The Royal Nonesuch

Drs. Lucas and Eisenberg were delighted to learn they were both featured in an excerpt from author and Marin County native, Glasgow Phillips’ novel, The Royal Nonesuch, where the author describes his first meetings with Peter and Jen. We are all incredibly proud of their “literary cameo”, and invite you to read part of it below!

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“…It was dusk, and we were back in the car to leave when we saw her oncologist walking across the parking lot. This was the doctor who had sent her marrow down to Stanford, and I had missed him on the first day. She told me I was going to love him and rolled down the window to call out. He smiled and came over to the car, greeting her warmly and shaking my hand. His name was Dr. Peter Eisenberg.

Dr. Eisenberg was a portly but vital man, maybe in his early fifties, with the red-bridged nose of a runner and a salt and pepper beard. In the past seventy-two hours, Dr. Eisenberg, without his knowledge, had been comprehensively vetted by my aunt Tawnie—technically my ex-step aunt, but we were as close with her family as with any of our blood kin. Dr. Eisenberg was supposed to be the best, and Tawnie was in a position to know. Her research on physicians, dentists, educators, realtors, babysitters, and any other persons who might provide support services to the job of keeping your families’ lives in order and on track was so rigorous that she could have started her own credentialing service. Not that those were her only areas of interest—she was also knowledgeable in the areas of architecture, contemporary art, and global politics—but without a doctorate in fluid dynamics, you would have small hope of becoming her pool guy.

Dr. Eisenberg may have passed her vetting process with flying colors, but he struck me as being far too happy to be a highly respected oncologist. Cancer was, after all, the pinnacle of seriousness—thus the saying, “serious as cancer” –and this grinning man was wearing a Mr. Potato Head tie. I could not help noticing, as my eye bounced up and down between Dr. Eisenberg’s face and Mr. Potato Head’s, how very closely Dr. Eisenberg, with his tanned forehead, bushy eyebrows, close-set eyes, and different-colored nose, resembled Mr. Potato Head. If Dr. Eisenberg was as smart as he was reputed to be, he was aware that he resembled Mr. Potato Head, and therefore it followed that he knew that each solemn conversation he had over the course of his day as a highly respected oncologist was punctuated by a goofy sight gag.

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My mother asked Dr. Eisenberg if he knew yet whether she had lymphoma. Since she had no obvious tumors, and lymphoma was often detected first through abnormalities in the blood, it already had come up as a strong possibility. Dr. Eisenberg said he didn’t know yet. The results would be in tomorrow. But we should keep our fingers crossed in the hopes she did have lymphoma. “Wait,” said my mom. “I thought lymphoma was bad.” “It’s terrible!” he responded gleefully. “But if you have a lymphoma, then you get Dr. Lucas! And she’s the best!”

We bid good evening to this madman and went home. The next day we went to our appointment at Dr. Eisenberg’s practice, located in a strip of seventies-era office buildings adjacent to Marin General. There we learned that she did indeed have lymphoma: an indolent Stage 4, non-Hodgkin’s B-cell lymphoma, complicated by hemolytic anemia. Lymphoma was a cancer of the white blood cells—that I knew—and the rest was explained by Dr. Lucas, the hematologist of whom Dr. Eisenberg had spoken so grandly the prior evening.

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Her first name was Jennifer—Jen. Like me, Jen Lucas had gone to high school in Marin County, a few towns north. She was one year older than I was. In elegant flats, she was about my height, though by contrast she was attractive, clear-eyed, and serious. While I had been making an ass of myself navel gazing, p***s twisting, and branding scams, Jen Lucas had been going to college on a basketball scholarship, matriculating to Georgetown Medical School, advancing hematology research at Stanford, and being recruited as the youngest partner by twenty years at the best private oncology practice in northern California, where her job was saving people’s lives.”

To read more of Mr. Phillips’ novel, visit Amazon.com or your local bookstore.

Marin Cancer Clinic was the first practice in the nation to participate in CancerLinQ.

By Kathy Holliman, M.Ed.

Gaining access to the experience of oncology practices across the country motivated early participation in CancerLinQ, according to physicians at the vanguard practices.

“If I can benefit from best practices around the country, it will directly benefit my patients,” said Peter Eisenberg, MD, of Marin Cancer Care in California, one of the first vanguard practices to upload its patient records data to CancerLinQ. “What I have to learn by participating is whether we are doing it right and taking care of our patients appropriately. Are we using standard regimens? Are our patients doing as well as we might expect? Are we missing something?”

Dr. Eisenberg noted that randomized clinical trials include a relatively small number of patients, have very specific inclusion and exclusion criteria, and “may or may not reflect the patients we see in our practice.” With CancerLinQ, his practice will be able to track, for example, the thousands of patients with lung cancer who are treated in a year and understand the trajectory of their care, he said.

Uploading data to CancerLinQ from Marin Cancer Care’s electronic medical records (EMR) system was challenging and “cost us something in terms of our practice manager’s time and our [information technology] guy’s time, but the potential for learning far outweighs the expenditures that we have made.”

Now that his practice has worked through the technical challenges with the help of the ASCO CancerLinQ team, Dr. Eisenberg and his partners will soon be taking a look at the rich data from their own practice. They anticipate that later this year they will be able to compare their data with practices across the country. “If somebody is getting better results in Kansas City or elsewhere, I want to know what they are doing,” he said.

“I think it was very bold of ASCO leadership to put such an effort together. It is a huge project but one that has terrific implications for the care of our patients. I applaud the team that has spearheaded this effort,” he said.

Montgomery Cancer Center

Keith Thompson, MD, at Montgomery Cancer Center in Alabama said that having access to the “combined wisdom of so many patients treated in centers all over the country will be a tremendous advance in our understanding of cancer and cancer care. The opportunity to understand what is happening with so many patients is a big deal.”

CancerLinQ, he said, will give physicians the ability to “measure their quality and look at what they are doing. Physicians around the country really embrace the idea of being able to look themselves in the mirror and see whether they are doing a good job and whether there are things they can do better.”

A team from CancerLinQ was instrumental in helping Montgomery Cancer Center upload its data. “They came in and analyzed the way we interact with our own EMR, asked questions about how data are stored, and then they analyzed our data before drawing it into the system.” That process, he said, took several months and a lot of hard work, “but they made it easy for us.”

Dr. Thompson’s center has recently started looking at a subset of the data, “taking it for a test drive” to understand how this information can be used to improve patient care.

Michiana Hematology-Oncology

Robin Zon, MD, at Michiana Hematology-Oncology in northwest Indiana, said her practice “couldn’t say yes fast enough” when given the opportunity to be among the first participants in CancerLinQ.

“The whole concept of using big data to better enhance our overall learning has been long in the making. This is a fabulous initiative that ASCO is doing, with the goal of improving quality and patient care.”

The Michiana practice holds about 120 tumor boards each year, she said. “There is something to be said about experience, which is above and beyond what you would get from a guideline. We would often say that it would be great if we could share our collective wisdom. We have all this experience in these file cabinets and now in EMRs.” With CancerLinQ, that depth of experience can now be shared with other practices across the country, she said.

Dr. Zon, a member of ASCO’s Data Governance Oversight Committee, said that she and her colleagues rely on ASCO as a trusted and honest broker. ASCO is “our go-to in terms of education, understanding new information, new interventions, new technology. It makes sense that ASCO’s CancerLinQ would be our go-to for rapid learning to enhance patient care.”

SUMMARY: The first participants in CancerLinQ say that gaining access to the experiences of other oncology practices will enhance patient care. Peter Eisenberg, MD, of Marin Cancer Care in California, says that CancerLinQ provides his practice the opportunity to learn “whether we are doing it right and taking care of our patients appropriately.”

TWEET:  CancerLinQ vanguard practices say they will have the ability to measure their quality and share their collective wisdom.

Oncologists Trek For Cancer

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Dear Friends,
We are training as “Two Caring and Daring Docs” for an 11 day sacred trek in Nepal in September to raise funds for the Breast Cancer Fund.  We will be trekking up to 9 hours a day at 12,00 – 14,000 feet in the Mustang region of Nepal, a hidden kingdom that was completely closed to foreigners until 1991.

As medical oncologists, we take care of women with breast cancer.  Every day. many are cured – – some are not.  But whether they are cured or not, they all have to endure the fear and anxiety that accompanies the diagnosis.  They all have to keep dozens of doctor visits.   Some have to complete long chemotherapy regimens.  Most have to take pills for years.  They all have family and friends who worry about them.  Many have small children.  Work is disrupted.  Life is disrupted.  All wonder why they got breast cancer.  And all wonder if it will ever “come back.”

The key to unlock the secret of the causes and cures of breast cancer hasn’t been found yet, but great strides are being made.  The Breast Cancer Fund is examining the scientific evidence linking exposures to environmental chemicals and radiation with breast cancer.  To this goal, we are raising money with the help of your generous support.

EVERY PENNY YOU DONATE GOES TO THE BREAST CANCER FUND.  We pay for all the expenses of our trip.  If you donate $100 or more, we will carry a prayer flag  with the name of whom you wish to remember or honor.

Please visit our site and make an online donation at https://prevention.breastcancerfund.org/goto/twocaringdaringdocs or mail a check payable to Breast Cancer Fund with “Two Caring and Daring Docs” in the memo line and mail it to us.

Much love and many thanks,

Bobbie Head and Jennifer Lucas

Marin Cancer Institute Receives Outstanding Achievement Award from American College of Surgeons’ Commission on Cancer

One of only four programs in the state, only program in Northern California to receive award

April 13, 2015

GREENBRAE, CA — The Marin Cancer Institute at Marin General Hospital announces that it is once again among an elite group of cancer programs in the United States that have earned an Outstanding Achievement Award from the American College of Surgeons’ Commission on Cancer (CoC). The hospital’s cancer program underwent a rigorous reaccreditation survey in May 2014 after which it received Gold Level designation, the highest level of accreditation. In 2014, seventy-five programs out of the more than 1500 surveyed across the country received Gold Level designation, which qualified them for the Outstanding Achievement Award; the CoC announced the results in March 2015.

The Marin Cancer Institute is one of only four cancer programs in California, and the only one in Northern California to earn the award. This is the third consecutive time the cancer program has received this award, earning the distinction in 2008, 2011 and now in 2014.

Outstanding Achievement Award winners represent approximately 15% of the programs surveyed in 2014 and represent the “best of the best” according to David McKellar, MD, chair of the CoC. “Each of these facilities is not just meeting nationally recognized standards for the delivery of quality cancer care, they are exceeding them.”

Accreditation by the CoC sets quality-of-care standards for cancer programs and reviews the programs to ensure they conform to those standards. Accreditation is given only to those facilities that have voluntarily committed to providing the highest level of quality cancer care and which undergo a rigorous evaluation process and review of their performance. To maintain their accreditation, facilities must undergo an on-site review every three years.

In addition to exceeding the seven standards of care required for an Accreditation with Commendation, the Marin Cancer Institute fulfilled all 27 additional standards required for a Comprehensive Community Cancer Program.

“This national recognition not only demonstrates the high level of cancer care we deliver here at the Marin Cancer Institute, it testifies to the special work done here every day by our staff and physicians for patients, families and our community,” says Lloyd Miyawaki, MD, MPH, chair of Marin General Hospital’s Cancer Committee.

The CoC accredited cancer programs in the U.S and Puerto Rico represent approximately 30 percent of all hospitals. The accredited programs diagnose and/or
treat more than 70 percent of all newly diagnosed cancer patients each year.

Marin General Hospital’s cancer program has been continuously accredited since 1985.

About the American College of Surgeons’ Commission on Cancer
Established in 1922 by the American College of Surgeons (ACS), the CoC is a consortium of professional organizations dedicated to improving patient outcomes and quality of life for cancer patients through standard-setting, prevention, research, education and the monitoring of comprehensive quality care.

Cancer gets personal for Marin oncologist

Peter Eisenberg and MIJ

Richard Halstead from the Marin Independent Journal, writes about Dr. Peter Eisenberg, a prominent oncologist who has been treating Marin cancer patients for more than 36 years, return to work after experiencing his own brush with the dreaded disease.

Listening to Eisenberg, 68, recount his successful surgery for thyroid cancer in July, however, one might think he'd just recovered from nothing more serious than a bad cold. Read the full article here.

San Anselmo doctor has helped Marin breast cancer sufferers for 26 years

Marin Independent Journal

Megan Hansen from the Marin Independent Journal has written an article about Marin Cancer Care's very own physician, Dr. Bobbie Head who has seen it all — witnessing the evolution of new medical treatments and watching patients handle their fears. "My goal in going into oncology was to relieve pain and make sure people can die a peaceful, dignified death. That has changed as fewer people I take care of are dying," Head said. "I enjoy reassuring people we can treat them." Read the full article here.

Management Lessons From the MAYO Clinic

Mayo Clinic Model of Care 

Patient Care

  • Collegial, cooperative, staff teamwork with multispecialty integration.
  • A team of specialists is available and appropriately used.
  • An unhurried exam and time to listen to the patient.
  • A physician takes personal responsibility for directing patient care over time in a partnership with the local physician
  • Highest quality patient care provided with compassion and trust.
  • Respect for the patient, family and the patient’s local physician.
  • Comprehensive evaluation with timely, efficient assessment and treatment.
  • Availability of the most advanced, innovative diagnostic and therapeutic technologies and techniques.

The Mayo Environment

  • Highest quality staff, mentored in the culture of Mayo and valued for their contributions.
  • Valued professional allied health staff with a strong work ethic, special expertise, and devotion to Mayo.
  • A scholarly environment of research and education.
  • Physician leadership
  • Integrated medical record with common support services for all outpatients and inpatients.
  • Professional compensation that allows a focus on quality not quantity.
  • Unique professional dress, decorum and facilities.

The clinic has patient‐centric aspects in their scheduling system. Most importantly, it provides the physicians an opportunity to spend as much time as needed with each patient, a critical Mayo commitment.

The architectural intent has been to create a sense of substance that justifies patient confidence. “Patients immediately need to feel that they made a good choice in coming to Mayo Clinic.”

Further encouraging collaboration is an all‐salary compensation system with no incentive payments based on the number of patients seen or procedures performed. A Mayo physician has no economic reason to hold onto patients rather than referring them to colleagues. Nor does taking time to assist a
colleague result in lost personal income.

Dr. Trasek, CEO of Mayo, AZ, continually reinforces the principle of “teach don’t blame.” When something goes wrong, when a mistake occurs, it should be viewed as a teachable moment, an opportunity to get better.

Mayo Clinic and its patients benefit from a high level of volunteerism from the staff. Extra effort for the patients and the team is embedded in the essence of the culture. Most Mayo employees volunteer hard. “Mutual respect is important here,” asserts Bridget Jablonski, a nurse team leader for oncology. “ There is an expectation that you treat everyone with respect whether it’s your patient or colleague, physicians, housekeepers., everyone. You incorporate them as a member of the team. None of us could do our job without the contributions of others.”

Mayo Clinic’s two primary values‐“the needs of the patient come first” and “medicine should be practiced as a cooperative science” reign over all others.

After hearing comments about the unexpected efficiency of Mayo in patient focus groups, their marketing efforts added a question about efficiency in their patient satisfaction surveys. The results show that systems and processes that efficiently control the flow of the patient experience are as
important as the care provided to patients’ overall satisfaction.

Nothing is more important than finding the right individuals to lead, whether physicians or administrators. It is not enough to rely on the gifts of emerging leaders. “ The nurturing of physician leaders is extremely important.”

None of the Mayo four facilities has the traditional “hospital administration “ found in most hospitals. Rather, Mayo hospitals operate largely through a physician‐led hospital practice committee on each campus. The key members are the physician chair, the nursing chair and a designated hospital administrator. They serve as a triumvirate for day to day decisions within the hospital.

The Mayo management model uses many thousands of hours of the precious resource physician time. They have up to 80 committees to deal with issues across campuses. Much of the administrative work is accomplished through committees and task forces.

Mayo Clinic’s salary system is deeply rooted in the culture and the values that created this unique organization. The Mayo brothers were committed to paying all employees fairly and generously though not lavishly. Dr. William Mayo believed that the salaried physician was a crucial element in their practice model. It doesn’t matter whom they see, how long they spend, what they see, they just have do the best they can for the patient here.

Newly employed doctors earn a salary that will, with annual increases, max out in five years. Physicians earn more vacation time and academic rank but top off in income quickly. Financial incentives have not been necessary to motivate physicians who embrace the values and mission.

They evaluated their compensation system and concluded that a productivity‐based compensation system would not necessarily increase productivity significantly among physicians and, more importantly, could irreparably damage their culture. To sustain high productivity, the major management objective is “to foster an environment of unity and trust.”

The shared management structure at Mayo works well. “ The physicians have as much at stake as administrators do to ensure that the institution profits financially. Administrators have as much at stake as the physicians do to ensure that patients are well cared for.

Mayo thrives because a benevolent employer fosters a generous, giving spirit in its workforce. Those who need to bask in the starlight of personal recognition or wealth thrive elsewhere.

Most management decisions at Mayo are made by groups, not by individuals. The CEO is the spokesperson for the decisions.

The Mayo has continually nurtured the next generation of leaders who believe in its values. The term limits associated with most leadership ensures the rotation throughout the organization.

High performing organizations do deliberate hiring. They take the time necessary to find just the right employee. “ Mayo is not an easy place to get hired.” They have so many steps, so many people involved in screening and interviewing, even at entry‐level jobs. The people who survive really want to work there.

Panel interviews are standard across the organization. A panel may ask, “ Tell me about a time you had to disagree with your boss to make a mistake from being made.”

Candidates may be asked to describe a past project. Whether candidates use the word “I” or the word “we” is of particular interest to the panel.

Mayo focuses on values over skills. Skills can be trained and values cannot.

Mayo invests significantly in in‐service training. Many are a single session with several hours of education; others might extend over a few days.

They invest in their employees. In most cases, Mayo helps the employees who are failing or under performing find a niche that better fits who they are and the capabilities they offer.

Patients do not encounter physicians in casual attire . Unless they are in surgical scrubs. Mayo physicians wear business attire at work. “ The wearing of business attire rather than white coats is recognized by our patients as a unique dress code that projects an aura of expertise and respect for patients accompanied by warmth and friendliness.”

Mayo nurses wear white because research shows that is what hospital patients prefer. They require solid colored scrubs as well. Each unit needs to come to a consensus for the color from a list of approved colors.

No marketing textbooks or marketing consultants guided the founding of the brand. Mayo had a one person marketing staff from 1986‐1992. To this day, it uses little media advertising to promote clinical care.

The two primary sources of external brand communications are word‐of‐mouth –often conveyed via the Internet‐ and publicity, including reports in the news media.

Mayo Clinic is a benevolent employer. Because, Mayo Clinic takes good care of its employees, the employees are more likely to take good care of those they serve.

Mayo Clinic leads all other U.S. providers when you look at objective measures of outcomes, safety, service, preventable death, mortality rates adjusted to account for preexisting medical problems and health status, and adverse event with harm to the patients. The catalyst to change is transparency‐ there is open sharing of performance measures of the clinical groups.

Money matters at Mayo. The difference between Mayo and other organizations is that money doesn’t drive the bus. Mission does, and this is a key reason the Clinic can attract good staff members who do such good work.

The physician perspective wins out when there is a tie vote on decisions. Administrators are partners, but they are not equal partners, and this is purposeful.

Mayo is intolerant of prima donnas regardless of whether they are administrators, nurses, doctors or anyone else. You may find a few here and there, but they rarely hire these kind of people, and if they do, they don’t last long.