Chapter 01: Multidisciplinary Care at MD Anderson
In this chapter, Dr. Rodriguez provides an overview of MD Anderson’s multidisciplinary approach to patient care. She defines the approach and notes that it began with R. Lee Clark’s vision for cancer care. She gives examples of the specialties that collaborate to provide comprehensive management of a patient’s disease throughout treatment. She also offers observations on how the tradition of multidisciplinary care has had an influence on the culture of the institution.
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
The Interview Subject's Story - Overview; Overview; Definitions, Explanations, Translations; MD Anderson History; Multi-disciplinary Approaches; Institutional Mission and Values; Survivors, Survivorship; Patients, Treatment, Survivors; Patients; Patients, Treatment, Survivors; This is MD Anderson; Discovery and Success; Devices, Drugs, Procedures; MD Anderson Culture
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History of Science, Technology, and Medicine | Oncology | Oral History
Tacey Ann Rosolowski, PhD All right. Well, thank you very much, Dr. Rodriguez, for coming in today.
Alma Rodriguez, MD My pleasure.
Tacey Ann Rosolowski, PhD I just wanted to say for the record, that today is April 17, 2017, and we are doing the first of what I hope will be a few video interviews, with interview subjects for the institutional oral history project at MD Anderson. So, thank you for being our experiment this afternoon.
Tacey Ann Rosolowski, PhD
I wanted to start by asking you about the tradition of multidisciplinary care at MD Anderson, and first if you could tell me a little bit about how you define it, how it's understood, and then maybe give an overview of how it has evolved at the institution.
Alma Rodriguez, MD Multidisciplinary care is a framework for integration of all the relevant specialties that touch or have a significant impact on how a patient's condition is managed. It is intended to have all of these expert viewpoints integrating at an appropriate point in time, when the care planning is being made, and that these individuals, in a collaborative fashion, come to a consensus decision on how it is that the process of the care delivery is going to occur. This model traditionally includes of course, the medical oncologist, the radiation oncology specialist and the surgical specialist. Two other disciplines that are really critical to the treatment planning process are also the diagnostic specialties, and that is pathology and diagnostic imaging, because obviously, without the right diagnosis and without the appropriate staging of the tumor, it becomes very difficult to plan the appropriate care that is indicated for the patient's condition and stage of the illness. So for us, we view multidisciplinary planning really as that process that brings the knowledge of all these different disciplines to bear on the treatment planning.
I want to add, however, that there is another whole domain of supportive disciplines that also contribute significantly to multidisciplinary care planning, [ ]and that is psychosocial services, as well as rehabilitative services, nutrition, and other specialties that really enable the patient to reintegrate into a healthy state of being [ ] through their cancer care. The scope of supportive care is rather complex and very broad. To facilitate that, one of our prior leaders at the institution envisioned that all of these disciplines would work together in a single environment, and so that's how we designed our clinics. For example, the Connally Breast Center integrates, within the infrastructure of that center, the visits that the patient has with the medical oncologist, with the surgeons, with a radiation specialist, and even with plastics consultants at times. Within the center, there are also social workers. We have access to consultation by other specialists and we can also integrate their input into the care for the patient.
Tacey Ann Rosolowski, PhD I have a couple of questions. First is, does the patient ever meet with the entire team, or virtually the entire team?
Alma Rodriguez, MD Not usually, simply because it's very difficult to coordinate everyone's schedule, but we do try to coordinate the patient's schedule so that all of those events, or meeting face to face with all of the relevant providers does occur, hopefully within the same day or within a very short span of time. Now, when the actual treatment planning is done, the clinicians come together in what are called Multidisciplinary Planning Conferences, and the patient's case is discussed and the relevant pathology is reviewed, the diagnostic imaging studies are reviewed, the planning from the perspectives of the oncologist, the surgeon and the radiation specialist are reviewed, and then if you will, a comprehensive plan is then agreed upon. This is really very important, again particularly for solid tumors and for certain categories of malignancies that are rare and complex in their management, it is absolutely essential. For example, in hepatobiliary malignancies that are rare but require very complex treatments or very complex planning of their care, these conferences are essential to arrive at an agreed upon plan. Head or neck surgery and head or neck chemotherapy and radiation planning, equally important for certain complex cases of colorectal malignancies. Again it's essential that this structure of planning must occur, in order for the treatment to be most optimum, because we know that outcomes, [ ] particularly for these complex malignancies, is very much driven by the level of expertise of the participants, but also the timeliness and sequential planning of each of the phases of the treatment.
Tacey Ann Rosolowski, PhD Now, you mentioned a period in the past when there were design decisions made about how to set up clinics. Could you say a little bit more about the history of the development of multidisciplinary care here?
Alma Rodriguez, MD Well, I think that probably from the beginning of the institution, the vision of Dr. Clark was that patients would receive, of course, the optimum care for their malignancies. The institution has a very long history [ ], back to the 1940s, when surgery and radiation were essentially the only two therapeutics for malignancies that were effective at the time. He did develop [the process ] of the Tumor Board, and discussion of the patient's care by the surgical and radiation specialists, but over time, the complexity of treatment management that then integrated [ ] meaningful chemotherapeutic strategies, it's become much more complex. In the 1990s, with awareness of how the complexity of the treatment planning was evolving, again the operations leadership of the institution made the decision to structurally plan the design of the clinics so that all of the important disciplines would be housed within a given specialty center for a disease category. That's why today we have the GI clinics, the thoracic clinics, breast center, et cetera.
Tacey Ann Rosolowski, PhD Was that an unusual decision at the time?
Alma Rodriguez, MD Yes. I think it was a very innovative and visionary decision at the time and it has evolved [ ], progressively [ ]. I mean, I think at the beginning, probably there were some centers that were not as well coordinated as others, but over time, I think all the centers have made tremendous efforts to have not only a culturally accepted framework for how this works, but operationally, to facilitate for patients having appointments that are streamlined and [ ] well-coordinated . [This meant to avoid] waste of time unnecessarily, in moving from one treatment modality to the next, or to whatever the next step of the treatment plan would be.
Tacey Ann Rosolowski, PhD Now, you mentioned culture a little bit earlier and I wanted to follow up on that and ask, how do you see the providing a multidisciplinary care feeding or supporting the culture of the institution at large?
Alma Rodriguez, MD Well, I think that the concept of multidisciplinary care being important in cancer, in essence levels the playing field if you will. We know that each of us plays an important role in this, in our mission, and to that effect, I think that we are a fairly democratic organization. We know the importance of anesthesia, of diagnostic imaging, of the medical oncology teams, you name it. Every one of those, every specialty really has a role to play, and we couldn't do it without each other. We couldn't achieve the outcomes that we achieve without everyone collaborating. One of the disciplines that, or one of the domains of care, that actually was brought into the institution after I joined MD Anderson, was [ ] internal medicine, [ ] to help us to manage the patients comorbid conditions that of course can influence how well the patient tolerates surgery, how well the patient tolerates chemotherapy, and therefore [ ]their outcome [ ]. I've seen that division grow over the years. Truly today, I don't think that we could say that we could function without the pulmonary service or without cardiology or without endocrinology or without general internal medicine or you name it, any one of the [internal medicine] specialties that we currently have onboard. We appreciate that they all contribute to our care of the patient [with] cancer, for the best outcome of the cancer treatment.
Tacey Ann Rosolowski, PhD It sounds like a recipe for healthy respect.
Alma Rodriguez, MD I would say so, yes.
Rodriguez, Alma MD and Rosolowski, Tacey A. PhD, "Chapter 01: Multidisciplinary Care at MD Anderson" (2017). Interview Chapters. 280.
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