Wednesday, May 16, 2018

Saying the Things Unsaid, Even When We Aren’t Their Doctors


Perhaps one of the hardest things about medicine is cross-coverage, that is, to be the covering doctor for your partners, whether for the occasional night, weekend, or longer. It’s not something done only in oncology. All specialties in medicine have this system, which allows us to have  lives outside of our hospitals and clinics. What’s hard about it, for me, is not the hours covered, but assuming care for patients I do not know. In such circumstances, I rely on my partner’s sign out, their documentation covering the last outpatient visits, or when necessary, their guidance provided on a phone call. Cross-coverage has made me aware of the art in medicine, and in oncology, and this is no more significant when it comes to patients living with advanced cancer.

Thursday, April 12, 2018

On Patient Care and Equipoise as SWOG Meets in San Francisco


I am heading to San Francisco where I will take part in the SWOG Semi-Annual Meeting. To those who might be unfamiliar with us, SWOG is a group funded by the National Cancer Institute and is part of the National Clinical Trials Network (NCTN). We run clinical trials across disease sites and scenarios, from prevention to treatment to survivorship and palliative care. SWOG members travel from all across the country twice a year to meet, learn, teach, and plan—all of this in the most interactive way possible, in as inclusive a way that we can imagine. Thanks to the leadership in our Patient Advocacy group (shout out to Wendy Lawton and Rick Bangs!), this includes patient advocates, who are embedded more and more into aspects of trial design at the earliest point.
The goal is to launch clinical trials across the country, and once that happens, to ensure they successfully accrue. We spend a lot of time trying to improve accrual—from making sure our investigators open as many trials as possible, supporting them once that happens, and then, to ensure patients are made aware of them in as “non-scientific lingo” as possible. Yet, I have come to recognize (though not the first time) that we as clinicians can sometimes be our own barriers to accrual.

Wednesday, March 14, 2018

February Break

It’s been a busy few months. In addition to professional transitions last fall, I traveled extensively across the country and internationally lecturing. I had immersed myself in the significantly greater administrative responsibilities of my new role, with days scheduled to meet with my new colleagues, fellows, institutional leaders, and staff. I loved it (still do). But it also meant I wasn’t home often, and when I was, I would make dinner, eat dinner, retire to my office for a couple of hours, then go to sleep so I could wake early and do it all over again.

Tuesday, February 20, 2018

Why Should I Stop?

Part of the challenge in oncology is maintaining the balance between hope and reality, and that is probably the most important thing to strive for on behalf of patients living with metastatic disease. Often times, the important conversations relate to treatment options, goals of care, and patient preferences (i.e., frequency of visits to the doctor, side-effect profiles of treatment options, and the important life events patients do not want to miss). Yet, some of the most important are also the ones I struggle with the most.