by Eric J. Keller, MS3, Feinberg School of Medicine at Northwestern University
“You have cancer….”

“What?” Mr. Markowski[1] thought to himself. All he could hear was the muffled voice of his new oncologist, Dr. Harris. And what was that ringing? It was like a grenade had detonated in that small office. He was, well, shocked.

“Mr. Markowski?” Dr. Harris asked faintly. “Yes?” “I’d like you to see a colleague of mine. His name is Dr. Jeff Okada. He’s an interventional radiologist who may have some additional options to discuss with you.”

Minutes later, Mr. Markowski had left. There were no tears, no questions, just a deafening silence. Dr. Harris learned back in his chair with a long sigh and picked up his phone. “Jeff? This is Greg Harris over at the VA, how are you today?” … “Well, I got this guy with HCC who might be a candidate for one of your embolization procedures. You think you could see him later this week?” … “The patient’s name is Mark Markowski, date of birth 5/26/50….” “You sure you don’t need anything else?” … “Okay, well thanks, Jeff.”

Within a few days Mr. Markowski was in Dr. Okada’s office. All charts and previous imaging had been collected by his staff and reviewed. Mr. Markowski had expected a short visit; after all, he figured you’re either a candidate or you’re not. Instead Dr. Okada took a seat close to him and shook his hand. He asked Mr. Markowski about his life, concerns, hopes, and values. “You know,” Dr. Okada said, “Radioembolization is great procedure, but I want to make sure it’s a great procedure for you. Has Dr. Harris spoken to you about getting you paired with a patient advocate?”

“Perhaps he had,” Mr. Markowski thought to himself, “but that entire conversation had been a blur.” “Maybe,” Mr. Markowski replied “Perhaps you can take me through things again?”

Dr. Okada would ultimately perform a radioembolization on Mr. Markowski, but not before understanding the greater context of his new patient’s needs and discussing alternatives. After performing the procedure, Dr. Okada continued to follow up with Mr. Markowski and his family, monitoring the effects of his treatment not only on imaging but in terms of patient satisfaction and quality of life. Furthermore, he played a critical role in coordinating Mr. Markowski’s care, facilitating communication between care teams and access to community resources until Mr. Markowski slipped away in his sleep on home hospice.

A couple months later, Mr. Markowski’s wife stopped by Dr. Okada’s office. “I just want to thank you for being there for our family during this last year. I’m not sure you realize what a difference you made.”

The radioembolization had had a modest response in terms of technical success, but the service Dr. Okada provided had a lasting impact. For those unfamiliar with the current shift in the professional identity of interventional radiologists, Dr. Okada’s role in Mr. Markowski’s care may come as a surprise. IR’s historic position has been more akin to a consultant or receiver who accepts patients briefly for a potential procedure only to hand them off. Dr. Okada was instead a quarterback.

As a new primary specialty, there is an increasing interest in understanding and defining IR’s professional identity. New IR residencies will likely seek to foster mastery of imaging, procedural care, and nonprocedural patient care as a critical defining factor1. However, terms such as “patient-centered care,” “professionalism,” and “excellence” are so ubiquitous in healthcare that they often deserve further definition.

Expanding on these terms is outside the scope of this article, but Dr. Okada’s interactions with Mr. Markowski provide at least two examples worth mentioning: Dr. Okada sought to understand Mr. Markowski’s needs in the larger context of his personal narrative, and by doing so, he was able to become a co-narrator, partnering with Dr. Markowski to direct his care and address his needs2,3. Dr. Okada also promoted certain medical virtues4 in his actions that Mr. Markowski and his family likely perceived and valued. That is to say, what made Dr. Okada’s care perceived as “excellent” likely had more to do with him being perceived as honest, compassionate, and prudent than the technical success of his radioembolization.

The story above is simply one example of the lasting impact an interventional radiologist can have in lives of patients and their families. As the specialty’s professional role continues to grow, it may not only improve patient care in terms of minimally-invasive, imaged-guided procedures, but whole persons as well.

Citations:

  1. Kaufman JA. The interventional radiology/diagnostic radiology certificate and interventional radiology residency. Radiology. Nov 2014;273(2):318-321.
  2. Brody H. “My story is broken; can you help me fix it?” Medical ethics and the joint construction of narrative. Literature and medicine. Spring 1994;13(1):79-92.
  3. Charon R. Narrative and medicine. The New England journal of medicine. Feb 26 2004;350(9):862-864.
  4. Pellegrino ED. Professionalism, profession and the virtues of the good physician. The Mount Sinai journal of medicine, New York. Nov 2002;69(6):378-384.

[1] Although this story is based on real events, all names and specific details are altered for anonymity.