Ralph George: The Breast Cancer Program at St. Michael’s Hospital

Ralph George and senior technologist Monika Sitarz

Ralph George has been recognized as an outstanding teacher and surgical oncologist throughout his career. His Breast Clinic at St. Michael’s Hospital has a friendly and caring atmosphere facilitated by the close intimate quarters that make communication immediate and effective. There is a well-developed relationship at the clinic with family doctors and general surgeons who treat breast cancer. The Unit has a strong reputation for supporting breast cancer care at a specialist level, without displacing patients from their familiar surroundings. The centre is a lively, intimate, multicultural hive of Canadian patients and staff from many countries of origin. There is an engaged group of receptionists who meet and advise patients. All have easy access to Dr. George whose door is always open.

Ralph has many teaching and education awards received throughout his career from his time at Memorial University as an undergraduate to his residency at Queen’s and his current position in the University of Toronto Department of Surgery.

At the clinic, there are several senior nurses, one family doctor, and three general surgeon oncologists. Dr. George says: “I love it here; this is the best job I’ve ever had.” He was a general practitioner in St. Anthony, Newfoundland, then decided to become a surgical oncologist. He went through a training program at Kingston focusing on breast cancer and melanoma, then spent three years as a fellow at the Roswell Park Cancer Institute in Buffalo. He enjoys skiing, camping and canoeing, and reads on the subway four or five pages per day on his tablet. His reading list includes Ulysses, Paradise Lost and Dante’s Inferno. His wife Dianne, a former ICU nurse, works in a family doctor’s office in Toronto. They have three grown children – one teaching Biology, one a ski instructor, and one beginning her degree in Social Work.

“The Breast Cancer Unit was started more than 20 years ago by James Mahoney in 1989. Ralph has been the Director for the past 8 years. “I’m proud of the spontaneous family spirit of the unit, which was given the name– the CIBC Breast Cancer Clinic in 2004, after a grant from CIBC. The clinic provides surgical operations – 425 cases per year with a full spectrum of breast disease. There are three surgeons, one family doctor, 2 plastic surgeons and two medical oncologists and 3 radiation oncologist who rotate through the clinic. A full specialty tumor board meets every Friday. The radiation is done at Princess Margaret Hospital. There is excellent rapport with referring doctors and among the specialists. The clinic provides specialized complex care, has an annual fundraiser, organized by a patient and an annual continuing professional development event for family doctors (a symposium at the Li Ka Shing Cancer Institute). The physical plant is bustling and busy and very familial. It may need a larger venue as its volume continues to increase. It’s very good for teaching, as surgical residents and surgical oncology fellows and breast cancer fellows rotate through. Surgeons who will be in general practice with some focus on breast cancer in Coburg, Barrie and other surrounding communities will not be competing with the surgical oncologist in the two year surgical oncology fellowship. I often travel to Huntsville, Brampton and Thunder Bay for locally delivered breast CME. Senior residents rotate for 4 months, juniors for 3 months on the service. The residents like the breadth of exposure, not just cancer. It’s good for the community surgeon who will deal with the mastitis of pregnancy due to prolactin increases and other common benign breast diseases.

“The patients and staff come from a broad spectrum typical of St. Mike’s population, including transgender patients and newly arrived Muslim women for which a separate waiting room is available. We have two new surgeons Jory Simpson and Adena Scheer, a Surgeon Scientist who is studying how decisions are made in a complex population and the role of the onco-plastic surgeon. 10% of breast cancer patients receive simultaneous reconstruction. Many patients come from Windsor and other places where former trainees have settled. The staff treats all of them like royalty when they call. Toronto is a centre filled with subspecialists. The country needs real general surgeons with specialty support. The website receives lots of hits.”
(http://www.stmichaelshospital.com/programs/breastcentre )

MM