We hear an oncologist’s perspective on healthcare from Rana Bitar in this episode of the Perspectives on Healthcare Podcast with Rob Oliver. Rana is originally from Syria and now practices in the state of New York. She is an oncologist/hematologist in private practice and member of Generation X.
Here are 3 things that stood out as Rana Bitar shared an oncologist’s perspective on healthcare:
· Quality healthcare, in the realm of oncology, involves being a healer for the patient. Being a healer is more important than being a doctor, according to Rana Bitar.
· A cancer diagnosis impacts far more than just the individual receiving the diagnosis. It affects their entire social circle.
· It is necessary to treat each case as a unique human experience, understanding each patient’s circumstances, philosophy, place in life, and goals.
· Bonus: Quality of life is not determined by a medical professional but by the patient themselves.
You can learn more about Rana Bitar and her book through the links below:
Website https://www.ranabitar.com/
Twitter http://www.twitter.com/ranabitarbooks
Facebook https://www.facebook.com/RanaBitarBooks/
Here is the transcript of Rana Bitar providing an oncologists perspective on healthcare”
Rob Oliver: Thank you. And welcome to another edition of Perspectives on Healthcare. Today’s perspective comes from Rana Bitar, she is a hematologist and oncologist. She is a member of Generation X. And Rana, welcome to the podcast.
Rana Bitar: Thank you. Thank you for having me.
Rob Oliver: Absolutely. So let’s jump right in here and tell me a little bit about yourself and your role in health care, please.
Rana Bitar: Sure. I was born, raised and educated in Damascus, Syria. I came to the US in 1990 for my medical training, and I eventually specialize in hematology oncology, which means I treat patients with cancer and blood disorders. And I’ve been in practice in upstate New York for about 22 years. I’m also a poet and a writer. I completed a master in English and creative writing a few years ago. I have published poems and essays in many journals. I have a book, Poetry, published in 2019, and I have one coming up next year. And I just published a few months ago a nonfiction book about one book about my experience as an oncologist.
Rob Oliver: Fantastic. Congratulations on the books, and I wish you much success with that.
Rana Bitar: Thank you.
Rob Oliver: Yeah. As far as hematology and oncology go, are you dealing mostly with lab results? How much of an interaction are you able to have with the patients and how much of it is kind of doing testing and that kind of thing that’s removed from the patients?
Rana Bitar: Yeah. It is a full perspective of oncology. I see patients, examine them, take their history, do lab results, read the scans, treat them, talk to them. So it’s 100% interaction with patients in conjunction with analyzing the lab data and their studies and the pathology reports and all of that.
Rob Oliver: Okay. What does quality health care mean to you?
Rana Bitar: Well, that is a universal definition of quality healthcare, which is usually defined as having access to qualified healthcare professionals who will administer care safely and according to standardized measures. But in oncology quality care takes a step further. In my opinion, a lot of oncologists can provide the appropriate level of knowledge and follow treatment guidelines. But an oncologist needs not only to treat disease. I think they also need to be healers. Cancer is a life altering experience, and it could be the Mark that may tell a patient they have a few months or a few years to live. And many patients faced with such a serious realization, they really don’t have time or energy to organize their thoughts and be focused on the prospect of looking at quality rather than quantity. So as a healer, an oncologist can help their patient accept their vulnerability. They can assure them from a state of pain and devastation to a state of realization and focused on the moment so they can examine their lives and their priorities and start thinking about the things they probably always shelves, like relationships they never had or trip they didn’t make or words they didn’t say. So I think if an oncologist can do that, they can elevate the quality of care they provide to their patients. In my opinion, being a healer in oncology is as important, if sometimes not more important than being a doctor.
Rob Oliver: Okay. So what I’m hearing you say is that your work as an oncologist involves not just looking at cancer cells and not just looking at blood composition and so on, but you’re also looking at the psychosocial elements of it. I’m curious, are you working with people in their families as well, or because that’s what you talked about is relationships that they didn’t have or things that they should have said or that kind of thing? Does that element enter into the care that you’re providing as well?
Rana Bitar: Well, actually, when you deal with patients with cancers, you’re always in close contact with their families. I mean, it’s not only them in the room when I see them or when I talk to them on the phone. It’s the whole aspect of dealing with them and their position in their family and their work and all of that. So it always naturally involves their family members and sometimes their friends, sometimes their neighbors. So it extends beyond the patient themselves.
Rob Oliver: Okay. Can you give me an example of quality healthcare?
Rana Bitar: Yeah. As I mentioned earlier in Oncology, delivering quality care does not only mean treating each case appropriately and safely, but also treating each case as individual human experience with sets of challenges and difficulties that are specific to that patient, and that involves getting closer to patients emotional struggles and listening to their suffering and trying to understand their personal philosophy about life and death. So an example, say you have three patients with lung cancer with the same stage and the same treatment options, and Oncologists can go in the room and present the evidence based treatment plan to each patient according to the national guidelines. But these patients are not the same people. One patient might be a healthy grandfather whose goal in life is to spend quality time with his grandchildren. And it’s summertime and he wants to go to the beach or use more park with them. And he doesn’t want to lose his hair. It’s important to him not to make the young kids feel anxious about him. So I listen to him, and I understand his point of view. I don’t read the tool or discredit his concerns about his hair. So we left the treatment options. And although the one that would not involve losing his hair is not the best based on your clinical evidence based data, but we go with it because what’s important to him at that moment is not the higher response, but the chance of not going bald. Same situation. Second, patient with the same stage of cancer, same treatment options. But this one is young, and he has to work to support his family, his breadwinner. So we work his team, a regimen around his work schedule. He’s worried that his wife doesn’t understand why he’s tired and why he can’t do what he used to do with the kids. So I bring them in and we talk about what she can do to help him, what she should Cook at home, what she should tell her kids about why their father is not being as active with them. And we bring to life all the possible collateral concerns. And that is a lot of the tremendous pressure the family can go through during such a challenging time. Third, patients, same type of cancer, same stage. But this one is an older patient. He has dementia. He can’t make his own decision about does he want to go through treatment or he wants to opt for supportive care, and the family needs to make that decision for him. So I meet with his daughter and we talk about the treatment options, the possible side effects, and most importantly, we talk about him, about the patient, about his life prior to his diagnosis with dementia. What was his philosophy, his values? And based on that, we conclude that if he were to make his own decision, he probably wouldn’t want to receive chemo. And we opted to enroll him in supportive care program. These are three examples of what quality of care is not about, only especially in ecology. It’s not about an algorithm that you go through. It’s about individualizing what each patient needs and what their priorities and what would be best for them at that time.
Rob Oliver: Right. So again, what I’m hearing you say is that quality healthcare is really dependent on the patient and what their goals are and making sure that the health outcomes match with the stage of life that they’re at and with their goals in life. Can I just get you to clarify something for me? You had talked about as an oncologist being a healer. And my sense is that you don’t mean just healing people from cancer. It involves a different type of healing than just healing disease.
Rana Bitar: Absolutely. It’s the conjunction. It’s not only administering chemo and talking to them about their diseases, but also talking to them about their life around that disease. So it’s not one or the other. It’s a complementation of the medications and the administration of treatment. It has to be complemented with understanding the patient’s philosophy and their priority, but not instead, obviously.
Rob Oliver: Got it. What do you wish people understood about your role in healthcare?
Rana Bitar: Well, in some circles, oncologists are looked at as toxic chemo pushers who keep pushing drugs, even if it’s futile. I actually have patients who would go to the Er for colicistectomy if they have gallbladder disease. And they get told that, well, they have cancer, they better go in Hospice and forget about it. And some of the health care providers still operate in years past analogy. In that regard, having cancer is no longer a six month sentence as it used to be with the new treatments that we have. I’m seeing patients with brain metastases living with cancer, good quality of life. They lost their kids getting married. They meet their grandkids. So I would say people in the health care system don’t rush into giving patients automation based on outdated information. Just let the oncologists do their work and talk to their patients because they know them best.
Rob Oliver: You bring up a buzzword that really hits home with me, and it’s the concept of quality of life. And really the question becomes, who determines quality of life? And for me, listen, I’m a person with a disability, okay? I’m a quadriplegic, I use a power wheelchair. And there are a lot of people that would look at me and say that I have a low quality of life, but I live my life and I’ve got a high quality. I’m very satisfied with the things that I am able to accomplish and what I’m able to do. And I think that what you’re alluding to is the fact that sometimes medical professionals are evaluating what they think a person’s quality of life is. And that’s not necessarily accurate. It really depends on their own outlook and their own experience to determine quality of life. Does that make sense at all?
Rana Bitar: It makes all sense, yes. I think quality of life is not determined by the healthcare providers. It’s determined by the patients. What does it mean to them to live a quality of life? And that varies tremendously between patients and their background and their philosophy. It can be determined by their doctors? Absolutely not. I’ve had patients telling me that their quality of life is not to come into the office every week for blood tests. And I have patients telling me that their quality of life means that they feel confident that they’re doing everything to fight their disease, even if it means they spend hours every week in a chemo. So it varies tremendously and can only be determined by the patients themselves and not the doctor.
Rob Oliver: Thank you for sharing that. What excites you about the future of health care?
Rana Bitar: What excites me is the medical innovations that now give us much hope to otherwise used to be helpless situations, from gene therapy to mRNA technology to biotech breakthroughs. Also, what excites me is the availability of knowledge at the tips of my fingers. Because in oncology things change pretty fast every day. There is no study, new trials, new medications. And having the accessibility to be on top of all the recent information is a blessing to me.
Rob Oliver: Yeah, that’s so true. And I would imagine that your patients have similar experience in which there is information and knowledge available to them as close as the nearest computer or smartphone where they can Google something. And I would imagine that you’re finding that patients today have at least the opportunity to be more informed about their own care than they ever have in the past.
Rana Bitar: Yes, I think it goes both ways. They have definitely more opportunity to be informed, but also sometimes they get misinformed by the wealth of information they have. So this is where your role as an oncologist come to clarify to them what the valid information that they read and what’s not. But definitely the access to information is tremendous these days, and it’s very helpful.
Rob Oliver: Very true. So what is one thing medical professionals can start doing today to improve the quality of healthcare?
Rana Bitar: Well, I wish there was one thing that could be done to improve quality of care. I think many things need to come together to do that. Some should come from the outside, that we don’t have much control as doctors, like changing the role of insurance companies in dictating what doctors could do or couldn’t do, changing the formula of drug coverage and copay programs, like improving quality of electronic medical records to avoid redundancy and duplication. But the one thing that doctors can do today is really to restore the sacred doctor patient relationship of trust and respect that’s sadly been put on a shelf and replaced by either, as I mentioned before, misinformation on Google or relying on some other Media’s information. And I think to do that, doctors should start being more engaged in their patients with a close humanistic level and deep empathy.
Rob Oliver: Tell me more about that concept that you mentioned of the sacredness of the doctor patient relationship. What does that mean to you?
Rana Bitar: Well, it means to me that when a patient comes in, they are especially from my experience with cancer patients, they are scared the minute they learn they have cancer. By the time they come to me, they had Googled 100 sites and websites and information and information about drugs and all of that, and they’re confused. They have all this data thrown at them from every angle, and they can’t maneuver all of it to kind of figure out what to do unless when they come into their oncologist, they feel that the College is understanding them and hearing them and have compassion to their concern. Unless they start trusting that their best interest is on his or her mind, they get lost in all this information that they have. So I think that sacred relationship is very important between the doctor and patient. That comes with time and with a close relationship. Again, especially in oncology because it is very hard for a patient to maneuver all these information that are available everywhere with your cancer patients. You see them very often, and I see them very frequently, once or twice a week. And unless you have this closed relationship with them, that becomes a burden on them to try to understand each article they read or each thing they Google on the web and this is I think it’s very important for the quality of life because they go on through their journey with ease, knowing that they are being cared for and their concerns and questions are answered.
Rob Oliver: Thank you so much for sharing that and listen Rana Bitar, I appreciate you joining me today for the podcast. I appreciate you sharing your thoughts and giving insights into the work that you do and I respect your perspective on healthcare.
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