ASCO President Eric Winer on Partnering with the Patient

ERIC WINER: Hi. I’m Eric Winer. I am a medical oncologist, a medical oncologist who has focused my life 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’s ASCO presidential theme is Partnerships with Patients, the Cornerstone of Clinical Care and Research. And it was a very consciously chosen topic. I do many things and have done many things in my career. I taught, researched, and cared for patients. But everything I do is fundamentally based on patient care, and it grew out of my interest in making patient care as good as it can be for everyone.

I still see patients; I still feel very strongly about visiting patients. I can’t do too many hours in 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 the experiences I had as a child and as an adult, as a patient, and realizing how important doctors, physicians, and other health care professionals can be to those who have serious illnesses. And it gives me a lot of satisfaction to take care of people, but also to feel like I have a really positive relationship with them and I’m a partner with them around their care and their participation in research.

In fact, if one wants a patient to consider participating in a clinical trial or other research study, it is very important that the patient understands exactly what the research is about, what the clinical trial is about, and that it all comes from effective partnerships. I think there are many, many doctors and many nurses and many assistants and pharmacists and social workers who are already doing a great job of working with their patients, but I think we can always do a better job. .

I also think there are forces at play that make it more difficult than ever.

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ERIC WINER: Sometimes people ask, what is a clinical trial? And a clinical trial provides care, but it provides care in a research context. And clinical trials come in different shapes and sizes.

The most advanced clinical trials are trials that compare a standard treatment. So imagine that we have a standard treatment for breast cancer, which may consist of one or two drugs or a certain type of radiation therapy. And in that clinical trial, you often compare that standard treatment to something that many people think is better.

Maybe it’s better because it’s more efficient. It may be better because it has fewer side effects. Still, there are people who have given it a lot of thought and thought that this new treatment might be better. And then the patients in that clinical trial are called randomized.

So one patient is prescribed one treatment and another is prescribed another. And it’s usually not based on any characteristics of the patient. It’s really random. And in this way we can ask the question, is the new treatment better than the standard treatment?

ERIC WINER: I actually think patients get better care and are more satisfied with their care when they actually feel like they’re part of the team and that they have a close partnership with their doctor, with their nurse, with you. And there have actually been studies that have proven this. The Institute of Medicine, now the National Academy of Medicine, did a review many years ago that strongly suggested that patients who feel part of a team and have close partnerships have better overall outcomes and they last for a shorter time. they are more satisfied with their care and, as a general rule, perform better.

And I guess the way I like to think about it is that the medical team is the expert on medical treatments. The patient and sometimes the patient’s family are also the patient’s experts. Making the right decision requires a combination of medical judgment and knowledge, very in-depth knowledge about the patient.

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Now, I think part of it is that as a physician, when you’re trying to make a decision with a patient about whether they want to do treatment A or treatment B, and it makes sense to make one decision or the other, you don’t just make that decision decision without knowing anything about the patient, how old the patient is, what the patient’s family situation is, and perhaps most importantly, what the patient’s preferences are. Would they be willing to take any possible treatment if it would in any way increase their chances of getting rid of the cancer coming back? Or they are someone who would say I don’t want treatment if there is a significant chance it will cause neuropathy or numbness in the fingers or toes because I need to use my hands for my job and my job is critical to me.

Or a patient says, I don’t want to have a treatment that in any way interferes with my time with my children and taking them to their appointments and doing whatever it takes to care for them. So I think the best decisions come from a back-and-forth dialogue.

ERIC WINER: When we talk about partnerships, we’re not necessarily talking about friendship. And actually, I think most doctors would say that their patients don’t really become their friends. People they are close to. But they are not their friends. And I think most patients would say that their doctor is not going to be their friend.

On the other hand, I recognize that just as anyone in life meets people who become friends, occasionally you meet a patient and get to know them even better.

But as part of the partnership, you have to think about what makes a good partner. Therefore, I believe that a good partner is clear communication, listening, responding, respect.

But I also think that we have to keep in mind when we talk about these partnerships that sometimes the playing field is not felt even for the patient. Sometimes the patient feels that he does not want to take up too much of the doctor’s time. They don’t want to upset the doctor.

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And I think that maybe patients should worry a little bit less about that and feel free to speak their mind and express their concerns and not withhold information from the doctor or the nurse that might be helpful in building a partnership.

So I really hope that patients in general are not afraid to tell their doctors almost anything. I think this fear comes from many different sources.

I think sometimes patients just worry that they’re taking up too much of their doctor’s time, and if there’s something they want to talk about, like their pain, that takes away from the time they’d like to spend talking about the cancer treatment they’re getting. must be charged.

And from my point of view, this is very bad. Because you want the patient to tell you about their pain or other symptoms.

However, I think there are patients who are concerned that their doctors are judging them, criticizing them, and that their doctor doesn’t seem to be willing to cooperate. And from my point of view, this is also bad. And you want to build a relationship of trust.

And ideally, the doctor shouldn’t send messages that he’s going to be angry based on what the patient says. And I honestly don’t think most doctors are.

I will also say that I think cancer doctors are a special breed. I think most people go into oncology because they are interested in cancer. They often had personal or family experience with cancer. And they go into it because it’s a mission they feel they want to accomplish.

And that’s why I think that cancer doctors, perhaps more than anyone else, are people that patients can’t be intimidated by, and they’re really there to help the patient.