Chapter 05: Bringing Focus to Patients’ Emotions

Chapter 05: Bringing Focus to Patients’ Emotions

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Description

In this chapter, Dr. Fisch describes the process of entering a fellowship program in Hematology/Oncology and General Internal Medicine at Indiana University at Bloomington. He then explains that it was during this time that he became interested in “things that were happening to cancer patients that we weren’t talking about.” He gives examples, first discussing the problem of depression in cancer patients. He then explains that on the transplant service, patients were uniformed about treatments and he did a project on the effect of informed consent on emotions.

Identifier

FischMJ_01_20150205_C05

Publication Date

2-5-2015

City

Houston, Texas

Topics Covered

The Researcher; The Researcher; Professional Path; Inspirations to Practice Science/Medicine; Influences from People and Life Experiences; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Patients; Patients, Treatment, Survivors

Transcript

Tacey Ann Rosolowski, PhD:

So when in medical school did you kind of select a research focus, or did it happen then?

Michael Fisch, MD:

So I was interested in ID, so I have this mentor who’s in Infectious Diseases, and ID was perfect because multi systems involved, the complexity, right? All organ systems, all ages, happens in young, happens in old, happens in the hospital, happens in the community setting. Lots of bugs, lots of drugs. UVA was famous for its infectious disease expertise. They had Mandell, Douglas, and Bennett’s Principles and Practices of Infectious Diseases. They called it the PPID. It was like the bible of ID, and many of those authors were from UVA. Mandell was the head of ID at UVA, and Dr. Farr was on the faculty and had some chapters in there. So this was the strength of the department, and a big, thick book, chapter after chapter of infections and all kinds of cool things. So I loved the complexity and I liked ID, and at some point that was sort of my mindset. I guess when I first started med school, when I first went into medicine, I was wanting to be a pediatrician, I guess, because that’s what I knew from my own pediatrician. But then my pediatrics rotation was more inpatient oriented, and I just saw developmentally devastated children and that you couldn’t really talk to, and that didn’t appeal to me that much. But ID, with all these smart guys doing clever diagnostic thinking and quite a lot of science about the biology of infections, and so anyway, I liked that. But then I think in the course of my training, my dad would sort of cross-examine me and poke some holes in this idea of infectious diseases, because it seemed to him—and he’s not in medicine, but it seemed to him that there is no special angle that the ID—like nobody’s afraid to prescribe antibiotics, and so you didn’t really have your turf. I mean, everybody can do, and they can do it wrong, but you didn’t have any exclusivity, and it’s a very intellectual field. But he was interested in me keeping an open mind. Then as I did my hem/onc rotations, I found, well, here’s another realm of the same sort of things that I like, right? Multiple systems involved, the whole body, full range of ages, and lots of cancers, lots of drugs, different tumors, different—so chemo and tumors was to microorganisms and antibiotics, same general premise of wild complexity, multisystem, except instead of being largely a consultative arena, it was longitudinal; that is, making relationships with patients and families, helping them understand “What’s happening to me? What’s going to happen to me? What can be done to help me?” That was part of the skill set, so that whole personal part, mapped with the complexity, really got me interested. And then also my own family history. I had some family experiences with cancer, including during medical school a grandfather who had cancer and an uncle who had a cancer. So I was, I guess, becoming more interested in cancer medicine in the course of those personal experiences, plus just realizing it mapped my skill set reasonably well.

Tacey Ann Rosolowski, PhD:

Were those individuals treated at MD Anderson?

Michael Fisch, MD:

No, none of them came to MD Anderson. I might take a—

Tacey Ann Rosolowski, PhD:

Absolutely. We’re taking a quick break at about eight minutes of twelve. [recorder paused]

Tacey Ann Rosolowski, PhD:

So I will let us resume. Okay, we are back after a brief break, and it is about two minutes of eleven. I misstated the time. It was 10:53 when I turned off the recorder. All right. So you were talking about research on—or your kind of tracking into hematology and oncology.

Michael Fisch, MD:

Yes, tracking into that. Even though my mentor was in infectious diseases, some of the research I’d done was in infectious diseases, I’d just gotten hungry for formulating hypotheses, figuring out how to configure experiments of some sort, whether it’s a retrospective cohort study or some sort of prospective study that would help answer the question, but becoming intrigued with hematology/oncology because it had some of the same good features of infectious diseases but also it seemed to have its own special turf, like other people don’t give chemotherapy because they just want to see if they might be able to get it right. They seemed to respect that they’re not going to be doing that unless they’re totally qualified, whereas, again, antibiotic world seemed open to all.

Tacey Ann Rosolowski, PhD:

Now, let me ask you, were you already thinking about a career in academic medicine at the time? I mean, where’s private practice in all that? What was your thinking?

Michael Fisch, MD:

Yeah, never considered private practice.

Tacey Ann Rosolowski, PhD:

Really?

Michael Fisch, MD:

Never even came close to thinking about that.

Tacey Ann Rosolowski, PhD:

Why is that?

Michael Fisch, MD:

You know, I don’t know. I was so hungry to learn, and the environment of learning seemed so much in the academic world of asking questions, doing research, being around other people who were super curious, who were trying to change the way care was delivered or find new approaches new therapies. So the whole environment was all that I want. I mean, that was always what I wanted.

Tacey Ann Rosolowski, PhD:

That makes sense.

Michael Fisch, MD:

And I really never wavered from that. I had done that retrospective chart review study and then the next summer, the summer after my first year in med school, I got involved with a prospective study where I got to—well, the study involved a silver-impregnated catheter, like a catheter cuff, that when you’re putting in a central venous catheter, the cuff would expand and the silver ion would have this antimicrobial effect. The whole idea was to reduce catheter-related infections. So the study was a randomized trial of the silver-impregnated cuff—they called it VitaCuff—versus an ordinary catheter. And my job was to randomize the patients when they were getting these things put in and to collect some clinical data at the time of the insertion of the catheter. So I got to carry a pager around, which at the time was a big thrill, for a whole summer. I’m on call the whole summer, and if somebody needed a catheter put in at two a.m. in the ICU, then I showed up at the ICU and did the randomization assignment and took down the clinical data. So that was sort of thrilling, but it was also, as I found out, pretty disruptive. Maybe it’s a late afternoon on a week night and I’d be trying to play some golf before it got dark, and then my pager would go off and I’d have to haul off the golf course, drive in to the ICU, and get ready to do that. So I learned the sacrifice of what being on call really does. I remember going on a date with my wife, who is now my wife, and I remember I had a dinner date and I was making—the only thing I knew how to make, I think, was spaghetti. And I was having over for spaghetti and some bread in the oven. (laughs) Totally lame. But I think I got paged in to do the VitaCuff before she even showed up, so like at the time that she was supposed to come over, I was gone. (laughs)

Tacey Ann Rosolowski, PhD:

She still married you?

Michael Fisch, MD:

Yeah, yeah. But this was not a time where you just text and say, “I’ve got to go.” I mean, it wasn’t exactly as easy to sort of not be there. But that’s the kind of thing that that study was. But that was a prospective study. [telephone interruption]

Tacey Ann Rosolowski, PhD:

So tell me how your work with Dr. Farr—or did you kind of shift mentors as your research focus shifted in medical school?

Michael Fisch, MD:

Yes.

Tacey Ann Rosolowski, PhD:

Then what happened after?

Michael Fisch, MD:

Right. So, no, I didn’t really shift mentors, so he remained my mentor. And I didn’t really do research related to hem/onc while in med school. I didn’t shift. Med school was just getting through med school, and my research experience was in the summers of my first year. Then after that, it was—you know, I don’t really remember much specific research, just digging through all the other things you had to learn and do in medical school. And then I went into internal medicine training at UVA, so I went from undergrad to med school to internal medicine, all at UVA.

Tacey Ann Rosolowski, PhD:

And you did your residency in 1993.

Michael Fisch, MD:

Right. It was ’90 to ’93 was my residency, yeah. And so during that period of time, I started to—again, totally absorbing just to do internal medicine residency, but we did publish a paper in the Annals of Internal Medicine related to our pneumococcal bacteremia study, so we were following through on that work, and it kind of came out while I was in residency. I remember that my colleagues were impressed that I had a publication during residency. It was really the fruition of something that started earlier. And our catheter study got published in JAMA, so those kind of things were exciting. And I got involved in the kind of things that internal medicine residents get involved in, just little projects, case reports at the local chapters of our Medical Society chapters, and, you know, just little academic things that you can do as a resident, talk about, publish a case report of a weird infective endocarditis or this or that, you know, that sort of thing. If you look on my CV, you’ll see little dabbles of the kind of things you might expect residents to be able to get involved with. I wasn’t one of those folks who was on an MD/PhD track, a physician/scientist track. Now, as I interview people who want to go into fellowship here and I realize just how incredibly accomplished they are, I mean, the fellowship candidates for this program are way more accomplished than I was at that time. They have something more to say than a case report, generally speaking. They have some of the similar things, that they like what they’re doing, they’re hardworking, their colleagues respect how they’re functioning in their role, they have potential, but there are people who come to our fellowship who are quite scientifically accomplished and have been doing lots of lab work and are physician/scientists ready to conquer the world. But I was a clinician, clinical researcher.

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