Last week, I had the pleasure of giving a talk on cancer at the University of Iowa Carver College of Medicine Mini-Medical School, a series of presentations provided to the lay public to introduce them to a topic in medicine. Every time I give a talk to a lay audience, I think back to a wonderful woman I had as a patient when I was doing my oncology training in the 1980s. She was a retired English teacher who took pleasure in gently ribbing me about the words I selected when I spoke with her (once a teacher, always a teacher). I recall one time when I suggested we consider putting her “on trial.” Her response – “Put me on trial? What a strange phrase. I certainly wish getting cancer was against the law! Why do you want to put me on trial?” That lead to an animated conversation about not only that phrase, but how doctors use expressions when talking to each other that are interpreted differently by patients. While I don’t recall which additional specific phrases we discussed back then, that conversation had a long lasting effect on me, and the phrases I use when I speak to patients, families and the public.
Cancer, as in many complex problems, can best be approached by looking at it from every angle, i.e. in three dimensions. We do this literally through reconstructing images such as CT scans, confocal microscope pictures or computerized molecular modeling. We also do this figuratively through the 3Ds of discovery, development and dissemination.
I will always remember this spring as a time of weddings. First (and foremost!), my daughter’s wedding in Iowa City in late May followed by weddings in June of a cousin in Florida and a nephew in Maryland. I also came upon a number of weddings during my recent visit to Romania, including a wedding procession marching down the main street in a tiny Transylvania town and weddings taking place in the Orthodox and Catholic churches of the beautifully preserved and restored fortress town of Alba Iulia. Continue reading
Everyone involved in budgeting knows the process includes reviewing past performance, determining how to use resources, and projecting future performance based on the outlined plans. In a steady state, or in environments where change is incremental, the outcome of this process can be straight-forward, predictable and similar from year to year. The process is more challenging in times of dramatic change when past performance can be a poor predictor of future success. Planning in such times is analogous to constructing a building on shifting ground.
Indeed, the ground on which we base clinical care for cancer patients is undergoing major shifts in not one, but two dimensions. Continue reading
There is a great debate raging among cancer research leaders around the country.
- It is not about whether this is an incredible time in cancer research that is fundamentally changing our understanding of cancer – we all see advances being made in our centers every day.
- It is not about whether this enhanced understanding of cancer will change how we approach cancer medicine – we all see research advances that have resulted in dramatic improvements in how we treat many of our patients, and many more are on the way.
- It is not about whether some cancers have proven to be incredibly difficult to treat – we all know there are some types of cancer where progress has been devastatingly slow.
- It is not about whether increased funding for cancer research would speed up progress against cancer – we all agree that increased funding is needed to accelerate progress, particularly for the most refractory cancers.
Several years ago, I made a “decision” that I needed to figure out a better way to make decisions.
We all struggle with decisions whether big or small. We all sometimes delay making difficult decisions, or revisit the decision once it is made again and again. For me, difficult decisions can vary from deciding what treatment to recommend for a cancer patient, to determining how best to structure a new cancer research program, to deciding whether I should attend yet another meeting. There are times when I feel overwhelmed by the sheer number, the potential consequences and the variety of decisions that need to be made, particularly if I put off the difficult ones and let them build up. Continue reading