Professor Jeffrey Rosenfeld is head of the department of surgery at Monash University and director of the department of neurosurgery at Alfred Hospital. Clinically, he specialises in cerebrovascular, brain tumour and skull base surgery. He is also a prominent researcher with a focus on neurotrauma. He is a major general in the Australian Defence Force and former surgeon general of Defence Force Reserves. He has authored more than 220 publications, and was awarded a Member of the Order of Australia in 2011.
“When I was a junior surgical registrar I was told I was not capable of being a surgeon. I didn’t believe that and pursued my goal. Later, I wanted to become a neurosurgeon, but was advised to do general surgery. I had a job lined up as a general surgical registrar in London when I learnt that, for the first time, there would be formal interviews for neurosurgery training. I went along and was accepted. Having now had a successful neurosurgery career for the past 30 years, the message I would give junior doctors is don’t give up on your dream, please pursue it if that’s what you really want to do.
I was interested in the brain and neuroscience when I was a medical student and junior doctor, and once I’d experienced neurosurgery I realised it suited my personality and interests. You need very strong attention to detail. The precision of the work appealed to me and I liked the high-stakes surgery. I could see that I could make a big difference to people’s lives.
One thing that really struck me was just how beautiful the living brain is. You see pictures of it in textbooks, but when you actually see the real thing, the beauty of the organ pulsating, with blood surging through the myriad vessels, it is an awe-inspiring sight. To have the responsibility to operate on the human brain is a great privilege.
I have a particular academic and clinical interest in neurotrauma. I was attracted to neurotrauma research because the outcomes for severe brain injury are still quite poor. Recently, I was co-principal investigator on the first multicentre randomised controlled trial of decompressive craniectomy for patients with severe diffuse traumatic brain injury. It created a lot of controversy when it was published in the New England Journal of Medicine last year, because we found the operation didn’t improve outcomes for these patients. In fact it increased the number of survivors in a vegetative state. The research hasn’t settled the issue. It’s raised a lot more questions, but that’s okay, that’s what research should do.
I’ve also done a lot of work in the developing world to try and improve neurosurgery services. I visit Papua New Guinea every year and have also worked in countries such as China, Vietnam, India and Fiji. If we teach general surgeons how to do neurosurgery, and nurses how to look after neurosurgery patients, the outcomes can improve substantially. I’ve also published a book on performing neurosurgery in resource-poor countries, Neurosurgery in the tropics, which has had a wide influence in the developing world.
I’ve served on seven deployments with the Australian Defence Force to Iraq, Rwanda, East Timor, Bougainville and the Solomon Islands. It is a privilege to provide medical care to our troops on operation and within Australia. In Iraq I looked after numerous bomb blast victims, both military personnel and civilians. I’ve tried to bring this knowledge back to Australia so that if we’re ever struck by a bomb blast there’ll be a lot of well informed emergency care providers.
When I was a medical student, in 1973, I was offered a research position with Professor Graeme Clark, the inventor of the bionic ear. I actually turned him down because I wanted to finish my medical degree quick smart. In retrospect that probably was not a great decision! I missed out on that one, but I’m now involved in developing a bionic eye, using a brain prosthesis, with a team at Monash University. The unique feature of this project is that it’s a multidisciplinary effort between engineering, neurosurgery, ophthalmology, physiology and also private industry. It’s been very exciting to work with professionals who look at things completely differently to doctors. We’re on track to implant the first device in early 2014.
Being an academic neurosurgeon can be challenging because of the need to balance clinical work with research, supervision, teaching and administration. Work–life balance is also a particular issue. I don’t know the answer to getting the balance right. I probably have spent too much time with medicine and not enough with family. I have to give enormous credit to my wife Debbie for allowing me to achieve what I’ve achieved — she gave up a career as a paediatrician for many years to raise our three children, of whom we are very proud.
Throughout my career I’ve focused on trying to be kind and courteous to people, not only to patients but also to other staff. When I see doctors who are aggressive and rude, I find this reprehensible. I suffered bullying, particularly when I was a junior doctor, and I vowed never to bully anyone myself. If people were respectful and kind to one another we could eliminate many problems in medicine.“
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