"How Do I Know if It's a First-Class Place?"

Craig R. Hildreth, MD

We are seeing a revolution in cancer care in this country, not just due to advances in chemotherapy and biological therapy, but also in how we communicate and connect with our patients. Fading fast are the days when oncologists felt no particular need to go out of their way to provide detailed counseling, and thanks to the internet, long gone is the time when the truth about malignant tumors was sequestered from the general public. With minimal effort anyone today can arm themselves with a stack of questions for their doctor-even before the initial visit. Numerous organizations run websites devoted to patient advocacy and information about various diagnoses and treatment options. Getting the best advice about a particular disease has never been easier. Can we say the same about that particular place, that sanctum sanctorum where cancer goes to die-the cancer center?

Meticulous research followed by well-designed clinical trials builds persuasive evidence of the value of a new cancer drug because the results speak for themselves, ie, patients live longer, or suffer less. How does one go about determining the quality of a cancer center, though? Has anyone listed the requirements for success? After years in practice I have developed some ideas about what it takes to create a consummate oncology clinic. For what it’s worth, here they are:

First the easy stuff: if you are proud of your product, you work hard to build the "brand," which for a cancer center means introducing it to the public, time and again, via marketing. If you spend enough money, the brand becomes familiar to the community-simple enough. Beware, however, of confusing advertising with quality. Billboards are impressive, but what happens after one walks through the front door, or as we call it, the "patient experience"? Will this be a good one or an experience reminiscent of Dante’s Inferno?

Now the hard stuff: in my view, efficiency is one of the two essential components of a successful patient visit. Cancer care requires a team, with oncologists charged with being the leader, and that means making sure that time is not wasted: patients will be put promptly into exam rooms, all necessary data will be in the chart, telephones will be utilized like a master painter over his canvas, treatment plans will be formulated and put into place without delay, and most importantly, there will be time to counsel patients and families thoroughly. Marketing is a bunch of fluff compared to the actions of the clinic. It is there where a center earns its reputation.

The other component of excellence in an oncology clinic is that old clich, quality of care, and by this I mean using established treatment guidelines like the National Comprehensive Cancer Network to shape decisions, researching diseases and drugs so that decisions are made from a position of intellectual strength, and at all times communicating clearly and skillfully with staff members and patients. Oh, and there is always room for compassion, patience, a sense of humor, and other virtues in our clinic.

Success in cancer treatment, like other major diseases, is measured in what are called outcomes, and in this fine oncology clinic we may see remission, we may see cure as an outcome, but often we watch an inevitable dimming of the lamp of life, to the final extinguishment. As important as efficiency and quality are in the clinic, we must also respect our patients’ time at the end of life and not squander it with futile therapies. This is why we have hospice care.

Finally, there is satisfaction, which is the ultimate goal in dealing with life-limiting diseases like cancer. No matter what fate brings, we must strive to ensure that patients were satisfied with their care, and that family members were given the respect they deserve. In addition clinic leaders must insist that their staff is satisfied with their own experience in our clinic, for unhappy nurses and unhappy secretaries often lead to unhappy patients-and that is what I call a "never event," never to be allowed to happen, yet never to go uncorrected if it ever should occur.