Jim Waisman is one of the most respected breast cancer oncologists in the world. For many years a leader in the research and academic aspects of breast cancer, Dr Waisman has been a Co-Director of Breastlink for the last five years. He has a unique ability to work alongside women in their fight for a cure and survival of breast cancer, and to become their friend and confidant in the process. He is a tireless campaigner of Optimal Care for women.

“It is not uncommon for me to reach a point in a consultation with a patient where a decision is unclear. The data may be unclear the, options may be varied and the patient faces uncertainty as to the right choice. So then she asks: ‘doctor, what would you say if I were your wife or your mother?’ Most doctors hate this question, after all it is not about “me” it's about “you”.

Yet for me this is absolutely the right question…but most physicians misunderstand the intent of the question.

The patient is saying ‘Please…treat me like I am your family. Treat me like I am that precious to you. This may be for me a life and death decision. Treat me exactly as you would want to be treated not because we are the same or would react the same but because I ,as your patient ,am deserving of your absolute commitment to the most complete,thorough,comprehensive, cutting-edge, expert, consistent, compassionate care possible. Care you would insist on for yourself or your loved one. Care that is at its essence "optimal".

Lets take a journey with a breast cancer patient coming for the first time to Breastlink and see how we strive to optimize care.

The first contact of course happens on the phone. So that is our first “impression”. How is the patient greeted? Is she “heard”? If there is urgency and distress is that noted? Does she get a timely appointment? Is there accommodation to special needs? Does she know what to bring to the first appointment? Does she understand the competencies of the doctor she is seeing? At the end of that first phone contact has she felt "optimally" cared for?

At Breastlink we call this the intake process and the individuals interviewing the patients must have experience dealing with all the different aspects of breast cancer. They must be equipped to handle all the nuances and questions, and to be sure all the relevant data is gathered and that a timely referral is made. Their job is to ensure access to the appropriate service be it radiology, surgical oncology, medical oncology, genetics or even to a resource outside the practice when the patient cannot see us directly. For you as a patient, care must begin before the actual visit!

The next step has to do with analysis of information. Typically it includes reviewing x-rays, pathology slides, physician notes and patient history. This is all gathered and analyzed BEFORE you, the patient arrive. The data is only a part of you but it is the platform on which we begin to build a picture of “Optimal Care”. From it we can review and discuss the data and be prepared to define what more we need to know about you BEFORE we see you.

As an example, a part of the breast biopsy is preserved in paraffin wax called the “tissue” block. We may want that tissue brought to us before the first consultation. That tissue may need additional studies done by our pathology team. If we wait until we see you first and then get the tissue blocks it may delay treatment decisions. Why should we waste your time, your energy? You deserve the most in-depth analysis before your visit so that we can provide a comprehensive opinion at the time of the initial consultation.You deserve “Optimal Care”.

So now you have had a comprehensive individualized interview over the phone. We now have your relevant information and the relevant medical records that have been subjected to independent review by our experts, e.g. your mammograms and breast biopsy slides. You have been educated about the “Optimal Care” process and now we know about you.all BEFORE we meet you.

Here is a real-life example. You are 50 with a biopsy that shows early breast cancer. You are sent to us for a second opinion because you understand that there may be a need for chemotherapy. You work 40 hours a week and come home to take care of three kids ages 12,15 and 18.The 15-year-old is taken by you to basketball practice after you get back from work. The 12-year-old goes to Girl Scout camp and you are the troop leader. Your husband travels in a sales position and is gone four to five days per month and you are responsible for car pooling the kids to school when he is gone. All your family live in another city, your friends all work and have their own busy lives. You are told by your initial oncologist that you are going to be sick from chemotherapy, you need someone to bring you to your visits, you have to go on disability and you will be too sick to take care of your family for several days a month”.

“How do I fit the cancer into my life?” you ask.

I like to call this the “hurricane effect”. Life is in crisis, the chairs and tables and books are flying around the room and you and the family are just trying to hold on and not go into flight yourselves.

We can’t stop the" hurricane" but we can help give you the tools to make the world safer and sane again. It now becomes a partnership. Dealing with the logistics, the financial concerns ,the children’s emotional turmoil, and the impact on your husband becomes a shared responsibility.

It is our belief that you have an inherent right to this kind of “Optimal Care”. Breast cancer by definition is a serious illness, in some cases life threatening. Therefore, if we enter a contract with you, the explicit and implicit expectation must be that your care will be optimal all of the time, at all levels, with all caregivers.

As your physician I am most directly responsible to deliver and to oversee the “Optimal Care” process. That means: you have the right to expect that I am an expert in breast cancer. At Breastlink we ONLY practice in the area of breast cancer and breast disease. Our clinical, research and teaching activities are committed to one area. When we encounter a patient with a different cancer we refer them to other experts, even though as medical oncologist we are trained to take care of all cancers.

Why? Because otherwise we cannot deliver “Optimal Care”. To stay at the cutting edge, to know and be involved in the most current research, to be the leaders and innovators in our field, we intentionally focus the entire practice in the area of breast cancer. So, at the core of our philosophy each physician, surgeon, radiologist, medical oncologist, plastic surgeon, pathologist, geneticist must be an expert, an authority in the area of breast cancer.

As your medical oncologist I will interview you and provide you with an audiotape of our discussion.

Why? So you can focus on our conversation without needing to take notes or be distracted by thinking you need to remember all these new complex facts. You can listen to the tape and share it with others, and be prepared at a second visit to ask questions. I will get an entire history from you and we will outline a plan of care that is comprehensive, collaborative and offers only state-of-the-art medical care. It is then my responsibility to facilitate your journey so that the next contact, e.g., the breast surgeon, assumes full responsibility for your care, coordinates that care with me and continues to fully communicate with you and your family.

The discussion with me may include the need for chemotherapy first or surgery first. Maybe I’ll disagree with a previous consultant. Maybe I’ve supported your ability to save your breast. I may offer you a special research protocol that gives you an opportunity not available somewhere else. The discussion that we have and the depth of that discussion and your ability to trust the recommendation and deal with the difference of opinion has a lot to do with the totality of your experience at Breastlink. Most important, you must leave feeling that recommendations serve your best interests and not mine.

The breast cancer journey is long and varied and full of complexities that cannot always be anticipated. As long as the commitment to your very best interests is insisted upon at every juncture at every interface with a member of the care team, and as long as you can keep asking, “What would you want if it were you?”, you should be receiving Optimal Care.

For further information on Optimal Care at breastlink click here.