Compounding Passions: Rathmell’s Path to Anesthesiology, BWH

James Rathmell stands by two of many photographs he has taken.

BWH Bulletin recently sat down with James Rathmell, MD, chair of the Department of Anesthesiology, Perioperative and Pain Medicine, to discuss his first seven months at BWH, his goals for the department and how his diverse interests in medicine and photography have shaped his career path. An established leader in pain medicine, Rathmell joined BWHC in June 2015.

What initially attracted you to BWH?

I spent the last 10 years at MGH, and when this opportunity arose, the chance to stay in the Harvard system and to join one of the best hospitals in the country was an opportunity I couldn’t pass up. This department has a great long history of being one of the best training grounds for anesthesiologists in the country. It was an opportunity to join all of these great innovators here at the Brigham.

What early goals did you have for the department?

Interim chair Bhavani Kodali, MD, did an excellent job of keeping the department stable and moving forward, which is always a challenge during an interim period. The first three months, I was meeting everyone and learning. At the 90-day mark, I made the first changes, which largely involved getting everyone working in the same direction.

My vision is broadly about creating the next generation of innovative anesthesiologists—the people who go on to practice anesthesiology and pain management and define how it is practiced across the U.S. and around the world. We want to continue to train those people, something the Brigham has done for many decades. We also have several extraordinary labs that are doing groundbreaking research; now we need to develop the next tier of young and mid-career researchers who go on to build their own labs.

Increasingly in health care, there’s an administrative and leadership piece as well, and we want to develop the next generation of anesthesiologists who are going to be leading Operating Rooms (ORs) and ICUs and pre-operative assessment centers.

How have you seen the field change over your career?

Anesthesiology has changed dramatically. One example is that we’ve gone from a specialty where the vast majority of anesthesiologists spend the majority of their time in the OR, either directly administering anesthesia or supervising other providers giving anesthesia, to a good proportion of faculty spending the majority of their time outside of the OR. About 50 percent of the work we do now is outside of the OR.

How has anesthesiologists’ role across the continuum of care changed?

Anesthesiologists’ role has become more prominent. We’re involved in the continuum of care from the decision to perform surgery all the way through recovery. We’ve become critical members of the team who enable surgeons to do what they do in the safest possible fashion.

Dr. Rathmell talks more about anesthesiologists’ role on the care team.

How and when did you first become interested in the field?

I went to medical school to be an oncologist. One of my passions is photography, and so as I got into my second and third years of medical school, I became very interested in ophthalmology and actually started an ophthalmology residency. During intern year, I realized that I liked taking care of people who are sick, but you largely don’t take care of systemic illness in ophthalmology. I switched to anesthesiology because I loved pharmacology, and I never looked back. That was 28 years ago.

Dr. Rathmell offers advice for medical students and residents struggling with their choice of specialty.

Can you describe your research?

I’m a clinical researcher, so I’m involved with clinical trials all the way from phase 1 (first-in-human) through post-marketing studies on drugs and sometimes devices. In the past five years, my research has focused on using image guidance to safely place needles for pain treatment.

Does your love of photography influence your work as a clinician and hospital leader?

I do all of the cover design and images for the journal Anesthesiology, so I am constantly thinking about how to present complex information in a way that gets the message across clearly and visually. I often bring photos or illustrations into the education realm, too. When I learn new techniques and teach others, I use those same visual skills.

How do you decide which photos will be featured on the cover of the journal?

I read the issue and try to take something out of it that we can illustrate visually. The November issue (see image at right) featured a new survey comparing the demographics of anesthesiologists 10 years ago vs. today. The survey was nationwide and takes into account gender, age, ethnicity, type of practice, etc. I wanted to illustrate that diversity, and what came to mind was our beautiful lobby at the Brigham. I wondered, could I get a large group from the department together and photograph them in the lobby? Collaborating with professional photographer and artist Diemut Strebe, we gathered everyone in the lobby late one Friday afternoon. Diemut had the brilliant idea of scattering everyone across the lobby, which gave the image a wonderful effect. Our department is extremely diverse, and I thought the cover would speak to the diversity across anesthesiology. It worked, and the department loved it.

Can you talk about the importance of mentorship?

In each phase of my career, mentorship has been critically important. I think that each phase or task that you have to accomplish requires a unique mentor, and I’ve had many mentors over the years. A good mentor helps guide you through and then celebrates when you are successful.

What do you want the rest of the BWH community to know about the department?

You have this incredible group of physician innovators who are great team members and facilitators. We can be very innovative no matter what you’re doing across medicine—from clinical care to education to research to leadership. Come find us; we’re good teammates.