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Cancer Care Issues - Advice From Dr. Cary Presant

Can Oncology Be Fun Again?

Cary Presant, MD, Oncology, Hematology/Oncology, 03:23PM Oct 9, 2013

Physicians are becoming burnt out more and more rapidly.  A very interesting comment on this observation was reported in American Medical News (a publication soon to be discontinued) on June 17, 2013.  In that communication, they reviewed a report in the Annals of Family Medicine by Andrew Schutzbank.  He is a medical director of a group of primary care clinics in Cambridge, MA.  He was reporting on their attempts to make the experience of primary care more enjoyable and relaxing.  The burn-out rate of physicians is about 30% according to a 2003 study in the American Journal of Medicine.  50% of doctors have at least one symptom of burn-out and this was confirmed in oncologists at a poster presentation at the American Association Clinical Oncology meeting in June 2013. 

In the Annals of Family Medicine study of patient satisfaction, they reported double the rates of patient satisfaction if care was provided by a physician who said they were very satisfied with their practice, compared to only half that rate if physicians were less satisfied.  Those physicians who were very dissatisfied were more than twice as likely as other doctors to retire and four times as likely to become part-time in the ensuing months. 

As a result, the author of the Annals of Family Medicine study offered suggestions for primary care physicians, but they are very pertinent to oncologists as well. I found them important enough to share them with you here. The recommendations included having lab tests done before appointments so that physicians did not have to see patients and then repeat the review of their condition and then further contact patient after later seeing the results of lab studies.  Such inefficiencies were leading to burn-out and lack of satisfaction.

It was recommended that standing orders be developed to allow nurses to treat uncomplicated problems so that physicians would have more time to focus on serious difficulties.  Care coordination should be performed by non-physician members of the team in order to help focus better support for patients and reduce time spent by doctors.  It was recommended that a scribe be employed to help to complete documentation. Longer prescriptions and more refills should be ordered to avoid the necessity of having to see patients at frequent intervals if patients have been stable.  Nurses should filter out normal lab results and leave only abnormal results for physician review and action. 

With regard to office operations, it was recommended that increased communication could result from having closer work locations among team members. Daily clinical discussions among staff could help to anticipate problems. Talking directly with all members of the staff to solves problems more efficiency than through office email communications. It was recommended that regular meetings among staff be conducted to focus on improving quality of care. 

These are very important recommendations which we should discuss with our staff, and consider which ones would be worth implementing in our practices. We should realize that these  can help minimize burn-out in our staff and in ourselves.  Maintaining a very positive attitude, “making medicine fun again” is important in achieving the best care for our patients, who can appreciate when we are facing difficulties. 



Poll: Do you know oncologists who are burnt out? 1. No, everyone I know is doing fine.|2. Yes, nearly everyone is burnt out.|3. Some are burnt out, some are distressed.|4. I'm afraid to ask.|
About This Blog

Dr. Cary Presant describes research results, observations on oncology issues, and discussions on current cancer care topics that can help improve your quality oncology care and your oncology practice.

Disclosure: Cary A. Presant, MD, has disclosed the following relevant financial relationships:
Served as a director, officer, partner, employee, advisor, consultant or trustee for: Diatech Oncology; Digital Medical Network
Received research grant from: Diatech Oncology
Have a 5% or greater equity interest in: Diatech Oncology; Digital Medical Network
Received income in an amount equal to or greater than $250 from: Diatech Oncology
Served on the Board of Directors for: Medical Oncology Association of South California; Cancer Schmancer

  • Cary Presant

    Cary A. Presant, MD, FACP, a hematologist and medical oncologist, is a staff physician at Wilshire Oncology Medical Group. He has been director of cancer programs at Washington University School of Medicine, the Jewish Hospital of St. Louis, and the City of Hope National Medical Center in Los Angeles, California. He is currently Professor of Clinical Medicine at the University of Southern California School of Medicine. Dr. Presant's current research includes pharmacologic improvement of chemotherapy effectiveness by magnetic resonance spectroscopy, as well as the development of a new chemotherapy sensitivity test, based on apoptosis, for all types of cancer. He is the author of over 400 scientific articles in cancer treatment, cancer detection, chemotherapy, experimental tumor biology and pharmacology, liposomes for cancer diagnosis and therapy, magnetic resonance spectroscopy, measurement of quality of life in cancer patients, and quality care in oncology. As an author, Dr. Presant has written Navigating American Medicine, soon to be published, and is the physician columnist for the national patient Website Dr. Presant is past president of the California Division of the American Cancer Society, Chairman of the Board of Directors of the Medical Oncology Association of Southern California (MOASC), past Director of the American Society of Clinical Oncology (ASCO), and past president of the Association of Community Cancer Centers (ACCC).

The content of this blog does not necessarily reflect the viewpoints of Medscape.
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