ERIC WINER: Hi. I’m Eric Winer. I am a medical oncologist, a medical oncologist that has spent my life focusing on breast cancer and breast cancer research. And I am now the Cancer Center director at Yale University at Yale Comprehensive Cancer Center and the physician in chief at Smilow Cancer Hospital.
This year, my presidential theme for ASCO is partnering with patients, the cornerstone of clinical care, and research. And it was a very deliberately selected theme. I do many things and have done many things in my career. I’ve educated, I’ve done research, I’ve taken care of patients. But everything that I do fundamentally has been based in patient care and has grown out of my interest in making patient care as good as it can possibly be for everyone.
I still see patients; I still feel very strongly about seeing patients. I can’t do it too many hours a week. I spend about half a day a week in clinic, but I think the day I stop seeing patients is probably the day I retire.
ERIC WINER: I think that much of my commitment to patient care comes from experiences that I had as a child and as an adult, as a patient, and recognizing how important doctors can be, doctors and other health care professionals can be for people who have serious illnesses. And it gives me a great deal of satisfaction to both take care of people, but also to feel like I’m in a really positive relationship with them and partnering with them around their care, and for that matter, around their participation in research.
And in truth, if one wants a patient to consider participating in a clinical trial or other research studies, it’s really important that that patient understand just what that research is about, what the clinical trial is about, and that all comes from effective partnering. I think that there are many, many doctors and many nurses and many physician assistants and pharmacists and social workers who already do a great job in terms of partnering with their patients, but at the same time, I think we can always do a better job.
I also think that there are forces at play that are making it more difficult than it ever was before.
ERIC WINER: Sometimes people ask, what is a clinical trial? And a clinical trial is providing care, but it’s providing care within a research setting. And clinical trials come in different shapes and sizes.
The most advanced clinical trials are trials that are comparing a standard treatment. So let’s imagine we have a standard regimen for breast cancer that may consist of one or two drugs or a certain kind of radiation therapy. And in that clinical trial, you’re often comparing that standard treatment with something that a lot of people think might be better.
It might be better because it’s more effective. It might be better because it has fewer side effects. But nonetheless, there are people who have thought about it a great deal and have thought that this new treatment might be better. And then in that clinical trial, patients are what is called randomized.
So one patient is assigned one treatment, another patient is assigned a different treatment. And it’s usually not based on any characteristic of the patient. It’s truly random. And in that way, we can ask the question, is the new treatment something that is better than the standard treatment?
ERIC WINER: I actually think that patients get better care and are happier with their care if, in fact, they feel they’re part of the team and that they have a strong partnership with their doctor, nurse, what have you. And in fact, studies have been done that have demonstrated this. And there was a review done by the Institute of Medicine, now called the National Academy of Medicine, many years ago that strongly suggested that patients who feel like they’re part of the team and have strong partnerships have better overall outcomes, have shorter lengths of stay in the hospital, are more satisfied with their care, and just as a general rule seem to do better.
And I guess the way I like to think of this is that the medical team is an expert in the medical treatments. The patient and sometimes the patient’s family is an expert in the patient. And it takes putting together both the medical judgment and the knowledge, the very in-depth knowledge about the patient, that leads to the right decision.
Now I think one part of this is that as a physician, when you’re trying to make decisions with a patient about do you want to do treatment A or treatment B and this does one decision or another make sense, you can’t just make that decision without knowing something about the patient, knowing how old the patient is, what the patient’s family situation is like, and perhaps most importantly, what the patient’s preferences are. Do they want to take any possible treatment if it will increase their chance of remaining free of a recurrence of cancer by any amount. Or are they somebody who would say, I don’t want a treatment if it has any substantial chance of causing neuropathy or numbness in the fingers or toes because I need to use my hands for my work, and my work is critical to me.
Or is it a patient who says, I don’t want to take any treatment that’s going to interfere in any way with my spending time with my children and being able to take them to their appointments and do everything that’s necessary for their care. So I think the best decisions come from a dialogue that goes back and forth.
ERIC WINER: When we’re talking about partnerships, we’re not necessarily talking about friendships. And in fact, I think that most doctors would say that their patients don’t actually become their friends. They’re people they’re close to. But they’re not their friends. And I think most patients would say that their doctors don’t become their friends.
On the other hand, I will acknowledge that in much the same way that any of us meet people in life who become our friends, every once in a while, you meet a patient, and you get to know them even better.
But as part of being a partner, you have to think about what makes a good partner. And so I think what makes a good partner is communicating clearly, listening, responding, respecting.
But I also think we have to keep in mind when we talk about these partnerships, is that the playing field sometimes doesn’t feel even for the patient. The patient sometimes feels like he or she doesn’t want to take too much of the doctor’s time. They don’t want to make the doctor upset.
And I think that perhaps patients should worry a little bit less about that, and should feel pretty free to say what’s on their mind and express their concerns, and not keep information from the doctor or the nurse that could be helpful in developing the partnership.
So I would really hope that patients, in general, won’t be scared to tell their doctors almost anything. I think that fear comes from many different sources.
I think sometimes, patients are just worried that they’re going to take too much of their doctor’s time, and that if they have something that they want to talk about, like the pain they’re having, that that’s going to deprive them of time that should be spent talking about the cancer treatment that they’re receiving.
And from my standpoint, that’s really too bad. Because you want a patient to tell you about the pain or the other symptoms that they’re having.
I think also, though, there are patients who are worried about being judged by their doctors, being criticized by their doctors, seeming uncooperative to their doctors. And from my standpoint, that also is too bad. And you want to have a trusting relationship.
And ideally, the doctor shouldn’t be sending messages that they’re going to get angry, based on something that the patient says. And in truth, I don’t think most doctors are.
I’ll also say that I think cancer doctors are a special breed. I think that most people go into oncology because they care about cancer. They’ve often had some personal or family experience with cancer. And they go into it because it’s a mission that they feel that they want to fulfill.
And so I think maybe cancer doctors, more than almost anyone else, are ones that patients shouldn’t feel very frightened of, and they’re really there to try to help the patient.
