Monthly Archives: January 2016

WERE DOCTORS BETTER AT QUALITY OF CARE BEFORE COMPUTERS?

dr smashing computerIn 2013, two key studies highlighted an alarming conclusion: The electronic health record or EHR may be hindering the quality of healthcare.  One study found that the EHR was the main culprit in doctor “burnout.”  The second study found that emergency room physicians click the computer mouse 4,000 times during a 10 hour shift. The EHR and its truckload of computerized quality measures are turning away doctors and nurses from the true essence of their work – Caring for the patient.

Just last week,  Mr. Andrew Slavitt, Medicare’s acting administrator, announced the end of a Federal program that tied Medicare payments to a long list of quality measures demanded by users of the EHR.  Mr. Slavitt stated, “We have to get the hearts and minds of physicians back.  I think we’ve lost them.”

At First Dayton Cancer Care, over $250,000 and hundreds of hours of work have been spent to get the EHR up and running – quite an accomplishment for an independent office.  I witnessed how “making the EHR look good” impacts on the time that may be better spent with patients.  It has changed our workflow greatly. The clinical staff is required to check a lot of boxes, often on items that are irrelevant to the reason the patient is seeking our help. I still refuse to go into an exam room with a computer. I learn so much about what is truly going on with my patients when I can look them in the eye and watch their body language. These computer prompted questions do not tell the whole story. Fortunately, First Dayton Cancer Care selected a EHR that is specific to radiation oncology. We are able to obtain the necessary information to take excellent care of our patients in addition to everything the government demands of us.

But through all the trials and tribulations of the EHR, I have not seen a single report showing that the EHR is saving lives or improving the quality of care. On a nationwide level, billions of dollars have been spent on the EHR, with little to show for the time and cost. And your medical records are still not all in one place because hospitals and physician group EHRs do not allow secured integration of Personal Health Information (PHI).

While I’m am not advocating that measures of quality can simply be thrown away, I am urging the people in Washington to talk to doctors, nurses and patients, so-called stakeholders in the game, to measure clinical outcomes that truly matter.  And in a simple way that does not take away from face to face time with patients. I think we need a revolution in technology so the doctors and nurses do not spend all their time “box checking” on the computer.

In a recent New York Times opinion essay, Dr. Robert Wachter of the University of California San Francisco Department of Medicine quoted a late leading figure in the field of quality management.  “In 2000, shortly before Professor Avedis Donabedian died, he was asked about his view of quality. What this hard nose scientist answered is shocking at first then somehow seems obvious.  ‘The secret to quality is the love’, he said. “

So for all the time and expense of measuring what the ‘experts’ call clinical outcomes, clinical processes and clinical organizational structure, what it seems to come down to is to CARE.  This is the root of why I will not do a patient visit with a computer in my hand. I only hope that “Digital Medicine” does not drive out truly caring doctors and nurses from the field and does not discourage bright young people from entering medicine.

If you have any questions about your cancer, please feel free to call me, Dr. Edward Hughes, at First Dayton Cancer Care at 855-DAYTON1.

 

BREAST CANCER: THE TOP 5 THINGS YOU NEED TO KNOW

Over 8,000 breast cancer researchers and clinicians attended the San Antonio Breast Cancer

Know the results of these 5 research studies to help make treatment decisions.

Know the results of these 5 research studies to help make treatment decisions.

Symposium meeting in December 2015.  Here are some of the key highlights that I though would be important to our breast cancer patients.

1. Lumpectomy and Radiation Therapy Is Better Than Mastectomy

In a 10 year study of 37,000 women in the Netherlands, the relative risk of death was 20% lower in women who underwent lumpectomy and radiation therapy versus mastectomy alone.  The 10 year overall survival was 76.8% with lumpectomy and radiation therapy versus only 59.7% with mastectomy alone.  Importantly, the overall survival benefits held even for women who had lymph node positive disease.

  1.  With Lumpectomy and Radiation Therapy, It’s a Good Idea to Stop Smoking

Over 40,000 women were studied by the Early Breast Cancer Trialists’ Collaborative Group.  The results were clear cut-those women who underwent lumpectomy and radiation therapy but continued to smoke were at increased risk for lung cancer and heart disease.

The study was somewhat dated as the median time to entry into the study was 1983. And breast radiation therapy has improved dramatically over 30 years.  But I believe these results still ring true.

3. Skipping Chemotherapy Altogether in Postmenopausal Women with Breast Cancer

Post-menopausal women with the so-called luminal A subtype breast cancer can consider skipping chemotherapy altogether and still expect a good prognosis even when node positive (ER/PR positive, HER-2 negative). Analysis of the “old” Danish Breast Cancer Cooperative Group 77B Trial finally confirmed what many clinicians already thought: Patients with low risk breast cancer do not need chemotherapy.

4. Heart Medications Protect against Herceptin Damage

In the MANICORE  study, women taking both the beta-blocker bisoprolol (Concor) and the ACE inhibitor perindopril(Converyl, Aceon) preserved heart function.  The study may be a life saver for many of those breast cancer patients who take Herceptin for months. Herceptin is known to cause heart damage.

5. Preventing Breast Cancer Recurrence In Women with DCIS: Anastrozole May Be Just As Good As Tamoxifen

The IBIS DCIS Trial and the NRG/Oncology/ NSABP-35 trial showed that the drugs are equally effective. Anastrozole is my choice because of its fewer side effects.

Be sure that you consider these 5 facts when you are making decisions about the treatment plan that is best for you. The goal should be do treat your breast cancer without causing further health issues.

If you have any questions about your breast cancer treatment, please feel free to call me, Dr. Edward Hughes, at 855-DAYTON1

What Is “Onco-Politics” and How It May Affect Your Cancer Cure

Let us start out with some shocking facts. 

 1. About 40% of all cancer cures are due to radiation therapy, but only 11% are due to chemotherapy – so says Professor Michael Richards, the United Kingdom’s cancer czar. american medical politics

 2. Of the 200 featured clinical trials supported by the US National Cancer Institute, only 11 involve any radiation therapy, and only 2 involve modifiers of radiosensitivity. 

3. Despite pre-clinical trials showing that stereotactic radiosurgery, like that delivered by Cyber Knife, generates an immune response against your own cancer, there are no major trials at the National Cancer Institute that address this approach. 

So what’s the hold-up?

I think part of the answer may be found in a recent memoir called “The Death of Cancer” Dr. Vincent DeVita, a chemotherapy specialist who for over 40 years held just about every major position in cancer care – from a lymphoma specialist at the National Cancer Institute to Physician-in-Chief at Memorial Sloan-Kettering Cancer Center, to the head of the Cancer Center at Yale University.  In his recent book, Dr. DeVita paints the portrait of a “Cancer Industrial Complex” desperately in need of a new direction.  Dr. DeVita’s memoir details a very human endeavor hampered by petty politics and power mongering.  In short, it’s been “Onco-Politics” since President Nixon declared the War on Cancer in the early 1970’s.

Yet in the end there is hope.

The nationally recognized radiation oncology thought leaders, Dr. J. Martin Brown and Dr. John Adler from Stanford University, wrote in a recent editorial “… Given the molecular therapeutic revolution that is about to take over the treatment of cancer and the socioeconomic power of Big Pharma, it is not inconceivable that radiation oncology could be marginalized as only a physically based specialty… Yet the prospects of a brighter future are there….  What patient would not prefer 1 or up to 5 daily fractions over the current practice of 6 weeks of daily treatments or oftentimes highly morbid conventional surgery.”  Their editorial was published in the International Journal of Radiation Oncology, Biology and Physics in late 2015.

But I am hopeful that the spectacular results with stereotactic radiosurgery, like that delivered by Cyber Knife, will win out at the end of the day.  If you have any questions about the treatment of your cancer, please call me, Dr. Ed Hughes, at 855-DAYTON1.

 

 

5 Things You Need to Know When You Finish Cancer Treatment

Here is a blog post that Dr. Hughes wrote a while ago. It is a favorite of his patient’s so we thought it was worth repeating.

5 Things You Need to Know When You Finish Cancer Treatment

Now what? Is that it? Am I done with cancer? How do I keep it away? How do I know it’s not back? Why do I feel lonelier now than I did during treatment?

Eating Healthy is part of the Top 5

Eating Healthy is part of the Top 5

These questions often plague a cancer survivor. It can be frightening to finish treatment. For the past few months you have seen physicians, nurses, therapists and other health care professionals sometimes daily; and now you are on your own. Here are 5 things I tell my patients.

  1. Make sure you have a treatment summary and a survivorship plan from each of your cancer specialists. And make sure that your primary care physician has a copy too.
  2. Understand that the transition from cancer specialists back to your primary care physician may result in a lot of anxiety for you and your family. That is normal. And o.k. Trust this doctor.
  3. Make sure you and your primary care physician keep a watch for signs of late treatment side effects. Let your primary care physician know about any new symptoms that you may experience. While I don’t want you to become paranoid, I do want you to communicate with your doctor. If in doubt, call your specialist.
  4. Keep up to date screening recommendations for people with your type of cancer. Follow the survivorship plan carefully. Also continue to have the recommended screenings for other types of cancers. Just because you had one type, unfortunately doesn’t make you immune to others
  5. Embrace new healthy habits, like a good diet and daily exercise. You have been given another chance. Make the best of it.

Many survivors have a New Normal. It will take some time for your body to find this new normal. Your energy levels, eating habits, and appearance may have changed. Find out what is best for the new you. Worrying about recurrence is a part of this new normal. It can be healthy as long as it doesn’t consume you. Following these 5 steps can help you to be a healthy, happy survivor. Our nurses will be happy to help you create your survivorship plan.