Dr. Philip Brooks is a clinical professor of obstetrics and gynecology at the Geffen School of Medicine at UCLA, and Director of Operating Rooms at Cedars-Sinai Medical Center, where he currently practices. Since 1965, when Dr. Brooks entered private practice, he has been at the forefront of advancing technology in his field. His research led to the development of operative hysteroscopy, which he then introduced into China and Israel. More recently, he has been working on the development of minimally invasive ways of treating abnormal uterine bleeding. In this interview, he highlights "the quest of doctors to find the best, safest, simplest, and least expensive ways of helping patients."
Uterus1: Was there a point in your life when you knew you wanted to be a doctor?
Dr. Brooks: I think I’ve always wanted to be a doctor. When we’re young, I don’t think we have the foggiest idea of what the practice entails. We idealize medicine based on some of our role models, and I loved my pediatrician as I was growing up. But I don’t think we know what it’s like until we get to caring for people.
We see doctors as being kindly and caring and loved and warm, and doing nice things and making people well, but in the real world, there is an overwhelming responsibility to the well-being and the health of the patients; not just to their physical health, to getting them through a toothache or an appendicitis, but helping them emotionally overcome serious, life-threatening, or even just temporarily disturbing illnesses. The responsibility is awesome, and the opportunity, the possibility, the breadth of impact that we have on the lives and well-being of patients, is enormous.
Uterus1: Was there a point in your life where you knew you wanted to be a gynecologist?
Dr. Brooks: There became a kind of general feeling I had as I went through medical school that I really enjoyed the care of women best; that is, I had a great deal more appreciation for them, for their complexities, their depth, their emotional side; and I suppose part of why I really enjoy caring for women is that I had this really great mom. My father died when I was five, and I was the youngest of three children. As I went through medical school, I enjoyed caring for my female patients, and the idea of doing the little bit of medicine and the little bit of surgery and the little bit of psychology and a little bit of hand-holding and caring and protecting made my decision fairly easy. By the time I was through medical school I had delivered 45 babies as a medical school student, which is unheard of even today. I enjoyed those rotations more than anything.
Uterus1: What do you feel is your greatest contribution to obstetrics and gynecology?
Dr. Brooks: My greatest contribution is the breadth of my teachings. I have created movies and videotapes for teaching purposes, and I have lectured and operated all over the world. I brought my single greatest specialty, which is operative hysteroscopy, to the state of Israel: I was the first one to introduce it. We did the first hysteroscopy in the Republic of China as a teaching team. So I think that my greatest contribution has been the teaching of so many students and peers how to do some of the new avant-garde things that I helped to develop. It was my research on hysteroscopy that got the resectoscope approved by the FDA for use in gynecology. It had never been, before. And because of that, I have been asked to teach about operative hysteroscopy everywhere I go, and those opportunities have been both glamorous and very rewarding. I’ve had a fabulous career that I am most appreciative for.
Uterus1: Can you describe the operative hysteroscopy for our readers?
Dr. Brooks: To simplify a great deal, it is the use of very narrow telescopes and very narrow instruments to operate inside the uterine cavity, to save the uterus from hysterectomy, to improve well-being, in terms of bleeding problems, and to improve fertility. We have developed little tiny tools to work in a little tiny cavity, off of a big video screen, to fix a uterus that’s in trouble from benign causes.
Uterus1: What is your current focus in patient care or research?
Dr. Brooks: Right now my current focus is to continue to offer and develop minimally invasive and outpatient procedures for the care of women, along the lines I’ve mentioned. I do a lot of stuff in my office, and I teach a lot about how to do it, using local instead of general anesthesia, which reduces the risks and costs associated with the procedure tremendously.
Regarding the newest procedures that I’ve been involved with, I am one of the principal investigators for a new technology — hydrothermal ablation, or HTA — that uses telescopes and a watertight seal to put room-temperature salt water, saline, into the uterus. Once we’ve assured that we’re in the right place, the water is heated up to 90 degrees centigrade (almost but not quite boiling), and it virtually seals the blood vessels, cooking the uterine lining to destroy the surface of the uterus and blood vessels, so that women who have progressively worsening menstrual hemorrhage can be treated with a simple ten-minute office procedure, and with something like a 95% success rate.
I am a devoted advocate of HTA because it does manage abnormal bleeding in a conservative and safe way. That’s the kind of thing that I hope I can spread the most. All of us, the inventors and the other investigators, have worked very hard for that particular reason: to provide for our patients the safest and simplest and most effective method of treatment of this problem.
Uterus1: This procedure is available now in the U.S.?
Dr. Brooks: Yes, it’s been approved by the FDA and we’re conducting ongoing studies. There have now been well over 22,000 or 23,000 cases that have been done, and our attempt is to try to avoid hysterectomy for bleeding from benign causes. There are 650,000 hysterectomies in the US every year, and about 200,000-250,000 women are bleeding from benign causes such as polyps and fibroids. There used to be a great number of hysterectomies done for those reasons. I think women who would rather not have one deserve the right to conserve the uterus if at all possible, with a technique that is safe. The telescope minimizes the risk of injuring the wrong structures, and has an enormously high success rate.
Uterus1: Do you see a trend in your field towards these kinds of minimally invasive procedures?
Dr. Brooks: As much in our field as in any other. There has been a trend over the last several decades — and gynecology has led the way — to learning and developing techniques to provide a minimally invasive surgery for the management of disease.
We’re training more people; more physicians are learning techniques. There’s no question that it will continue. We’re doing more laparoscopic hysterectomies, which are great, and minimize hospitalization and morbidity; they are being done more and more. Physicians are learning these procedures and becoming more comfortable with them. We’re also working on other techniques to destroy things like fibroids by interfering with their blood supply: both uterine fibroid embolization and other techniques to reduce the vascular supply to the fibroids and deprive them of the nourishment that they require to grow.
The fact that women have fibroids is nothing; it’s when they get big enough to compress the uterine lining and blood vessels that there are symptoms of pressure and miscarriage and bleeding. If we can interfere with the growth and the blood supply of fibroids, we can try to minimize their impact on women’s health.
Uterus1: What do you see as the most important new trends in obstetrics and gynecology?
Dr. Brooks: I think the most important new trends are the improvement in our understanding of the management of reproductive problems, problems all the way up through menopause, menopausal management, the breakdown of tissues, osteoporosis, that kind of thing. I think that minimally invasive surgery is a very major trend.
The improvement in helping people get pregnant when they want to and can’t has been very dramatic. I don’t know how much more we can do, outside of ethically questionable things such as cloning. The development over the last twenty years, of fertilization outside the body, has been very dramatic.
Uterus1: How do you expect your practice to be different in five years?
Dr. Brooks: Well, I’m getting old. I expect my personal practice to be lightening up. I don’t have any ideas of retiring, but I will probably do less actual clinical practice and more teaching as I continue to age and as I continue to have an impact. I think that unlike the movie business, medicine still applauds the lives [of] the experienced physicians who bring the wealth of experience, of having been there, and the sensitivity required by medicine, as opposed to just the science of it.
Uterus1: What has been your own greatest impact on the field?
Dr. Brooks: I think my greatest impact has been on the actual care of patients. It’s not so much the scientific arena, but the clinical arena, where I am respected, because of my avant-garde concepts of managing diseases. The majority of what I do, and teach, and have been considered an expert in, I never learned in my residency; it’s all been invented since I finished my training. But I have learned it and taught it. I have really been virtually the pioneer in my community for all of those technologies, and have taught others how to incorporate them into their practices.
I am respected for advancing cutting-edge concepts of managing diseases, while being conservative and practical and trying to care for patients in a way that suits them.
Uterus1: For our readers who may be looking for an excellent obstetrician-gynecologist, how would you recommend they find a good one?
Dr. Brooks: The best way is to talk to a physician that you trust, who offers the kind of care that you like, and ask him for somebody in obstetrics and gynecology who has the same kind of feeling. When you go to a medical society, their obligation is to treat everybody equally, so they give a rotation of three or four names in order. Ask a nurse at a hospital who they see as the best practitioner, not the nicest guy but the person who takes the best care of patients, who is kind and caring and committed to answering phone calls and calming the fears and confusion of patients. I think that’s probably the best way of ensuring that you get a quality physician.