Dr. Peter Dodek, who has been a centerpiece of the CHÉOS community for more than two decades, is set to retire at the end of the month. Dr. Dodek is a critical care physician, a researcher, a teacher, an occasional administrator, and tireless advocate for evidence-based care. We sat down with Dr. Dodek to talk about his journey and what he has learned through his diverse career.
A Winding Road
It wasn’t until the middle of his undergraduate degree that Dr. Dodek decided to pursue a career in medicine. Before then, he was focused on his training in biochemistry at UBC, learning from professors like Dr. Michael Smith of the eponymous Michael Smith Foundation for Health Research.
Even while he attended medical school in Toronto, he was unsure whether he wanted to be a practicing physician.
“At the time, I thought that I might become a high school biology teacher and bring some real-world perspective to what was being taught at that level,” he said.
But during medical school, an instructor and role model inspired him to pursue a residency in internal medicine, a speciality that involves the treatment and management of complex diseases across multiple systems in the body.
During his residency at Harbor-UCLA Medical Centre in California, one of Dr. Dodek’s primary roles was to look after critically ill patients in the intensive care unit (ICU). It was there that yet another mentor inspired him to shift his trajectory.
“The director of the ICU showed how you could be careful, methodical, and rational in the treatment of critically ill patients, all while being compassionate,” said Dr. Dodek. “This was at a time when we really didn’t have many randomized controlled trials in critical care; much of what was done was based on observational research or opinion.”
The director’s leadership ultimately motivated him to go after a career in critical care medicine and a fellowship in pulmonary and critical care medicine in San Francisco. It was this experience, which involved both basic and clinical studies, that cemented his interest in research and its application to patient care.
The Benefits of a Clinician-Scientist
After completing his training, Dr. Dodek moved back to Vancouver to take a job as a clinical instructor at UBC and continue his pulmonary research at what is now the Heart and Lung Institute (HLI). But it was his clinical responsibilities at St. Paul’s that triggered his next career change.
“My clinical duties showed me that there were many inefficiencies in health care and opportunities to improve the way we do things,” he noted.
He became interested in the area of quality improvement (QI) and returned to UBC for yet another round of training, this time in clinical epidemiology at the School of Population and Public Health (SPPH).
“This training shifted my career from basic science towards health systems research and quality improvement,” he explained.
At SPPH, Dr. Dodek was taught by the likes of Drs. Martin Schechter and Joel Singer, both CHÉOS Scientists. Beyond epidemiology, he received training in program evaluation, health economics, and guideline development and implementation.
Dr. Dodek became a champion for clinical guidelines and has since given over 30 invited talks on their development and implementation. He also served as the Chair of the BC Council on Clinical Practice Guidelines with the BC Ministry of Health.
His focus on using the best available evidence to inform practice came at a time when the concept of evidence-based medicine was on the rise.
“Evidence-based medicine was a momentous shift in how medicine was practiced,” he said. “Essentially, it’s about giving a solid foundation to the things we do, rather than basing them on opinion or who has the loudest voice at the table.”
Patients clearly benefit from care that is based on scientific evidence; however, this relationship is a two-way street. Being a clinician-researcher allowed Dr. Dodek to identify research topics that were important to both care providers and patients.
Through identifying problems or inefficiencies that he and his colleagues were experiencing, Dr. Dodek’s research and quality improvement projects addressed questions that were directly applicable to patient care. One example of this, he says, is a QI project that resulted from an observation about daily x-rays of every patient in the ICU.
“The time delay in getting the results to the ICU led us to examine this practice and, through conducting a literature review, we found that there wasn’t much evidence to support daily x-rays,” he explained. “This led to a QI project and results that ended that practice, ultimately freeing up time and resources to be used elsewhere.”
In his role as the division head for critical care at St. Paul’s Hospital, which he held for nearly a decade, Dr. Dodek continuously encouraged trainees and new clinicians to search out published research as a way to bolster critical thinking and better decision making.
“A hub for clinical and health services research”
Dr. Dodek’s switch to focus on health systems research in the mid 90s also initiated his involvement in what would eventually become CHÉOS.
At the time, there was a growing interest in having a hub for clinical and health services research at Providence Health Care. Dr. Dodek was invited to help make that dream a reality, collaborating with Drs. Peter Paré and Martin Schechter, among others, to develop the fledgling CHÉOS (at the time called The Health Research Centre).
This involved the development of a synergistic relationship between the federally funded CIHR Canadian HIV Trials Network (CTN) and researchers such as Dr. Dodek, who were focused on non-HIV research, mostly at the provincial level. This allowed the researchers to share resources and space, but more importantly, expertise.
“Being able to share research support staff between the different projects and researchers was invaluable,” he explained.
It’s this centralization and sharing of knowledge and expertise that really made the organization flourish, he said. Dr. Dodek, along with Dr. Anita Palepu and others, constantly worked to encourage more researchers and clinicians to join CHÉOS and benefit from this collaborative environment.
Dr. Dodek has also exposed himself to new types of methods, approaches, and areas of research. Over the years, he has worked with anthropologists, psychologists, qualitative researchers, and others to address problems from a multitude of angles.
This has allowed his research to go where it needed to in order to ultimately effect change in care practices. An example of this is his most recent area of interest: moral distress in ICU personnel.
“This started with original work in ICU quality improvement and safety, which brought up the importance of organization culture for patient outcomes,” he explained. “This work led to the investigation of moral distress and its impact on staff and patients, and now we’re working on developing interventions to address it.”
When asked what advice he would give young researchers and clinicians, Dr. Dodek had two suggestions. The first, exemplified by his circuitous career and shifting interests, is to keep searching and trying different things until you find an area you are passionate about.
“If you’re passionate, you’ll do a good job. If you don’t have that passion, the work will never be as good as when it’s infused with passion,” he noted.
Driven by his own passion, Dr. Dodek plans to continue carrying his ongoing research projects forward into retirement and mentor other researchers to give back some of the knowledge he has gained over his career. He also plans to continue work in Nepal and South Asia, where he has helped set up courses on critical care and quality improvement.
His second piece of advice is even simpler than the first.
“Surround yourself with nice people,” he said. “It will make things a lot more fun, and that is the ultimate goal: to have fun in what you are doing.”
Outside of the research world, Dr. Dodek’s retirement plans include returning to jazz piano lessons after a 45-year hiatus, travelling with his wife, and spending time with his 90-year-old father and two sons.