Patient First, Cancer SecondBy Guest Blogger Dr. Afsaneh BarziAugust 2019
“How can I help you today?” is a question that I ask all of my patients at their first clinic visit. In response, they often look at me as if I must not have reviewed their records, nor spoken to my colleague who referred them, nor even spoken to my physician assistant who met with them before me and briefed me on their clinical issues!
But please know that “How can I help you?” is a rhetorical question which expresses my deep desire to identify and deliver the relevant and personalized information that can help each patient most effectively. I believe that patients seek my advice to ensure they are making the right health-related decisions and to feel confident that they have looked at and understood all of the possible options before taking action. I signed up to be an oncologist precisely for this reason—to help patients make often-difficult decisions at this most difficult time in their lives. Thus, I owe it to them to understand them, as much as I can, so that I can best help them face their difficult time ahead.
Historically, medical care involved providing the treatments that were available, without any firm knowledge of their effectiveness. More recently, there has been a shift to delivering care that is supported by evidence (known as evidence-based medicine) and is shown to benefit patients. Evidence -based medicine is rigorously developed through clinical trials or systematic data collection. In the role of an oncologist, I rely on the findings from clinical trials to inform the decisions I make with my patients regarding their treatment. When I read the report of a clinical trial, I end up knowing a lot about the patients who were treated on the trial, but I don’t know anything about those who were not treated on that trial. Is the only difference between these patients that some were presented with the opportunity to enroll in the clinical trial, and some were not? Or did some patients choose not to be treated on the trial? If it is the latter, why did they choose not to participate? We do not know the answer!! Yet we accept the clinical trial results and assume that patients who walk into our practice can be given the same treatment as the clinical trial population with similar rates of success. What if the reason that patients didn’t go on the trial was that they could not afford the cost of the frequent clinic visits that are required for the treatment? Similarly, I would not treat my 73-year-old patient with an aggressive therapy knowing that she has some early dementia and may not be able to remember all of the medications that she is supposed to take to complete her course of therapy. The patient in front of me may more closely resemble the patients who declined the trial than the patients who participated in it, but it is only through getting to know my patients better that I can identify the often-unrecognized obstacles that can sabotage an otherwise carefully planned treatment schedule. I would not be delivering personalized care if I didn’t tailor treatment plans to fit the unique characteristics of each patient!
To me, effectively caring for cancer patients goes beyond evidence-based medicine, which can fail to address patients’ cultural, psychological, and socio-economic concerns, or even undiagnosed medical problems. To provide optimal care, I must customize my message to each patient’s individual needs and unique life situation, and to that end, I want to know more about my patients as individuals, not just more about their cancers. I deeply believe that I am not just an oncologist; I am one human being caring for another. Naturally, I want to get to know my patient better to provide the right information in the right format. This is the art of oncology, the joy of my day!
How do we move forward toward patient-centered cancer care? The cancer community must come together and partner with patients and providers to advance the process of collecting and delivering relevant patient information to providers. This information would include individual patient preferences for the type and depth of information that would best help with their decision making, as well as their risk-taking vs. risk-averse characteristics. Access to information about a patient’s fears, concerns, and social circle, as well as important events in the patient’s life might also positively influence the success of the decision-making process. We are just at the cusp of understanding the value of this kind of information in personalizing care to our patients.
I get it. I, too, might feel weird if my oncologist asked me “How can I help you?” Doesn’t she know that I need chemo? How about a PET scan? What is my prognosis? But I ask you to be patient with me as I ask questions that may seem unnecessary. Know that I understand how valuable your time is and trust that every moment I spend with you is an effort in doing my best for you and trying to become a better provider for my next patients. I value the trust that you have placed in me and hope that I return the favor in kindness and care. I hope that one day I can speak about you and your character as eloquently as I can speak about your cancer.
Afsaneh Barzi, MD, PhD, is an Associate Professor of Clinical Medicine at the Keck School of Medicine of USC and an oncologist and researcher at the USC Norris Comprehensive Cancer Center. Dr. Barzi treats patients with gastrointestinal malignancies; her areas of interest include cancer care delivery and outcome research.
USC Norris Cancer Survivorship Advisory Council Blog provides a broad range of opinions which do not necessarily represent the opinion of the USC Norris Comprehensive Cancer Center. This and all information related to cancer, cancer treatment and healthcare should be discussed with your physician.