Ideas about a Lung Cancer Clinic
The original text for this idea was written in September 2003. It began a few years back and evolved during my residencies in general thoracic and cardiac surgery. Seeing the inefficiencies in thoracics, and the effective system of treating high volumes of patients in cardiac, allowed me to come up with a model of care for patients with lung cancer. I also drew upon my impressions of the Mayo Clinic, as translated to me by others who had been there. Of course, at that time I had not even visited the place. Now that I am at Mayo as a fellow, I am even more convinced that lung cancer care should be the way I describe in the text below.
What follows is what you might call an slightly modified and 'matured' executive summary of the original document entitled "Philosophy of Lung Cancer Clinic":
The underlying premise behind the model of care proposed is that surgeons are experts in surgical technique and surgical decision-making . Physicians are experts in the medical evaluation and medical treatment of patients. In a lung cancer clinic the patient is assessed by the repirologist and oncologist first. They may consult with the surgeon, but the surgical visit takes place only after the patient has been evaluated fully.
Each patient that is seen gets discussed. The recommedation to proceed with or without surgery has to be discussed by all members of the team and has to be justified. This adds transparency. The presence of surgeons in the discussion prevents patients from being denied surgical options by non-surgeons. There must be a concensus opinion by the team.
The postoperative care should be under the direction of the surgeon with consistent involvement by the respirologist. That is to say that a respirologist routinely follows the patient during their hospitalization. The surgeon must have enough insight, however, to understand that physicians are experts in medical issues, and their contribution to this phase of the patient's care is important. Physicians must understand that medical issues postoperatively are not necessarily approached or treated in the same way as in a patient who has not undergone an operation.
Follow-up for operated lung cancer does not require a surgeon, unless there are surgical issues. At least one postoperative visit with the surgeon is recommended to ensure late complications are caught. The patient will also not feel 'abandoned' by their surgeon.
The fact that the surgeon's time is not taken up with the work-up and follow-up of patients allows them to concentrate on surgical decision-making and operating. Less numbers of surgeons are required to do this work.
The full document I created is available to anyone who wishes to have it. At the time of last writing this 'philosophy', I had not yet been to the Mayo Clinic. One thing I have learned is that patients truly appreciate the leadership role a surgeon has in their care. Therefore, I believe that the surgeon should stay in charge of the patient during their entire hospitalization and all decisions must go through the surgeon. The other reason this is important is that no one has more of an interest in the patient's recovery than the surgeon. It is their name on the chart. No intensivist or internist will ever be more invested in the outcome of the patient than the surgeon.
What follows is what you might call an slightly modified and 'matured' executive summary of the original document entitled "Philosophy of Lung Cancer Clinic":
The underlying premise behind the model of care proposed is that surgeons are experts in surgical technique and surgical decision-making . Physicians are experts in the medical evaluation and medical treatment of patients. In a lung cancer clinic the patient is assessed by the repirologist and oncologist first. They may consult with the surgeon, but the surgical visit takes place only after the patient has been evaluated fully.
Each patient that is seen gets discussed. The recommedation to proceed with or without surgery has to be discussed by all members of the team and has to be justified. This adds transparency. The presence of surgeons in the discussion prevents patients from being denied surgical options by non-surgeons. There must be a concensus opinion by the team.
The postoperative care should be under the direction of the surgeon with consistent involvement by the respirologist. That is to say that a respirologist routinely follows the patient during their hospitalization. The surgeon must have enough insight, however, to understand that physicians are experts in medical issues, and their contribution to this phase of the patient's care is important. Physicians must understand that medical issues postoperatively are not necessarily approached or treated in the same way as in a patient who has not undergone an operation.
Follow-up for operated lung cancer does not require a surgeon, unless there are surgical issues. At least one postoperative visit with the surgeon is recommended to ensure late complications are caught. The patient will also not feel 'abandoned' by their surgeon.
The fact that the surgeon's time is not taken up with the work-up and follow-up of patients allows them to concentrate on surgical decision-making and operating. Less numbers of surgeons are required to do this work.
The full document I created is available to anyone who wishes to have it. At the time of last writing this 'philosophy', I had not yet been to the Mayo Clinic. One thing I have learned is that patients truly appreciate the leadership role a surgeon has in their care. Therefore, I believe that the surgeon should stay in charge of the patient during their entire hospitalization and all decisions must go through the surgeon. The other reason this is important is that no one has more of an interest in the patient's recovery than the surgeon. It is their name on the chart. No intensivist or internist will ever be more invested in the outcome of the patient than the surgeon.
posted by Luis G. Quiñonez, M.D. at
3:02 AM
1 Comments:
Fantastic! You write very clearly and directly, and that is always a good thing.
But I must say that I think this is more a practical suggestion than a philosophy. What's philosophical about it? Aren't you just suggesting a different structure, a different path for patients to follow? While structural and processual changes ultimately rest on changes to a philosophy of care, I see no philosophy here. Maybe it's in another part of the piece.
Anyhow, I am also curious as to who would adopt the work that the surgeon would no longer have to do?
And, while you are very prudent and balanced in stressing the role of the physician and other health care workers in the medical treatment of the patient, you ultimately just place the surgeon at the top of the hiearchy anyways!
So you don't want to be bothered with work-up and follow-up to a certain degree, but you final say on all decisions made as the patient flows through the hospital?
Booooooooo!
In the end, I am so happy that you are sharing your ideas, they are clearly informed and of an expert nature. Now it's just time to choose some of your great ideas and make them happen, i.e. research, not just hypothesis making and pajetica-centric!
I look forward to more.
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