Eric Winner, a medical oncologist, currently serves as the director of the Yale University Cancer Center and the chief physician at Smilow Cancer Hospital. With a focus on breast cancer research, Eric’s presidential theme for ASCO this year is “Partnership with Patients,” which he believes is the cornerstone of clinical care and research. His passion for patient care stems from his experiences as a patient himself, recognizing the importance of physicians and health professionals in providing care for those with serious illnesses. Eric continues to see patients, spending about half a day a week at the clinic. He strongly believes that patients receive better care and are happier with their care when they feel like they are part of the team and have a strong partnership with their healthcare provider. Effective partnerships result in better overall outcomes for the patient. Eric also notes the importance of a doctor-patient dialogue that includes understanding the patient’s preferences and life circumstances. While Eric acknowledges that partnerships are not necessarily friendships, clear communication, active listening, and mutual respect are critical components of a successful partnership. Eric encourages patients to express their concerns and fears freely and not to withhold information that may be helpful in developing their care plan.
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ERIC WINER: Hello. I’m Eric Winner. I am a medical oncologist, a medical oncologist who has spent his life focusing on breast cancer and breast cancer research. And now I’m the director of the Yale University Cancer Center at the Yale Comprehensive Cancer Center and the chief physician at Smilow Cancer Hospital.
This year, my presidential theme for ASCO is partnership with patients, the cornerstone of clinical care and research. And it was a very deliberately selected topic. I do a lot of things and have done a lot of things in my career. I have educated, I have researched, I have cared for patients. But everything I do has been fundamentally based on patient care, and has grown out of my interest in making patient care the best it can be for everyone.
I still see patients; I still feel very strongly about seeing patients. I can’t do it many hours a week. I spend about half a day a week at the clinic, but I think the day I stop seeing patients is probably the day I retire.
ERIC WINER: I think a lot of my commitment to patient care comes from experiences I had as a child and as an adult, as a patient, and recognizing how important physicians, physicians, and other health professionals can be to people who have serious illnesses. And it gives me great satisfaction to care for people, but also to feel like I have a really positive relationship with them and partner with them around their care and actually around their participation in the research.
And really, if you want a patient to consider participating in a clinical trial or other research studies, it’s really important for that patient to understand what that research is about, what the clinical trial is about, and that it all comes from a partnership. effective. I think 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 believe that there are forces at play that are making it more difficult than ever.
ERIC WINER: Sometimes people ask, what is a clinical trial? And a clinical trial provides care, but it provides care within a research setting. And clinical trials come in all different shapes and sizes.
The most advanced clinical trials are trials that compare a standard treatment. So let’s imagine that we have a standard regimen for breast cancer that may consist of one or two drugs or a certain type of radiation therapy. And in that clinical trial, that standard treatment is often compared to something that many people think might be better.
It could be better because it is more effective. It could be better because it has fewer side effects. However, there are people who have given it a lot of thought and have thought that this new treatment could be better. And then in that clinical trial, the patients are what’s called randomized.
So one patient is assigned one treatment, another patient is assigned a different treatment. And it’s usually not based on any characteristics of the patient. It’s really random. And in that way, we can ask the question, is the new treatment any better than the standard treatment?
ERIC WINER: I actually think that patients receive better care and are happier with their care if they actually feel like they’re part of the team and have a strong partnership with their doctor, nurse, whatever. And in fact, studies have been done that have shown it to be so. 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 are part of the team and have strong partnerships have better overall outcomes, have shorter lengths of stay in the hospital, they are more satisfied with their care and, as a general rule, seem to be doing better.
And I guess the way I like to think of it is that the medical team is an expert in medical treatments. The patient and sometimes the patient’s family is an expert on the patient. And you need to bring together both medical judgment and knowledge, very deep knowledge about the patient, that leads to the right decision.
Now, I think part of this is that as a doctor, when you’re trying to make decisions with a patient about whether you want to do Treatment A or Treatment B and this decision makes 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, and perhaps most importantly, what the patient’s preferences are. Do they want to take any possible treatment if it increases their chances of staying free of a cancer recurrence by any amount? Or are you someone who would say, I don’t want treatment if it has any substantial chance of causing neuropathy or numbness in my fingers or toes because I need to use my hands for my job, and my job is critical to me?
Or it’s a patient who says, I don’t want to take any treatment that is going to interfere in any way with the time I spend with my children and be able to take them to their appointments and do everything necessary for their care. So I think the best decisions come from a dialogue that goes back and forth.
ERIC WINER: When we talk about partnerships, we’re not necessarily talking about friendships. And in fact, I think most doctors would say that their patients don’t really become their friends. They are people close to them. But they are not your friends. And I think most patients would say that their doctors don’t become their friends.
On the other hand, I will recognize that in the same way that any of us meet people in life who become our friends, from time to time you meet a patient and get to know them even better.
But as part of being a partner, you have to think about what makes a good partner. So I think what makes a good partner is to communicate clearly, to listen, to respond, to respect.
But I also think that we must take into account when we talk about these associations, is that the playing field sometimes does not feel even for the patient. The patient sometimes feels that he does not want to take too much of the doctor’s time. They don’t want to bother the doctor.
And I think maybe patients should worry a little less about that, and they should feel pretty free to speak their minds and express their concerns, and not withhold information from the doctor or nurse that might be helpful in developing the partnership.
So I really hope that patients, in general, are not afraid to say almost anything to their doctors. I think fear comes from many different sources.
I think sometimes patients are just worried that they’re going to take up too much of their doctor’s time, and that if they have something they want to talk about, like the pain they’re in, it’s going to deprive them of time that should be spent on talk about the cancer treatment they are receiving.
And from my point of view, that’s really too bad. Because you want a patient to tell you about the pain or other symptoms she has.
However, I also believe that there are patients who are concerned about being judged by their doctors, being criticized by their doctors, appearing to be uncooperative with their doctors. And from my point of view, that is also a pity. And you want to have a relationship of trust.
And ideally, the doctor shouldn’t send messages that they’re going to get angry, based on something the patient says. And in truth, I don’t think most doctors are.
I will also say that I believe that oncologists are a special breed. I think most people go into oncology because they are concerned about cancer. Often they have had some personal or family experience with cancer. And they do it because it is a mission that they feel they want to fulfill.
So I think maybe medical oncologists, more than almost anyone else, are the ones that patients shouldn’t be too scared of, and are really there to try to help the patient.
https://www.webmd.com/cancer/news/20230605/doctor-patient-relationship-winer?src=RSS_PUBLIC
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