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GW School of Medicine & Health Sciences Center for Faculty Excellence
March 2023 Faculty Spotlight
Excellence in teaching & learning, scholarly endeavors, and leadership are all around us at SMHS. The Center for Faculty Excellence would like to Spotlight our faculty’s contributions to SMHS, George Washington University, and beyond. Each month we will spotlight faculty from across the Academic Medical Enterprise. We want to thank our highlighted faculty members for sharing with us their advice and perspectives!
- SMHS Center for Faculty Excellence
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Join the CFE as we highlight Dr. Raymond Pla, MD an Assistant Professor of Anesthesiology and Critical Care Medicine, who discusses his academic and professional journey to Anesthesia. Raymond grounds his clinical service, and approaches to teaching learners through the lens of the principlism model of bioethics. He details the importance of ethical principles in being an advocate for patients and communities through roles on the Hospital Ethics Committee and his excitement in the new partnership between the hospital and SMHS over in Southeast DC.
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Interview Q/A
How long have you been at GW SMHS? What drew you to your current position?
Ray: I completed my residency in anesthesia in 1998 and my critical care fellowship in 1999 at GW. Upon completing my fellowship, I joined the faculty and have remained a member since. What drew me to my current position at GW was the privilege of teaching (and learning) from residents and medical students and the mentorship senior members of the faculty would provide a young anesthesiologist such as me. It has always been my dream since medical school to practice in an educational setting.
As academic settings go, I felt that this department was small enough for me to do many different things (e.g., neuroanesthesia, thoracic, advanced/difficult airway) and, in so doing, find my clinical and academic niche. Later, I would join a number of committees that support the academic and clinical missions of the department and hospital.
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Why did you decide to pursue a career in Anesthesiology?
Ray: Before attending medical school, I had a unique opportunity to spend the summer shadowing the Howard University kidney transplant team. This opportunity allowed me to see the entire process; meeting patients with advanced kidney disease prior to transplantation, watching the kidney transplant surgeries as they unfolded, and then seeing patients during follow-up from the hospital intensive care unit to the outpatient- clinic after hospital discharge. As fascinating as the entire process was to watch and learn, I found myself drawn to and focused upon what was occurring at the head of the operating room table and in the surgical intensive care unit. During surgery, I found myself initially at the monitors displaying the patients’ vital signs and then stepping over to the head of the bed to gain a better viewpoint of the surgery and asking the anesthesiologist a question or two and then several more questions. Gradually, I found that what the anesthesiologists were doing- monitoring and manipulating physiologic parameters in real time- just as interesting to me, if not more so, than the anatomy and operation itself.
In medical school, the study of the respiratory and renal physiology and pharmacology of the anesthetic gases and vasoactive medications, began to solidify the foundation of an interest in a career in anesthesia; a foundation laid during the aforementioned experience. During my third-year clinical rotations, surgery rotation and OB-GYN, I once again experienced the thrill of the perioperative environment. I even scrubbed in on as many C-sections as I could, just to be in the operating room. Still, I kept thinking about what the person at the head of the table was doing and just found it more captivating to me. By that point when many of my classmates’ specialty interests began to take shape, it had become clear that the draw to anesthesia was one that I just could not and should not ignore. I found my home! Ultimately the draw to anesthesia, was a visceral response to the pharmacologic therapeutic measures to manipulate human physiology in real time and I found it very profoundly compelling and decided to pursue anesthesiology as my specialty.
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What are your major responsibilities here at GW SMHS in terms of teaching, research, and service?
Ray: I look at teaching, service, and research as being interrelated, rather than distinct entities. Through my position, I have active engagement in all three. The privilege of clinical service is that I care for patients and in doing so, improve their condition, the human condition. And this is the most fulfilling act of service that I can commit. Teaching: I feel compelled to pass on to the next generation of learners, my insight, my experience, the wealth of knowledge I have accumulated and refined over the years. In a way, it is how I express gratitude to my mentors, those who did the same for me.
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How do you approach clinical service?
Ray: What informs and impacts my clinical service is something that I teach young learners, there are three lenses through which one can look to shape clinical decisions; a risk management lens, that is practicing defensive medicine; In this mindset, our clinical decisions are shaped by an overarching goal to avoid (medicolegal) risk. A second lens, I refer to as the evidence-based practice lens. “I do this because the data suggest that this is the very best way to proceed”. On the surface, this sounds very reasonable, but this view does not allow for a consideration for patient autonomy. What I consider the third (and my preferred) lens is the lens provided by bioethics. I prefer this prism, because if we use the principlism model of ethics and its components - autonomy, beneficence, non-maleficence, and justice - clinical decisions should be scientifically sound and beneficial; just or generally free from bias-though we know that is not always the case; and considerate of patient’s wishes and input. Put another way, we use science and the current state of evidence, remain faithful to a patient's autonomy, and apply a thoughtful empathetic approach to every patient we serve regardless of race, gender, religion, economic status, orientation, and such. Viewing our patients not just as patients, but as people with fears, concerns, hopes, and dreams with opinions that are informed by their culture, their religion, and background we have a duty to respect their decisions and move forward in accordance with both what is scientifically reasonable while respecting their wishes.
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What is your favorite thing about your current role or responsibilities?
Ray: Within my responsibilities, I am the Co-chair of our Clinical Competence Committee and serve on the CUMEC, so I have a voice and influence the future of the curriculum at GWSMHS and the future of my specialty. However, for me, the most rewarding of my responsibilities is serving on the Hospital Ethics Committee. I link this back to the topic of justice, which is the third of the four ethical pillars. We are becoming more aware of the role that race, gender, and orientation play in the outcomes in medicine. It is important to me that we uphold the highest standards of justice as we deliver health care, not only as an abstract construct, but as a living and breathing thing. What I mean by this is that we cannot just discuss these topics, we have to practice them and ensure that we offer all of our patients, regardless of the race or gender of the provider relative to that of the patient, the full benefit of the accepted standard of medical practice and the current science. Then we must completely reject the decisions rooted in our unconscious bias, the thoughts and opinions that adversely influence an outcome. It is really rewarding and an enormous responsibility to be the only active member on the Hospital Ethics Committee from the clinical staff working in the perioperative space and in my department, in particular. I’d like to think that I bring an increase in awareness of some of the ethical dilemmas that arise in the operating room area and watch my colleagues be a part of the solution to these dilemmas.
Through my role on the Hospital Ethics Committee, we've been able to highlight these practices with each and every patient and encounter we have and that has been an enormously rewarding part of my roles at GWSMHS. My work on this committee greatly influences a large portion of my teaching. Working in anesthesia, we need to emphasize that our learners, our residents, will graduate and need to be, if not fluent, at least very proficient in bioethics and able to identify some of the common sources of bioethics conflict in clinical practice, in perioperative medicine.
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What about the future of the Anesthesia Department and/or GW excites you?
Ray: We have talked a lot about healthcare disparities and were aware that healthcare disparities existed before the pandemic and before some of the tragic deaths of particularly Black men and Black women in this country. We were aware that those healthcare disparities have existed for a long time. However, more recent events, have shone an especially bright light on healthcare disparities. I think we need to step away from the term for a moment and identify what is really at stake here, lives. We are talking about individuals and their futures, families, and communities in which the trajectory has been irreparably altered when we allow healthcare disparities to continue unabated. So, in real terms again, we are talking about people and their potential that end prematurely when we allow health care disparities to continue. We fall short of our own moral responsibility. What does that mean? Well, if we break that down, we discuss situations like food deserts and healthcare deserts and people who live in communities where access to the highest standard of care is not available. So perhaps the most exciting thing to me is the partnership between the hospital and SMHS over in Southeast DC. This community has been underserved with respect to quality and state-of-the-art healthcare, an area where infant and maternal mortality and heart and kidney disease are particularly high. There is a chance for us to answer that moral responsibility, engage in health care justice and begin to address those unacceptably high rates of disease and even death, which is very exciting to look forward to.
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What impact do you hope to have on your trainees, colleagues, or peers through these roles?
Ray: My hope is to influence their value system and get my learners to accept the necessity of understanding general principles of bioethics just as they accept principles and practice of airway management and cardiovascular physiology and pharmacology and other areas long considered central to the safe practice of anesthesia. Further, if they could use a bioethics lens to influence clinical decisions as I do, that would be a dream realized. What would that look like in practice? Inspiring them to embrace and contribute to the evolving science of anesthesia practice as a way to ensure ongoing beneficial care delivery to patients. Next, inspiring them to see the importance of a just delivery of healthcare to every patient, requires them to face and confront their individual unconscious bias, a tall ask to be sure, but the next generation is enormously talented and committed! I also hope they embrace patient autonomy: the decisions that require our most vigorous effort to respect are the ones with which we disagree. It's easy to agree with someone's decision to proceed with a procedure or therapy when you are the one offering that procedure or current data suggest it likely to be beneficial, but patients decline, nonetheless.
You can share facts with your learners, but we also understand that with the evolving science, what we take to be facts today may change as a product of scientific research and discovery. If I can influence a value system to embrace evolving science and to ensure that every single patient you encounter has the benefit of that science, that's what beneficence and justice look like and then being faithful to autonomy. Well, then, you’ve got it all.
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What are you looking forward to working on or doing here at GWSMHS currently or maybe in the future?
Ray: With respect to the hospital being built in Southeast DC, I am really looking forward to the partnership of GWSMHS and the hospital being a part of the community it serves. We should strive to be more than just a building where people suffering from an illness come; while this is also important, we need to be a part of preventative care and become full members of our communities. Being a part of the community means outreach by partnering with schools and community centers and welcoming some of the young people who are the future of medicine. Many of these young people have very few role models who look like them; very few who embody, the idea for a young Black boy or girl that someday becoming a healthcare provider is 100% possible. We all call this area home. Many of us were born and raised here, we root for the same teams, and we welcome spring weather together, and so on, and so forth. Yet we all don’t share in the same benefit of health and opportunity. We need to partner with our neighbors, and I think establishing this hospital there, is a tremendous opportunity for us to make an enduring positive difference.
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How does this Faculty Spotlight and recognition make you feel?
Ray: It is truly an honor and humbling to be recognized this way. When we discuss my teaching and service, I think back to why and how I got here. I am here because of my mentors. My father was a math teacher before becoming a dentist and my mother retired from the faculty at Howard University; they were instrumental in my path here, as well as other mentors along the way during medical school and other faculty have influenced and encouraged me. There is also one other person in particular who really influenced me in terms of my teaching and how I approach educating my learners, especially in terms of thinking about how learners run a race to be better every day. This race is not against those who are behind you but rather you are trying to catch up to those out in front of you. My father-in-law, who is a retired professor of sociology at Princeton University, was an extraordinarily committed educator. I was influenced by an interaction between a student and him that happened many years ago. We were on vacation, and we ran into a former student of his who was a young African American man, a former student. He told my father-in-law, he didn’t feel like he really belonged at Princeton or could measure up to do the work, but Professor Taylor, as he called him, inspired him, took the time to mentor him and help him grow the confidence that allowed him to go on to graduate from Princeton, then Columbia Law School, and he was now working as an attorney in New York. These were things he didn't think were possible had it not been for the influence of my father-in-law. So I think of him, both of my parents, my grandmother who was an educator, the faculty member at one of the historically black medical schools in the country, Meharry Medical College, and also a couple of current and former faculty members at SMHS- Dr. Marian Sherman, Dr. Seneff, and Dr. Jack Zimmerman- the people who inspired and instilled in me the belief that I could run a race, that I could run fast enough, that I could begin to look forward to some of the great educators out there in front of me. All of that allowed me to be where I am today and still influences me.
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Final thoughts on how to stay motivated and keep moving forward?
Ray: Change is hard. Sometimes the resistance is rooted not just in inertia, but we think “Well no one else is doing that?” That may be true. Still, we have to remember when you are a leader, there may be fewer people or organizations in front of you for you to “chase”. You cannot be afraid to fail. If fear stops you, then you have already failed!
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