Head and Neck Surgical Oncology: An Inside Look with Dr. Michael Odell
Join for us an interesting discussion with Dr. Michael Odell from the University of Ottawa! Dr. Odell subspecializes in the field of head and neck surgical oncology.
Show Notes
Katie: Hi everyone and welcome to TheOtoApproach a podcast created by medical students for medical students to teach you about all things otolaryngology. I’m your host Katie and today we are joined by Dr. Michael Odell.
Dr. Michael Odell is an ablative and reconstructive head and neck surgical oncologist at the Ottawa Hospital and an assistant professor of Otolaryngology at the University of Ottawa. Born in Toronto and raised in Ottawa. Dr. Odell received his undergraduate degree in anatomical sciences from McGill University in Montreal in 1994. He subsequently completed his undergraduate medical training at Queen’s University and his Otolaryngology Head and Neck Surgery residency at the University of British Columbia. He was certified as a fellow of the Royal College of Physicians and Surgeons of Canada in 2003, subspeciality training in ablative and reconstructive surgery of the head and neck was undertaken at the University of Toronto from 2003 to 2005. Dr. Odell was then recruited to be the director of head and neck surgery in the department of Otolaryngology at St. Lewis University, and occupied this position until his return to Ottawa in 2009. He is currently the vice chair of Otolaryngology Head and Neck Surgery and the site chief of the Ottawa Hospital’s general campus. He recently was named Ontario’s Head and Neck Cancers lead and the chair of the provincial head and neck advisory committee.
Katie: Hi Dr. Odell. Thanks so much for joining us on the podcast today to talk a little bit about your career, just to start we would love to hear a bit about your subspecialty.
Dr Odell: Great. So first of all thanks for having me, this is a really cool idea especially when we're all sort of lockdown and you guys can travel around the country and spend time with us. So I think this is a really valuable effort that you guys are putting into this, to help educate yourselves and to make sure that you pick a career that is best for you. My subspeciality, So I’m Michael Odell and I am a Head and Neck Surgeon, I work in Ottawa, Ontario and my subspeciality is Head and Neck Oncology, so I do both ablative and reconstructive head and neck surgery and I also do endocrine surgery, so thyroid and to a much lesser extent parathyroid surgery.So how I got into this, I will say is a combination of Nature and nurture. So my father is a retired head and neck surgeon, so I’ve kind of known a little bit about head neck surgery from a very young age. I have to give full props though, my mother is a pathologist and I didn't become one of those so apologies to my mom. So sort of knew from a pretty early point in my science training or medical training that surgery was something that really interested me. I did a lot of research as an undergraduate student that required a lot of technical stuff, harvesting tissues and stuff and that really sort of put the hook in me to want to be a surgeon.
When I went to medical school, I developed a relationship with a thoracic and cardiac surgeon who really sort of nurtured the oncology part of it. So I thought cardiac surgery might be interesting but he really emphasized that cancer was a really dynamic field and allowed some technical challenges but also had a bigger picture to it, you know, with regards to prevention and strategies for multidisciplinary care, and that was a really interesting field and so I ended up gravitating towards cancer and then I think the combination of having seen a head and neck surgeon in my household, with the desire to do cancer surgery sort of lead me first to ENT and then into head and neck. Really to be honest, when I applied for ENT they asked me why ENT and I really just told them I wanted to do head and neck cancer surgery, and amazingly they still gave me a residency spot. So thank you to them for that. But after 5 years in Vancouver, spending time with some really great mentors there, so Scott Durham and Don Anderson were the two head and neck cancer surgeons out there and I believe they are both still active, I went to Toronto for 2 years and spent time with some real major contributors to the field of head and neck oncology, so Pat Gullane, Jeremy Friedman and Ralph Gilbert and that was the end of my training.
Katie: Excellent. Okay so it definitely seems like there was some kind of inspiration from your family as well as some key mentors.
Dr Odell: For sure I mean my parents were very supportive, they weren't prescriptive so they didn't say you know “you should do this or you should do that.” They sort of just said well here’s what we know, you've seen what you seen as you’ve grown up, but make sure you pick something that you really enjoy and that's I think that's a message I would have for your listeners who are trying to decide.
Make sure that whatever it is that you do you have a real passion for it because some of the novelty of all of this stuff does wear off overtime and you want to make sure that you have a true underline passion for it because that's what's going to sustain you. I mean your careers are going to last somewhere between twenty-five and forty-five years, that's a hell of a long time to do something you're not passionate about. And so they were very good mentors in terms of that, to say make sure that you love it,don't do it for any reason other than passion and interest. And then the cardiac surgeon in Kingston was extremely welcoming. I approached them when I was a first-year medical student and he allowed me to come to his clinic and go to his operating room and get that kind of enthusiasm mentorship early on. I think was really fundamental for me really deciding for sure that I wanted to do surgery and that I wanted to do cancer surgery.
Because if you come up against someone who really looks like you're not enjoying themselves or is not particularly interested in mentoring that could be very challenging. So I guess the other piece of advice I would have is that if you can identify a mentor that you do connect with on some level, that can be really valuable as well. And I've tried to mentor some people throughout their training and I haven't gotten formal feedback on how that's worked out but I hope it's worked out okay, I stay in touch with almost all of them. But I think those two things are key to making sure you pick something that is sustainable for you because it is a long path from cradle to medical grave.
Katie: yeah for sure and I think that's definitely a big thing that a lot of medical students we have talked to are wondering, kind of figuring out whether this is the correct lifestyle for you and whether this type of training is best for you. And I think what you mentioned about having mentors is so important I think most of the medical students that I've talked to you or worked with would agree that having a good mentor can make all the difference.
So I'm curious as well, once you were kind of into your Otolaryngology residency was there anything other than what you have already said that helped you pursue a fellowship or were you just kind of right from the start you knew that head and neck oncology was for you?
Dr. Odell: I was pretty sure. Surgical residency is challenging and even though it probably contained some of the most rewarding and enjoyable parts of my entire life, there were certainly times we're not only did I not know about being a head neck surgeon, I didn't know about being a surgeon at all. I mean you talk about lifestyle sacrifices, we've done everything we can I think recently to mitigate those sacrifices because we want to develop well-rounded individuals who are surgeons and not the other way around. But it's really really challenging and so I would say during my residency and also during my fellowship there were times where I sort of wondered maybe if I less strenuous career choice might not make some more sense and that's where I think the underline passion for caring for patients with cancer and for doing complex surgical procedures really sort of helped me keep focused during those times, because there were some really really tough ones. Anybody who's been through a surgical residency will tell you there are days where you sort of wonder why you are subjecting yourself to this kind of workload and intellectual challenge, and really physical challenge of being a surgical resident. It's something that's not for everyone for sure. Also I mean, I have just been very lucky in that I had pretty good mentors in Vancouver too who really had exceptional technical abilities and really showed me what the field is capable of, if it was approached with a sort of enthusiasm and good knowledge and good technical know-how and passion. I think when you see that, it makes you want to maybe not only do that but do it ever so slightly better if that's possible.
Katie: For sure and I guess kind of having that passion to propel you through the rough times is really important.
Dr. Odell: Yeah, I mean this residency at is evolving and that's a good thing you know I did my residency now while almost 25 years ago and it was very different there there was very little in the way of call limit sir or duty hour restrictions for anything like that, so you know you could come into work on a Monday and by the following Monday could have worked up to 120 or 130 hours, which is excessive and we have recognized that has a doctor's that this is not how we work or learn it at our highest. And so yeah you can really need some underlying motivation to get through times like that. But having said that, some of those times also contain formative experiences where I learned how to manage extremely stressful situations effectively, where I developed some really strong bonds with my fellow surgeons and really showed myself what I could do and that's a very rewarding, albeit tiring experience as well.
Katie: Absolutely, What would you say are some of your favourite aspects of the subspeciality?
Dr. Odell: Caring for cancer patients is special in my opinion, of course I have a very inherently biased position on this, but there is very little in Medicine that scares patients and people as much as the word cancer and my job doesn't start in the operating room my job starts from the moment I meet that patient and I get to start to transparently inform them about what's going on, because sometimes they come in with a lot of confusion in a lot of lack of knowledge I try to reassure them that we know what they have, we know what to do, we know what the outcomes are, we know what's best for them, and we know how to support them and that's a very sort of non-surgical component to it but it's very rewarding because you can take people who are severely anxious and make them comfortable albeit in the framework of having a life-threatening disease. There's the technical components and I think ENT in general has a great variety of technical challenges and technological ways to deal with those challenges. I think it's really fascinating the way that we can do things endoscopically, robotically, microscopically, medically, and all of these things.
But I really think major had neck surgery has a real mix of what I would call traditional, most people call old-fashioned surgical approaches, open surgical approaches, to the more modern less invasive approaches, transoral laser surgery, transoral robotic surgery, you know you can enter into the weird and wonderful discussion of minimally invasive endocrine surgery, but nobody really knows at all times what those actually mean, but certainly there's so much opportunity for a diverse surgical practice. Then reconstruction for me is where I can really test my intellectual abilities on an ongoing basis because no two reconstructive issues are identical and there's complex interplay between function, cosmesis, and patient satisfaction and technical complexity that are never the same twice. And again when the novelty of knowing that you can operate on somebody starts to go away, the challenge has to come from something else and so for me it's to figure out how I can continually improve at making oncologic defects less and less impactful to the life of our patients.
Katie: Yeah, that's kind of an interesting point you bring up that ENT kind of gives the opportunity to continue having these really challenging surgeries and experiences, even when you're already quite far into the specialty itself. Are there any procedures or patient presentations that you find most interesting?
Dr. Odell: So it's interesting, I think you almost have to separate those two things. I think from a presentation I'm going to get kind of boring here and maybe a bit nerdy about some of the stuff. But thyroid cancer care is really fascinating to me and the reason it's fascinating is that this isn't a disease that kills many people, but it's very interesting for my perspectives in two ways. Number one: the evolution of thyroid cancer care, even since I was a fellow in 2003, has been dramatic, it's almost gone 180°. During my fellowship, everybody with thyroid cancer got the same treatment which was total thyroidectomy, postoperative Radioactive iodine, postoperative thyroid suppressive therapy. It was becoming clear, even then, that in many cases that it was probably excessive. But there was such a hesitancy to change cancer treatment, because it is cancer treatment, that it seemed back then that it would be very very difficult to ever change patterns of practice, even though we knew we were probably over treating patients and therefore probably hurting them while we were helping them. If you look at today, so I guess we can almost say 2022, there is a huge trial open in Toronto and we've been trying to open it here in Ottawa COVID has derailed us a little bit, but where patients with what are felt to be low risk thyroid cancers, are actually offered no treatment other than observation.
And so we've gone all the way in 20 years from giving everybody everything to offering some people nothing. And to me that has really helped informed my work outside of clinical care which is in the generation of quality standards and policies, but it's fascinating to see that change and to watch the evolution of medicine in real time. I find that super cool like I said it's a bit nerdy because it's not a big fancy operation or something that's ridiculously complex, but to see the actual philosophy of medicine change in real time is something that I think is really encouraging because it means that you can make changes if changes need to be made. When it comes to the technical stuff I still think that oral cavity cancer reconstruction is unparalleled when it comes to the satisfaction you get out of doing it well and the inherent complexity that each individual patient brings to. You know our oral cavity is a huge component of what we are as human beings, it allows us to communicate, it allows us to breathe in an unrestricted fashion and it allows us to eat. And we know, certainly COVID has reinforced this, but getting together to talk and to eat is a core social value for who we are as humans. Patients with oral cavity cancer sometimes lose that and the fact that we can sometimes take a situation that would appear relatively hopeless and allow patients to communicate and eat and socialize again is challenging, it's intimidating, but it's unbelievably rewarding when it goes well. And to get feedback from patients and hear back from the patient's dentist who you can't believe how good their oral cavities look is something I never get sick of.
Katie: Wow, that’s really interesting and I think what I’m hearing is that you definitely appreciate the social aspects of these diseases and really enjoy working with patients to improve their quality of life.
Dr. Odell: Oh for sure. I mean I think we are moving increasingly away from strict measures of success like 5 year survival and we are embracing, in an increasing fashion, the impact of cancer therapies on the lives of people and I think that's critical. It’s wonderful to say that you have cured somebody but it’s even more wonderful to see them be happy, because happiness is contagious right? It’s, to me, the core values of cancer care shouldn’t just be cure, it should be to restore life to as close to normal as possible.
Katie: Absolutely, What would you say are some of your least favourite aspects of the subspeciality?
Dr. Odell: Yeah, there’s a big impact on quality of life. Major head and neck surgery is not something that is elective, when bad things happen to your surgical patients it has to be cared for immediately. So there’s no question that head and neck oncology and reconstructive surgery in particular, forces you to make sacrifices in other areas. Again, the evolution of medicine has allowed us to embrace team structures a little bit better than we used to. When I was a resident the cases were by a single surgeon. So they would do everything from the tracheotomy at the beginning, all the way to the final closure of the skin. And certainly that’s a model that is less and less frequent these days. Here in Ottawa, we have four ablative surgeons and three reconstructive surgeons and for the major cases, that involve a free flap, we try to involve at least three of the four team members, so there is not only surgical support at the time of the procedure but also support for the potential one of the team members might not be around a couple days later, or might need to take her kids to school or to the doctor or get a COVID test, or you know somebody to be able to have somebody operate then be able to go away on vacation 2 or 3 days later and know their patients will be well cared for by the team members. I think there is a lot of provider satisfaction that’s built into an approach like that and that’s something that’s also becoming a more metric in health care, which is we got to care for the patients but we have to care for each other as well because if we want to continue to attract really brilliant young minds to the field of medicine and especially to the field of surgery, and in my case the field of complex oncology, you have to show them that it’s not something that will swallow the rest of your life. It’s something that can generally, not always but generally peacefully coexist with your other interests and other time commitments.
Katie: Definitely and it’s nice to hear that more team based approaches are being kind of emphasized in this career as well. So I think that that provides our listeners with a really great introduction to head and neck oncology and what that looks like for you. DO you have any areas of research that you are particularly interested in?
Dr. Odell: So I have never been a particularly passionate researcher. And so even though I enjoyed doing some research, I did a fair bit before medical school and a fair bit during medical school. During residency, I really became more enamoured with becoming a really quality clinician and I did some research, we were not mandated to but strongly supported to do some research. And then when I started my fellowship, I had initially planned on doing a masters of clinical epidemiology, to sort of get better research training and unfortunately couldn’t come to fruition. A number of things sort of led me to taking a job in the United States, where I wasn’t required to do any research, I was just required to provide clinical care and education. And so I sort of fell off the research treadmill, I guess at that point and never really got back on. So when I came back to Canada, and I’ve always had academic positions, when I came back here I was sort of asked “would you prefer to be in the education stream, the research stream, or the sort of newly named administrative stream?” And I sort of looked at those three options and said “Well, I would love to do education or administration, but probably not research.” And so I am going to bend your question a little bit because I think this is something that I am very passionate about and I want your listeners to get passionate about too, which is the area of administration, which is a very loose term. It doesn’t mean running a hospital, but what it means is getting involved in managing the system of healthcare and that is an extremely extremely important role for doctors to have because nobody knows how the healthcare system affects better than physicians and patients. And so we know that patients get involved because you don’t have to be a doctor to become a health minister or anything like that. But we also know that clinicians have unique input and unique perspectives on how the healthcare system runs. And so what I’ve really gotten passionate about and involved with over the last I guess we will say 10 years now has been the generation of healthcare policy and system improvement. So my real passion now lies in measuring our system, figuring out where the gaps are and then figuring out how to make ourselves better. The beauty of that, and this is a bit a testament to my poor attention span maybe, but the beauty of generating policy is that once it’s generated it goes into action almost immediately. Whereas, if you find a gene that might cause oral cavity cancer it might be 20, 30, 50 or 100 years before it comes into clinical practice. And so you are sometimes less likely to see the impact right away, whereas what we can do in policy is take all of that amazing research and distill it down into a way that it gets applied clinically and then make it work. So to me it’s all a part of the same stream. You know we educate people so that they can provide clinical care and do research, we do research to figure out what is that we are doing and write policy to make it all better. And so writing policy, to me, seems to be the closest to the finish line and maybe i’m not a marathon runner and more of a sprinter, but it’s been extremely satisfying to be involved in projects that had tangible and almost immediate overnight benefits to the patients, which is something that’s just great to see.
Katie: That’s actually really interesting to hear about, I don’t think we have talked a lot about policy making on the podcast so far. So it is kind of nice to hear that there are other areas other than research and education and academia.
Dr. Odell: For sure, and that’s the beauty of the better understanding we have of systems in this day and age. And the fact that with the capabilities we have to amass and analyse data that we didn’t really have previously, there’s all sorts of new opportunities that are starting to come up for practitioners. So I think quality improvement is something that most people had no idea what it was 5 or 10 years ago, and now you can get a masters in quality improvement from Harvard. It’s the application of something that businesses have done for a long time to the field of health care, which is to assess where your system is underperforming and then make it perform better, you know by giving people incentives to do things or by providing them with the support that they need to do a better job and that’s a super satisfying way to care for people, without face to face caring for people. And so we attract such an intelligent subset of the population to medicine, who are often super insightful and very aware of their surroundings and we sort of haven’t really supported those talents once they get out of medicine. You know, we make sure they are looking after patients and doing bench research or epidemiologic research and teaching their colleagues which is all wonderful and I think it’s extremely valuable but we also need to leverage some of those other awarenesses to make the whole thing better. And that’s becoming something that governments and businesses and hospitals are really starting to recognize and so there’s a huge opportunity. I have a couple of residents that I’ve mentored over the last few years, who have said “should I do research or education?” and I have told them to do quality and policy and they have kind of looked at me sideways, but I think it is becoming clearer that this is going to be a real a real pathway to be able to influence the healthcare system, which is something we all try to do as practitioners but that’s on a single unit basis, whereas policy is on a population basis. So you know there is nothing wrong with doing the very best with every single patient, that’s great I do it every day, but there’s just a different intellectual challenge that comes with figuring out how to make the whole system run more smoothly.
Katie: Okay, thank you so much for speaking about that. I think that our listeners will find that really interesting and kind of a new take on things for sure. My last question for you is, we are wondering if you have any advice for medical students who are interested in Otolaryngology?
Dr. Odell: Absolutely. Find a mentor, to circle back to that. It can be really intimidating to navigate an application for a surgical residency. You know, otolaryngology is competitive and in medical school we come up against such a high performing peer group, that it’s really easy to get overwhelmed with the concept of applying to a competitive program and so having a mentor there I think really helps put things in perspective and also is extremely valuable in helping identify those areas that are most impactful when it comes to your application, and not only your application but that’s why all you guys listen for right now I suspect with CaRMs looming, but the reality is there is life beyond CaRMs and you want to make sure that, like I said the next 25 or 45 years of your life are spent doing something that’s meaningful and enjoyable for you, and I think a mentor really helps with that. The other thing I would say is that, there are some tried and true ways of improving your prospects for residency and they haven’t really gone away. So anything that makes you unique is something that we love to see and like I said we attract a diverse group of amazing people to medicine and otolaryngology as well. So emphasize those things that make you special and make you different and everybody’s got something. Certainly there is all kinds of appetite when we select our residents, and I have not been involved for a couple of years just for transparency's sake, but there is a real desire to encourage diversity on multiple levels. SO we aren’t talking about the simple measures of diversity, we are talking about diversity of interests and strengths and it makes the group as a whole, it makes them more dynamic, it makes our lives more interesting. And so everybody who applies for ENT does all the same stuff, they all do extremely well at school, they all do research, they all do electives pre-COVID of course, but the ones who always stick in my memory are those who emphasize something that was different and very interesting. And so you all got that, we all have something that makes us individual, make sure to encourage that, it doesn’t really fit under the typical CV building pillars, it makes you interesting to people and that’s a good thing.
Katie: Okay, Thank you so much Dr. Odell. It’s been really wonderful to hear you talk about your speciality and giving us a little bit of insight into your world.
Dr. Odell: Thanks Katie and thank you for having me, I really appreciate the opportunity to talk to you and your listeners. It’s a great idea and I really applaud you guys for having the insight and the initiative to go and do stuff like this, especially during this time. Good luck to you and all your listeners and we will see you around.
Katie: And thank you so much to our listeners for tuning in today and we hope that you will be back for our next episode.
