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Q&A: Robert C. Wright M.D., Fellow of the American College of Surgeons Owner, Meridian Surgery Center

From the August 6, 2012, print edition

Robert C. Wright’s father worked for Boeing, and he grew up moving from town to town throughout the Midwest as his father went from project to project for the company. Wright went to high school at Foster High School near Tukwila and attended Washington State University — originally to be a veterinarian. He found that allergies wouldn’t allow him to pursue a veterinary career, so Wright got a degree in biochemistry and then went to University of Washington for medical school. After medical school, where he met his wife, Wright did residency at Texas A&M for five years in surgery. By that time, he was convinced that the Pacific Northwest had free air-conditioning, and he established a private practice in 1990 in Puyallup.

Why Puyallup? 

This was home for my wife and me. Our families are here and our kids have all grown up knowing their cousins and being close to their grandparents.

In the early years, hospital-based surgery dominated my practice. Puyallup had only one hospital and rapid population growth — so there was plenty of work for me locally. I’ve always wanted to live in a community where I would run into people that I have taken care of.

Since opening my own surgery center and developing my focus on hernia surgery, I have expanded my hospital privileges to Tacoma and am able to attract and serve patients from all over the Puget Sound and beyond for hernia and other surgical needs.

What challenges are unique to health care in our area? 

First, the state has very few medical insurance companies and that inhibits competition. Secondly, we have high malpractice costs, making it less attractive for physicians to come to Washington.

In addition, Pierce County has become dominated by three large medical delivery systems. This has resulted in high health care costs. The expensive care is one of the significant impediments to business expansion in our area.

How did you arrive at a focus on hernias? 

Hernias are one of the most common operations a general surgeon performs. For a number of decades, research on hernias was virtually nonexistent. And with the advent of laparoscopic surgery, all research was dominated by biomedical equipment industry — but that is changing.

Now, the challenge in hernia research has been an attempt to understand the pain patients have from the hernia and to prevent chronic pain. That is the focus of my research.

Is enough hernia research being done?

It’s improving. In the last eight to 10 years, the medical community has seen the development of a surgical journal and the creation of a professional society to specifically address hernias. That has dramatically increased the number of published papers focusing research on hernias. 

What is the next topic for you to tackle?

My research has established the fact that sensory nerves are in fact damaged by the hernia itself in specific locations.

The next topic is to tackle the correlation between the pain experienced by the patient from the hernia and the histopathology of the damaged nerve.

Describe your research.

My research is a surgical clinician’s endeavor to explain the pain of a hernia in biological terms by what is seen under the microscope.

Starting a decade ago, researchers began to notice that if they routinely removed some of the sensory nerves in the area of a hernia, their patients had less pain. Shortly thereafter, I noticed a damaged nerve during surgery.

My training had been to always leave the nerve intact. However, after other researchers indicated that removal of the nerve is a safe practice and can decrease pain, I removed a nerve and sent it to the pathologist for review. The pathologist found a neuroma, which is a degenerative nerve tumor caused by the trauma of the hernia pressure.

My research expands on that finding to describe where the nerve is usually damaged. Now, I am working with a neuropathologist at the University of Washington and Harborview to more accurately depict, in professional neuropathy terms, the amount of damage that is being done. The next step will be to then correlate that with the symptoms that patients experience from their hernias.

I have been asked to present a video at the American College of Surgeons meeting. The video depicts an open hernia repair when abnormal nerves are identified, and then shows what those nerves look like under the microscope.

The presentation makes it clear that, in some instances, the hernia has damaged the nerve and it is not normal, as has traditionally been taught in surgical training. Surgeons need to see and recognize the abnormal nerve.

How do national health care initiatives affect your hernia practice?

Many say that surgery centers like Meridian Surgery Center as well as private practices, will not survive the national health care initiatives.

That being said, it’s difficult to imagine that such surgery centers and private practice physicians who can provide excellent quality care at a lower cost will not have a place in the health care system of the future.

In the future, we will apparently have Accountable Care Organizations that will attempt to provide cost-effective care and avoid the expensive hospital setting for care, when appropriate.

At the Meridian Surgery Center, we provide publicized results and excellent outpatient surgical procedures at significant cost savings to the patient, the employer and the insurance company, compared with hospital surgery. We look forward to being a part of the solution to high medical costs.

Another significant change is that hospitals now seek to employ many surgical specialists, so there are fewer surgeons and other providers in private practice. This actually increases the cost of medical care because there is less price competition in the marketplace. 

Are surgeons competitive with one another or is there collaboration?

Like many providers of similar services, surgeons are indeed in competition with one another. Savvy consumers know that they have many choices when it comes to surgical care.

They are ultimately in control of choosing the surgeon who cares for them, and they need to do their research online and ask questions of their referring provider.

They have choices, and they may have to stand up for their right to choose. A hospital system cannot dictate this decision for them — it is the patient’s right to choose.

As a private surgeon, I’m privileged to collaborate with care providers in both hospital systems. I see the greatest collaboration among health professionals who care for cancer patients.

In my work with cancer and breast cancer patients, I work with oncologists, radiation oncologists, other surgeons, plastic surgeons and nursing professionals as we come together to advance patient care in this area.

Describe the American College of Surgeons conference at which you will be presenting your research.

The American College of Surgeons is a professional organization of surgeons with more than 20,000 members. The meeting in Chicago Sept. 30 through Oct. 4 will attract more than 14,000 people, who will provide educational updates on a wide variety of subjects.

I will present my research, inguinal neuritis and its identification during inguinal hernia repair, at the General Surgery Video Session. My research was one of only three hernia-related research presentations selected for inclusion.

What are your biggest challenges?

For the first 24 years of my practice, my biggest challenge was getting enough sleep when providing emergency care. Balancing family with a very busy surgical practice and carrying a beeper 24 hours a day remains an on-going challenge.

After 10 years of running Meridian Surgery Center, a recent challenge that I overcame was opening the new center in March 2011.

What have been your biggest successes?

I am proudest of having the opportunity, every day, to help people solve their health problems and return to a full life. That’s very satisfying to me.

Other important achievements include expanding my privileges outside Puyallup at multiple hospitals in the county.
I was the very first surgeon in the state to perform a hiatal hernia operation using robotics. I am also quite proud of my clinical awards.

I received The People’s Choice Award five times while on call at Good Samaritan Hospital. And in 2010, I received the Research Award from the American Hernia Society, one of three annual awards. I was very surprised to receive the award because I am not industry or institutionally funded, just my own private resources, for the research I perform at the Cascade Hernia Institute.

That award was associated with the lead article in General Surgery News the following month.

What keeps you up at night?

If I have a patient who is experiencing a problem, I will frequently be up at night doing research and thinking over the issues. I am always concerned about my patients.

What would you change in your career?

I would have made sure that I got more sleep earlier in my career.

What does the future hold?

I want to continue to provide my patients with top quality care through surgical advances that help them return to their normal lives.

To do this, I will continue to work with pre-med students in conducting clinical research, and I will expand the use of outpatient surgery in my practice.