We need to keep pushing for innovative ways to present large volumes of increasingly complex information, but we also need to remember that our enthusiasm (or lack thereof) for our chosen field definitely has an impact on our students. One thing I have noticed is that there is much more of an emphasis on self-care for students and residents, which I think is important and a much needed change. That was non-existent when I was in training - we were expected to be all about patient care, 24/7. While I think there are challenges with the current 80-hour work week system, I believe it will turn out more well-rounded physicians who are able to continue practicing in good mental and physical health for many years.

Healthcare is constantly evolving. I remember as a college and medical student hearing experienced surgeons complain about the loss of the fee for service model and the development of Medicare. Other changes followed - as a surgical resident, we were warned about health maintenance organizations and the lack of autonomy. We are facing additional changes and challenges right now. The reality is that the only constant is change. As physicians it is often frustrating, but I think we need to focus on providing the best care to our patients, within the constraints of the system.

Do you have any final thoughts regarding the medical profession as a whole?
Medicine is a very challenging and humbling profession. It is an honor to take care of each and every patient. While there are many challenges, I cannot imagine a more rewarding career. If your heart isn't in it, I'd recommend choosing another career path. The stakes are too high to be in such a demanding profession that you don't love.

What does it take to be a breast surgeon?
I think for a breast surgeon, it takes all the skills of a good physician and surgeon - technical expertise, a good fund of knowledge, compassion, and an open inquiring mind. One thing that's different about breast surgery compared to general surgery or other surgical subspecialties is that there are longer-term patient relationships, and it can be more of an office-based practice. I started out seeing anyone and everyone with any sort of breast condition - pain, cysts, benign lumps, abnormal mammograms, abscess, etc. As my practice has grown, I'm seeing primarily breast cancer patients, but I still see a fair amount of benign disease. A patient with a hernia or cholecystitis or even colon cancer will come in for an initial consult, maybe a pre-op appointment and a handful of postop appointments and that's it. Breast patients can be your patient for life, and you inherit their entire family and support system as well. Breast is more emotional - I had surgeons tell me after I stopped taking ER call - "oh you must have so little stress now..." - but I am dealing with women and their breasts all day long! But it is nice to be able to sleep through the night, especially as I get older. I'd suggest spending some time with breast surgeons - make sure that style of practice is what you are really interested in as it is very different from general surgery.