Joey Wahler (Host): He's Chief of Staff at Shriners Children's Portland. So, we're getting to know orthopedic surgeon, Dr. Robert Bernstein. Welcome to Healing Heroes PDX, the podcast series from the specialists at Shriners Children's Portland. Thanks for joining us. I'm Joey Wahler.

Dr. Robert Bernstein: Thanks for having me.

Host: Yeah, absolutely. Hi there, Dr. Bernstein. Great to have you aboard. We appreciate the time. So first, for you, a career in pediatric orthopedics is a true family affair, right? Tell us about that.

Dr. Robert Bernstein: Yes. So, my father was a pediatric orthopedic surgeon. And when I was growing up, I had quite a bit of time with him. I was able to make rounds with him. And eventually, when I was in high school, I worked as a scrub tech and was able to scrub for him. So, I was even able to spend time with him in the operating room and see how much fun he had. And my goal in my life was to be as much as I could like my father. And so, of course, he was a pediatric orthopedic surgeon, so I had to become a pediatric orthopedic surgeon.

Host: That's awesome. It seems like so many people in medical professions, doctors and others for that matter, were struck by the healthcare bug very early on and knew from that point that's what they wanted to do. I guess for you, it doesn't get any earlier than that, right?

Dr. Robert Bernstein: Yeah, I think that there are, and I think there's a lot of orthopedic surgeon father-son or father-daughter teams that occur, because Orthopedics is so much fun.

Host: Now, when you say fun, that's not necessarily the word that I would have expected someone to use about what rubbed off on the profession from their parent. What was so much fun?

Dr. Robert Bernstein: Well, early on, just seeing how my father interacted with children, so he would play with the children when he was examining them and have a chance to interact with the families, and I think that that was fun for him. He enjoyed that. And that's something that rubbed off on me. In addition, Orthopedic Surgery is sort of like carpentry. So, we get to use a lot of tools, we get to use drills, and hammers, and saws. And, quite honestly, working in a wood shop is kind of fun.

Host: Well, doc, now that you put it that way, that does sound like a lot of fun. So, moving on, by joining Shriners Children's Portland, your career kind of came full circle in a way, correct?

Dr. Robert Bernstein: That's correct. So, my first job after I had finished my residency and fellowships was at Shriners Children's in Los Angeles, which is now Shriners Children's Pasadena. And so, I spent six or seven years there and very much enjoyed working in the Shriners system, because of its amazing mission to take care of children regardless of ability to pay. And so, when I had another opportunity to work for the Shriner system, when this job became available as the Chief of Staff in Portland, I jumped at it and came up to visit and fell in love with the hospital and the Pacific Northwest and decided this is where I want to finish my career.

Host: As you well know, the Shriners Children's name and reputation speaks for itself. What do you think makes Shriners Children's Portland so unique compared to other pediatric hospitals?

Dr. Robert Bernstein: There's a number of reasons why Shriners as a system is much more special than some other systems and is very different. The first is that we're not a money-making organization. So, we do not live on the ability to make a profit. In fact, we lose money on every single patient and we have an endowment that helps us sustain the high quality of care that we provide.

We do collect from insurance if a family has insurance, but we don't ever send anybody to collections. This is a system that really is interested in providing highest quality care regardless of anybody's ability to pay. We won't turn anybody away who has insurance or doesn't have insurance. All we need to know is that we can provide the appropriate care for them. And if we're able to do that, then we will do so. And we're not limited in how we provide that care. In addition, the Shriner system really provides what we like to call wraparound care. So, it's not just the orthopedic surgeon that's providing the care. It's also the rehabilitation, the orthotics, and prosthetics. We have all of those facilities here on site, particularly here at Shriners Children's Portland. So, we have rehabilitation, which includes occupational therapy, physical therapy, speech therapy, play therapy. We have orthotics and prosthetics, so we can actually make a prosthesis or an orthosis for the patient. And that tech is here onsite, able to see the patient the same day that we're seeing the patient. They can even come down into clinic and see the patient with us. Those are very special things that generally do not occur at other children's hospitals.

Host: Gotcha. So, you talked a little bit there about Shriners Children's well known mission. But when we talk about the care itself, and you alluded a little bit to it there, obviously, you're dealing with Children, you're dealing with their parents or their caretakers as well. These can sometimes be sensitive situations, I'm sure. So, what's the approach to patient care at Shriners Children's Portland? How do you navigate getting kids and their families as well through what can be some tough times and on to better days ahead?

Dr. Robert Bernstein: Well, we tried to provide the kind of care that I would expect that someone would provide to my family. So, when I see a patient and talk to a family, I tell the family that this is what I would do for my child. And I'm going to treat your child exactly as if your child was my child. I will treat them as my own. And everything that I talk to you about, we'll discuss the risks and the benefits, we'll discuss the options. What could you do? Why is one better than another? And then, be very open and understanding and try and take the time to listen to the family and their concerns, because their concerns may be concerns that are different than I might have.

And so, that whole concept of taking the time to listen to families I think is really critically important to providing medical care, not just the quality of the surgery itself, but actually hearing the family and helping them navigate through the difficult times that are ahead for them so that they can have better times afterwards.

Host: And I would imagine, Dr. Bernstein, that that would make a family, the parents of a child coming to you and yours, feel very comfortable, wouldn't it?

Dr. Robert Bernstein: Well, that's our goal. Our goal is to make the families feel as comfortable as possible, to feel that they're getting the best possible care that they can, and to treat them, both the child and the family, as a unit.

Host: Now, speaking of you and yours, you work, of course, as part of a big team, to say the least. So, how important is collaboration among your staff when treating these patients?

Dr. Robert Bernstein: Collaboration is very important, and we have a team of 10 pediatric orthopedic surgeons, soon to be 11 pediatric orthopedic surgeons, and that's actually one of the reasons that I took this job. When I came up here, the facility is beautiful, but I had an opportunity to meet all of the physicians that are on staff here, and I feel that they are the highest quality people I have ever worked with, and they work together as a team. They help each other out. They collaborate, they talk, they go over cases together. Once a week, we go over every surgery that's going to happen in the hospital and review that operation to make sure that the indications are appropriate to find out whether the physician needs the assistance of another physician, whatever we can do to make sure that that child is going to get the best quality care that it can.

Host: And speaking of which, you're also involved with teaching the next generation of orthopedic surgeons. So, what's that like for you?

Dr. Robert Bernstein: Well, that actually is perhaps in some ways the most fun, which is being able to pass the torch and to teach principles to young physicians that are going to become pediatric orthopedic surgeons or just general orthopedic surgeons, but so that they understand how to provide care for children. We actually are somewhat unique. We have a residency program from a hospital, our affiliate next door at Oregon Health Science University, and we have those residents rotate with us, but we're also the only hospital in the United States that is accredited to provide pediatric orthopedic training for the Australian residents. So, we actually get Australian residents and fellows that come and spend time at our hospital, so we get to teach them as well. And that's really the most fun, because not only are we passing on this information and hopefully improving the care in the future, but we actually learn from them too. When you have a young person who is not used to providing this particular type of care and they ask questions, sometimes those questions are really quite prudent and will make us rethink how we're doing things. So, it really is a give and take situation.

Host: Wow. That's awesome. Have you picked up any Australian phrases along the way?

Dr. Robert Bernstein: Some that have to do with beer and Australian rules football; otherwise, no.

Host: Okay. How about when it comes to giving advice? I'm wondering two things. One, what's the best piece of advice your dad gave you as a physician himself? And then, secondly, any advice for aspiring pediatric orthopedic surgeons or medical professionals that you have yourself?

Dr. Robert Bernstein: That's an interesting question. What is the best piece of advice my father ever gave me? And I think that it is going to be a little bit of surprise to you. So, my father came to help me when I was at Shriners in Los Angeles doing a difficult case. My father was a very gifted surgeon and we struggled with a case. It was not an easy case. I think I'd been in practice perhaps a year. At the end of the operation, I said, "Dad, when do you feel like you know what you're doing?" And my father said, "The day I finished residency, I knew everything, Matt." And ever since then, every single day, I realize I know less and less. And I think that when we come out of our training program, there's often a hubris that we think we know everything and we know what the answer is. And as you gain experience, you realize that there are so many subtleties That you really have to slow down and rethink every single patient and everything that you do. You don't know the answers for everything. And I think that that humility is extraordinarily important. And that's, I think, what I would want to impart upon any future pediatric orthopedic surgeon, be humble, take the time to rethink things. Don't always think you know what the answer is, because as times change and your experience changes, you will realize that what you thought you knew, you don't. And what you thought you didn't know, you may have some significant insight into.

Host: It's kind of like that old saying, what is it, you have to know what you don't know, right?

Dr. Robert Bernstein: I think so. I would agree with that.

Host: So, a couple of other things. How about in terms of the big picture here, what would you say is a particular case or a particular breakthrough or maybe a research product that you and yours have considered a big recent victory for the staff at Shriners Children's Portland.

Dr. Robert Bernstein: We have a physician here, Dr. Michelle Welborn, who is doing some research on something called collagen X. And collagen X was actually identified by a geneticist here at Shriner Children's Portland. And that collagen is only produced in growth plates, and it's only produced in fractures that are healing. And so, if you don't have a fracture there's a very limited amount of time where that type of collagen is present in your body, which is when you're actively growing. And when we try to make determinations of how much growth a child has left, particularly when we're looking at such things like scoliosis, when do we stop bracing a child who has a scoliosis curve? When is their growth done? Right now, we base that on some very gross evaluations that are usually radiographic. When do the growth plates look like they're closing in the hand and that sort of thing? Well, it turns out that this collagen X biomarker may allow us to be much more efficient in determining when growth is ready to stop and when we can stop having a patient wear a brace. And I think that's going to revolutionize the treatment of scoliosis as well as many other growth-related disturbances.

Host: Wow, that sounds big indeed. How about this? You're not only an orthopedic surgeon, you're also, as we said, Chief of Staff. What's it like balancing both those key roles at Shriners Children's Portland? What do you do in your spare time?

Dr. Robert Bernstein: Well, I think that being Chief of Staff is a huge responsibility. And it's not just trying to make sure that everybody is working at the top of their license and providing the best care, but also teaching leadership skills to my staff, because eventually I will retire and many of my staff will move up into leadership skills and may eventually be a Chief of Staff. So, how you interact with administrators, how you interact with families, how you make decisions based on what's best for the entire system. I think all of those things are very important. And so, I try to emulate good leadership to my staff on a regular basis.

Host: And what do you do when you're not working to kind of have a change of pace away from the job?

Dr. Robert Bernstein: Well, I enjoy bike riding. My wife and I, between us, have seven children, which are all adults, and we like to go and visit them and travel and do a little bit of piano playing and wine tasting.

Host: Seven children. Are any of them following in your professional footsteps as you did with your dad?

Dr. Robert Bernstein: Unfortunately, no. None of my children have chosen to go into Medicine, although I have one that does cancer research.

Host: Gotcha. Well, that's an important job as well, of course. On a lighter note, I understand you're known at Shriners Children's Portland for sporting bow ties, yes?

Dr. Robert Bernstein: Yes, I love bow ties. I learned to tie my own bow ties when I trained on the East Coast. And they don't fall in the child's face when you're doing an examination. So, it's a very efficient way and clean way of still having a tie but not bothering the families.

Host: That's great. So, it's not only a fashion statement, but professionally practical as well from a medical standpoint.

Dr. Robert Bernstein: Yes, exactly.

Host: In summary, doctor, what would you say is most rewarding to you about your role at Shriners Children's Portland? When you get home from work at the end of the average day, what's a good day for you?

Dr. Robert Bernstein: A good day for me is when I've had the opportunity to provide really good care to families and to make families feel comfortable. But also, I often will sit back and think about the physicians and the rest of the staff of the hospital that I had an opportunity to work with. The people that are working at Shriners Children's Portland are really dedicated to the mission and, oftentimes, have been here for 20 or 30 years because of that dedication and I think that's really quite remarkable and says a lot about our system.

Host: Absolutely. And let's not forget, when possible, it's got to be fun, right?

Dr. Robert Bernstein: Absolutely. Every day should be fun.

Host: You're right about that. Well, folks, we trust you're now more familiar with Dr. Robert Bernstein. Keep up all your wonderful work from you and your team. And thanks so much again.

Dr. Robert Bernstein: Thank you.

Host: And for more information, please visit shrinersportland.org. Again, that's shrinersportland.org. If you found this podcast helpful, please share it on your social media. I'm Joey Wahler. And thanks again for being a part of Healing Heroes PDX, the podcast series from the specialists at Shriners Children's Portland.