Fulfilling The Commitment To Highest Quality Care Through Patient-Oriented Research

She is an older lady, worn and tired. The radiant enthusiasm of her smile is diminished. Her disease has recurred and it is insidiously draining her of all vitality. During our meeting, I focus on determining which of her many symptoms might be relieved. Afterwards, her constant companion asks, "Doctor, do you enjoy your work?" I pause and say, "Yes. I love my work and feel fortunate to do what I do." And, I might have added, I feel overwhelmed with the challenges. Every day I care for people with diseases for which we have an elegant biological explanation but no effective, well-tolerated treatments.

We discuss her options for further care. I review the typical behavior of this disease, the likely outcome without further therapy, and the uncertain benefit relative to the risks of further therapy. We have known each other several years, so she is not surprised when I suggest that further therapy, if she chooses it, should be through a clinical trial.

This is an unprecedented time in the study of the biology of human disease. Exciting discoveries are reported almost daily concerning the causes of cancer. But the distance between understanding cancer's cause and effectively treating it is vast. Many people continue to die of their illness or of complications related to treatment. My personal choice is to actively engage in research while practicing medicine. My goal is to translate laboratory insights into drugs and treatment strategies that improve the outcome for individuals with cancer. However, first and foremost, I am a physician who cares for people today. I believe patient-oriented research, dedicated to improving future medical care, allows me to take the best possible care of people today. This claim may surprise many physicians.

What is patient-oriented research? It is the systematic study of a disease in order to understand its likely consequences and to determine the therapy of most benefit without undue side effects. Physicians counsel, recommend and administer treatment, and those with a significant involvement in patient-oriented research are perhaps best suited to accomplish these tasks. Counseling is enhanced because clinical trials require the physician-investigator to explain and justify the new approach to other physicians. Recommendations for treatment are most likely to be reasonable when they have undergone similar review. And, most important, treatment choices are greater and perhaps more realistic.

For many cancer patients, no effective FDA-approved treatment is available. While investigational approaches may not prove effective either, they do offer possibilities for patients now and in the future. Further, today's beneficial treatments would never have been developed without the physician-investigators and patients who participated in clinical trials.

My patient and I continue our long and difficult conversation. She eventually chooses to participate in a trial of a new therapy being conducted to determine its safety and effectiveness in treating her disease. She knows it is a risk. She also knows that the process which made this option available assures her that the choice of this therapy is not arbitrary and that her care will be of the highest caliber. For my part, I am assured that my choice to participate in patient-oriented research allows me to honor my commitment to provide the highest quality of medical care possible to her and others.

(Dr. Cripe is assistant professor of medicine, Department of Medicine, Division of Hematology/Oncology.)