Chapter 13: Reflections on Communications

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Chapter 13: Reflections on Communications

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Dr. Baile begins this chapter by listing the accomplishments he is really proud of, then sets his work on communications in the context of a changing institution. He explains that he has seen advances in research and treatment options, but not corresponding advances in the people side of medicine. He notes that leaders can serve as models to promote these advances. He then shares his own thought process as he looks at his own career, wondering “have I failed at not making this a priority?” He discusses a 2014 institutional initiative, “The Language of Caring” that failed, noting that the faculty was too busy to take part and advance it.

Identifier

BaileW_03_20160823_C13

Publication Date

10-25-2016

City

Houston, Texas

Topics Covered

The Interview Subject's Story - View on Career and Accomplishments; Growth and/or Change; Critical Perspectives on MD Anderson; Patients; Patients, Treatment, Survivors; Leadership; Overview; MD Anderson Culture; Professional Practice; Understanding Cancer, the History of Science, Cancer Research; Institutional Politics

Transcript

T.A. Rosolowski, PhD:

What—as you look back—I mean, you know, you’ve talked about that this was a great place for you to build an academic career—what are some things that are really kind of the—when you look over what you’ve done, I mean, what are the real high points, the things that you’re really pleased to have achieved?

Walter F. Baile, MD:

Well, I’ve gotten a Distinguished Teacher Award from the UT system, which has really been terrific. That my reputation has gotten me appointed as Co-Chair of the ASCO Committee on developing guidelines for communication skills that’ll be published in the JCO. I’ve had the opportunity to, you know, meet people who were extraordinarily influential in collaborating with me to publish and do important work. And that’s been just incredible. There’s a lot of really smart people around. And, you know, so those things are really important. I’ve had—I’ve been given—was given the opportunity to create this iCare program, which, I mean, I did. I mean, I did something, and people use it a lot, and I’ve got a reputation. But in terms of sort of making communication skills an institutional priority, you know, it’s—I haven’t been successful. Maybe I haven’t tried hard enough. But education has not really ever been an institutional priority so to speak, either. You know, it’s been something that was considered important, okay, but research is the name of the game here, you know? I mean, we have a Graduate School for Biomedical Research, right, that our president is a lab guy, our former president is a lab guy, John Mendelsohn, right [oral history interview]? Mickey LeMaistre [oral history interview] I don’t think was a lab guy at all, but, you know—but, you know, we are—we’ve become a bit of a drug development entity, haven’t we? Yeah. I mean, we continue to hire people, I understand, for the ICAC or whatever it is, for the Research Institute, when there is a hold on other spending. I don’t know if that’s true or not, but someone told me that. But it wouldn’t be surprising, given the institutional priorities, which are driven by the president. You know, and it—you know, it’s all—it’s Jim Allison. Right? I know. And, you know, so people come here for a very different reason. They come here because they know there’s a possibility of cure in clinical trials and things of that sort. People go to the Cleveland Clinic because not only is there good medical care but, you know, they’re well taken care of. I think people here, in general—I’m not saying they’re not well taken care of, but if you really want to say, “We’re going to make sure every patient has a great experience with their doctor,” no. And maybe we shouldn’t. I mean, you know, there are places that have different priorities, and so—

T.A. Rosolowski, PhD:

Well, it sounds like you’ve seen some change in the culture and the priorities of the institution.

Walter F. Baile, MD:

Yeah. We’ve grown big, and we’ve grown really into a drug development entity. We’re about drug development, right? We have a lot of alliances now with pharmaceutical companies. Now, I don’t know all the ins and outs of that, but, you know, I think that the moonshot is about developing drugs to kill different cancers, right? So, and, you know, immunotherapy is now the big thing, and killing melanoma—getting rid of—so the success with melanoma has been just incredible, but what do you do about the patients who don’t get cured? What do you do about the patient who’s in no protocol, no treatment plan? Somehow you have to take care of people within the context of giving them the right drug. Medicine will never only be about drugs. It will be about people, and it will always be about people. And unless we educate our clinicians how to take care of people who are—have a very serious disease in a compassionate way, that, you know—I think that, for me, our priorities will always be a little skewed toward the other side. Now, I don’t know in the old days when—I don’t think you’ll see our president walking into the lobby and covering a patient with a blanket, or picking them up to a room.

T.A. Rosolowski, PhD:

Yeah, it’s definitely a cultural change.

Walter F. Baile, MD:

Yeah. So you know, leaders are models, and our president didn’t take care of patients very long, and—so, you know, there’s been a lot of commotion at the top about shared governance, and what our priorities are, and all that kind of stuff, and whether or not the people in the trenches in the clinics are as absolutely important as the people who are sitting over in the Mendelsohn Institute, Sheikh Zayed Institute. I don’t know. It’s a little bit over my head, but—

T.A. Rosolowski, PhD:

You know, I guess I’ve been really aware in our conversations that, you know, you have such a deep knowledge about certain dimensions of the institution that I really am unaware of, so I really want to ask you: what else do you want to say? (laughter) Because I’m in a place where I don’t know what I don’t know, and I’m not sure what the best question is.

Walter F. Baile, MD:

Well, I ask myself, okay, have I sort of failed in not making this more of a priority for the institution, and have I not screamed loud enough, have I not tried to find some bully pulpit around this issue. It’s one thing I’ll probably always ask myself. And did I—was I too sort of accepting of a more limited role in teaching clinicians, sort of, you know, starting with the fellows, and putting up for—but, you know, then I remind myself you can’t be a one-man show. You really can’t. There are very few one-man shows. The Pope maybe, right? (laughter) You know, not even Obama’s a one-man show. He’s got a lot of people to answer to. Pope has only one person to answer to, right? So, you know, there are very few one-man shows. The President of China is trying to be a one-man show, but he’s got to kick a lot of people aside to do that. And I always tell people, never be the only person that’s doing the job that you’re doing without having collaborators and other people, because if you’re the only person it’s hard to get leverage. So, you know, I think that there was an opportunity when we had the Language of Caring. You remember that?

T.A. Rosolowski, PhD:

You mentioned that last time, but we didn’t go into it.

Walter F. Baile, MD:

Yeah. The Language of Caring was this very superficial program in which they taught people how to be respectful to one another, essentially, right? And people—so it was rolled out to the employees, and, you know, we spent a lot of money on it. But when a group of clinicians got together to roll it out to the faculty, nothing ever came of it.

T.A. Rosolowski, PhD:

Why?

Walter F. Baile, MD:

Well, because one Dr. Burke [oral history interview] said that we can’t ask faculty to take time to learn how to do these things. It was a very clear statement, because everybody was too busy. And secondly, there was then a plan to roll it out on a voluntary basis, but no leadership emerged to do this. No one said that, “Here’s a budget, okay, and we’re going to hire some people to make sure that there is a substantial program available to the faculty to do these things.” And there were people interested in doing that, but there was never anything created to move it forward. That’s why it died.

T.A. Rosolowski, PhD:

Now, what year was this, about?

Walter F. Baile, MD:

Two years ago.

T.A. Rosolowski, PhD:

Oh, two years ago. Okay, so 2014, so relatively recently.

Walter F. Baile, MD:

Yeah, something like two years ago.

T.A. Rosolowski, PhD:

Yeah. And that must’ve been around the same time that there was intensified discussion about patient experience and all of that.

Walter F. Baile, MD:

You know, I don’t know if those were parallel things.

T.A. Rosolowski, PhD:

Yeah, I was just curious. Yeah, it just seems—it’s funny, just some of these things seem like a no-brainer, but there’s such an education process. I mean, it’s like kind of going back to where we started. You know, you’re sitting with another person who has a very different perspective on the same situation. How do you, if you’re working with something the other person doesn’t understand, how do you slowly get them to open their imagination to begin to see things from your perspective?

Walter F. Baile, MD:

There are ways of doing it, but it takes time.

T.A. Rosolowski, PhD:

Yeah, it does take time.

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Chapter 13: Reflections on Communications

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