Welcome to The Blind Spot. Every misdiagnosis, every missed diagnosis, has a story. This show goes looking for it.
In the premiere episode, host Dr. Aditi Nerurkar sits down with Dr. Nadine Jackson, gastrointestinal medical oncologist at Dana-Farber and associate professor at Harvard Medical School. Their conversation starts with a simple question. What does it actually feel like to practice oncology right now, when the science is moving faster than the guidelines can capture it?
Dr. Jackson is honest about it. Some days exhilarating. Other days exhausting. Most days both. From there, the two doctors move through the systems Dr. Jackson has built to keep up. The three questions she asks before every patient encounter. The mentor who told her "know what we know, start there." The argument running underneath it all: staying current isn't a luxury. It's part of the job. And the system has to make room for that work.
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Episode Transcript
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Speaker 1 (00:15):
Welcome to The blind Spot. I'm doctor Aditi and Rukar,
your host. I'm so glad you're here for our inaugural episode.
This episode is sponsored by Pfizer. This show has been
a long time coming, not just for me, but for
everyone who has ever sat in an exam room and
felt like something important wasn't being said or maybe wasn't
(00:36):
being heard. Whether you were the one in the chair
or the one holding the chart, you probably know that feeling.
The conversation that almost happened, the question that didn't quite
get asked, the moment where two people who both wanted
the same thing somehow walked away from each other feeling confused.
That's the blind spot. And we're going to spend this
(00:57):
season finding all sorts of different blind spots in how
we deliver healthcare, naming them and figuring out what to
do about them. Because when I've walked into an exam room,
everything about that interaction is part of diagnosing what's going on,
body language, the unspoken stuff, or right as my hand
has been on the doorknob to leave that Hey, I
(01:18):
almost forgot to tell you, that is really really huge.
I've usually had just fifteen minutes. We usually have just
fifteen minutes to do all of this, as well as
making a plan for next steps. It's almost impossible for
both parties to feel heard and understood in this time crunched,
resource strapped environment, and this show is here to help
(01:41):
make it more possible together. I should know, because before
I became a Harvard doctor specializing in stress, I was
a stressed patient who felt dismissed and struggled to get answers.
When I found my way out of my own patient struggle,
i've it's to become the doctor I needed. I guess
(02:02):
that's why better provider patient communication is at the heart
of my work, both past and present, with my patients,
my colleagues, and even the public. It's easy to place blame,
but the one thing this show is not here to
do is a sign blame. It's not the healthcare provider's fault.
We have such a short time together with impossible demands
(02:24):
on our time and attention. It's not the patient's fault
that they feel rushed, unheard, perhaps scared, and can't relax
in an intimidating setting. And it's no secret that healthcare
is polarizing these days in all sorts of ways. So
here I want to declare a space of empathy, exploration,
and compassion. We're here to put the puzzle together to
(02:47):
make sure we all have the pieces we need. It's
a joint task. You know, we're on the same team.
Medicine is not a fixed body of knowledge. It's a
living thing, constantly revised, a casion only overturned, and right
now in oncology, especially moving faster than perhaps any other
moment in modern medical history. The biomarker landscape alone has
(03:11):
transformed so dramatically in the last decade that the guidelines
a physician learned in residency may bear only passing resemblance
to the standard of care they're expected to deliver today.
New tests, new targets, new evidence, and underneath all of it,
new questions about what we know, what we think we know,
and what we haven't figured out yet. As a physician,
(03:34):
I know the particular anxiety of a patient who arives
at an appointment armed with a study I haven't seen
something published last month, flagged in a patient advocacy newsletter,
shared in an online community that I've never heard of.
When we're navigating a serious diagnosis together, that relationship is
going to be crucial all the way through the structural
(03:56):
reality that knowledge moves faster than any one clinician can
absorb it, and that the system we've built around physician
patient interaction hasn't fully caught up to that fact is
where our blind spots can pop up, and that's the
focus of our episode today. My guest is someone who
has spent their career at the intersection of all of this.
(04:17):
Doctor Nadine Jackson is a medical oncologist and clinician investigator.
Her work is at the front lines of oncology, where
the biomarker conversation is no longer a specialty consideration, it's
a clinical expectation. We're going to talk about what it
actually looks like to stay current, what gets lost when
physicians can't, and what the conversation between the doctor and
(04:39):
patients sound like when the science is moving thrillingly fast.
Let's take a look, Doctor Nadine Jackson, Welcome to the
blind Spot. Your personal story of how you became a
physician is fascinating. Could you tell us a little bit
more about your journey and how you ended up on
(05:03):
the cutting edge of oncological science.
Speaker 2 (05:05):
So I am currently a gastrointestinal medical oncologist at the
Dana Farber Cancer Institute in Boston, Massachusetts. I'm also an
Associate professor of medicine at Harvard Medical School. I really
was motivated to pursue oncology because it sits at the
intersection of patient centered care and implementation and really fascinating biology.
(05:29):
The science of cancer and how we deliver that care
is really what I focus on, So how we implement
and get what we know out to the patients who
need it in real time. I began my healthcare training
as a nurse at University of Pennsylvania. I was fortunate
to work with the dean then Mary Naylor on a
(05:51):
fascinating research study focused on older adults, and then I
worked as a Ralston House Scholar Ralston House Scholar as
a geriatric program to train future geriatricians and doctors. Johnson
and Lavisa More were two of my mentors there, and
really observing how they approach the study and the science
of geriatrics and gerontology, combined with my exposure in nursing,
(06:15):
really helped me to focus on that population for care.
I matriculated to medical school because I wanted to pursue
a very deep path in medicine. I wanted to be
able to do a lot of complex research in medicine,
and my training at Johns Hopkins prepared me well for that.
And in addition to my MD earning, my masters in
(06:37):
public health gave me the broad perspective of what it
means to think about science, what it means to think
about health care and health and what are the domains
that informed that practice. And so those experiences combined really
brought me to this field of oncology. As a gastro intesloncologist,
(06:59):
I get to learn a lot about the complexity of care,
not only the care itself and how we deliver the care,
the diagnosis itself, and all the factors that go into that,
including the biomarker piece that I've focused on more recently,
but also how we bring all of those pieces together
to really improve outcomes for our patients.
Speaker 1 (07:19):
And how do you feel that your background as a
nurse first and doctor second contributed to your approach today.
Speaker 2 (07:28):
Nursing is a field that is very patient centered, and
I would argue that medicine is as well, except our
perspective of how those two elements are delivered may lend
us to believe that medicine is not really driven by
patient care, and that couldn't be further from the truth.
My nursing exposure gave me a level of comfort with
(07:51):
engaging with patients directly and making sure that I asked
patients what their priorities were, what mattered most of them,
Because as you're delivering care, no matter what aspect you're
delivering that care from from pharmaceuticals, from nursing, from bench
research to translational research and clinical research, if you anchor
(08:15):
on what matters most of the patient, then you can
eliminate a lot of the barriers to how you deliver
whatever it is you're trying to deliver to that patient
and to their family. And I think nursing really helped
me to get very comfortable with that and to bring
that question along with me and apply it to my
medical practice as well.
Speaker 1 (08:32):
It's fascinating that you say that, because in my work
in stress and burnout, that is the question that I
often ask, you know, what matters most? Absolutely? Yeah, doctor Jackson.
You mentioned that biomarker study earlier. The biomarker landscape has
shifted so dramatically from where you sit. What's driving that change?
Speaker 2 (08:54):
Right? Now from where I sit, what's driving the change
in the biomarker landscape is a convergence of technology and biology.
That technology really helps us to understand at a faster
pace what the underlying biology of cancer is, to expand
our understanding, to translate and interpret in real time. The
(09:16):
testing that we used to have only accessible to a
small minority of folks in the US is now widely
available and accessible. But if one does not access genomic
testing or biomarker testing early in a cancer diagnosis, it
can prevent you from having access to the best levels
of care.
Speaker 1 (09:36):
In addition to the study that you mentioned, Yeah, is
there a particular development or category of discovery that you
think is the most underappreciated even amongst oncologists.
Speaker 2 (09:48):
I think being able to recognize that this is not
extra work that we're doing when we think of biomarker testing,
this is fundamental and foundational work. It is what will
inform who gets access to what and when, and if
we're able to be more selective and more tailored in
the treatments that we select based on their genomic findings,
(10:11):
then we're actually able to help them live better with
that diagnosis. So I think that's underappreciated the fact that
it may feel like a lot of work. We're all
tackling so much when we engage with our patients. But
this extra quote unquote conversation that we're having about genomics
and biomarker really does pay off in the long run
for the patients that we're taking care of.
Speaker 1 (10:33):
It's not just the volume of information, it's the pace.
And as you are practicing medicine, what is it like
to practice medicine at this pace? You mentioned that there
are days when it's exhilarating, other days when it's exhausting,
some days a combination of both. But what does it
feel like on a day to day basis to practice
(10:54):
at this pace?
Speaker 2 (10:55):
It's definitely rewarding. It's rewarding to be able to have
information that you can share with patients that makes a
meaningful difference in their lives, lives of their loved ones
and their communities. To be able to speak with great
detail about what we know about their cancer, but also
over time, what we've learned. For me, I do this
(11:17):
by interacting with my colleagues in a variety of different
tumor boards, which are ways that we will discuss what
is the best approach for this patient. I appreciate the
fact that we're willing to come together to make sure
that we're meeting the highest standards of care when we
engage with patients, but I also look back at each
interaction and I really, as I approach each patient, ask
(11:39):
three key questions, which is really thinking about what is
the strongest evidence that we have to support the decisions
that we're making, And then what does the patient's biology
and their clinical and social contexts add to this discussion,
And then more specifically for my patient, what are their
individual goals and their tolerance of risk. I think that
(12:00):
helps me in my conversations with our patients to make
decisions that are tailored to their needs in real time,
incorporating the best level of evidence. But it also encourages
them to take the risk of genomic testing, thinking about
clinical trials. These are aspects of care that many patients
sometimes feel very overwhelmed by, but having that conversation upfront
(12:24):
really helps us to make a shared decision together.
Speaker 1 (12:27):
I love that framework those three questions, stintink that will
be very helpful to others who are maybe starting out
in their medical careers and would love to have a
framework to use when engaging in this dialogue with patients.
So thank you for sharing that. Guidelines are supposed to
be the anchor and they synthesize consensus that helps tell
(12:48):
us as clinicians what the evidence actually supports. But in
biomarker driven oncological care, guidelines feel like they're always catching
up to the science. How do you navigate that gap
between what the data is showing and what the guidelines
have formalized?
Speaker 2 (13:05):
I would say I fall back on that framework again.
Guidelines help us to have a shared and common language
with which to discuss what the evidence shows us up
to a certain point in time, So they're really a
snapshot of what we know. But you're absolutely correct, it's
hard to keep pace with the data as it's submerging
quite rapidly, and so falling back on what is the
(13:27):
strongest level of evidence. But the guidelines cannot substitute for
the information that you get in context of care for
your patient, what their goals and their preferences and tolerance
of risk are.
Speaker 1 (13:40):
You have to ground yourself in, of course, the theory,
but then you want to always have that practicality as
you engage. That's correct every physician has a system, or
at least we all attempt to have one, yes to
stay current. And you mentioned tumor boards. Some doctors and
(14:01):
healthcare providers use journals, We attend conferences, we speak to
other colleagues, and like you, engage in trumor board discussions.
What does that look like in practice for you, and
in what instances do you feel like that potential that
potentially breaks down in terms of having a system that
sometimes works and sometimes doesn't. I would love to hear
(14:23):
about when you feel like that works and what is
your system that you use to stay up to date.
Speaker 2 (14:28):
Certainly that collaboration with colleagues. I am very fortunate to
practice in an academic research center and so keeping pace
is a part of my day to day work. But
I would say my system is layered, so it incorporates
understanding what we know, so that's attending national conferences, joining
the tomor boards, the journal clubs, but also thinking about
(14:51):
where we have gaps in the evidence and what we
don't know, and then laying that on the patient or
the population as it so may be that you are
interacting with. So are my patients represented in the study?
Is this population well represented by the study. Is there
any supplemental data that can help me as I'm thinking
(15:11):
through this particular problem, and I think it answers the
second part of your question is where does that break down?
I think it breaks down where we have evidence gaps,
where we don't know what the checklist, so to speak,
should be, and when we're kind of defining the boxes.
But for me, the solution to that is to continue
to push our research forward, to really think carefully and
(15:33):
critically about every decision and evidence that we introduce to
make sure that it is representative of the population of
folks diagnosed with cancer who we are seeing. So it's
both using the system that's built on the evidence, but
also understanding that there are gaps, and that's a part
of the work, that's a part of the responsibility that
we have is to fill those gaps.
Speaker 1 (15:55):
So beautifully said, you know, awareness is that first step,
and when you are aware of the gaps existing, you
can in fact close those gaps.
Speaker 2 (16:04):
Correct.
Speaker 1 (16:05):
It sounds like the system that you have in place,
the layered system, as you so eloquently stated, has taken
decades of practice. You've been in clinical medicine for decades,
You've done so much research. You are a pioneer in
the field. When in your career did you develop this
practice and did you have any mentors or colleagues that
(16:27):
helped you learn how to incorporate all of this new
information in an ongoing way.
Speaker 2 (16:33):
I developed the system fairly early in my practice. It
was very clear that the place to start was based
on the evidence that we had. One of my mentors,
and I keep this phrase in my mind at all times,
he said to me, know what we know. Start there,
because you can get so overwhelmed by what we don't know.
(16:53):
So at the very least, know what we know, So
that's where we should all start. I am very, very
honored to have had mentors and sponsors and advocates who
are both transparents but also humble share their experiences of
how they continue to learn and continue to grow, and
(17:13):
also colleagues peers who we're doing this in real time together.
But I think that phrase really stood out to me.
Start from what we know, and then your work is
figuring out what we don't know and really addressing that.
Speaker 1 (17:27):
I'm going to take that with me. Know what you
know so simple, mm hmm, but it's something that you
can hold on to as you weed through and you know,
manage the overwhelm of the pace of information coming at
as fast and furious.
Speaker 2 (17:43):
Correct.
Speaker 1 (17:44):
Correct. Healthcare provider aren't the only ones keeping up with
the science. We know this. Are you seeing patients coming
(18:05):
in really informed about their diagnosis and potential treatment.
Speaker 2 (18:10):
I do have patients who are very informed about their diagnosis,
and they come in with extensive research. But I would
say many patients, although they have information, don't know how
to make sense of that information, don't know how to
integrate it into their values and their preferences and their
priorities about their care, and feel quite overwhelmed, particularly when
(18:34):
we're meeting. A big part of my approach is to
give that a name, to speak to that feeling of
being overwhelmed, to also normalize that this process is inherently overwhelming,
particularly when you're thinking about a cancer diagnosis, and to
reassure that we are partnering together and that's really what
we're doing when we're caring for our patients, as we're
(18:56):
partnering with them, with their families, with their communities to
deliver the best care possible. And I'll go back to
something you said earlier. In those periods where we're uncertain.
It's also important to point out that we're uncertain about this.
We don't know this or we don't know this yet,
but here are the ways that we're going to try
to find out and even I take care of patients too,
(19:18):
have cancers where we don't know where the cancer started,
cancers of unknown primary sites. We are still going to
figure out a way to take care of you, and
we're going to do that using the best level of
evidence that we have. I'll bring it back to the biomarkers, right.
This is where our biomarkers again underappreciated in our work
thus far, but hopefully that will gain in its use
(19:40):
and applications more over time. Biomarkers really help us to
fill in these gaps in uncertainty and really build the
evidence to support the decisions that we're making.
Speaker 1 (19:51):
You're so eloquent in describing the doctor patient relationship and
how it is loaded with emotion and overwhelm, anxiety, uncertainty,
and your expertise is to hold all of that in
a safe space so that you and the patient can
move forward together.
Speaker 2 (20:11):
Correct.
Speaker 1 (20:13):
Do you find that these situations can be a challenge
and how do you navigate that while continuing to empower
that patient who is sitting in front of you.
Speaker 2 (20:23):
I have the benefit of being able to see a
little bit into the future, right, so I know that
the overwhelm or the distress or the chaos, let's say,
of a new diagnosis will not always be that way
and will not always feel that way. I think a
part of our responsibility is to speak to that that
I understand what you're going through right now or I've
(20:46):
seen this before, so normalizing that this happens, but it
does not predict the future. I will share with my
patients that even though the beginning of your course may
have been a little bumpy and rocky, it doesn't mean
that it's going to predict what your outcome will be,
and that no matter what happens right, we're still going
(21:06):
to be working together to figure this out. I think
that's a big part of our responsibility is the partnering
with our patients, and what we bring to that is
our expertise in terms of delivering care and thinking through
the again that complexity of data, but making sure that
we're continually partnering with our patients in that process.
Speaker 1 (21:26):
And you said it so beautifully, doctor Jackson. The first
step is to normalize and validate the difficult experience, you know,
instead of that's correct hitting them with all of the
data and the different tests that you're going to do
and how you're going to proceed, just first sitting with
that patient in that difficult moment. Normalizing and validating goes
so far. It's the first clinical intervention.
Speaker 2 (21:47):
Yeah, I would add that we spoke at earlier in
our conversation about the pace of technology and the science
and how rapidly is moving and how much information we
have to absorb and into rate. But a part of
what we're doing as well is pacing with our patients.
So yes, it may be overwhelming, but we can pace
(22:08):
our understanding and are working through some of these tougher
decisions a bit over time and being clear on the
decisions that we have to make quickly. Again, the biomarking
testing should be one of the first things that we're
doing in a cancer diagnosis. The testing, even though it's
much more rapid than it used to be, it still
(22:28):
takes time. And if we want to have that information
at our fingertips to make decisions, we need to have
it early in the course of care. So I'm a
strong advocate for early testing, early education, early integration, and
decision making and ongoing conversations about how we're using this
information to drive care.
Speaker 1 (22:49):
Your approach is so meaningful to me, particularly because you
very much it is so evident that you think so
deeply about the emotional component of illness and not just
the medical component of illness.
Speaker 2 (23:01):
Correct.
Speaker 1 (23:02):
Correct, Ye. There's a particular kind of conversation that I
think is underappreciated, and you've touched on this in our
earlier conversation. It's the one where the physician is to
tell the patient that the science simply isn't there yet,
for instance, when there might not be a validated biomarker yet.
(23:24):
How do you, doctor Jackson hold that conversation.
Speaker 2 (23:29):
I think it's important to acknowledge that the data is
not there for everything yet. That's a part of the work.
That's why we do this work. And my setting, we're
often approaching our patients and their families to ask questions
to participate in research studies. So I think another part
of that is, well, why are we asking you? This
is why? And to bring our patients and their families
(23:51):
into why we're so excited about the work that we
do because we're seeing the improvement and it may not
be for that patient at that time, although sometimes it is.
I have many patients who have done quite well, but
over time we're seeing improvements and those incremental improvements are meaningful.
But it is important to talk about what we don't know,
(24:15):
and that's the motivation for learning it, finding it, participating
in these studies that we launch, including the study that
I mentioned earlier.
Speaker 1 (24:24):
You know, doctor Jackson, when a doctor says to the patient,
I'm not sure, I don't know, that can be a
very powerful moment because it means you know, I don't know,
but I'm going to be with you so we can
figure it out together.
Speaker 2 (24:37):
Correct.
Speaker 1 (24:37):
So there isn't that sense of abandonment, but rather empowerment
in the journey ahead, and.
Speaker 2 (24:43):
You have to stay there in that space, and I
think that can be difficult. It's not something that you
are not a class on uncertainty, right and as we're
going through our training, but that is the experience of
doing this work. But the beauty of it it is
that you can answer those questions over time, and that
(25:04):
you can, as you've already pointed out, empower patients as
they are making their decisions based on the data that's available.
Speaker 1 (25:11):
You. In your work as a pioneer in oncological care,
you work with colleagues across different practice settings at Data
Farber with other colleagues there in an academic medical center,
but you also work with colleagues at community hospitals and
smaller private practices. Do you feel that the physicians and
(25:31):
healthcare providers in those different contexts experience the speed of
biomarker science differently?
Speaker 2 (25:39):
I am quite sure that my colleagues experience the speed
of biomarker science, and I would add the complexity of
that data as it comes in it can be quite
difficult to interpret. I've been fortunate to work with as
a part of driving kind of biomarker education and navigation support,
(26:00):
work with testing vendors as well, who have turned their
attention to helping providers navigate this very complex space. My
work has focused on how do we help patients navigate
the space because they're huge gaps in that and we
certainly don't want misinformation around this data. We certainly don't
(26:20):
want reduced access because of this data or because of
lack of testing or engagement with it. And I think
a big blessing that we have in the way that
we work with our colleagues, both at affiliated sites but
also non affiliated sites, is this commitment to partner with
them in the care of their patient. So we are
(26:41):
very fond of having our own panel of patients that
we're managing primarily, but we also have patients who we
are not interacting with every day, but we're also assisting
in their care as consultants because we want to make
sure that patients, regardless of their touch point with Dana Farber,
are getting the best level of care. That's really what
our mission in oncology is about.
Speaker 1 (27:03):
You have developed a system to stay up to date
with decades of training. Are there a few places that
you would say to not engage in.
Speaker 2 (27:16):
He'll be honest. I don't tell my patients not to
look there or not to look here, because what I
want them to do is to feel empowered to discern
good information. So instead, I try to give them tools
by which the filter information. So for example, sharing what
(27:37):
we would consider our gold standard or the best level
of evidence is a randomized clinical trial, and where we
can mount a randomized clinical trial where we have a
sufficient patient population that can be enrolled to a study.
That's where we would say that's the best level of evidence.
Also understanding that in some situations, particularly rare care answers
(28:01):
or cancers with very poor prognosis, we may not have
the ability to mount a randomized clinical trial, certainly not
one measured over years, and so understanding why we would
use data that does not meet the gold standard in
context that may be the best level of information that
we have. I would also say anything that is asking
(28:22):
you to pay for your treatments to be able to
get that information. We're having these conversations with our patients
all the time, and so if you are not given
access to information, I think that could be a red flag.
And then they're very reputable resources through the National Institutes
(28:43):
of Health, the National Cancer Institute, that are more reliable
because they are robustly tested, that should be used as
a resource. The last resource that I will say is
there's a clinical trials database as well, where some of
our patients, ones that we mentioned are already heavily researched
before they come in have searched this clinicaltrials dot gov
(29:06):
website to look for opportunities for trials. And I certainly
encourage patients to do that, but also give them some
guidance on what are the search terms that are specific
to your cancer? How do we describe this cancer? If
I were speaking to a colleague, what are the terms
that I use that almost give you kind of a
fingerprint of the cancer if you were to search for it.
(29:28):
So you're not misled, you're not going down the wrong
path in terms of information.
Speaker 1 (29:33):
You really are thinking three four steps ahead because you
know your patients are going to engage in all sorts
of information, and so you want to make sure that
they are doing it in a responsible way.
Speaker 2 (29:44):
Correct.
Speaker 1 (29:45):
And I want to end with something hopeful and forward looking.
When you imagine your field in ten years, what are
some of your hopes for what we've discovered.
Speaker 2 (29:57):
I am convinced that in ten years are patients who
are coming into our institution first and foremost, that we
have found ways to go out to our patients so
they're not always having to come to us. So we
are embedded within our communities and the communities that we're serving,
that we're accountable and we're transparent, and we continue to
(30:18):
be so. But I would also imagine that patients are
coming in with their biomarker information as a part of
their diagnostic data at the outset of their diagnosis, not
weeks months later and in some cases never obtained, that
we're getting that information as quickly as possible. I would
also envision that we're using that data in real time,
(30:41):
and that we're pulling the biomarker data, integrating it with
other diagnostic features around their disease, but also around who
this person is, what are their priorities, what are their
prior histories, what is their social contexts, what's their health
literacy level? As we're engaging in these conversations, that we're
(31:01):
pulling all of that information together. And then I also
envision that, in addition to sharing with patients that your
outcome in terms of survival is expected to be this
versus that based on use of this particular regimen, that
we can also describe what their quality of survival will
look like. And I see us really having that at
(31:22):
our fingertips in real time for the patient in front
of us as we make these decisions. And I would
be remiss if I didn't add that. I would envision
that our structure of being able to support patients is
reflected not only the care that we deliver, but how
we pay for the care that we say we want
to deliver, and so that is reflective of us as
(31:44):
a whole, as a whole field.
Speaker 1 (31:46):
You know, doctor Jackson, your story, your personal story of
first being a nurse who then became a doctor. In
hearing you speak about the journey and how to me
you embody humanism and medicine, and I wonder if that's
played a role or it's just who you are. But
(32:08):
the responses, the eloquence, just the depth of your understanding
of the human experience. And it really seems like you
are sitting shoulder to shoulder with every patient you see.
And it is such an honor to speak to you,
and truly you are such an exemplar of what it
means to be a doctor.
Speaker 2 (32:27):
Thank you so much. I appreciate that. But I would
add again the context in which your practice is so important.
So make sure for students trainees, as you're considering how
you will practice, make sure you bring your full and
authentic self to that practice. Your patients need you to
be you, And also make sure that you're practicing with
(32:51):
colleagues who share those goals and are very driven by
the needs of their patients as well as I do.
Speaker 1 (32:57):
Thank you so much for taking the time to speak
to me and for joining us on the blind Spot.
Speaker 2 (33:03):
Thank you very much.
Speaker 1 (33:07):
Thank you so much to doctor Nadine Jackson for joining
us today. She is an exemplar of what it means
to be a compassionate physician and practice humanism and medicine
using the lens of the biopsychosocial model and whole person care.
I don't think I've ever heard someone so eloquently describe
the complexities and the tension in oncological care as beautifully
(33:31):
as doctor Jackson did. That's part of what I hope
the blind Spot can be, not just a source of information,
but a safe place where we can be candid about
the structural realities of practicing medicine right now, The pressures
you're navigating, whether you're a provider or a patient, the
conversations that are harder than they should be. You're not
(33:52):
alone in that. Join us next time. We're talking about
something we touched on today, patients coming into doctors' offices
armed with so much more information than was ever possible before.
But that comes with its own challenges too. We'll talk
all about it next time. In the meantime, follow the
(34:14):
show and leave us a review. It genuinely helps us
reach more of the people who might be running into
blind spots in their own care, whether they're giving it
or receiving it. You can find me across the web
at doctor Aditi Narukar. I would love to connect with you.
The blind Spot is a production of Iheart's Ruby Studios,
and this episode's sponsor is Pfizer. Visit Pfizer dot com
(34:38):
for more information. Until next time, thanks for listening.
Welcome to The blind Spot. I'm doctor Aditi and Rukar,
your host. I'm so glad you're here for our inaugural episode.
This episode is sponsored by Pfizer. This show has been
a long time coming, not just for me, but for
everyone who has ever sat in an exam room and
felt like something important wasn't being said or maybe wasn't
(00:36):
being heard. Whether you were the one in the chair
or the one holding the chart, you probably know that feeling.
The conversation that almost happened, the question that didn't quite
get asked, the moment where two people who both wanted
the same thing somehow walked away from each other feeling confused.
That's the blind spot. And we're going to spend this
(00:57):
season finding all sorts of different blind spots in how
we deliver healthcare, naming them and figuring out what to
do about them. Because when I've walked into an exam room,
everything about that interaction is part of diagnosing what's going on,
body language, the unspoken stuff, or right as my hand
has been on the doorknob to leave that Hey, I
(01:18):
almost forgot to tell you, that is really really huge.
I've usually had just fifteen minutes. We usually have just
fifteen minutes to do all of this, as well as
making a plan for next steps. It's almost impossible for
both parties to feel heard and understood in this time crunched,
resource strapped environment, and this show is here to help
(01:41):
make it more possible together. I should know, because before
I became a Harvard doctor specializing in stress, I was
a stressed patient who felt dismissed and struggled to get answers.
When I found my way out of my own patient struggle,
i've it's to become the doctor I needed. I guess
(02:02):
that's why better provider patient communication is at the heart
of my work, both past and present, with my patients,
my colleagues, and even the public. It's easy to place blame,
but the one thing this show is not here to
do is a sign blame. It's not the healthcare provider's fault.
We have such a short time together with impossible demands
(02:24):
on our time and attention. It's not the patient's fault
that they feel rushed, unheard, perhaps scared, and can't relax
in an intimidating setting. And it's no secret that healthcare
is polarizing these days in all sorts of ways. So
here I want to declare a space of empathy, exploration,
and compassion. We're here to put the puzzle together to
(02:47):
make sure we all have the pieces we need. It's
a joint task. You know, we're on the same team.
Medicine is not a fixed body of knowledge. It's a
living thing, constantly revised, a casion only overturned, and right
now in oncology, especially moving faster than perhaps any other
moment in modern medical history. The biomarker landscape alone has
(03:11):
transformed so dramatically in the last decade that the guidelines
a physician learned in residency may bear only passing resemblance
to the standard of care they're expected to deliver today.
New tests, new targets, new evidence, and underneath all of it,
new questions about what we know, what we think we know,
and what we haven't figured out yet. As a physician,
(03:34):
I know the particular anxiety of a patient who arives
at an appointment armed with a study I haven't seen
something published last month, flagged in a patient advocacy newsletter,
shared in an online community that I've never heard of.
When we're navigating a serious diagnosis together, that relationship is
going to be crucial all the way through the structural
(03:56):
reality that knowledge moves faster than any one clinician can
absorb it, and that the system we've built around physician
patient interaction hasn't fully caught up to that fact is
where our blind spots can pop up, and that's the
focus of our episode today. My guest is someone who
has spent their career at the intersection of all of this.
(04:17):
Doctor Nadine Jackson is a medical oncologist and clinician investigator.
Her work is at the front lines of oncology, where
the biomarker conversation is no longer a specialty consideration, it's
a clinical expectation. We're going to talk about what it
actually looks like to stay current, what gets lost when
physicians can't, and what the conversation between the doctor and
(04:39):
patients sound like when the science is moving thrillingly fast.
Let's take a look, Doctor Nadine Jackson, Welcome to the
blind Spot. Your personal story of how you became a
physician is fascinating. Could you tell us a little bit
more about your journey and how you ended up on
(05:03):
the cutting edge of oncological science.
Speaker 2 (05:05):
So I am currently a gastrointestinal medical oncologist at the
Dana Farber Cancer Institute in Boston, Massachusetts. I'm also an
Associate professor of medicine at Harvard Medical School. I really
was motivated to pursue oncology because it sits at the
intersection of patient centered care and implementation and really fascinating biology.
(05:29):
The science of cancer and how we deliver that care
is really what I focus on, So how we implement
and get what we know out to the patients who
need it in real time. I began my healthcare training
as a nurse at University of Pennsylvania. I was fortunate
to work with the dean then Mary Naylor on a
(05:51):
fascinating research study focused on older adults, and then I
worked as a Ralston House Scholar Ralston House Scholar as
a geriatric program to train future geriatricians and doctors. Johnson
and Lavisa More were two of my mentors there, and
really observing how they approach the study and the science
of geriatrics and gerontology, combined with my exposure in nursing,
(06:15):
really helped me to focus on that population for care.
I matriculated to medical school because I wanted to pursue
a very deep path in medicine. I wanted to be
able to do a lot of complex research in medicine,
and my training at Johns Hopkins prepared me well for that.
And in addition to my MD earning, my masters in
(06:37):
public health gave me the broad perspective of what it
means to think about science, what it means to think
about health care and health and what are the domains
that informed that practice. And so those experiences combined really
brought me to this field of oncology. As a gastro intesloncologist,
(06:59):
I get to learn a lot about the complexity of care,
not only the care itself and how we deliver the care,
the diagnosis itself, and all the factors that go into that,
including the biomarker piece that I've focused on more recently,
but also how we bring all of those pieces together
to really improve outcomes for our patients.
Speaker 1 (07:19):
And how do you feel that your background as a
nurse first and doctor second contributed to your approach today.
Speaker 2 (07:28):
Nursing is a field that is very patient centered, and
I would argue that medicine is as well, except our
perspective of how those two elements are delivered may lend
us to believe that medicine is not really driven by
patient care, and that couldn't be further from the truth.
My nursing exposure gave me a level of comfort with
(07:51):
engaging with patients directly and making sure that I asked
patients what their priorities were, what mattered most of them,
Because as you're delivering care, no matter what aspect you're
delivering that care from from pharmaceuticals, from nursing, from bench
research to translational research and clinical research, if you anchor
(08:15):
on what matters most of the patient, then you can
eliminate a lot of the barriers to how you deliver
whatever it is you're trying to deliver to that patient
and to their family. And I think nursing really helped
me to get very comfortable with that and to bring
that question along with me and apply it to my
medical practice as well.
Speaker 1 (08:32):
It's fascinating that you say that, because in my work
in stress and burnout, that is the question that I
often ask, you know, what matters most? Absolutely? Yeah, doctor Jackson.
You mentioned that biomarker study earlier. The biomarker landscape has
shifted so dramatically from where you sit. What's driving that change?
Speaker 2 (08:54):
Right? Now from where I sit, what's driving the change
in the biomarker landscape is a convergence of technology and biology.
That technology really helps us to understand at a faster
pace what the underlying biology of cancer is, to expand
our understanding, to translate and interpret in real time. The
(09:16):
testing that we used to have only accessible to a
small minority of folks in the US is now widely
available and accessible. But if one does not access genomic
testing or biomarker testing early in a cancer diagnosis, it
can prevent you from having access to the best levels
of care.
Speaker 1 (09:36):
In addition to the study that you mentioned, Yeah, is
there a particular development or category of discovery that you
think is the most underappreciated even amongst oncologists.
Speaker 2 (09:48):
I think being able to recognize that this is not
extra work that we're doing when we think of biomarker testing,
this is fundamental and foundational work. It is what will
inform who gets access to what and when, and if
we're able to be more selective and more tailored in
the treatments that we select based on their genomic findings,
(10:11):
then we're actually able to help them live better with
that diagnosis. So I think that's underappreciated the fact that
it may feel like a lot of work. We're all
tackling so much when we engage with our patients. But
this extra quote unquote conversation that we're having about genomics
and biomarker really does pay off in the long run
for the patients that we're taking care of.
Speaker 1 (10:33):
It's not just the volume of information, it's the pace.
And as you are practicing medicine, what is it like
to practice medicine at this pace? You mentioned that there
are days when it's exhilarating, other days when it's exhausting,
some days a combination of both. But what does it
feel like on a day to day basis to practice
(10:54):
at this pace?
Speaker 2 (10:55):
It's definitely rewarding. It's rewarding to be able to have
information that you can share with patients that makes a
meaningful difference in their lives, lives of their loved ones
and their communities. To be able to speak with great
detail about what we know about their cancer, but also
over time, what we've learned. For me, I do this
(11:17):
by interacting with my colleagues in a variety of different
tumor boards, which are ways that we will discuss what
is the best approach for this patient. I appreciate the
fact that we're willing to come together to make sure
that we're meeting the highest standards of care when we
engage with patients, but I also look back at each
interaction and I really, as I approach each patient, ask
(11:39):
three key questions, which is really thinking about what is
the strongest evidence that we have to support the decisions
that we're making, And then what does the patient's biology
and their clinical and social contexts add to this discussion,
And then more specifically for my patient, what are their
individual goals and their tolerance of risk. I think that
(12:00):
helps me in my conversations with our patients to make
decisions that are tailored to their needs in real time,
incorporating the best level of evidence. But it also encourages
them to take the risk of genomic testing, thinking about
clinical trials. These are aspects of care that many patients
sometimes feel very overwhelmed by, but having that conversation upfront
(12:24):
really helps us to make a shared decision together.
Speaker 1 (12:27):
I love that framework those three questions, stintink that will
be very helpful to others who are maybe starting out
in their medical careers and would love to have a
framework to use when engaging in this dialogue with patients.
So thank you for sharing that. Guidelines are supposed to
be the anchor and they synthesize consensus that helps tell
(12:48):
us as clinicians what the evidence actually supports. But in
biomarker driven oncological care, guidelines feel like they're always catching
up to the science. How do you navigate that gap
between what the data is showing and what the guidelines
have formalized?
Speaker 2 (13:05):
I would say I fall back on that framework again.
Guidelines help us to have a shared and common language
with which to discuss what the evidence shows us up
to a certain point in time, So they're really a
snapshot of what we know. But you're absolutely correct, it's
hard to keep pace with the data as it's submerging
quite rapidly, and so falling back on what is the
(13:27):
strongest level of evidence. But the guidelines cannot substitute for
the information that you get in context of care for
your patient, what their goals and their preferences and tolerance
of risk are.
Speaker 1 (13:40):
You have to ground yourself in, of course, the theory,
but then you want to always have that practicality as
you engage. That's correct every physician has a system, or
at least we all attempt to have one, yes to
stay current. And you mentioned tumor boards. Some doctors and
(14:01):
healthcare providers use journals, We attend conferences, we speak to
other colleagues, and like you, engage in trumor board discussions.
What does that look like in practice for you, and
in what instances do you feel like that potential that
potentially breaks down in terms of having a system that
sometimes works and sometimes doesn't. I would love to hear
(14:23):
about when you feel like that works and what is
your system that you use to stay up to date.
Speaker 2 (14:28):
Certainly that collaboration with colleagues. I am very fortunate to
practice in an academic research center and so keeping pace
is a part of my day to day work. But
I would say my system is layered, so it incorporates
understanding what we know, so that's attending national conferences, joining
the tomor boards, the journal clubs, but also thinking about
(14:51):
where we have gaps in the evidence and what we
don't know, and then laying that on the patient or
the population as it so may be that you are
interacting with. So are my patients represented in the study?
Is this population well represented by the study. Is there
any supplemental data that can help me as I'm thinking
(15:11):
through this particular problem, and I think it answers the
second part of your question is where does that break down?
I think it breaks down where we have evidence gaps,
where we don't know what the checklist, so to speak,
should be, and when we're kind of defining the boxes.
But for me, the solution to that is to continue
to push our research forward, to really think carefully and
(15:33):
critically about every decision and evidence that we introduce to
make sure that it is representative of the population of
folks diagnosed with cancer who we are seeing. So it's
both using the system that's built on the evidence, but
also understanding that there are gaps, and that's a part
of the work, that's a part of the responsibility that
we have is to fill those gaps.
Speaker 1 (15:55):
So beautifully said, you know, awareness is that first step,
and when you are aware of the gaps existing, you
can in fact close those gaps.
Speaker 2 (16:04):
Correct.
Speaker 1 (16:05):
It sounds like the system that you have in place,
the layered system, as you so eloquently stated, has taken
decades of practice. You've been in clinical medicine for decades,
You've done so much research. You are a pioneer in
the field. When in your career did you develop this
practice and did you have any mentors or colleagues that
(16:27):
helped you learn how to incorporate all of this new
information in an ongoing way.
Speaker 2 (16:33):
I developed the system fairly early in my practice. It
was very clear that the place to start was based
on the evidence that we had. One of my mentors,
and I keep this phrase in my mind at all times,
he said to me, know what we know. Start there,
because you can get so overwhelmed by what we don't know.
(16:53):
So at the very least, know what we know, So
that's where we should all start. I am very, very
honored to have had mentors and sponsors and advocates who
are both transparents but also humble share their experiences of
how they continue to learn and continue to grow, and
(17:13):
also colleagues peers who we're doing this in real time together.
But I think that phrase really stood out to me.
Start from what we know, and then your work is
figuring out what we don't know and really addressing that.
Speaker 1 (17:27):
I'm going to take that with me. Know what you
know so simple, mm hmm, but it's something that you
can hold on to as you weed through and you know,
manage the overwhelm of the pace of information coming at
as fast and furious.
Speaker 2 (17:43):
Correct.
Speaker 1 (17:44):
Correct. Healthcare provider aren't the only ones keeping up with
the science. We know this. Are you seeing patients coming
(18:05):
in really informed about their diagnosis and potential treatment.
Speaker 2 (18:10):
I do have patients who are very informed about their diagnosis,
and they come in with extensive research. But I would
say many patients, although they have information, don't know how
to make sense of that information, don't know how to
integrate it into their values and their preferences and their
priorities about their care, and feel quite overwhelmed, particularly when
(18:34):
we're meeting. A big part of my approach is to
give that a name, to speak to that feeling of
being overwhelmed, to also normalize that this process is inherently overwhelming,
particularly when you're thinking about a cancer diagnosis, and to
reassure that we are partnering together and that's really what
we're doing when we're caring for our patients, as we're
(18:56):
partnering with them, with their families, with their communities to
deliver the best care possible. And I'll go back to
something you said earlier. In those periods where we're uncertain.
It's also important to point out that we're uncertain about this.
We don't know this or we don't know this yet,
but here are the ways that we're going to try
to find out and even I take care of patients too,
(19:18):
have cancers where we don't know where the cancer started,
cancers of unknown primary sites. We are still going to
figure out a way to take care of you, and
we're going to do that using the best level of
evidence that we have. I'll bring it back to the biomarkers, right.
This is where our biomarkers again underappreciated in our work
thus far, but hopefully that will gain in its use
(19:40):
and applications more over time. Biomarkers really help us to
fill in these gaps in uncertainty and really build the
evidence to support the decisions that we're making.
Speaker 1 (19:51):
You're so eloquent in describing the doctor patient relationship and
how it is loaded with emotion and overwhelm, anxiety, uncertainty,
and your expertise is to hold all of that in
a safe space so that you and the patient can
move forward together.
Speaker 2 (20:11):
Correct.
Speaker 1 (20:13):
Do you find that these situations can be a challenge
and how do you navigate that while continuing to empower
that patient who is sitting in front of you.
Speaker 2 (20:23):
I have the benefit of being able to see a
little bit into the future, right, so I know that
the overwhelm or the distress or the chaos, let's say,
of a new diagnosis will not always be that way
and will not always feel that way. I think a
part of our responsibility is to speak to that that
I understand what you're going through right now or I've
(20:46):
seen this before, so normalizing that this happens, but it
does not predict the future. I will share with my
patients that even though the beginning of your course may
have been a little bumpy and rocky, it doesn't mean
that it's going to predict what your outcome will be,
and that no matter what happens right, we're still going
(21:06):
to be working together to figure this out. I think
that's a big part of our responsibility is the partnering
with our patients, and what we bring to that is
our expertise in terms of delivering care and thinking through
the again that complexity of data, but making sure that
we're continually partnering with our patients in that process.
Speaker 1 (21:26):
And you said it so beautifully, doctor Jackson. The first
step is to normalize and validate the difficult experience, you know,
instead of that's correct hitting them with all of the
data and the different tests that you're going to do
and how you're going to proceed, just first sitting with
that patient in that difficult moment. Normalizing and validating goes
so far. It's the first clinical intervention.
Speaker 2 (21:47):
Yeah, I would add that we spoke at earlier in
our conversation about the pace of technology and the science
and how rapidly is moving and how much information we
have to absorb and into rate. But a part of
what we're doing as well is pacing with our patients.
So yes, it may be overwhelming, but we can pace
(22:08):
our understanding and are working through some of these tougher
decisions a bit over time and being clear on the
decisions that we have to make quickly. Again, the biomarking
testing should be one of the first things that we're
doing in a cancer diagnosis. The testing, even though it's
much more rapid than it used to be, it still
(22:28):
takes time. And if we want to have that information
at our fingertips to make decisions, we need to have
it early in the course of care. So I'm a
strong advocate for early testing, early education, early integration, and
decision making and ongoing conversations about how we're using this
information to drive care.
Speaker 1 (22:49):
Your approach is so meaningful to me, particularly because you
very much it is so evident that you think so
deeply about the emotional component of illness and not just
the medical component of illness.
Speaker 2 (23:01):
Correct.
Speaker 1 (23:02):
Correct, Ye. There's a particular kind of conversation that I
think is underappreciated, and you've touched on this in our
earlier conversation. It's the one where the physician is to
tell the patient that the science simply isn't there yet,
for instance, when there might not be a validated biomarker yet.
(23:24):
How do you, doctor Jackson hold that conversation.
Speaker 2 (23:29):
I think it's important to acknowledge that the data is
not there for everything yet. That's a part of the work.
That's why we do this work. And my setting, we're
often approaching our patients and their families to ask questions
to participate in research studies. So I think another part
of that is, well, why are we asking you? This
is why? And to bring our patients and their families
(23:51):
into why we're so excited about the work that we
do because we're seeing the improvement and it may not
be for that patient at that time, although sometimes it is.
I have many patients who have done quite well, but
over time we're seeing improvements and those incremental improvements are meaningful.
But it is important to talk about what we don't know,
(24:15):
and that's the motivation for learning it, finding it, participating
in these studies that we launch, including the study that
I mentioned earlier.
Speaker 1 (24:24):
You know, doctor Jackson, when a doctor says to the patient,
I'm not sure, I don't know, that can be a
very powerful moment because it means you know, I don't know,
but I'm going to be with you so we can
figure it out together.
Speaker 2 (24:37):
Correct.
Speaker 1 (24:37):
So there isn't that sense of abandonment, but rather empowerment
in the journey ahead, and.
Speaker 2 (24:43):
You have to stay there in that space, and I
think that can be difficult. It's not something that you
are not a class on uncertainty, right and as we're
going through our training, but that is the experience of
doing this work. But the beauty of it it is
that you can answer those questions over time, and that
(25:04):
you can, as you've already pointed out, empower patients as
they are making their decisions based on the data that's available.
Speaker 1 (25:11):
You. In your work as a pioneer in oncological care,
you work with colleagues across different practice settings at Data
Farber with other colleagues there in an academic medical center,
but you also work with colleagues at community hospitals and
smaller private practices. Do you feel that the physicians and
(25:31):
healthcare providers in those different contexts experience the speed of
biomarker science differently?
Speaker 2 (25:39):
I am quite sure that my colleagues experience the speed
of biomarker science, and I would add the complexity of
that data as it comes in it can be quite
difficult to interpret. I've been fortunate to work with as
a part of driving kind of biomarker education and navigation support,
(26:00):
work with testing vendors as well, who have turned their
attention to helping providers navigate this very complex space. My
work has focused on how do we help patients navigate
the space because they're huge gaps in that and we
certainly don't want misinformation around this data. We certainly don't
(26:20):
want reduced access because of this data or because of
lack of testing or engagement with it. And I think
a big blessing that we have in the way that
we work with our colleagues, both at affiliated sites but
also non affiliated sites, is this commitment to partner with
them in the care of their patient. So we are
(26:41):
very fond of having our own panel of patients that
we're managing primarily, but we also have patients who we
are not interacting with every day, but we're also assisting
in their care as consultants because we want to make
sure that patients, regardless of their touch point with Dana Farber,
are getting the best level of care. That's really what
our mission in oncology is about.
Speaker 1 (27:03):
You have developed a system to stay up to date
with decades of training. Are there a few places that
you would say to not engage in.
Speaker 2 (27:16):
He'll be honest. I don't tell my patients not to
look there or not to look here, because what I
want them to do is to feel empowered to discern
good information. So instead, I try to give them tools
by which the filter information. So for example, sharing what
(27:37):
we would consider our gold standard or the best level
of evidence is a randomized clinical trial, and where we
can mount a randomized clinical trial where we have a
sufficient patient population that can be enrolled to a study.
That's where we would say that's the best level of evidence.
Also understanding that in some situations, particularly rare care answers
(28:01):
or cancers with very poor prognosis, we may not have
the ability to mount a randomized clinical trial, certainly not
one measured over years, and so understanding why we would
use data that does not meet the gold standard in
context that may be the best level of information that
we have. I would also say anything that is asking
(28:22):
you to pay for your treatments to be able to
get that information. We're having these conversations with our patients
all the time, and so if you are not given
access to information, I think that could be a red flag.
And then they're very reputable resources through the National Institutes
(28:43):
of Health, the National Cancer Institute, that are more reliable
because they are robustly tested, that should be used as
a resource. The last resource that I will say is
there's a clinical trials database as well, where some of
our patients, ones that we mentioned are already heavily researched
before they come in have searched this clinicaltrials dot gov
(29:06):
website to look for opportunities for trials. And I certainly
encourage patients to do that, but also give them some
guidance on what are the search terms that are specific
to your cancer? How do we describe this cancer? If
I were speaking to a colleague, what are the terms
that I use that almost give you kind of a
fingerprint of the cancer if you were to search for it.
(29:28):
So you're not misled, you're not going down the wrong
path in terms of information.
Speaker 1 (29:33):
You really are thinking three four steps ahead because you
know your patients are going to engage in all sorts
of information, and so you want to make sure that
they are doing it in a responsible way.
Speaker 2 (29:44):
Correct.
Speaker 1 (29:45):
And I want to end with something hopeful and forward looking.
When you imagine your field in ten years, what are
some of your hopes for what we've discovered.
Speaker 2 (29:57):
I am convinced that in ten years are patients who
are coming into our institution first and foremost, that we
have found ways to go out to our patients so
they're not always having to come to us. So we
are embedded within our communities and the communities that we're serving,
that we're accountable and we're transparent, and we continue to
(30:18):
be so. But I would also imagine that patients are
coming in with their biomarker information as a part of
their diagnostic data at the outset of their diagnosis, not
weeks months later and in some cases never obtained, that
we're getting that information as quickly as possible. I would
also envision that we're using that data in real time,
(30:41):
and that we're pulling the biomarker data, integrating it with
other diagnostic features around their disease, but also around who
this person is, what are their priorities, what are their
prior histories, what is their social contexts, what's their health
literacy level? As we're engaging in these conversations, that we're
(31:01):
pulling all of that information together. And then I also
envision that, in addition to sharing with patients that your
outcome in terms of survival is expected to be this
versus that based on use of this particular regimen, that
we can also describe what their quality of survival will
look like. And I see us really having that at
(31:22):
our fingertips in real time for the patient in front
of us as we make these decisions. And I would
be remiss if I didn't add that. I would envision
that our structure of being able to support patients is
reflected not only the care that we deliver, but how
we pay for the care that we say we want
to deliver, and so that is reflective of us as
(31:44):
a whole, as a whole field.
Speaker 1 (31:46):
You know, doctor Jackson, your story, your personal story of
first being a nurse who then became a doctor. In
hearing you speak about the journey and how to me
you embody humanism and medicine, and I wonder if that's
played a role or it's just who you are. But
(32:08):
the responses, the eloquence, just the depth of your understanding
of the human experience. And it really seems like you
are sitting shoulder to shoulder with every patient you see.
And it is such an honor to speak to you,
and truly you are such an exemplar of what it
means to be a doctor.
Speaker 2 (32:27):
Thank you so much. I appreciate that. But I would
add again the context in which your practice is so important.
So make sure for students trainees, as you're considering how
you will practice, make sure you bring your full and
authentic self to that practice. Your patients need you to
be you, And also make sure that you're practicing with
(32:51):
colleagues who share those goals and are very driven by
the needs of their patients as well as I do.
Speaker 1 (32:57):
Thank you so much for taking the time to speak
to me and for joining us on the blind Spot.
Speaker 2 (33:03):
Thank you very much.
Speaker 1 (33:07):
Thank you so much to doctor Nadine Jackson for joining
us today. She is an exemplar of what it means
to be a compassionate physician and practice humanism and medicine
using the lens of the biopsychosocial model and whole person care.
I don't think I've ever heard someone so eloquently describe
the complexities and the tension in oncological care as beautifully
(33:31):
as doctor Jackson did. That's part of what I hope
the blind Spot can be, not just a source of information,
but a safe place where we can be candid about
the structural realities of practicing medicine right now, The pressures
you're navigating, whether you're a provider or a patient, the
conversations that are harder than they should be. You're not
(33:52):
alone in that. Join us next time. We're talking about
something we touched on today, patients coming into doctors' offices
armed with so much more information than was ever possible before.
But that comes with its own challenges too. We'll talk
all about it next time. In the meantime, follow the
(34:14):
show and leave us a review. It genuinely helps us
reach more of the people who might be running into
blind spots in their own care, whether they're giving it
or receiving it. You can find me across the web
at doctor Aditi Narukar. I would love to connect with you.
The blind Spot is a production of Iheart's Ruby Studios,
and this episode's sponsor is Pfizer. Visit Pfizer dot com
(34:38):
for more information. Until next time, thanks for listening.
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