When a young Matthew Ramsey sat in his first premed lecture many years ago, he was so turned off by the cutthroat, “me-driven” attitude of some of his classmates that he nearly fled the room. But his drive to understand and affect the human condition kept his mind open…and his body in his seat. Now a sought-after shoulder and elbow specialist at the Rothman Institute in Philadelphia, Dr. Ramsey makes a difference not just in the operating room, but in the lab and in the literature. He is Assistant Editor of the Journal of Shoulder and Elbow Surgery and a Consultant Reviewer for the Journal of Bone and Joint Surgery. Dr. Ramsey is also shaking up the design world. Elbow implants have remained largely unchanged for nearly 20 years…no more. Dr. Ramsey is now redesigning the most widely used elbow implant in the world—the Zimmer elbow.
A self described “blue collar physician, ” Dr. Ramsey was raised in Schenectady, New York, and was surrounded by those who exuded hard work, charity and compassion. “My mom raised us three boys with the help of a supportive extended family. My grandfather was a Presbyterian minister who was the gentlest human being I have ever met. When I got to college and encountered a lot of aspiring doctors who were brash and out for themselves, it gave me pause. I thought, ‘If this is what medicine is, then I don’t want it.’ I ended up choosing political science as my major, but also took science courses ‘just in case.’”
After taking a year off between college and medical school to ponder his options, Dr. Ramsey signed on the medical dotted line…he just had to be a physician. “No matter how much I explored other career possibilities—one professor even tried recruiting me for the CIA—I could see that in sharing a difficult part of their lives with doctors, patients are giving us a tremendous gift. Over time this outlook has only solidified, and now I firmly believe that the very least we can do is engage the patient as a human being. I love the humanity of medicine; that doesn’t always make my schedulers happy, though, because I often linger in the exam room with patients as we explore their issues.”
An intuitive medical detective with a big heart, Dr. Ramsey says,
If you don’t enjoy the complexity of someone’s problems, then you don’t enjoy the beauty. I want to know what someone’s life is like beyond his or her problem. I firmly believe that we must bring more to the patient than the science of what we are doing.
“I once had a patient with a bad rotator cuff tear who was particularly distant, and I could see that something else was bothering him. It turns out that he had recently lost his job; this person was so relieved that I took the time to connect with him. Not only is this a ‘nice’ thing to do…it helps unclutter the clinical problem.”
While in medical school at the State University of New York Health Science Center at Brooklyn, Matthew Ramsey did indeed have what one might think of as “the Brooklyn experience.” He explains, “It was a tough neighborhood and a tough clientele, both of which prepared me to work in any kind of environment that I might encounter going forward. As for sorting out what field I wanted to enter, I had spent several summers in high school working construction; I also spent some time with a family friend who was an orthopedist. The immediate gratification was appealing…and all of the sawing, banging, and chopping was a direct extension of my comfort with manual labor.”
After a general surgery internship, Dr. Ramsey entered the orthopedic residency at Thomas Jefferson University Hospital in Philadelphia. “I got to walk among giants, including Dick Rothman and Robert Booth—there was not a ‘B’ rated surgeon in the bunch. Shoulder piqued my interest because it was different, was anatomically challenging, and was in its infancy.”
While not exactly shrugging off the shoulder, Dr. Ramsey then encountered an even less “popular” joint that merited exploration. During my fellowship at the University of Pennsylvania Medical Center the famed shoulder surgeons Joe Iannotti and Gerry Williams came to me and said, ‘There’s this thing called the elbow and no one in Philadelphia is addressing it. We want to change that, so can we send you to Mayo Clinic for specialized training? Then we’ll hire you and you will be the elbow man.’ I accepted the challenge that many of my colleagues had avoided.”
Those who accept challenges are, naturally, more likely to fail than those who never dive in and try. Dr. Ramsey states, “If you are averse to failure then you are not going to succeed. The first patient I ever operated on I had to take back to the OR because I misplaced a screw. I had to look that person in the eye and tell him what had happened. If you’re the kind of doctor who emits an ‘I am better than you’ attitude, then you’re going to have all sorts of problems in your career. But if your comportment leads people to view you as real, and you’ve connected with them and outlined the risks, then they will be more forgiving if something doesn’t go as planned.”
But often, says Dr. Ramsey, one must go looking for failure in order to make things right. “While at Penn I did some work on rat rotator cuff surgery where we looked at what factors contributed to failure. The challenge with rotator cuff surgery in humans is that we have a 20% failure rate. I am pleased that some of that work translated into what surgeons now do clinically.”
“In designing elbow replacement systems I have worked with Steve Kurtz, Ph.D., who runs the lab at Drexel University. For five years we have retrieved not just the implants, but the tissues around the implants in order to study the mechanism of failure. I am now working with Zimmer to redesign the most widely used elbow implant in the world. To date we have found that the most significant issue is articulation between the components, with the way that metal and plastic interact being the weakest link.”
While Dr. Ramsey doesn’t stand in front of a mirror and berate himself, he does credit rigorous self-evaluation as part of his success. He also turns this spotlight on potential residents. “Years ago I vowed to constantly engage in self assessment, to the point where I am my harshest critic. Being honest with yourself and others sets the stage for a good set of ethics. I can’t stand the bravado that medicine sometimes brings out in physicians. We struggle with people’s perceptions of us as doctors—including our motivations—and those who ‘act out’ don’t serve anyone well.”
“In most cases, however, you can’t teach compassion or ethical behavior.”
When I am interviewing potential residents I don’t ask questions to assess their intelligence—the fact that they are smart is usually a given. I ask questions that will reveal their ethical principles…things that will tell me how they would react in a certain situation.
“I look for things on an application that seem unusual and then drill down into them to see if the applicant is telling the truth. If they say that have woodworking experience, then I ask a few pointed questions on that topic. If they purport to run marathons, then I dig into the specifics of their training regimen. But compassion, so necessary in medicine, is pretty tough to assess in an interview. In my experience, it is a quality that comes from difficult life experiences such as losing a parent at a young age, undergoing a serious illness as a child, etc. The fact is that surgeons are just not wired for ‘touchy feely.’”
Research isn’t an area where compassion comes into play, however. The study setup and numbers tell the tale. As Assistant Editor of the Journal of Shoulder and Elbow Surgery, Dr. Ramsey is pleased to see that many people get it right. And yet…“There is a lot of sloppy research out there. Many people aren’t focusing on the study questions and are making them excessively broad. For example, let’s say someone is examining the things that contribute to rotator cuff failure. They look too broadly, however, and don’t see key points like age, smoking, quality of the tissue that contributes to failure, etc. They’re either answering a question that has already been answered or ignoring information and not moving the question forward. The fundamental question that researchers need to ask is, ‘Will this add anything to our understanding to the problem?’”
On the home front, the question used to be, “Dear, do you have to go golfing again?” Dr. Ramsey laughs, “After years of fighting about golfing, my wife has decided to join me—and we have a great time. Our daughter is a junior in college, is a business major and is planning a career in the music industry. Our son is a freshman in college, plays several musical instruments, and wants to write for television. They have turned out to be stellar human beings. For that, I largely credit my wife, who sets a great example, and is a wonderful friend to us all.”
Dr. Matthew Ramsey…with compassion as his guide, he enjoys the complexity of it all.
