April 2003
Volume 27 • No. 4

Questions answered on informed-consent policy

HIPAA Highlights

Revision to professoriate changes result in new "adjunct faculty" designation

New policy clarifies decision-making on admission of ED patients

Patient safety program cited as national model

Architect of Trauma Program navigated his career through twists and turns

Momentum builds with construction projects

Architect of Stanford's trauma program navigated his career through twists and turns

David Gregg hasn't had an ordinary medical career. Consider that by age 18 - before he'd even applied to medical school - he had observed scores of surgeries, was assisting in heart surgeries himself (albeit on dogs), and his mentor was heart-transplant pioneer Norm Shumway.

That was only the beginning of Gregg's career. He subsequently pursued his ambitions to become a cardiac surgeon; found his plans thwarted after challenging the status quo at a premier U.S. medical institution; found his calling in trauma surgery; and built, almost from scratch, Stanford's top-quality trauma program.

Today, Gregg divides his time between the Menlo Clinic, where he is a general surgeon, and Stanford's trauma program, where he is one of four on-call trauma surgeons. "I've had a great career - I have no regrets," he says.

Growing up in Atherton and Los Altos, Gregg was fascinated with medicine, starting with the house calls his family's doctor made. At 15, he got a summer job as an orderly at the old Palo Alto Hospital - a job he held for three summers. Though the job wasn't glamorous, Gregg enjoyed getting to know the surgeons, who let him observe their surgeries.

Shumway took a liking to Gregg and in 1961 he offered the 18-year-old a summer job in his dog lab, where he was developing heart-transplantation techniques. Gregg worked in the lab for five summers, doing orderly work, preparing the dogs for surgery and, under Shumway's guidance, assisting with the canine surgeries. "It was amazing," Gregg recalls. "Here's this young kid, working in a lab where history was being made."

Thereafter, Gregg's heart was set (so to speak) on cardiac surgery. After studying biology at Northwestern University, he attended medical school at George Washington University, receiving his MD in 1971. Following a general medicine internship at Boston City Hospital, he returned to Stanford for a cardiac surgery residency. The Vietnam War intervened, however, and in 1973 Gregg was selected for a two-year posting at the surgery branch of the NIH's Heart and Lung Institute. Gregg and his NIH colleagues performed coronary artery bypass surgery, then a relatively new procedure.

Gregg was alarmed to learn that the institute's mortality rate for bypass surgery was significantly higher than at Stanford - a discrepancy he attributed partly to an organizational culture that he felt discouraged innovation. Seeking positive change, Gregg suggested that the institute adopt new techniques to improve its coronary-bypass outcomes. While Gregg's call to action led to improvements, it put him out of favor with the institute's leadership. Soon thereafter, "I knew my career in cardiac surgery was over." Still, he says, "I know I did the right thing."

Returning to Stanford in 1975, Gregg began a residency in general surgery - a field he enjoyed because of its variety. During this residency, Gregg secured his Menlo Clinic position. And by working with William Blaisdell, a Stanford-trained surgeon who later became UC-Davis' chair of surgery, Gregg discovered trauma surgery.

The field was often perceived as general surgery's ugly stepchild, with its on-call hours and middle-of-the-night surgeries. But Gregg found the work exciting and rewarding. "Trauma is on the short list of things in medicine that really matter," he says. "If you do it right, you can not only save someone's life but also restore them to full function."

Stanford's trauma program lacked resources and stable leadership, but Gregg was determined to change that. Taking the job of part-time trauma director - which he held alongside his Menlo Clinic position - Gregg recruited high-quality physicians, updated old equipment and boosted morale in the program.

In 1998, Stanford was designated a Level-I trauma center. The program has since grown steadily in volume, efficiency and quality. Gregg continued as part-time director until fall 2001, when David Spain was recruited as full-time director. "He does extra work that he doesn't have to do, but he believes in it and enjoys it," Spain says of Gregg's continuing on-call trauma work. "He built this program through lots of headaches. I respect him tremendously."

Today, Gregg says he's achieved a happy balance in his work. "I have the exciting, unpredictable work with trauma, and I have my day-to-day practice at the Menlo Clinic. My professional life is about as perfect as it could be."