• June 6, 2017

    The Faculty 5: Robert Mennel, MD

Five questions for Dr. Mennel, a longtime member of the internal medicine and oncology faculty.

1. What first drew you to the field of oncology?

I really wanted to do internal medicine and focus on taking on unusual problems. Then when I was with a hospital unit in the Navy, I realized that all the really interesting problems were going to go to the subspecialists anyway, and not the general internist.

So I started looking for a subspecialty that was a horizontal cut across medicine – that is, it didn’t deal with just one organ system and would have a lot of internal medicine. At that point in time, that was oncology.

It was a relatively new specialty when I started my fellowship in 1976. Many physicians felt uncomfortable taking care of patients with cancer, and I saw a lot of patients not getting the care they deserve. I thought it would be a good specialty for me because it had a lot internal medicine components and these patients would develop a lot of difficult problems that I would need to help them deal with.

2. Is there advice or a lesson that you learned as a resident or fellow that you always impart to your students?

We have so much technology and we’re so very busy I think, as a group, we tend to spend less time talking to patients. If we spent more time listening to our patients, I think most of the time we could figure out what is going on prior to ordering a bunch of tests. Of course, tests are very important and we should use them judiciously, but I think we’ve shifted from taking a detailed patient history and talking to them to ordering tests.

The other thing I was taught that I tell my fellows is that if you’re ordering a test, make sure you go and talk to the person performing the test for a couple of reasons. One, when you go look at a biopsy with a pathologist or an X-ray with a radiologist it will teach you to be a better pathologist or radiologist.

But more importantly, the face-to-face with the pathologist or radiologist will give them a better sense of the question you’re really asking, and it can become important for them in putting their differential together. They can also raise questions to you that you maybe hadn’t even considered, so it’s like another consult without the patient paying for it.

3. What is the most challenging part of teaching your specialty – a specialty where the outcomes aren’t always what you want – to students?

There are a lot of ways of measuring outcomes. Obviously, what we want to do and what everybody thinks about is curing someone or getting the disease to where it is manageable and not impacting the patient’s day-to-day life. However, even if you cannot cure them of their disease, I think helping people make decisions about bad outcomes can give them great comfort and closure on things. I think that’s important to understand.

But more directly to the question, the short answer is to always think. We have so many protocols right now, which I think is very good when you look at the whole population in a general sense. If a diagnosis of malignancy is made, our residents and fellows go right to the NCCN guidelines. But I always tell them to look at the guidelines, see what they’re recommending and then see if what’s being recommended is right for your patient.

Another good thing to remember is to be politely critical about everything because there is so much information that comes down the pipe, you need to really think, ‘does this make sense and what is the science behind this recommendation?’  

4. What sets the Baylor University Medical Center at Dallas medical education program apart in regards to oncology?

Number one, we have a wide variety of patients who walk through the front door. So if you go through the training program here, you’re going to see the everyday things you’ll see in practice, but also a lot of the once-in-a-lifetime things as well.

The other thing that’s true in oncology – and I think it’s true across all the specialties – is you have access to the attendings. I don’t think there is any field or anything where residents and fellows don’t feel comfortable coming to talk to the attendings. And not just on the academic stuff, but other problems as well.

The other thing is that of all the places I’ve been, Baylor Dallas has been the place where faculty and house staff have been very friendly, approachable and most people don’t have an agenda. Plus, with the academic orientation, there is such a good interaction between faculty and residents.  

5. What do you enjoy most about teaching at Baylor Dallas?

It’s the interactions. I’ve enjoyed the interaction with other faculty members, but mostly with the young minds who have not been exposed to something, who make you answer good questions about why you’re doing something the way you’re doing something.

We have a really smart group of fellows and residents in every area that I’ve run into. This isn’t really a work residency. I think the primary goal is teaching people. Everyone assumes that the flow of information is a one-way street from faculty to student. However, we are all students as well as teachers. The fellows residents, and med students teach me as much as I teach them because they have different ideas about things and it’s good to be exposed to a different way of looking at things.