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Taking Her Advice
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For years, Rozalina G. McCoy, M.D., has counseled patients and colleagues in Mayo Clinic’s Division of Community Internal Medicine about avoiding low-value tests and treatments — those that add costs, potential harm and burden for patients, yet have little proven benefit. It’s an easy thing to preach, but as Dr. McCoy learned through her own health scare, not so easy to practice.
In 2017, Dr. McCoy was treated for advanced Hodgkin lymphoma. Now in remission, the young mother of two preschool-age children should be reveling in her victory. But instead, as she writes in an essay to her peers published in the Journal of Clinical Oncology, Dr. McCoy finds herself anxious about no longer being continually monitored by her care team, who recommend not performing routine surveillance scans.
“I was surprised, confused, fearful and even defiant,” she writes. “Could I really forgo these tests?”
Dr. McCoy’s hematologist “argued that routine imaging tests generate false-positive findings, anxiety and high costs without definitive or meaningful survival benefit.” It was information Dr. McCoy knew well. She’d presented the same evidence to her own patients, albeit about different diseases and interventions. But now that she’d become a patient herself, Dr. McCoy “could not shake the fear that this reprieve was an illusion.”
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Empowering Patients Through Shared Decision-Making
Sometimes patient-centered care means doing less, not more. A litany of tests, treatments and procedures may be available for a condition, but they might not all be proven to add value to the patient’s care over time.
Overtreatment can even be harmful.
That can be difficult to communicate to patients who are vulnerable and scared. Through shared decision-making, physicians and patients discuss the evidence-based pros and cons of certain treatment strategies. The goal of research into shared decision-making by Rozalina G. McCoy, M.D., is to empathize with patients while also helping them make informed decisions about their own health.
It all adds up to higher-value care, according to researchers in the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. The center’s experts develop best practices such as shared decision-making that unclog the health care system of unnecessary costs and remain true to the Mayo Clinic Model of Care. By empowering the patient, the center upholds Mayo Clinic’s core value — the needs of the patient come first — amid an ever-evolving health care landscape.
That, Dr. McCoy writes, gave her a better understanding of the fears and worries her patients have shared with her, both about cancer and other diseases. “Living through these experiences led me to question and appreciate the basic tenets of shared decision-making,” she says in her essay. “As a physician in clinical practice, I no longer have the same naïve confidence in my ability to counsel patients about the waste of low-value tests, procedures and treatments. Instead, I can now empathize in a new and real way with their worries, hopes and internal conflicts about treatment decisions.” ■
After a frightening diagnosis, Marty Button found hope at Mayo Clinic. Ten years later, she thanked her care team from the summit of Mount Kilimanjaro.
Michele Halyard, M.D., began her journey as a radiation oncologist at Mayo Clinic 36 years ago. Today, she is recognized as one of the most influential and impactful leaders in the movement toward health equity.
Lionel Kankeu Fonkoua, M.D., is an oncologist with Mayo Clinic Comprehensive Cancer Center who specializes in the treatment of gastrointestinal cancers. He is leading a clinical trial focused on the immigrant African and Asian communities of Minnesota with a high prevalence of one type of liver cancer.