Moffitt Onco Update

Pathology Getting Personal: The Holistic Healer

February 01, 2018

Bui-and-Paul-pathology-web.jpg Ray Paul, an artist and sarcoma patient at Moffitt Cancer Center, with his pathologist, Marilyn Bui, MD, PhD

By Dr. Marilyn Bui

I believe that the patient is the ultimate driver of their own medical care and well-being. It’s important that they have the best possible understanding of their diagnosis and disease process so that they can determine how they will face their medical challenges – in mind, body and spirit. We as physicians are facilitators in this process, and I consider it our duty to be compassionate, competent, and provide the best possible care. 

As a pathologist, practicing “patient-centered pathology” means I need to be mindful that, behind each case, there is a patient who deserves my best effort. I am in the unique position to serve as a leader in multidisciplinary patient care in the era of precision medicine. It’s often said that 70 percent of medical decisions made by clinicians are based on a pathology or laboratory report, which shows the great responsibility with which we are entrusted. It’s my goal to live up to that responsibility. I will serve as the custodian of the patient’s tissue to ensure that it is used appropriately to generate accurate and timely diagnostic, prognostic and therapy selection information. I will be the manager of the patient’s laboratory data to help clinicians make sound medical decisions and provide effective care. I welcome the opportunity to interact with patients – to explain their pathology results, to perform fine needle aspiration biopsies, and more. When I practice pathology, my priority is the needs of the patient and the clinician.

Putting the patient first

Moffitt Cancer Center is made up of a team of oncology experts that includes physicians, advanced practice professionals, nurses, and a variety of support staff, whose goal is to ensure that patients at the center receive superior, patient-centered care. We also recently celebrated the first anniversary of our “Patients First” program, which is a collaborative effort to ensure that all patients receive timely, compassionate, innovative and personalized care. Patients First also incorporates our “Moffitt Promise,” which integrates the four core concepts of patient-and family-centered care: respect and dignity, information sharing, participation, and collaboration.

We’ve made a number of recent user-friendliness changes to improve the patient experience. First, the Patient Access and Clinic teams have created new scheduling and express check-in processes that have been progressively rolled out over the past year in several clinic locations to improve new patient access. Simplified algorithms make it easier for patients to be quickly scheduled with an appropriate provider. As patients arrive for their appointments, they are greeted by a patient access representative who immediately checks them in, bypassing full registration as long as the account details are current. The result is increased patient satisfaction, improved team member efficiency, reduced pre-visit wait times, and a reduced need for patients to wait in line. Second, we’ve changed how our care coordinator assistants (CCAs), who gather important patient information before the visit, perform their work. In the past, CCAs reported to individual clinics, even though information often needed to be shared throughout the clinic operation. Under the new design, they report to one manager as they reach out to patients and outside organizations to obtain records – which allows them to better coordinate resources and ensure consistent care.

There’s a well-known story about President John F. Kennedy’s visit to NASA in 1962. He noticed a janitor carrying a broom, introduced himself, and asked what the man was doing. The man responded by saying, “Well, Mr. President, I’m helping put a man on the moon.” To most people, the janitor was just cleaning the building – but he knew he was part of a larger story that was about to make history. Moffitt’s Chief Medical Officer and Vice President of Quality, Robert Keenan, shared this story in our first Patients First Meet and Greet of 2017 to inspire all Moffitt team members to look at the big picture and understand that we all play a role in Patients First – and that includes pathologists as much as anyone else. 

Patient-centered care in practice

From a cytopathology point of view, when I am called to perform a fine needle aspiration biopsy, I immediately put down whatever I am doing and go straight to the clinic. Why? Because I realize that, if I make even one patient wait in the clinic unnecessarily, it will delay not only that patient’s care, but also the care of all subsequent patients – and I don’t mind having to work late to catch up with non-patient-facing work. I also enjoy interacting with patients and clinical teams; I feel inspired and empowered by being closer to the patient, my clinical colleagues, and the opportunity to make a tangible difference by providing valuable pathology information.

From a sarcoma pathologist’s point of view, our multidisciplinary clinic format is really cool. Imagine – a patient comes to Moffitt Cancer Center and gets to see all of the subspecialties related to their care, all on the same visit. Not only that, but the physicians from different subspecialties communicate in real time to create a management plan. It’s like a personalized mini-tumor board on demand!

Of course, not every institution has these things in place or has the resources to implement them. I still think there’s a lot pathologists can do for their patients even without a strong, patient-centered infrastructure. For instance, a separate, patient-friendly pathology report in addition to the traditional ones for medical professionals would be well-received, and would help patients feel informed and empowered. It’s also wonderful when pathologists are able to make themselves available to explain their findings to patients. The benefits are threefold – patients learn about their disease and treatment; clinicians have more educated patients who become active participants in the treatment  process; and pathologists become more visible to those who rely on (and, in some cases, fund) our services. Finally, there’s great value in active social media involvement. It’s yet another way to provide patient education, and you may capture an audience online that you would never see in your office. 

"My Sarcoma" by artist and survivor, Ray Paul
"My Sarcoma" by artist and survivor, Ray Paul

Words to the wise 

I consider it our job as pathologists to help our patients understand what we do. Importantly, though, they need to know that education isn’t a one-way street. We don’t just provide patients with information; we can also learn from and be inspired by them. I learned this from one of my own patients, Ray Paul, a sarcoma patient at Moffitt whose approach to his pathologic findings – and the beautiful artwork he created to help him understand and cope with his disease – taught me a lot about interacting with patients, and about the value of such non-traditional interactions. It’s my hope that, as we work hard to connect with patients, increasing numbers of them will get to know their pathologists – and that, in doing so, both they and we gain valuable partners in the disease-fighting journey.

Marilyn Bui is a Senior Member of the Department of Anatomic Pathology, Section Head of Bone and Soft Tissue Pathology, and Scientific Director of the Analytic Microscopy Core at Moffitt Cancer Center. She is also a Professor and Director of the Cytopathology Fellowship Program at the University of South Florida Morsani College of Medicine Tampa, USA.

Originally published in the December 2017 issue of www.thepathologist.com.

Click here to read the full feature in The Pathologist magazine.