Chapter 19: International Travel and Providing Team Care to VIP Patients
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Description
Dr. Fisch notes that global oncology has become an increasingly important dimension of MD Anderson’s business. He explains that, as MD Anderson set up links with international partners, he helped them set up team-based treatment plans, multi-disciplinary care, and research. He gives examples of the types of research projects that might be set up.
Dr. Fisch talks in depth about his participation in international clinical care teams making “global house calls.” He explains that his role was to offer palliative care, manage anxiety, sleeplessness, and rehabilitation, sometimes spending weeks abroad. He notes that these special trips helped clarify the services he could offer as a general medical oncologist and demonstrate their value to the patients and the institution. He also describes how people would receive MD Anderson faculty overseas, which helped increase his own feeling for the institution.
Identifier
FischMJ_03_20150218_C19
Publication Date
2-18-2015
City
Houston, Texas
Interview Session
Michael Fisch, MD, Oral History Interview, February 18, 2015
Topics Covered
The Clinical Provider; The Clinician; Activities Outside Institution; Beyond the Institution; The Business of MD Anderson; Cultural/Social Influences; Global Issues –Cancer, Health, Medicine; Patients, Treatment, Survivors; MD Anderson Impact; Personal Background; The MD Anderson Brand, Reputation
Transcript
Tacey Ann Rosolowski, PhD:
All right. So we are recording, and today is February 18th, 2015, and it is about quarter of nine in the morning, and we’re having our third session today in General Medical Oncology with Dr. Michael Fisch, and it’s your last day at the institution.
Michael Fisch, MD:
That’s correct.
Tacey Ann Rosolowski, PhD:
(laughs) Well, thanks for fitting me in today after yesterday’s little technical glitch and all of that.
Michael Fisch, MD:
My pleasure.
Tacey Ann Rosolowski, PhD:
So we were plotting and planning a little bit before, and did you want to start with that story about international care just as an interesting example?
Michael Fisch, MD:
Sure. One of the things I’ve been asked here in my last days at MD Anderson as I reflect on the job of things that I’ll miss and things that will disappear from the scope of work that I’ll be doing, and one thing that is going to change will be the amount of travel that I do on an international basis. As I was telling my children this weekend, I was sort of reflecting on places I’ve been, and I’ve been to some countries in the Middle East and South America and to some countries in Europe and Australia and Africa. So there’s a fabulous opportunity to travel, and it makes one think, well, the mission of MD Anderson is to eliminate cancer in Texas, the nation, and the world, right? So there’s the world component, and that very much has been true in my career. And then as I think about the different context of the travel, some of the context has been for academic meetings, so I might give a talk or be part of a conference in Capetown in South Africa, or I may have given talks in other part of the country. I was part of a cardio-oncology workshop in Milan, Italy, for example. But another context is MD Anderson business. Sometimes what has been called global oncology, now sort of a part of a cancer network paradigm, there are MD Anderson partners in other parts of the world. So in Madrid there’s MD Anderson there, and I’ve been to that facility and talked to those folks and had a chance to travel with MD Anderson personnel to sort of fulfill some relationships on behalf of MD Anderson. I’ve been to Brazil in that context as well.
Tacey Ann Rosolowski, PhD:
What kind of role do you serve on those trips and have you served on those missions?
Michael Fisch, MD:
Yeah, different kinds of roles. So sometimes it just seems like I’m holding serve for MD Anderson, like an MD Anderson faculty to represent this or that. In my case, I’m pretty versatile. So, general oncology. Most other places in the world are not so super specialized and fragmented, and so they can really relate to the concept of general oncology. They see a lot of different diseases. The doctors that they have are versatile. They don’t get to just see lymphoma. They’re expected to see multiple diseases and there’s a case mix in their center. Then many times my context has also been at the interface of palliative care and supportive oncology and cancer care. So in a team of people, there may be specialists in other diseases, and then my general oncology plus palliative care perspective just rounds out the group. It makes all the other things they’re talking about interesting to me, still, and I’m sort of a relevant additional perspective. But then again, I can bring a subspecialty perspective that isn’t already there.
Tacey Ann Rosolowski, PhD:
Can you give me an example of the kind of conversation you would have when visiting with partners? What would you hope to accomplish, for example?
Michael Fisch, MD:
Yeah. So it depends on the nuances of each place, but sometimes it’s helping partners understand how they might construct multidisciplinary case conferences, how they may do team-based treatment planning, how they may engage their own teams plus MD Anderson teams so that how about their radiologists, their radiation oncologists, their surgeons, their medical oncologists, plus some of our radiation oncologists or some of our medical oncologists, maybe not a gigantic team, but how do you configure some of these things so that you get a mixture of disciplines and sometimes an inter-institutional perspective, and then how do you logistically work that out. How often are you going to do it, across which conditions? It’s very hard to do that pervasively, because it takes time to do that. It takes MD Anderson faculty time to regularly participate in those things, and it takes those teams, I mean, just like we do with team-based care, if you spend too much of your day meeting in multidisciplinary teams, then there’s not enough people to do the work, and there’s a lot of patients you want to take care of. So trying to figure out how to set that up, how much of that you want to do, and then how to bring some educational piece into that mix, and how to bring clinical research and research in partnership with MD Anderson into that. Some of it is sort of database research, like what is our experience with chemo-radiation for head and neck cancer for patients who are HVP-positive, and then to even describe that in some other institution, they have to understand how to properly stage the patients, how to characterize their HVP status, how to database it. And then what’s the purpose of collecting that information, right? If they’re going to make an investment in following that, for what? So lots of decisions to be made about those sort of things. And for that matter, one could be thinking, well, what about the symptom status or how often are people hospitalized during their treatment for head and neck cancer, because they get pain or they can’t eat well or they get an infection? And then as you start thinking about those kind of events, what’s their symptom status? How are we measuring pain? How do we treat pain? Do we have opioids? Do we use narcotics here? Do we feel culturally comfortable using narcotics? Are narcotics available in our country in the same way they’re available in your country? So all those kind of things come into the mix. So I was talking about context. So that’s MD Anderson business context. There’s research meetings. Professional society context, so I’ve had a chance to teach palliative care in Saudi Arabia and twice in Ghana as part of professional organization initiatives. ASCO is the main one in those contexts. And then I’m traveling not with MD Anderson colleagues, but just meeting other academic colleagues and spending time with them and meeting people from those countries and trying to understand where that country’s story is and what’s the goal of the conference and how they’re trying to build capacity to deliver certain kinds of care and how they view MD Anderson and how they view cancer care. So, very broadening. And then one unusual context, because I think many faculty have this experience of professional society or MD Anderson business travel to some degree, but I’ve also had the chance to be part of a literal clinical care that MD Anderson delivers globally, more or less like a house call, you know, but in other countries. And that’s very unusual, but for certain circumstances, when there’s enough resources and when the circumstances are there, MD Anderson has sent teams of physicians to deliver care remotely in other countries for important people. So I’ve done that kind of travel and had a chance to sometimes travel on very short notice. I remember one time getting a call from my office and giving some advice. This is basically a patient in an international setting that I’d already visited before, but I’d come back from that. Then I get a call, and I’m giving some advice over the phone about what I would do, and I remember the person saying, “Well, okay, thank you very much. Well, so why don’t you just come and do that?” I thought, “Well, it’s because I’m here.” And they’re like, “Why don’t you just go to the airport and come?” They were quite literal about that, like, “Drive to the airport and fly here.” And I ended up doing that the next day. I negotiated a chance to go get some luggage. But this is not just me doing things. This is led through MD Anderson leadership, and there were mechanisms for meeting the needs that we were being asked to meet and for fulfilling the responsibilities here that needed to be fulfilled. So it takes a leadership and a whole logistical engineering to make that. That’s either possible or it isn’t. Either you can do it or you’re willing to do it under selected circumstances or you’re not. In this case, under the right circumstances for MD Anderson has done some of that, and I’ve had the chance to do it, and it’s quite interesting. It’s quite an interesting way to relate to your colleagues too. You go spend sometimes weeks in unfamiliar settings working with other MD Anderson colleagues, trying to deliver care, MD Anderson care. It’s like a road game, you know. Can you do this outside of your own stadium? You’re familiar with your own locker room and the other kinds of people in your lives and people in your work environment who exist when you’re playing a home game. You go to an away game, it’s very different. Can we adapt some of our skills and get good outcomes and be creative and effective? It’s a different kind of teamwork. So, anyway, I’ve done that a number of times, and it’s quite interesting.
Tacey Ann Rosolowski, PhD:
So your role in those sort of scenarios, give me an example of what your role might be.
Michael Fisch, MD:
So my role, again, was more in the palliative care skill set, but understanding the underlying illness, the oncology part, what’s happening to the person, what’s going to happen, what we’re trying to do to help them, what the different team players are doing, and then adding specific value about how might we manage their anxiety or help them sleep or take care of this pain or achieve certain goals in their rehabilitation or what have you. So, supportive, palliative, rehabilitative elements of care and care planning, that would be my sort of added value for being one amongst others on the team to go out there.
Tacey Ann Rosolowski, PhD:
Well, clearly they see your value. I mean, that’s a highly privileged function to serve—
Michael Fisch, MD:
Yes.
Tacey Ann Rosolowski, PhD:
—going to take care of these international kind of VIP patients.
Michael Fisch, MD:
Yes, yes. So, yeah, I felt very honored to fill those roles and tried to do my best and put a lot of thought into what I was doing, and it was very gratifying.
Tacey Ann Rosolowski, PhD:
Did you feel that being selected to go on those kinds of missions, as it were, helped support the value of the kind of work that you do here at MD Anderson?
Michael Fisch, MD:
I think so. First of all, my department would get reimbursed for this time, so it was not like our work product suffered. The overall sort of production of the group was credited and some funds would be delivered back to the department for these efforts, so it contributed in that sense. But I think you’re right that it does sort of help tell the story if people are not sure. People are sure what a breast oncologist does and people are sure what a radiation oncologist does, but a general oncologist who does and understands supportive and palliative care is a little harder for some people to get their head around. Depends on what they know and how clinically familiar they are, and sometimes just have you been exposed to somebody who brings that to bear, you know, to sort of even understand what it would be. I’m always thinking in sports analogies, but maybe if you’re a football team that’s never played with a tight end, you don’t know the value of a tight end, but if you’ve had one or you’ve seen one in action, you might begin to have a flavor for how that could be useful for certain kinds of offenses or certain kinds of plays. So people start to become familiar with what that position might add, in particular what the experience of the whole team. So you talk to the other team members, and what’s it like having Mike there, or on this next trip or for this next patient, do we want him with us or do we need that? And, you know, people can sort of speak to what that brings. So I thought that was a very interesting experience and certainly one I’m grateful for. This whole dimension of international travel has been a great part of what my experience of MD Anderson has been and, I think, one of the things I appreciate about MD Anderson overall. It’s quite remarkable how people receive MD Anderson faculty internationally. You get so appreciated, it makes you particularly proud and attached to this work, because, like anybody else, you might feel less appreciated by people who are super familiar with you. (laughs)
Tacey Ann Rosolowski, PhD:
This phrase, “You’re never a hero in your own land.” (laughs)
Michael Fisch, MD:
Yeah, you’re never a hero in your own land. So we have so many talented people here that it becomes very ordinary, but you can really see how much you can add in faraway places by the depth of our knowledge and teams that we bring and then see how appreciative they are when we’re able to help. So, very gratifying.
Tacey Ann Rosolowski, PhD:
A great experience, yeah.
Recommended Citation
Fisch, Michael J. MD, MPH and Rosolowski, Tacey A. PhD, "Chapter 19: International Travel and Providing Team Care to VIP Patients" (2015). Interview Chapters. 842.
https://openworks.mdanderson.org/mchv_interviewchapters/842
Conditions Governing Access
Open
