Changing “Good Enough” Practice to Excellent Practice

Interventional radiologists provide cutting-edge treatments to patients with cancer, but excellent patient care involves more than a successful procedure. In this Q&A, Constantino Peña, MD, offers his advice on how to bring patient care to the next level. Dr Peña is an Interventional radiologist and the Medical Director of Vascular Imaging at the Miami Cardiac and Vascular Institute in Miami, Florida. He is a Course Director for the Symposium on Clinical Interventional Oncology (CIO).

What are some important keys to being a successful provider of interventional oncology?

It’s important to be involved with and integrated into the treatment team. You need to understand all the different issues and possibilities in terms of treatment of oncologic patients, and you need to work with the team caring for the patient by doing your part and being accessible. A good interventional oncologist is a complete provider who participates in all aspects of clinical management of patients, not just performs procedures.

What are some examples of care that you should provide in addition to procedures?

In addition to treating patients, you should also be prepared to manage potential complications associated with therapies and with the underlying disease. This may involve fluid management or managing thrombosis and thromboembolic disease associated with oncologic conditions. There may be need for drainages and biopsies, management of urinary or biliary obstructions, pain and malaise.

To put it simply, as an interventional oncologist you should be involved in all aspects of care.

How does one reach that goal of being involved in all aspects of care?

Some aspects of care may require that you have an office setting where you can see patients. For example, if someone receives a catheter for drainage, they can see you in the office if there are any issues with the catheter. A patient with a central line or port catheter issue or concern could also visit your office rather than being sent to the emergency room immediately. As IO develops, I think it’s important to develop management protocols and have availability for seeing patients quickly in the office.

It’s important to not only have an office practice, but for patients to easily see you in the office. For example, if another doctor on the team caring for the patient believes something may be problematic with the patient, that doctor can tell the patient to see Dr Peña’s team tomorrow. The referring doctors can have confidence that the patient will be seen, evaluated, and treated. We have to strive to provide that level of care and accessibility for patients.

How do you spread the word about the accessibility of the clinic?

You spread the word by setting up the office environment and then delivering. Once you start delivering a high level of service, people notice and talk about it. You’ll be providing benefit not only to the patient but also to the other physicians caring for the patient.

What are some challenges in setting up that infrastructure? What would you say to a colleague who is nervous about obstacles?

The obstacle is that you need a certain critical mass in order to assemble the team. If you are a single provider the start-up costs and maintenance costs may be difficult to manage.

However, many of us already practice in groups, and groups provide the advantage of scale.  If you have 5 people and you each add 2 or 3 more patients, the impact to the practice are multiplied. With only one person, much more growth is needed.

Do you have any advice for better interactions with colleagues on the larger cancer treatment team?

Tumor board attendance and management meetings are important, but you can have interactions with colleagues on multiple levels. For example, you can communicate in the lunch setting, or after a different meeting such as a hospital committee meeting rather than just tumor board. The best way is to pick up the phone and call; these interactions are always well received.

Can you give an example of someone not providing the best level of care? Who is doing “good enough” but could be doing better?

It could be as simple as interacting with a patient after a biopsy, or after placement of a catheter. Basically, someone might finish that procedure, and say “It’s all set. Call me if you have any problems.”

The mistake here is not having a set protocol and not being able to hand the patient well-thought-out instructions that give you an opportunity to explain the services you offer. The physician in the above scenario missed out on letting patients know how accessible you are, letting patients know that an office exists, and directly giving the patient the phone number to that office. There was also a missed opportunity of telling the patient what else you can do to help them.  Communication with patients and the treatment team is essential.  Each interaction with a patient is an opportunity to provide comprehensive care and build the recognition of our specialty. Those are areas where IR can improve.

Why do you think IRs aren’t already doing this well?

I think many folks don’t see the need and think they are already doing fine. They might assume that since they’re already attending tumor board, they are adequately interacting with colleagues. They might not see the benefit of having infrastructure and/or taking the time to set it up.

The bottom line is that being accessible is important, but you can be accessible and yet not deliver on what you have been asked to do. Setting up the infrastructure to allow you to manage various requests and aspects of patient care is the next step, and the effort will improve the care your patients receive, as well as your relationships with other members of the care team.