Eva Sheie (00:03):
The purpose of this podcast is simple. We want you to get to know your doctor before meeting them in person, because you're making a life-changing decision, and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. There's no substitute for an in-person appointment, but we hope this comes close. I'm your host, Eva Sheie, and you're listening to Meet the Doctor. Welcome to Meet the Doctor. My guest today is Plastic surgeon Mark Jewell. He's based in Eugene, Oregon. Welcome, Dr. Jewell.

Dr. Jewell (00:39):
Thank you. And good morning.

Eva Sheie (00:41):
So tell us a little bit about yourself as if a patient's listening to this who might be considering coming to see you.

Dr. Jewell (00:47):
Well, I have lived in Eugene for the last 44 years. After I finished my training at the University of Tennessee with some side training at Duke for microsurgery. My wife and I were big time runners and skiers and decided to make a lifestyle decision to move to Oregon so we could be running and skiing and have a good place for our family to grow up. Over the last 43 years, I've had the opportunity to really develop some interesting medical equipment, but also to focus in on issues of quality and safety in, uh, aesthetic plastic surgery. One of my mentors was, uh, Lucian Leape, who was a pediatric surgeon at the University of Kansas, where I went to medical school. Dr. Leape was one of the founders of, uh, the patient safety movement was actually one of the authors of, uh, crossing the Quality Chasm, which was a book talking about, you know, how do we do better in inpatient safety?

(01:54):
And I kind of took that to heart. I mean, you know, Dr. Leape would say, coming to a hospital is about as dangerous as jumping off a cliff with a parachute on your back in terms of serious adverse events or death at times, you know, which is about one in a thousand people, you know, having something terrible happen to them. But anyway, I I kind of, you know, got my practice going and started focusing on, you know, how do we improve quality? And I took one of the common operations, which is breast augmentation, and sort of started thinking about that. I had a, a, a new nurse that had joined me, and she's still with me today, some 41 years later. But, you know, again, to do, do process engineering, uh, service mapping, understand the whole process and what can be done to improve quality and safety has worked really well for us.

(02:47):
And, and certainly there are all sorts of planning systems out there, like the Toyota Production system and, uh, lean manufacturing, that, that focus in on quality and safety. And we were able to take some of the precepts of the Toyota production and adapt it for breast augmentation. And, you know, we kept improving our outcomes and things really have, you know, improved tremendously with regards to, here I am 45 years of using breast implants in zero perioperative infections. And, you know, part of this here is having a process, having people around you that understand the process and, and are focused on this versus a more casual approach. And, you know, the, the published infection rate for breast augmentation is anywhere between one to 3%, depending on who reports this sort of thing. And here we've gone 45 years, which is best in world, uh, with regards to quality outcomes, patient safety achievements, things of this nature.

(03:55):
So, you know, yes, this stuff does work. And you think of other industries like aviation, which is, you know, very, very safe these days. You know, again, they, they have processes. They hold themselves to the process. They don't do what's called workarounds where something isn't quite right and you have to sort of work around it to, uh, achieve the outcome. But anyway, that's one of my major accomplishments, which is best in world outcomes with regards to zero perioperative infections in 45 and a half years of using implants. The other focus I had was developing medical devices. I, I do have a background in design and engineering and became really interested in how to develop some of the tools for surgeons to use to improve outcomes. And one of these was the vaser, which is an ultrasonic liposuction system, uh, that I helped develop. And it was a very good system because it overcame limitations seen in earlier generation ultrasound devices, which was burns, uh, seromas, uh, woody in duration of tissues, things of this nature.

(05:08):
And again, with the vaser, you're surrounding yourself with a great process to use the device, which is, you know, how much wetting solution you put in, you know how much energy you apply based upon the amount of wetting solution. And you have a, uh, aspiration cannula that is very efficient. So you know, you know what you put in, how much energy's used, and literally to the cc what you take out. So this brings in the, you know, the aspect of precision finesse and safety into ultrasonic liposuction. So, you know, the Vaser was something I developed years ago, presented it here at the Aesthetic Society and actually won the, uh, Tiffany Award, which is the paper of the year for, you know, again, defining a process to use something that was thought to be unwieldy and unpredictable. And yet, you know, you turn it into something very predictable and safe.

(06:06):
Other contributions in ultrasonic surgery have been the Ethicon Harmonic scalpel. I helped design the current handpiece, which is a, a lovely cutting device that can separate layers. We use it every day when we do tummy tucks or, uh, some of the breast surgery procedures. And again, this is something unlike electrosurgery, because you don't have smoke, uh, you don't have as much heat in the tissues, and we get great outcomes with it. Other achievements in ultrasound have been the, uh, Liposonix device, which was from a company in Bothel, Washington. Uh, it's a non-invasive, high-intensity focused ultrasound device for body contouring. And then my final achievement was in ultrasound, was sort of the first diagnostic ultrasound imaging course for plastic surgeons years ago, teaching them how to image for breast implant integrity, quality of the capsule, looking at abdominalplasties for fluid collection, things of this nature. So I've been, I've been very involved in technology, technological development, and medical devices.

(07:16):
The other issue here to talk about is, uh, preoperative breast surgery. And, you know, it's, it's great to do primary breast augmentations and get them right and have very happy, satisfied patients. But, you know, there are a lot of patients out there with aging and failing breast implants. I mean, we've got millions of women going back, you know, to the nineties with, with old generation saline devices that are leaking or, uh, break. Uh, we've got even older generation devices before 1992 with very liquid gels that, you know, should be exchanged and upgraded. So, you know, the statistics here is that about two to one women want to maintain their, uh, life with implants versus removing them. And so I do have a chapter in a, a textbook that I published with, uh, Lee Pu from UC Davis on reoperative breast implant surgery. And so, you know, again, part of this here was outlining a process for surgeons to help patients maintain their outcome.

(08:24):
You know, and again, some patients have issues, they need a capsulectomy or address a malposition. Others just have a, a need for a straightforward implant exchange. But, you know, again, most women want to maintain their outcomes, and we've got good opportunities for these millions of women. And certainly it's something that we talk about in our practice management course. Uh, yeah, to, uh, here at the aesthetic meeting in Miami yesterday, uh, we had a four hour practice management course, and this is a,

(08:57):
I've been to that course.

(08:57):
Yeah. And I mean, I teach it with, uh, Robert Singer, Tom Siri, my wife, Mary Jewell, Mike Edwards, who's another preoperative breast surgeon, Ryan Miller. Inverne Weisberg. Anyway, we, you know, again, we talked about practice growth opportunities, which is preoperative breast surgery. Uh, you know, again, patients that you have in your practice that know you and like you, they wanna maintain their outcome and, you know, you need to help them understand the opportunity here for them. The newer regeneration implants we have are highly filled, they're very durable. Uh, they've got a very safe gel and certainly give patients, uh, a much better look than a saline implant that doesn't have upper pole fullness in the breast compared to these newer ones. So we've got, you know, again, a, a lot of opportunities here for pre-operative breast surgery.

Eva Sheie (09:58):
Early before you took us through all these incredible accomplishments of yours. You mentioned, uh, that you had a design and engineering background. So can you take us through that?

Dr. Jewell (10:10):
Sure. I grew up in Kansas. Uh, we had farms. I spent a lot of time out on the farm and certainly learned how to understand how things work and became intrigued with, you know, this sort of thing. Also, how to make things better. You know, that being said, I had an interest in how do you make interesting things that enable you to do things better in terms of tools, or in this case, a process for, you know, maintaining. One of our combines on the farm, we, we had wheat farm, we had a wheat farm. And so, you know, again, it's understanding what needs to be done and how do you do it, and how do you do it again and again and again, and write it down and keep developing things like that. So, you know, again, design, engineering, uh, that sort of thing. And I, I became, you know, intrigued with this at the University of Kansas, uh, when I was in undergrad and, and then decided, well, I, you know, if you wanna be an engineer or do you wanna be a doctor?

(11:14):
And I decided I wanna be a, a doctor. And, uh, went in that route. Uh, my next door neighbor, uh, behind us in Kansas City was the chairman of the Department of Plastic Surgery at the University of Kansas, David Robinson. I mean, I've had all these amazing coincidences. But anyway, he, uh, became my mentor when I was in med school. And, you know, I sort of followed in his footsteps. The other neighbor was a TWA captain, and he was the head of jet training and development, uh, incredibly gifted pilot. And, uh, he would take me down and let me fly in the simulator and, and with him and understanding the process of aviation and, you know, when something goes wrong, how do you manage it? And so this comes back to the patient safety background that I have, which is, has many parallels to aviation, you know, crew, resource management, but, but having a process and following it, and also having a process to manage adverse events if they happen. So these are, you know, again, interesting stuff. Certainly I had a lot of in inspiration from my father who was an in agribusiness and banking. And my mom.

Eva Sheie (12:29):
For me, this parallel was working in public radio and running live broadcasts. Because everything was planned every single moment, every single piece. And then it was all timed exactly right.

Dr. Jewell (12:42):
Yeah. It's, there's a certain benefit to having a script and following it, uh, time and time again. You, you know, the predictability of something. I mean, you know, you can't be totally predictable in surgery. At the same time, you know what the, the, the constraints are for safety and quality, and you stay within the, you know, within the fences. You know,

Eva Sheie (13:04):
Certainly the, this, this is maybe is gonna be a little roundabout, but the experience of taking something, thinking through something without doing it from beginning to end, and then doing that thing according to the plan that you wrote. And I was touring a preschool the other day, and at this particular school, they taught the kids, even the kindergartners, how to recreate a masterwork of art one square at a time. And it takes the kids an entire year. And they, she said they, in the beginning, they hated, it's so hard, they don't know how they're gonna do it, but by the end of the year, they've done a Matisse from beginning to end.

Dr. Jewell (13:45):
Sure. Yeah, I mean, to chop a process up into little bitty steps. And we do that in the office. It's called service mapping. We'll, we'll shut the office down on a Friday, bring in a, you know, a catered lunch. We'll put up a, a piece of paper that's probably six feet tall and 20 feet long, and map out the whole process from when the patient goes on the website to when they called, when they get scheduled, their intake, the consultation, how do we, uh, recreate in their minds what they're gonna look like, uh, you know, after a breast augmentation. And then from there, the preoperative consultation, day of surgery, surgery, aftercare, and, you know, you know, a lifetime of follow up. So it's, you know, again, it's service mapping and, and we sort of describe what is needed at each point. What are the fail points?

Eva Sheie (14:42):
Dr. Jewel, this is the exact thing that I do all the way up until the point where they land on the website. So what I've always done is from the, I have an idea to I choose this doctor, that's my service mapping process. So I would meet you right. When that person contacts the office.

Dr. Jewell (15:00):
No, you know, again, it, it's not just a bunch of pretty pictures on a website. No, but it's, it's patients getting a feeling for who they are dealing with, that they can trust this person and that, you know, they will get what they're hoping for out of all this stuff. And, and at the same time, me helping them calibrate their expectations to what's the reality, you know, which can be skewed at times. But anyway, it's putting the patient in the center of the whole thing at the same time, having them develop a, a large element of trust and understanding, you know, that they will be well cared for and a relationship that adds value to their life.

Eva Sheie (15:46):
Mm-hmm. <affirmative>, that's why I podcast, because I recognize that they were missing a really critical step in that getting to know you part before they come into the office. Oh, I agree. There was nothing really doing that well, especially since social media came along and made everything so much faster. So I'm kind of trying to counterbalance all of that.

Dr. Jewell (16:09):
Well, you slow it down a bit and allow patients to get a feeling for the flavor of the practice and the focus, and also what they're gonna get out of the whole thing.

Eva Sheie (16:23):
Yep. Exactly. And rare to find other people who think like that. So <laugh> Okay, so,

Dr. Jewell (16:30):
Well, we've thought it through.

Eva Sheie (16:31):
Yeah. A few times. I would love to come visit for one of those service mapping.

Dr. Jewell (16:37):
Oh, yeah. Or, or just come down and be a fly on the wall for a consultation. And, you know, again, I'm a, I'm a, uh, clinical professor of plastic surgeon at Oregon Health Science University. And so we have all the residents come down and, you know, they're, it's, it's jaw dropping for them because, you know, again, they don't do this stuff at the university and they don't understand the process from start to finish. They just think well you go into surgery and do this and do that. And, but, you know, again, it's, it's how do you touch someone's life, get inside their head to understand what they want, design an operation for them, but do this on the surface. And yet behind this, you've got process engineering, you've got operational excellence, and you've got years of experience of how do you get it right the first time.

Eva Sheie (17:27):
Speaking my language, none of this, of course, is possible without resources and other people and a team around me. Right?

Dr. Jewell (17:35):
Oh, I agree. And, you know, I mean, my wife Mary is our practice manager. Uh, she's been around forever. She's run a variety of FDA device studies, you know, that required 10 years of follow up, so she knows what's involved with devices and patients and life with implants, pregnancy, menopause, weight gain, weight loss, you know, those sorts of things. My nurse has been with me for 41 years, so she understands the process very well and keeps developing things. My surgical tech has been around for, I don't know, 10 years or so. I mean, you know, she understands what's involved. And then I have, uh, a daughter who's a, a nurse practitioner. So, you know, part of this is kind of the Chinese restaurant philosophy of getting your family involved in the whole thing. But, you know, again, we can design, we can deliver a superior outcome. Best in the world.

Eva Sheie (18:29):
Mm-hmm. <affirmative>, you mentioned that you like to run and ski. Is that still part of your life?

Dr. Jewell (18:35):
Yeah, very much so. I mean, we made a lifestyle decision to move to Eugene, Oregon. Uh, physical fitness, being able to work out every day, that sort of stuff. Uh, we, we ski over in central Oregon on Mount Bachelor or other places. I run a ski meeting every year with Renado Salts in Park City, and, you know, so we enjoy the outdoors. Uh, running is a big part of my life. I mean, you know, we are, we've run many, many marathons. We run ultra-marathons, run the Western states a bunch of times, which is a hundred miler.

Eva Sheie (19:09):
Yeah. That's serious running.

Dr. Jewell (19:10):
Yeah. Mary ran it once with me too, so. So, you know, again, it's having, um, the opportunity to be fit, paid off well.

Eva Sheie (19:22):
And do great work.

Dr. Jewell (19:23):
Yeah.

Eva Sheie (19:24):
What's on the horizon for you?

Dr. Jewell (19:26):
Well, that's a good question. I, uh, you know, I'm still operating and doing stuff. I have a young surgical associate that is gonna take over my practice eventually. I don't know when my daughter, you know, is our nurse practitioner who takes care of surgical patients, but it's extremely talented with, uh, the cosmetic injectables, neurotoxins, energy based devices, things like that. So, you know, I can say we're, we're, we're still involved.

Eva Sheie (19:56):
And I hope for long, a lot longer. If someone's listening today and they would like to reach out and learn more about you, where should they go?

Dr. Jewell (20:05):
Well, they can go to our website, which is www mark jewell md.com. Uh, our email address is info mark jewell md.com. The local number is 5 4 1 6 8 3 3 2 3 4. Operators are on duty. <laugh>

Eva Sheie (20:23):
Look us up in the Yellow pages.

Dr. Jewell (20:24):
Well, they don't exist anymore.

Eva Sheie (20:25):
<laugh>. Oh, I know. My favorite dumb joke when I do remote recording is if somebody's microphone is too low, I say, can you just grab a phone book? And they kind of start going, huh? And then nobody ever laughs at me. I need to find a new joke, cuz it's terrible.

Dr. Jewell (20:39):
Well, this is not a Sears catalog, you know.

Eva Sheie (20:41):
No <laugh>. I know, look for the Sears catalog. Thank you so much, Dr. Jewell. It was a privilege.

Speaker 3 (20:46):
You're welcome.

Eva Sheie (20:51):
If you are considering making an appointment or are on your way to meet this doctor, be sure to let them know you heard them on the Meet the Doctor podcast. Check the show notes for links including the doctor's website and Instagram to learn more. Are you a doctor or do you know a doctor who'd like to be on the Meet the Doctor podcast? Book your free recording session at Meet the Doctor podcast.com. Meet the Doctor is Made with Love in Austin, Texas and is a production of The Axis, t h e a x i s.io.