Chapter 04: MD Anderson’s Outreach Programs—the Physician Relations Programs
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Description
Here, Dr. Foxhall describes what was involved in the Outreach Programs, which resulted in the Physicians Relations Programs. He notes the ill will created immediately after the Texas Legislature’s 1995 decision to allow patients to self-refer. He talks about the scope of the programs set up to preserve patients’ connection to the primary care physician during and after cancer treatment; he also outlines the significance of the primary care physician’s role in this process.
Identifier
FoxhallLE_01_20140205_C04
Publication Date
2-5-2014
City
Houston, Texas
Interview Session
Lewis Foxhall, MD, Oral History Interview, February 05, 2014
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the Institution; The Clinician; The Educator; Building/Transforming the Institution; MD Anderson History; MD Anderson Impact; Institutional Mission and Values; Beyond the Institution; MD Anderson and Government
Transcript
Tacey Ann Rosolowski, PhD:
Okay. So then in ’93, you came to MD Anderson. And what was your mission at that point? What was your position and role?
Lewis Foxhall, MD:
So I was hired initially to help Dr. Painter with those outreach programs, to collaborate with primary care physicians on the education side. And they had a program at that time that was funded by our ERS [phonetic], our faculty plan that was supporting outreach programs and cancer prevention largely in the Rio Grande Valley, but also other parts of the state that I was asked to support. On the administrative side, I was asked to help set up programs that could address a growing problem in the community with physicians’ attitudes toward the Cancer Center. So there were some so-called town-and-gown issues at that point in time. So, pushback from community physicians that the Cancer Center was not necessarily their friend.
Tacey Ann Rosolowski, PhD:
Why was that attitude?
Lewis Foxhall, MD:
Just competitive issues, so [unclear]. So anyway, so I put together what we called the Physician Relations Program, so this was a program to reach out to community physician and oncologists, as well as primary care, and help them better relate to the organization.
Tacey Ann Rosolowski, PhD:
And this was originally—okay. So it was first the Office of Physician Relations, and then it became Physician Relations, right? Am I getting the name right?
Lewis Foxhall, MD:
Well, it was established as a program and then it was given this office designation which basically gives you a funding stream to help hire people and employ others to do your work. So that’s basically what that designation is, but it just recognizes it as a formal program within the institution.
Tacey Ann Rosolowski, PhD:
So tell me about the real work that you undertook as part of that program. What were the challenges?
Lewis Foxhall, MD:
Well, some of this was overlap with our education programming, so we had individuals that we worked with to go out and meet with the physicians in the community and talk to them about our prevention and screening programs, and also to talk to them about any issues they might have about challenges referring patients or getting feedback on patients. So a lot of the issues related to communication or the lack thereof around their physician, around their patients’ treatments when they were here. So we implemented a number of projects to help address those challenges.
Tacey Ann Rosolowski, PhD:
Now, what exactly is the relationship? Because I’d never thought about this before. You know, if an individual gets a cancer diagnosis, you know, what is the relationship they sustain with their primary care physician once they go into treatment in a Cancer Center? What does that look like? I mean, what were you dealing with at the time?
Lewis Foxhall, MD:
Well, you know, at that time, it was often one in which the clinician, primary care or otherwise, really got very little feedback or information about their patient after they were referred. So that was a big issue with a lot of people. This was about the time, in 1995, when the institution was approved by the state for self-referral. So that was another issue, and a lot of physicians felt it was an unfair competitive advantage that the institution had by receiving state funding. So they felt there was more direct competition. Prior to that time, it required a physician referral to be admitted to the hospital, but now it was open, anybody could just go their own way. So there was some feeling of disenfranchisement, I think, by the community doctors that the institution was not really respecting their relationship with the patient anymore. So that just created some ill will, and so our job was to try to help address that and help those physicians still feel part of the team, which we thought they were, but they obviously didn’t, and help them address these challenges that they had with being recognized. So we worked with a number in the institution to set up databases and information systems to help connect patients with their primary care physicians and their follow-up physicians so our faculty would know that people were connecting with the information.
Tacey Ann Rosolowski, PhD:
Why is it so important to sustain those connections?
Lewis Foxhall, MD:
Well, the physicians, community physicians, play a significant role. Many patients are self-referred, but a few are self-diagnosed, so at some point in time there’s an interaction with the physician, and that physician can facilitate access to the Cancer Center or can not. So having them feel comfortable with referrals or understanding where a patient might really benefit from coming to MD Anderson, helping them understand who our faculty are and what they do and how they’re different was an important part of that work.
Tacey Ann Rosolowski, PhD:
What about on the other side or during the process of treatment and then after treatment, what role does the primary care physician have in that?
Lewis Foxhall, MD:
Well, you know, it’s a situation that we still are trying to work with now, as far as follow-up or what we call cancer survivorship now, is that those patients eventually do show back up in the primary care office, and, fortunately, more people survive their cancer treatment than not these days, so our ability to return patients and get them back into their home situation is much better. So it’s that role in managing patients after treatment or sometimes even during treatment is one that’s more clearly an opportunity for primary care than it was back in those early days.
Tacey Ann Rosolowski, PhD:
As you were setting up these programs—I mean, I’m just thinking about the stories that I’ve heard from physicians and things I’ve read where physicians are sort of, “Oh, my gosh, there’s so much information I have to master now in order to be an effective doctor for my patients.” What has been the reaction of physicians when you present them with, “Okay, now we need to offer you a lot of information about how to support a survivor”? Or how do you manage the overload of information? Has that been a consideration or a challenge for you?
Lewis Foxhall, MD:
Well, I mean, I think it’s always a challenge in trying to provide physicians with educational opportunities that target the sorts of knowledge that they need at the time they need it, is really our job, and it’s trying to get that packaged in a way that they can use and adapt to their own particular patient setting. So the way we work here and the way we practice here is much different from most of the rest of the world, so it’s sometimes an issue of really trying to deliver that knowledge in a form that’s useful to the way that they practice.
Tacey Ann Rosolowski, PhD:
And what are some of the forms that you found were useful for primary care physicians?
Lewis Foxhall, MD:
Well, we used the traditional educational [unclear] of lectures and seminars, and we’ve had more hands-on training, workshops from time to time, depending on whether we’re able to find funding for those sorts of things. And it’s evolved now into more online education, those sorts of things, but those are nothing too unusual.
Tacey Ann Rosolowski, PhD:
When you first began with this kind of project in 1995, how many physicians were actively involved in receiving training, and how have those numbers changed over the years?
Lewis Foxhall, MD:
So you’re talking about just the education program, not the Physician Relation thing?
Tacey Ann Rosolowski, PhD:
Well, I mean, just the facets of this.
Lewis Foxhall, MD:
Okay. I don’t know how many people there were. There were several bajillion, I’m sure. But you know, we did and have done regular lecture series with community physicians, you know, I’m sure, you know, several hundred a year until now we operate our Faculty Speakers Bureau here for the institution, so that reaches, you know, a couple thousand physicians a year, utilizing various faculty members. And then the online services at that time were really nonexistent, but nowadays, that’s really a big part of what we try [unclear] because it’s more economical and still provides good educational information that physicians are, for the most part, interested in and enjoying using that sort of channel.
Recommended Citation
Foxhall, Lewis E. MD and Rosolowski, Tacey A. PhD, "Chapter 04: MD Anderson’s Outreach Programs—the Physician Relations Programs" (2014). Interview Chapters. 853.
https://openworks.mdanderson.org/mchv_interviewchapters/853
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