Q & A with Jay Doucet

In this interview we chat with Dr. Doucet about the division’s current strengths, his vision for the future and the challenges of meeting San Diego’s needs as the only Level I Trauma Center in the region.

May 23, 2019 | Interview by Tiffany Fox

Dr. Jay Doucet Appointed New Chief, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery.

UC San Diego Professor of Clinical Surgery Dr. Jay Doucet, MD, FACS, has been appointed the new Chief of the Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery. Dr. Doucet held the position on an interim basis for 18 months before taking the permanent role.

Dr. Doucet is also the medical director of both the Surgical Intensive Care Unit and Emergency Preparedness and Response at UC San Diego Health. He also performs trauma and general surgery and provides surgical critical care to patients. Prior to joining UC San Diego Health, Dr. Doucet was an attending surgeon at the U.S. Navy Trauma Training Center at Los Angeles County Medical Center/ University of Southern California, followed by two years at the University of British Columbia, where he was responsible for expanding the mission of the Canadian Forces Trauma Training Center as Director. Dr. Doucet has served on several overseas tours as a military surgeon in Afghanistan, Bosnia, Desert Storm and elsewhere, and also served in the Royal Canadian Air Force as a general duty medical officer and flight surgeon.

Q: What would you say is the division’s greatest strength currently?

A: Clinical excellence. We are the leading academic Trauma Center in the region, and we’re especially strong in looking after the complicated trauma patient or the elderly patient with multiple medical problems, but we also rescue people who have pretty severe injuries as well. We have the only burn unit in San Diego County, we have 39 ICU beds, and we do a lot of post-operative ICU care for other surgical patients in addition to trauma and burn patients. Our Trauma Center spaces are unusual in many ways, with separate trauma bays and the ability to take patients direct from the ambulance to the operating room for life-saving surgery. Most other hospitals don’t have that, in San Diego or elsewhere, and those structures and processes show in our results. I believe our outcomes are better because our excellent staff demonstrates something called extreme ownership. Each individual on our Trauma Team, from surgeons and nurses to the clinical support and administrative staff, is committed to that professional excellence.

Q: In San Diego County, what are the traumatic injuries that you see most often?

A: When I was a fellow, it was motor vehicle accidents and assaults, including gunshot injuries. The same things still happen, but now the most common injury is the elderly patient falling down, and a significant number of those either have fractures or brain injuries. It’s not much noticed in the media, but there’s really an epidemic, which some people are calling a ‘silver tsunami.’ Fortunately, we have an excellent track record in looking after geriatric trauma. We have also dedicated resources to trauma prevention, with a focus on the compassionate care of senior citizens and their loved ones.

Q: I’ve also seen in the local news that e-scooter injuries have become a big problem.

A: E-Scooters provide a perfect illustration of the concept of trauma as a preventable disease, instead of fate, or a series of random accidents. Like any disease, trauma has distinct causes or vectors. Trauma is one of the diseases that could be virtually eradicated by prevention – such as eliminating needlessly risky behavior, like riding e-scooters while distracted or impaired.

After the introduction of e-scooters to San Diego, watching scooter-related injuries surge to the current level where we see serious injuries daily, was like watching the emergence and spread of a new disease. We have received several patients with severe traumatic brain injuries from e-scooter accidents. We also have had patients with severe facial fractures requiring surgery to reconstruct and patients with arm, leg, and hand fractures. Unfortunately, we also have seen two fatalities from e-Scooter related brain injuries. However, aided by our talented consulting services, we have also had excellent outcomes for patients who are injured while riding scooters in San Diego. But prevention is always better.

Q: What is something you wish people knew about trauma surgeons and the division in general?

A: People think a Trauma Center is a building with a sign on the wall. It’s not. It’s about the people inside and the relationships they have. Sometimes people get the idea that the Trauma Center is just the trauma surgeons, and it isn’t. Trauma is the whole hospital. The trauma team in the trauma bay includes an attending physician, a fellow, three residents (likely from different specialties), two nurses, a trauma technician, a laboratory technician and an ultrasound technician. Other consultants could come in from other specialties to help us. We’re supported by 85 trauma nurses, and of course we work with the lab, the blood bank and imaging. We sometimes treat children and pregnant women, we have elderly patients and we sometimes even have patients with cancer who have trauma as well. We treat people from all walks of life -- rich, poor, and in-between, with or without insurance. Trauma is one of the great equalizers in life because it has the potential to affect anyone, anywhere, any time. To make it all work, we have to keep our shared mental model, our vision for the Trauma Center, alive within the whole institution. The trauma center is our promise to the community to do our very best for patients who are in a most vulnerable state, having the worst day of their lives.

Q: What is your vision going forward for the division?

A: It has to be maintaining our clinical excellence, as well as continuing public outreach and our research. We are an unusual division in that we do basic science research in addition to clinical research. We do outcomes and policy research as well, and our advocacy efforts are a part of that. In the past, when we would recognize that there should be a new policy and that advocacy should occur, that’s where the paper would end. A new concept is following through on that need for advocacy, which is actually going to talk to the people who do make the rules. We also need to educate legislators and the public. One of the things that becomes very obvious to trauma providers when they go to Washington or Sacramento is that there is a pretty large knowledge deficit regarding injury and trauma, and that very simple changes in policy can have a huge impact. An example is supporting state and federal bills to add training and cost-effective “Stop the Bleed” kits to AEDs that can help turn bystanders into first responders whenever trauma strikes.

Q: What are the top three things people can do to stay out of the Trauma Center?

A: Be a safe driver, be a safe pedestrian and make sure your home is safe. You can refuse to take needless risks.

Q: What is your approach to leadership?

A: I’m very lucky to lead a smart, talented group of people in our Division. They need the resources, the space and the time to do what they do best, so it’s important to make sure they have that and to make sure they’re able to do their jobs with as little interference as possible. I try to lead by example. I wouldn’t ask my team to do anything that I wouldn't do. That was taught to be by my best commanding officers over 22 years of active duty. Essentially, every day we need to strive for professional excellence, maintain our personal integrity, and communicate effectively with our team members upon whom we rely to provide outstanding results for our patients.