I enjoy circulating patient stories that speak to the emotional issues of what we do in cancer medicine. I like them so much that, these days, the first articles I read in many medical journals are those about the humanistic aspects of clinical medicine.
A few days ago, I came across a story about the practice of medicine that stuck with me. It's a story about how a radiologist was trained clinically over many years (JAMA 2017;318:331). He said the key to his clinical development was daily radiology rounds—the time when clinicians would come down to review the films of their patients together, in person. He noted these visits kept one engaged with other physicians in the hospital, but more importantly, you learned from your colleagues. Additionally, he came to realize the exchange was the highlight of the day and the key to a good radiology report.
Unfortunately, that interaction between the radiologist and the ordering physician is becoming extinct as everything is now digitized and the physician interaction is electronic. The piece closes with “A better part of an entire generation of physicians have now been trained in this new model. The clinicians used to come downstairs, challenge our diagnosis, and make us better radiologists. That doesn't happen anymore.”
Those of us with grey hair know all too well that the practice of medicine is very different than it was 20 years ago, and not necessarily for the better. When I was attending on the inpatient service with great frequency, I knew almost every doctor of the many practicing physicians in our large hospital. I would see them in the hall and discuss patients; I would call them up and discuss cases. If we were on the wards together on a weekend, we would round together. The point being we talked to each other. And in doing so, we learned from each other and we aligned on a treatment plan that we then swiftly executed.
Now, communication with other physicians is almost exclusively by notes in a chart on a computer. This flawed form of communication is void of human emotion, tone, or body language. Without interaction in person, questions and challenges are lost. Not only does this limit the vital transfer of information, it also means the opportunity to learn from each other is gone. And, while the electronic medical record (EMR) is supposed to lead to efficiencies, the loss of face-to-face interaction with your peers actually means there are countless, immeasurable delays in care simply because the clinicians are not aligned and have not had a conversation to develop a plan that can be immediately acted upon.
Taking Time to Talk
One of the keys to success of multidisciplinary clinics (MDCs) is simply being with clinicians of other specialties. Without question, MDCs improve access and are better for patients, but equally important, the docs, and all clinicians from different specialties, educate each other. One way in which this is accomplished is to be challenged. I, in fact, enjoy being challenged. I want to volley information and embrace a culture that believes that “team care” is the best care.
Interpersonal relationships are important within the clinic and paramount to building and sustaining relationships with outside physicians. Sometimes people ask me how I grew our BMT program. I think the key was to build relationships with referring physicians. Back then, it was fairly easy to do. First, I was all about access. If they were calling me, asking me for help with a difficult patient, I would make sure I saw that patient quickly. Then after I evaluated the patient, I called up the referring doc and gave him or her my opinion, and we mapped out a plan together. Bottom line—I talked to the physicians. We got to know each other as human beings. We developed a relationship.
Over the past 6 years, as cancer center chairman, I have tried to encourage all our physicians to make a phone call to the referring doc after the patient is seen. And I have failed miserably in this quest. An entire generation of people, some of whom are physicians in our cancer center, think talking to people over the telephone is a waste of time, believing that you can do everything with a text or an email and it saves everyone time. Thus, they think the request to call referring docs is ridiculous when you can simply email them your note in the EMR. Safe to say, I completely disagree.
Most notes in today's EMR are 10 pages of clutter and maybe, if you are lucky, one sentence that describes what the physician was actually thinking about the patient. I can promise you that referring physicians do not have time to scour 10 pages of notes for the one summary sentence. More importantly, there is a lost opportunity to develop relationships. Additionally, losses from the failed relationship opportunities are significant.
As an example, these days, keeping patients within our health care organization is the topic of many strategy sessions of our leaders. How do we prevent “leakage” of our patients to other health care systems and keep referring physicians loyal? I would say it should be fairly obvious—if you do not take the time to call up a referring doc, align on a treatment plan, and get to know them as people, then it is silly to expect them to be loyal to you or your organization.
Finally, one of my key roles as a leader is to set the vision for the cancer center. When I speak in public, my goals for the cancer center, my beliefs about the field of oncology, and my passion for medicine are immediately understood. Whether or not everyone buys into what I am saying, they understand the passion behind the message. They feel my authenticity. They do so because they hear my tone and witness my body language and facial expressions; it is genuine. As I stated above, circulating patient stories electronically helps to elevate culture, but there is no substitute for hearing a patient story face-to-face either in small groups or in a large forum. There is no way to project passion and authenticity over email. It has to be seen and heard.
I use email; everyone does. I even text. But, I became a cancer doctor in order to help people, to interact with patients, and to constantly be in touch with real people dealing with real life. As electronic communication creeps into our daily life, so many touch points with people are lost. I would argue that as we remove in-person communication in lieu of digital, we jeopardize a core principle of why many of us became cancer doctors—the people, the human interaction.
Encouraging your team to put down their phones, come out from behind their computer, and interact in person will have immeasurable benefits to your organization. Whether you want to optimize clinical care, elevate culture, and empower employees, or if you want to set a vision for your organization, start by talking to folks.
BRIAN J. BOLWELL, MD, FACP, is Chairman of the Taussig Cancer Institute and Professor of Medicine at the Cleveland Clinic Lerner School of Medicine. Cleveland Clinic is a top 10 cancer hospital according to U.S. News & World Report.
Straight Talk: Today's Cancer Centers