Mentor Spotlight: An Interview with Dr. Doreen Wiggins
Tuesday, February 6, 2018
During my first year of medical school, I was incredibly lucky to be paired with Dr. Doreen Wiggins for our doctoring course. I saw firsthand how she built relationships with patients through comprehensive care and empathy, how she cultivated an environment of teamwork and respect in her OR, and how she succeeded in endeavors not limited solely to the realm of surgery. When I was asked to interview a female mentor in surgery, I knew exactly whose incredible experiences and insights I wanted to commit to paper and share with other aspiring women surgeons.
Doreen L Wiggins, MD, MHL, FACOG, FACS is an Assistant Clinical Professor of Surgery and Obstetrics & Gynecology at Brown University. She received her Bachelor’s Degree in Chemistry and Psychology in 1984 from the University of Rhode Island, medical degree in 1988 from Brown University, and completed her Ob/Gyn residency at Women and Infants Hospital/Brown University. She founded the Center for Obstetrics & Gynecology in 1999 before pursuing further medical training in 2003, completing a SSO Breast Disease Fellowship at Women and Infant’s Hospital, and in 2009, graduating from the Intensive Course in Cancer Risk Assessment at the City of Hope in Los Angeles, California. Most recently, Dr. Wiggins completed the Executive Masters in Healthcare Leadership at Brown University.
In addition to her medical training, Dr. Wiggins completed training as a children's grief counselor at the Dougy Center in Oregon in 2000. She serves as Advisory Board member of Friends Way (RI's children's-only grief center) and in the past has been the Vice President of the Board, and volunteered as a facilitator. She was chosen in 2003 to be one of 26 cyclists in the Tour of Hope, a transcontinental bicycling relay with Lance Armstrong to promote cancer research and clinical trials. She has also been invited to meet with members of Congress on behalf of the Lance Armstrong Foundation to support cancer research and has received grants for local cancer survivorship outreach programs. She has published book chapters and journal articles and has received numerous awards for medical teaching at Brown University and awards for philanthropy. She has been invited to teach at several yoga retreats, including at Kripalu with Rajshree Choudhary for her Pregnancy Yoga Series since 2011. She is a mom to five kids.
What led you to a career in surgery, and why breast oncology in particular?
As a child, reading was a tremendous escape for me. I started to read Time Magazine in the 4th grade. It opened a worldly curiosity within me. I knew I wanted to become a doctor to help others at age 8. I loved the single focus of being in the OR. I enjoyed the spatial relationship and challenges that breast surgery provided – a puzzle you had to figure out, technique which utilized a two-dimensional image without true landmarks to excise a lesion with good margins in a cosmetic approach.
Breast Surgical Oncology is a multidisciplinary specialty; constant research has provided evolving patient-centered care with developments in screening, genetics, tumor biology, chemo, surgical planning, etc. On a human level, it is an honor to be present for women and their loved ones, to serve during vulnerable challenges. It causes me to pause: often when working, we rush through the day, act as task masters to get it all done; to listen, be present and stand strongly aside another is an honor.
Do you feel that you have faced extra obstacles in your career compared to your male colleagues? Were there things about yourself or your personality that you felt you had to change in order to succeed in this field?
I am a first generation graduate from college. I never thought I was different, better or worse than anyone else. I felt that I could do whatever I wanted, and it was my right - individual equaliberty, one could say. Being a woman has its challenges: people enjoy sharing their opinions of "supposed-to's;" there were sexual advances; there was, "serious doctors don't have babies" … I had five.
Male doctors ran most medical practices. I created a female practice to allow moms to create their own schedule and based the practice on productivity. The bank would not loan me much money for my practice; I was a risk because I was a mom, and my husband had to co-sign the loan even though at the time our medical collections were the same, without debt or other financial constraints.
On the mom front, there were many obstacles placed by women in the community because I was a working mom. I didn't care; I had a great working team at home; I brushed off naysayers; I knew who I was. I did make mistakes – many. I wish there had been more mentoring along all aspects of my career.
You have worked hard to cultivate a positive environment for trainees of all levels in your OR. In the past you’ve mentioned "Just Culture," a concept aimed to level different stakeholders in patient care. Can you talk about this concept and some of the other ways you have been able to foster an OR with engagement, openness, and patient safety before hierarchy?
This is my basic premise for how I see teaching, mentorship, building an alliance with care providers for the best patient centered care, and providing care to the providers themselves, because what we do does take a personal toll on us!
Dr. Lucian Leape, a member of the Quality of Health Care in America Committee at the Institute of Medicine and adjunct professor of the Harvard School of Public Health, stated that the single greatest impediment to error prevention in the medical industry is "that we punish people for making mistakes." Leape indicated that in the healthcare organizational environment in most hospitals, at least six major changes are required to begin the journey to a culture of safety:
We need transparency; we need mindfulness; we need support to providers when life throws them horror, sadness, loss, mistakes. We need to approach this with intent, create a culture of work-life balance, cultivate healthy lifestyle choices - exercise, nutrition, positive relationships, and meaning to what you do with an understanding of its implications. Doctors are not above others and do make mistakes, and this altered state of punitive risk creates burnout, stress, and hidden behaviors. It threatens the core of medicine. Accountability with openness and vulnerability is truthful. Blame and shame is the Dark Ages of Medicine. Our students are the future.
- We need to move from looking at errors as individual failures to realizing they are caused by system failures.
- We must move from a punitive environment to a just culture.
- We must move from secrecy to transparency.
- Care must change from being provider-centered (doctor-centered) to being patient-centered.
- We must move our models of care from reliance on independent, individual performance excellence to interdependent, collaborative, interprofessional teamwork.
- Accountability must be universal and reciprocal, not top-down.
You’re the Director of the Women’s Cancer Survivorship Program, which focuses on the multifactorial care that cancer patients need once they’re in remission or cured. You address everything from nutrition and activity to sex. Have you found buy-in from other providers in your field? What have been the barriers you've encountered, if any? What are future directions for this amazing program?
A cancer diagnosis is the beginning of an uncertain journey, with patients often facing treatments that change or impact life as they know it. It is often seen as a new threshold and gives rise to the concept of the self from before diagnosis. Studies show that physicians often do not discuss aspects of well-being that encompass the experience of living day to day: nutrition, exercise, returning to normal functions, anxiety and depression, intimacy, sexual function, fatigue, sleep, chronic pain, advance directives. We have to be thoughtful about educating patients prior to treatment/surgery about long-lasting implications to the decisions they make now.
Breast cancer survivors and the pink landscape bring much needed attention and understanding to this disease and to the experience of living beyond the diagnosis. I feel other cancer survivors suffer in the shadows. More needs to be done to bring survivorship to all our patients, beyond disease-specific agendas.
Outside of work, you have a number of hobbies and accomplishments, including completing several marathons including Boston, participating in the Tour de Hope, teaching pregnancy yoga at retreats in Costa Rica, and being a mom to five incredible children. All of these things are impressive in their own right. How do you do it?
Trying to achieve goals beyond my talent level and ability has inspired me to be a better self. Once during a fellowship interview the person interviewing me (a woman surgeon) asked me why I was setting myself up for failure. I felt it told me more about her and her limitations. Being kind and showing respect for others opens possibility. I always hired someone I felt was smarter than me, more talented or more diverse in talents. I could learn from them and I could challenge myself to be a bigger me. Also, I was always an athlete, and when running a race, pain would come in waves. One moment I’d think I can’t move my hip, but then I would, and I’d keep going and finish. This made me confident in other arenas. I don’t think I’d accomplish half the things I have without an exercise discipline.
What is your advice to women pursuing surgical careers?
Choose a discipline that brings you joy and tickles the passion in you. Find a mentor who will support and challenge you - there may be more than one. Try to get to know yourself and what you need for work-life balance. Negative and non-supportive others are external nuisances – they’re hard to live with and make you question yourself, but find a way to support yourself through those challenges since you will have to work with them. Continue to put your best self forward and remember you really can do anything. Don’t neglect yourself - good nutrition, sleep, regular exercise, connecting with nature, hugging, and human connections are so needed.
Sofia Aronson is the President of the Brown medical student chapter of AWS and is a fourth-year medical student at The Warren Alpert Medical School of Brown University. She earned her Bachelor’s of Science in Biochemistry at Brown University in 2014, and is planning to pursue a surgical career in an academic setting. Her interests include comprehensive care of cancer patients, reconstructive surgery, and gender parity in the workplace.