Ep. 56 | Jared Sanders, MD, General Surgery, SGMC Health

Transcript

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- Have you ever been told you might need surgery? And immediately wondered what happens next and maybe what questions to ask.

- Welcome to What Brings You in Today?, a podcast from SGMC Health. I'm Erika Bennett. And I'm Kara Hope Rockwell. And today we're here with general surgeon Jared Sanders. So Dr. Sanders, what brings you in today?

- Well, yeah, I'm, I'm here today to kinda answer whatever questions y'all might have or whatever you think general public might be interested in, whether it be in regards to general surgery or the breadth of what we do, or, or trauma, whatever. You know, I'm, I'm, I'm game for whatever, and excited.

- So give us some background on your career journey. How did you get here to SGMC Health?

- Well, I, I grew up in Americas, Georgia, went to Lee County schools pretty much, you know, all the way second through 12th grade, so I've always been kind of in the area. And my dad was an auditor for the state of Georgia with all the School Systems. And Valdosta has big school systems. It's got, you know, both the city and the county and then the college and the technical school. And so our summer vacation was in Valdosta, which was like the big city for me. And we'd come stay a whole week while my dad audited these school systems over here. And so that was my familiarity with, or familiarity with Valdosta was growing up and kind of coming to the big city. And when I was graduating, I went to Georgia Southwestern, right there in Americus. So, you know, always kind of been around this area. I actually was a school teacher for a couple years, taught seventh grade math and science up in Henry County, Georgia. Figured out seventh grade's a lot more difficult, you know, than, than I was looking for. And, and somehow, you know, kind of stumbled back to original plans I had when I first went to college that had kind of faded away and wanting to go into medicine, not even knowing exactly what field at that time, but just always having that kind of pull towards medicine. And so started pursuing that, you know, studying for MCATs and, and doing a lot of shadowing and, and rotations and did a lot of shadowing in Plains, Georgia, which was, you know, where I was from. And, and, and working with physicians at the hospital there in Sumter County back at that time, was not part of Phoebe, it was his own hospital. This was before they had the big tornado that tore it down. And so I was there kind of during all that. And so it was a unique, you know, period of when they were struggling and trying to figure out how to provide healthcare in a time of turmoil. And so all that kind of really stuck with me. And I think, you know, I think that's where I picked up some of that, you know, liking the trauma and liking some of the, the general surgery kind of broad aspects. 'cause I always seemed to be shadowing with general practitioners who did some surgery. You know, back in the old days you didn't have to be a surgeon. And then some of those that, that were surgeons kind of there, that were general surgeons that did a little bit of everything. And so when I did get into medical school at Mercer in Macon, I was the last class that all 60 of us was right there and entered in Macon at the same time. But they had started branching off and sending kind of their, your your clinical years, your third and fourth year were starting to go to Savannah. They'd split the class and kind of send 'em similar to what we're doing right now with having students from Mercer for their third and fourth year. So I did that when Savannah first started before they had their medical school. And so I did my clinical years out there in Savannah. Really loved the surgeons that I encountered out there. I liked a lot of, a lot about Savannah and the hospital, their memorial that I was at. And then, you know, decided to go into residency and went into Greenville, South Carolina. Spent five years in Greenville, South Carolina, which is, you know, a beautiful place to be if you've never been very hard. We had my, I had my two children up there with my wife Lizzie, and very difficult to get her to wanna move her. And those two kids down from Greenville, it is such an attractive city, but, but we both knew we wanted to be back closer to home. She's from Sandersville, Georgia has a big pull there and, and so, you know, that's a very small town as well. And so it, we just always kind of wanted to be back in a smaller community. And, and it was about my fourth, no, my third year in, I was on my pediatric surgery rotation actually up in Greenville. My program director knew I always wanted to do general surgery. Very few know that they were gonna do just general surgery coming in, but I always knew I wanted to do just general surgery and no, never wanted to go and, you know, highly specialize or be in a big city or anything like that. And he came and found me. He's like, listen, I got this sent to me in the mail and you're gonna go to it. And it was this rural health recruitment clinic put on by the Rural Health Alliance for state Georgia. And so I, it was up in, at Lake Lanier in Georgia and which isn't too far from Greenville, South Carolina. So he sent me to it for the weekend, the residency program did. And that's when I ran into Dr. Kim McGal and Leonard Parker, who are there representing South Georgia Medical Center. And we, and they said, we've got, we've got some surgeons that we think you'd get along great with and put me in touch with Miller Parker at that time. And so that's kind of, you know, those guys brought me down a couple times. What a blessing that you went to

- That conference. Yeah,

- Yeah. It was just random chance and, and I had always remember Valdosta with Fond memories and then, you know, met those guys and I knew they'd be great teachers and mentors and, and so they had an unbelievable reputation at that time. And I mean, of course still do, but I mean, you know, I just knew that that, you know, it was a place that, you know, had a lot of ability to, to train me in as well as to be in that community for a long time. And so that's what I was interested in looking for.

- And what year did you join SGMC Health?

- So it was 2016. I joined in 2016, the summer of 2016. So it was 10 years. 10 years. Yes, it is. We're hitting on 10 years.

- I mean, you said that you were a teacher. You, you are like, teaching's not for me, I'm gonna go do surgery.

- Surgery's easier. It's, it's wild. It's seventh grade is much harder than this. Yeah, yeah, yeah. Middle, they earn that summer vacation and now it's shorter. I,

- Well tell us a little bit about general surgery. So we kind of prefaced it in the intro, like when someone hears that they might have to have surgery, what kind of surgeries do, I mean, general surgery is general, so like how do you like liken that to the average person that might have to have surgery at some point?

- No, it's, it is a very good question. I get asked it all the time, probably the number one question you get asked. So what do you, what do you do? Yeah. You know, type sort of thing. And it's, it's a little breadth of all fields. You know, we, we want to, in a town like this, you can't house a bunch of specialists, you can't be just the colon doctor or you can't be just, you know, a liver doctor. You, you have to, you know, broaden and be able to take care a little bit of everything. One, just because, you know, the, the ability to be able to have the business to, for the hospital to be able to, you know, keep you there and keep you happy. You don't want to have a physician come in who's not getting any busy. They're, you know, they, they don't feel like they're, they're meeting their, you know, self-actualization of being, you know, utilized. And so you gotta be able to do a little bit of everything. And then because of that you do end up getting quite a bit of volume. And so we will treat anything from, whether it's skin cancer to, you know, your normal, what we would consider acute care surgery issues, gallbladders, appendixes, bowel obstructions, diverticulitis. We also treat a breadth of cancers outside of like skin cancers, urban eye lesions. We also, you know, treat colon and rectal cancer. We do a lot of breast cancer and some of my partners are more specialized in, you know, you've had Dr. Davis on who's highly specialized in thyroid, parathyroid, adrenals and endocrine tumors and, and dr how, you know, colorectal training. So we each kind of have these, these niches and specialties. I, I, I of course have always been drawn to breast cancer and, and, and there's overlap between, you know, each of us all, we all kind of cover each other and then we all do the trauma and we all do the acute care surgery. And, and we brought in recently some, some young general surgeons that, that are bringing their skillset such as Dr. Lynn Hartwood, bariatric surgery, who also does general surgery. You know, so, you know, even though you may have specialties, you still kind of cover that, that broad range of stuff. And, and it always keeps it interesting. You know, our job inborn, it's not the same thing every day. I can promise you that. Yeah.

- How do you ease patients' fears from like having surgery?

- You know, the good thing with being a general surgery is that you'd get a lot of volume. You know, we're, we're some of the highest volume surgeons out there for sure. And so, you know, you have a confidence that comes with repetition and that everybody knows. The more you you do, the more repetition you do, the more familiar you get with it, the more confidence you have in yourself. And I think that that that patients can see that and feel that. And, you know, I think it also comes from learning, you know, what are your limitations and, and knowing what they are. And so I'm very honest with patients. If I, if I ever feel that I, there's something that, that I can't do or there's somebody who does it better, especially with us being surrounded with such, you know, you know, really good tertiary centers and mayo and Shands right around, you know, the corner. I mean, then, then I will send them there and I have no problem sending anybody there. And I think, you know, when, when I talk to 'em and explain to them that these, these are things we do every day and I don't think you need a specialized center versus, you know, hey, if I ever thought you did, and I think we do in this scenario, I'm gonna send you there because they do this on a weekly basis. I see this maybe every two, three months, you know, sometimes less than that. And so, you know, we have good relationships with those referring facilities and the, and the surgeons at those facilities, whether it be like liver surgery or hepatobiliary surgery, some complicated colorectal stuff that, that we don't do here. We, we send them to those guys and, and, and keep in touch and tabs and try and help out, you know, how we can on this side. But I think it's just, you know, knowing that when you're speaking to 'em, you're speaking to 'em from experience and confidence and it takes a while to get that. And obviously I didn't have to begin with and I appreciate my first three years of patience, you know, trusting me and, and, and things going well. But you do, you grow very fast in, in this field and, and, and it's, again, you never know what you're gonna get. So prep and people were like, you know, it's, it's not like I know what case I'm doing in three weeks. I mean, I was on call last night and I didn't know what two cases I was doing this morning, you know, and I just did 'em. So you just don't know. And I think that also makes you more well-rounded and better to handle whatever circumstances or complications may arise during your surgery. But it's, it's communication and honesty and, and being willing to show your humility. And it's not a pride thing. Getting somebody to somewhere else where they need to be. I mean, that's, that's just part of the job.

- Well I think you're well known for your just genuine personality, your skill, but also your character is, I appreciate that evident through all of our patient reviews that we get. Absolutely. From your patients. So I commend you, you're, you are doing very well on that, kind of speaking on that trauma 'cause you're talking about unexpected things. You were very integral into the development of our trauma program here at SGMC Health and getting that started and kicked off. So tell us a little bit about that and kind of maybe where it is now and yeah, what all had to happen for that?

- Well, I'll be honest, we, we were already doing so much of the work, you know, we're, we're, even though we're near those, those trauma centers we're still over an hour away, even by ambulance at high speed. I mean, we, we were still somewhat isolated and right here on 75, so we were getting already some pretty significant traumas and we keep quite, the vast majority of what we get doesn't get transferred out. So we, we, we were already doing it, we just, we just needed to be getting the credit for it more than anything. And we needed to highlight, you know, specific areas and, and in doing that, when you start to work on these things and putting 'em together and realize, you know, we can improve in some areas too though. And, and we started, you know, redefining certain protocols we had and, and adjusting them and, and making them better and more rapidly available such as like massive transfusion protocols. We've got that in place to where blood is much more readily available to patients as soon as they get here. We can almost give moving those products even closer to the proximity of actually being in the ER rather than having to run, get 'em from the lab, making it a much more streamlined process so that when a trauma alert does go out and EMS calls it in that when the patient gets here, all teams that are needed or there and ready to go, I mean, that that's not just your, your ER doctors, it's not just, you know, the nurses. It's also having, you know, respiratory there, having the lab there, having an x-ray there, pharmacy there, and getting your surgeons on the way in that that's all now in place to where it happens in unison and at one time rather than just the phone tree going down. And so, you know, each of these steps that we make, you know, more protocol and, and streamlined, we can also study 'em better, you know, and we know how it's supposed to go and we can check boxes off when we sit down and review cases. And it may be just a simple thing like did they get their tetanus shot or did they get their antibiotics with an open fracture within a, you know, hours time, you know, we have goals that we outline and it makes it easier to achieve these goals when we're paying attention to 'em and recording the data. So it just builds on itself. So not only do we start getting credit for what we're doing, but then we start doing it better and we start tracking it better. And then we can report that. And I gotta give huge credit. Anytime you mention trauma program, I'm a small part in it compared to, you know, Emily Brown and what she did, and she's our EMS director and she, she is very protocol driven individual and a very type A individual when it comes to that kind of stuff. And you've gotta have someone like that on board to get something started like this. 'cause I, I think it happened where it started up and just kind of died down a couple times and she was just a bulldog and saw it through the end and, and just drug me along with her, you know. So you also had to have a motivated colleagues and partners and, and having that support trauma protocols can be, you know, a very time consuming thing sometimes to the professionals having to be there. 'cause trauma, most of it is non-operative. I mean, the vast majority of what we do is non-operative. So you, you know, to tell a surgeon they gotta come in and get ready when they're probably not gonna operate, you know Yeah. In the middle of the night and they know that 'cause you don't know what you're gonna get versus the old way of, you know, getting called and saying, Hey, we've got this that needs to go to, or it takes a mindset change and a willingness, but, you know, you save that time and lag way and then you've got somebody there too that's familiar with trauma and can steer the direction of how the workup needs to go. And, and so that buy-in from the general surgeons and the neurosurgeons and the orthopedic surgeons is, is very important, you know, to, to get something on. And we had a good shift in in that that helped us do that. Anesthesia as well was a big part of it, you know, I think of it, they're a big part of that as well.

- Yeah. So SGMC health became a level three trauma center back in June, 2023. So can you just explain a little bit, like what does that really mean for a patient or a family?

- Yeah, so you know, level one and level two trauma centers are obviously higher level level ones are usually just your, your basically academic centers where you have residents and research coming out of them. Level twos for a functioning standpoint have a lot of the same capabilities, if not almost all the same capabilities and maybe just don't have the research requirements or, or the amount of, or residents available and stuff like that are kind of the, the big difference between those two. If you just want to surface level a, a level three program, you know, really needs to have good ortho, we need to have good general surgery of course. But then also we're not gonna have all the specialties available, especially not in-house or 24 7. Those facilities have, you know, your general surgeons are mainly in house or you've got residents in house. And then they also have cardiothoracic surgery, which we have too here and we have neurosurgery, but they're, they're held to a little bit more tighter timeframes maybe. Or we also, they also have plastic surgery that's always available. ENT or max facial, they have the entire breadth of specialties that are needed, which we're just not able to, we don't have the manpower to be able to staff that 24 7 at our er. Sometimes we do, sometimes we don't. And another big part is the pediatric side of things. Two or burn centers that are kind of like affiliates to, to your trauma centers in a lot of time. And even level one trauma centers don't always have burn centers. So those are, those are all kind of special scenarios too that, that we still rely on and those are the patients, you know, that we mainly kind of transfer out those pediatric or burn patients or, or the specialties that we just don't have coverage for. And ENT, urology, oral maxillofacial surgery, ophthalmology, those things are hard to get. Yeah. 'cause a lot of those practices are almost private with their own surgery centers and they don't necessarily have to be on call. I mean, one of our, you know, ENTs or urologists sometimes they cover, you know, more shifts than they, they should, you know, just helping out our community. And so we're, we're very appreciative of that. But it, but it is demanding when you only have one or two of those in the community. Right. Versus you have five or six general surgeons that can, can split the call up. Yeah. Right. So

- Makes sense for what's that. Talked a little bit about trauma, but let's talk a little bit about another program that you helped kind of get off the ground. And that's our breast center.

- Oh, I, I won't take any credit for that. That's, you know, that's Dr. Harvey Miller and, and Mary and, and the, the cancer center guys that they're, they're all, that's all their baby and, and general surgery, you know, we're, we do the, the breast surgeries primarily and, and then that's a whole team approach and that's what that is. That, that the breast health center is really a multidisciplinary committee where we at this time are, are try to review every single breast cancer case that is diagnosed at this hospital and treated. And that's where we all sit down together and it's, it's general surgery, it's medical oncology, it's radiation oncology, it's pathology, it's radiology, and then it's, you know, the, the care coordinators and nurse navigators are all at that meeting too. And we review the workup, we review the pathology, we review the surgeries and then the, you know, what we call either neoadjuvant or adjuvant, whether we treat beforehand with chemotherapy or we treat afterwards with chemotherapy and radiation. And we review kind of that whole process and have a plan for that patient before we actually start that journey of treatment. And that, that's been very beneficial too. It keeps everybody up to date kind of, you know, each of these fields has its own research. Most of the time that research all aligns very well. Sometimes there's, there's, you know, kind of gray areas between those research and having that multidisciplinary committee helps smooth those gray areas out helps keep you up to date on what radiation oncology's literature's headed towards or doing nowadays or oncology things that I'm not going to pick up an annals of oncology. I'm, I'm gonna read my own material and I, but at those meetings we can get, you know, feedback from each other, how things are heading and where treatments go and 'cause they are all very much so interwoven in a treatment plan. Breast cancer is one of those that's very much so interwoven and it happens pretty, pretty quickly too. You know, with moving from, from either, whether it be neoadjuvant treatment, which is where a patient may receive chemotherapy or or monoclonal antibodies up front and then move into surgery and then right after that could go right into radiation only a couple weeks, three to four weeks later and then back in, you know, to radia chemotherapy. So I mean it's a and it's a lot coming at a patient very quickly. Yeah. So when all of our doctors are, are all saying they've all talked and they're all on the same board with treatment plan, it gives a whole lot more confidence to that patient Absolutely. When they're hearing the same thing from everybody. And, and we also can, can get those appointments in and, and more streamlined so that, you know, well I'm supposed to see so and so three months that's not going, you know, that's not gonna work when we up meeting, they're going here, here and here. And of course there's hiccups every now and then, but for the most part, what they've been able to do by pulling together that multidisciplinary committee has made communication significantly better, which in turn makes treatment better.

- Yeah. That's what drew you to have a special interest in in breast cancer surgery.

- You know, I, it's almost like anything, it kind of, it kind of comes to you over time. It's not one day I just decided to do that. I mean, I came out doing general surgery, I did, you know, work with some surgical oncologist in Greenville that I, I I liked a lot. You know, I, I worked very well with them. They wanted me to go into surgical oncology as specialty, but, but I, I, like I said, I didn't, you you, you can't really be in Valdosta, Georgia doing that. So, so I I I wanted to stay more broad. So there's always kind of that interest and gravitated to it. It's not that it's a technically difficult surgery by, by, you know, any means from that standpoint. There are things, you know, just like in anything you have to be careful with, you do have to, you work a lot with plastic surgery, you work a lot with your, like I said, the multidisciplinary and colleagues. It's something that, you know, is a very high anxiety, you know, cancer, we're talking about one in eight females, one in eight females. That's what uas are born with. I mean that's, that's amazing. I mean there's, the prevalence is just unreal. 12% lifetime risk and that's, that's the best it gets, you know, so I mean the anxiety is unbelievable. And then we have some really strong genetic mutations that really increased, you know, the cancer risk. And so I think my personality just kind of fell into it to where I, you know, maybe I just, you know, was a little more patient with those patients and, and understanding and maybe we just kind of gravitated towards each other over time. I, I think that's probably more of it than anything. And, and I don't know, I started liking more of that, more of that collegial approach to a disease where gallbladder, I don't need anybody appendix, you don't need, I mean, a lot of those things you, you know, they're just, they're just surgeries and you know, and I love those surgeries. There's nothing better than a, an appendicitis or a gallbladder or a hemorrhoid. You take care of it. The patient's feeling much better the next day and they go home. That's the best it gets, right? Yeah, yeah. And you love those, but this is more of a, a gradual process and then surveillance over time. And, and so as a surgeon you treat patients and then they're better and then you never see 'em again. Well, my breast cancer patients are different. I treat 'em and then I follow 'em through their, their, you know, adjuvant treatments and then they follow me, you know, for their life, you know, and I get to see 'em and we check imaging yearly and we do exams yearly and we stay up to date on what's going on with oncology. So I gotta have that little bit of, you know, that longitudinal care. Yeah. That longitudinal care to the small town you kinda want. Yeah. So I think that appealed to me as well.

- Do you see that breast cancer patients are trending younger? I,

- You know, I'd say yeah, I do feel like it just anecdotally, right. You know, I mean just from what we see, I don't know if it's from, we're doing a better job with surveillance, right? We're doing a better job identifying those families that are at risk and, and screening for genetic mutations and identifying them in younger, you know, whether it be siblings or children. Right. But yeah, I do feel like, you know, I've seen it get younger and I I feel like I, you know, aggressive, more aggressive tumors. Yeah. In younger patients too. Especially the African American population seems to have very aggressive tumors at, at younger ages. And so, you know, it's, you a very high anxiety thing. You know, females can have fibrocystic breast disease, they can feel lumps that are there one week and gone the next and you know, and it's, and and so you feel and you don't know and then it's there or isn't it there and you get an ultrasound of mammogram or when they don't see anything, but you still feel it. And so, and then you've heard the story of somebody has. So, you know, I like working with that too and, and trying to help reassurance. And we're getting, you know, more in line with almost doing things the same way Mayo does. You know, we had to get more MRI machines in, we had to increase the availability for that. We had to win insurance companies over time. So they let us get the studies and, and, and you know, and getting these other tests that can help, you know, in those scenarios. And, and it's just, you know, always trying to stay up to what the standard of care is in every field. But it's more important in those younger patients too that, that, that early detection because of the, sometimes they do tend to be more aggressive tumors more so than not.

- So I hear so much in what you're talking about. I hear so much like leadership skills. I know you served on as our chief of medical staff for two years and, and then you're having to serve in these different roles to help develop programs and things like that, which is far outside of just doing surgery, you know, did you expect that when you well yeah. Went into school and then what have you learned from that?

- That's a good question. I don't know that I expected it, you know, as you know, early on in career, but South Children's Medical Center is very unique in how it's set up with its medical staff. You don't have a chief of staff that's hired on or in position for 10 plus years. That's a near retired member of the medical staff community. Like you'll see in some other areas or you see on tv. Ours is a, is a voted on by the medical staff, but it's a rolling position too as well as the entire MEC, the medical executive committee is. And I think that's great because it, it gets people involved in early on it keeps that position kind of fresh. And so people earlier on in their career coming into the position, so I started out as chair of the Department of surgery and did that two years and then did chief of staff elect for two years and then went into the chief of staff position for two years and now I'm post chief of staff and, and somebody else is in each one of those roles. And, and it, it keeps the people in your department engaged and involved in moving into positions sooner. We also have other positions that kind of feed into those positions. And I think it's key that once somebody's been in our system here for, for two to four years, it's time for them to start getting involved with that me that leadership understanding, you know, the roles of the medical executive committee and what's, you know, what helps drive, you know, care and quality. Those members also sit on both the medical and surgical quality committees where they review, you know, cases, whether it be something from the ER or anesthesia or where, wherever in the department of surgery, OB GN, we review 'em all as a multidisciplinary committee as well. And medicine mirrors the same thing on the other side. And so having people evolve through those roles serve on those quality committees as well as, I mean, you know, even complaint and discipline committees, it's important to see the other side of all that and do it early on. I mean, I think that's what helps your system grow. And now I'm 10 years in and I'm rotating off of that already and you know, my kids are entering high school. It's kind of a perfect time to kind of do that too and spend some time and, you know, you feel like you've, you've put some of your time in and then you got the guys up under you, you know, growing and doing it. I, I think it's a, a really, you know, unique thing that happens here with the way they've arranged the medical staff. And so I think it's, it's, you kinda, you know, Dr. Ziegeler, you know, one of my senior colleagues, he, he always says, you are the leader, you get outta the way in Department of general surgery and that's general surgery wants to be at the table for everything. Yeah. We want to keep somebody in those positions. And moving up, Dr. Davis who's been with me since medical school, he, he's the chief of staff elect now. We, we like being involved. We touch so many different departments at general surgery. I mean, we're involved with pathology, we're involved with the er, we're involved with the, or the ICU, the floor, the outpatient offices. We touch everything kind of in general surgery. And so we have those relations and, and it's important for us to make sure we're involved in the decisions that goes on with all those departments. 'cause it, it reflects back to us. But we also take a lot of pride. I think you'll find that all your general surgeons are very community invested here. We don't recruit anybody here to be here for five years. We couldn't be here for 20 years. And that's our goal, you know?

- Okay. Alright. Well I think that just about wraps us up, but there is one more question. Question. What is your favorite meal to eat here at SGMC? Health?

- Corn Dog.

- Corn dog. That's what I get ready. No one sit. That's corn dog. Go

- Straight to the corn dog. That's what I, that's what I eat.

- They're good. They are good.

- That's funny.

- Well we appreciate you being on

- Dr. Thank y'all. No, thank you for having me on. I appreciate it and thank you

- For all of your leadership and your service to our organization. Thank you. You have been a pleasure to work with so

- Well I thank you for the opportunity that SGMC has given me and, and I appreciate my patience in the community. I do.

- Yeah. Alright, well that wraps us up. If there's any topics you're interested in or any particular guest you'd like for us to have on, you can let us know at sgmc.org/podcast. And don't forget to like and subscribe.