James Rathmell, MD, stands by two photographs he has taken.

BWH Clinical & Research News 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.

Rathmell is an established leader in pain medicine who has dedicated much of his work to the care of patients with acute, chronic and cancer-related pain. Over the course of his career, he has enhanced medical education for physicians and trainees through teaching in the classroom, strengthened continuing medical education activities and published original research and textbooks. 

In June 2015, he joined Brigham and Women’s Health Care (BWHC) from Massachusetts General Hospital (MGH), where he was executive vice chair and chief of the Division of Pain Medicine. At MGH, Rathmell guided the Center for Pain Medicine to become a successful patient-centered clinical operation, as well as a top-tier fellowship training program.

How would you describe your time as chair so far?  

JR: It’s been terrific. The Brigham is a wonderful place. It’s been very welcoming, and the department has been warm, open and helpful. It’s really been superb.

What initially attracted you to BWH?

JR: I spent the last 10 years at Mass. General and really liked all of the people whom I worked with and the environment. The next logical career step for me was to go on and become a chair, and so 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.

BWH’s Department of Anesthesiology, Perioperative and Pain Medicine 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 initial goals did you have for the department?

 JR: Interim chair Bhavani Kodali, MD, did a really nice job of keeping the department stable, 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 and getting finances in order.

Now I’ve come to the end of seven months, and the next phase is about getting people in the right position to take the department from where it is today to where we want it to be five and 10 years from now—getting the structure and the team in place to come up with a joint vision. My vision is broadly about creating the next generation of innovative anesthesiologists—the people who go on to practice anesthesiology and define how it is practiced across the U.S. and around the world. We want to train those people. The Brigham has done this for many, many decades, and now we will develop the next generation of leaders. I’ll soon have a team in place to do that across all the different domains—clinical care, training, research. We have several extraordinary labs—including Charles Serhan’s Center for Experimental Therapeutics and Reperfusion Injury and Omid Farokhzad’s Laboratory of Nanomedicine and Biomaterials—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. We also want to train those who will go on to teach the next generation.

There’s an administrative and leadership piece as well—anesthesiologists who are going to be leading ORs and ICUs and pre-operative assessment centers. We want to ask ourselves, how are we going to measure success every step of the way?

How have you seen the field change over your career?

JR: Anesthesiology has changed dramatically. We’ve gone from a specialty where the vast majority of anesthesiologists spend most 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—for example, running a pre-operative assessment center, like Angela Bader, MD, MPH, does; running the Intensive Care Units, like Nicholas Sadovnikoff, MD, does; or running the Pain Center, like Ed Ross, MD, does. About 50 percent of the work we do now is outside of the OR.

We’re now 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, and that teamwork really positions us well for accountable care in that we’re a critical element of the team that allows surgery to be performed in the safest possible fashion.

Anesthesiologists’ role has become more prominent. Imagine a pre-operative clinic of old. An anesthesiologist would collect and review data and make sure things were safe, but he or she wouldn’t take a central role in assessing how sick or well the patient was. Compare that to what BWH’s Weiner Center for Preoperative Evaluation does today. Anesthesiologists take the surgical history and physical, order and interpret tests, figure out appropriateness of care and discuss likely outcomes.

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

JR: I received a graduate degree in the pharmacology of anti-cancer drugs, and I went to medical school to be an oncologist. One of my passions is photography. I love the physics of optics, and so as I got into my second and third years of medical school, I became very interested in ophthalmology. I actually matched in ophthalmology and started an ophthalmology residency. During intern year, I realized that I liked taking care of people who are sick. In ophthalmology, you largely don’t take care of systemic illness. I switched to anesthesiology because I loved pharmacology, and I never looked back. That was 28 years ago.

I look back on it now when I talk to medical students or residents who are struggling with decisions about specialties, and I don’t think it really matters what specialty you choose if you make the best out of the specialty. I love anesthesiology, and I think I would have loved ophthalmology and I would have loved oncology. There is so much overlap in what you do; that’s what’s so wonderful about medicine. You can delve into so many different aspects.

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 largely on drugs and sometimes devices. Right after I finished training in 1992, I looked at inotropes—drugs that alter how forcefully the heart contracts—and muscle relaxants in cardiac anesthesia. My first publications were in those realms.

The second phase of my research career involved how we control post-operative pain, and I did a number of different studies—both my own that I dreamed up and conducted that looked at best doses and routes of delivery for analgesics, and industry-funded trials on a number of different analgesics that have not yet reached market.

The most recent phase of my research started out with chronic pain studies, both on drugs and devices aimed at pain relief and determining what works best, typically in multicenter randomized controlled trials. In the past five to six years, my research has focused on using image guidance to place needles for pain treatments and the safety of that.

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

JR: 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.

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

You have this incredible group of physician-innovators who know how to work on teams, and they can help you get things done. We’re great team members and great facilitators, and 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.