Chapter 08: The History and Philosophy of Multi-Disciplinary Care at MD Anderson
Files
Identifier
MendelsohnJ_01_20050103_C08
Publication Date
1-3-2005
City
Houston, Texas
Interview Session
John Mendelsohn, MD, Oral History Interview, January 03, 2005
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the Institution; Overview; Building/Transforming the Institution; Multi-disciplinary Approaches; Definitions, Explanations, Translations; Discovery and Success; On Research and Researchers; Professional Practice; The Professional at Work; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Technology and R&D; Patients; Patients, Treatment, Survivors
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
James Olson:
: I had a telephone interview with Dr. Balch [oral history interview] and he made a very similar comment. He said, ‘if I had cancer, I would go to MD Anderson’. And I asked why, and he said, first, it’s the cleanest hospital in the country’ and he said I think that tells you a lot about – and then went on to talk about unrivaled patient care and all that good stuff.
John Mendelsohn, MD:
: I think the idea at Anderson, which I’ve nurtured along but it was here before I came to, is it’s a collective process. Everybody here is full time. A patient walks in with prostate cancer. In some parts of the country, if you met the surgeon first, you’d be more likely to get surgery. If you met the radiotherapist first, you’d be more likely to get radiotherapy. There are reasons for one or the other, but there is no economic incentive here to hold onto a patient because everybody is on a full-time salary and we’re not bean counting. There is a stimulus here and encouragement here to set up all of the options and talk to the patient and let the patient make the decision. No matter what door you knock on, you’ll be cross-referred. So if you come in and talk to the radiotherapist first, you will always talk to the surgeon too and vice versa before a decision is made. And you are very likely to meet even the medical oncologist and chemotherapist would be brought in at the very beginning because there is more emphasis here on shrinking the tumors before you operate.
James Olson:
: Is this different than at Memorial?
John Mendelsohn, MD:
: Memorial, of course, is the other big cancer center where this kind of approach is – and I was chairman of medicine at Memorial for 11 years – this kind of approach is the one at Memorial but I think there is a stronger, multidisciplinary effort than at Memorial, and Memorial has it too. Memorial is excellent.
James Olson:
: One thing, as I interview people and talk about these things, I’ve tried to stay away from who did this first or who did this best sort of issue, although a lot of people I’ve interviewed said they thought MD Anderson did pioneer that model of multidisciplinary care. Especially because people are salaried and not coming in on private practice. Has that model become kind of the gold standard in cancer centers?
John Mendelsohn, MD:
: Yeah. You know, first of all, I don’t think the idea was invented here or at Sloan-Kettering, but this institution and Sloan-Kettering --but especially this institution-- had the resources and the density of people to do this. When I was in the cancer field at UCSD in the 1970s, oncologists treated a lot of different kinds of cancer. There were very few places … When the multidisciplinary approach was being developed here, the late 70s and 80s, there were very few places where you had the luxury at 35 to say, I’m only going to treat breast cancer for the rest of my life. Or I’m only going to treat prostate cancer for the rest of my life. Or I’m only going to treat leukemia for the rest of my life. When I was at UCSD, I was treating breast cancer, and leukemia, and a lot of diseases. In a way, that’s helped me. I’m more of a generalist than most of the people here. Now I’m not treating patients now, but I feel comfortable talking to the leukemia doctors, and the prostate doctors, and the breast doctors because I’ve treated all kinds of cancer back when I was more active as a clinician. So Anderson was in a position to take this concept which makes sense once you hear it: that cancer is a multidisciplinary problem. If the surgeons and radiotherapists and chemotherapists are going to get involved, let’s get them involved at the start. You can’t do that if you’re treating all kinds of cancer. You can’t … Logistically, if you’re treating breast cancer, prostate cancer, and leukemia, you don’t have a chance to get together with all of the surgeons to get them interested in prostate and the chemotherapists and get them interested in breast. There are too many meetings involved. You can only do this kind of thing once you specialize. And what we’ve done really in the past eight years since I’ve come, is strengthen the interest of two more groups in that, diagnostic imaging and pathology. So now the multidisciplinary clinics … More and more the vision is it’s five different disciplines acting together. Medical oncology. Surgical oncology. Radiation. Diagnostic imaging and pathology working together. The mammography unit is in the breast clinic, right where the doctors are seeing the surgical patients and mammography patients. They’re all in one area together. When I was in my earlier career at UCSD, the mammography unit was in the basement with the radiology department. So Anderson has the capability of pulling together the doctors that have – of orienting the arrangement of the practice of medicine around the patient rather than around the name of the discipline. Thirty years ago, there was a building with a lot of surgeons in it, and another section of a building with a lot of medical people, and the patient traipsed back. You must have heard the story of how they put a pedometer on a breast cancer patient before they set up the clinic here. She walked over a mile to see the people she had to see. Put a pedometer on her. Now there’s one hello … You go into the Nellie Connally Breast Center, there’s one window and the patient sits down and the patients walk, the surgeons and the medical oncologists and the mammographers and everybody. That’s an apocryphal story if it’s not true. Eva Singletary could confirm that for you. She’s the surgeon here that’s most known in breast cancer. So Anderson – did we invent the idea? No. But did Anderson really pioneer this in a practical way? Yes. We were the leader. Even more than the other institution that I worked at.
James Olson:
: Could you tell me philosophically about bringing in diagnostic imaging and pathology into this sort of – I may be misstating it – but sort of – with chemotherapy and surgery and radiotherapy, sort of these basic building block disciplines. Is that fairly recent? I’ve been doing reading on sort of interventional radiology.
John Mendelsohn, MD:
: Well, when you do interventional radiology, you have to go down where there is special equipment. What you ought to do is take a look at the new building and you will see the building is two buildings. The architect has explained this to me. So you’ve got a building like this with a whole lot of floors, but this part of the building is much more reinforced and stronger, because there are diagnostic and imaging centers on each floor, so the patients in the breast clinic can go on the same floor, walk over. The patients in the prostate clinic and the patients in the GY unit can walk over. The architects explained to me that this story is reinforced for a standard 10-story building. This is reinforced for a 20-story building because the weight of all of the equipment is there. So the idea is that even at the level of the architecture is looking forward. I don’t know any other place that does that. You can get more details from Dr. Burke [oral history interview] or Dr. [Callender], who is no longer here but who really designed this concept. So that’s really – that’s proof that we mean what we say when we say we’re going to integrate diagnostic imaging in with – because the surgeons all meet in the other part of that. It improves care because people talk. Right now, there are so many patients coming through here, so many e-mails and records going around, that I just think it’s very important that our doctors are talking to each other and are in the same area. The nuances of cancer care are myriad. It’s not written in books how to take care of cancer, but we have algorithms. And every patient, 80 percent of their cancer is textbook, but 20 percent of their cancer ain’t textbook, and our doctors have seen everything. And if they haven’t seen it, there’s a guy or a gal in the room next door that’s seen it, and you pull each other out and talk and compare notes, more than anywhere I know of.
Recommended Citation
Mendelsohn, John MD, "Chapter 08: The History and Philosophy of Multi-Disciplinary Care at MD Anderson" (2005). Interview Chapters. 1450.
https://openworks.mdanderson.org/mchv_interviewchapters/1450
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