ASH Clinical News ACN_4.14_Full Issue_web | Page 100

CLINICAL NEWS
On Location 2018 ASH Annual Meeting
Dr. Sekeres: More interaction with EHRs
and billing practices means less time to
be creative with our storytelling – both in
and outside of the EHR. The default mode
of working in the EHR is to cut and paste
from previous notes. That introduces
more errors in storytelling and discour-
ages clinicians from adding texture to
the story. We should be encouraging
clinicians to use the EHRs to capture the
patient’s story in a real way, rather than
using them to meet a billing level.
And, we even have less time to listen
to a story. In an exam room, many doc-
tors stare at their computer rather than
looking at the person sitting 2 feet away
who is telling the story. If 90 percent of
communication is nonverbal, like reading
body language and facial expressions,
then we are losing that from our relation-
ship with patients by staring at an EHR
on our screens.
What is the benefit, for both patients
and physicians, of engaging in narrative
medicine?
Dr. Sekeres: When we write, we organize
facts in a different way than how we may have
just heard them. In writing down the story,
we may realize, “Gee, one aspect of this story
doesn’t flow to the other… Maybe I need to
get more information to make that connec-
tion.” It may point us to deficiencies in a story
that we might not have considered previously.
REVLIMID [lenalidomide] capsules, for oral use
• Patients must sign a Patient-Physician agreement form and comply
with the requirements to receive REVLIMID. In particular, females of
reproductive potential must comply with the pregnancy testing,
contraception requirements and participate in monthly telephone
surveys. Males must comply with the contraception requirements [see
Use in Specific Populations (8.3)].
• REVLIMID is available only from pharmacies that are certified in
REVLIMID REMS program. Provide patients with the telephone number
and website for information on how to obtain the product.
Pregnancy Exposure Registry
Inform females there is a Pregnancy Exposure Registry that monitors
pregnancy outcomes in females exposed to REVLIMID during pregnancy
and that they can contact the Pregnancy Exposure Registry by calling
1-888-423-5436 [see Use in Specific Populations (8.1)].
Hematologic Toxicity
Inform patients that REVLIMID is associated with significant neutropenia
and thrombocytopenia [see Boxed Warning and Warnings and
Precautions (5.3)].
Venous and Arterial Thromboembolism
Inform patients of the risk of thrombosis including DVT, PE, MI, and
stroke and to report immediately any signs and symptoms suggestive of
these events for evaluation [see Boxed Warning and Warnings and
Precautions (5.4)].
Increased Mortality in Patients with CLL
Inform patients that REVLIMID had increased mortality in patients with
CLL and serious adverse cardiovascular reactions, including atrial
fibrillation, myocardial infarction, and cardiac failure [see Warnings and
Precautions (5.5)].
Second Primary Malignancies
Inform patients of the potential risk of developing second primary
malignancies during treatment with REVLIMID [see Warnings and
Precautions (5.6)].
Hepatotoxicity
Inform patients of the risk of hepatotoxicity, including hepatic failure and
death, and to report any signs and symptoms associated with this event
to their healthcare provider for evaluation [see Warnings and Precautions
(5.8)].
Severe Cutaneous Reactions Including Hypersensitivity Reactions
Inform patients of the potential for severe reactions including
hypersensitivity, angioedema, Stevens-Johnson Syndrome, toxic
epidermal necrolysis, or drug reaction with eosinophilia and systemic
symptoms if they had such a reaction to thalidomide and report
symptoms associated with these events to their healthcare provider for
evaluation [see Warnings and Precautions (5.9)].
Tumor Lysis Syndrome
Inform patients of the potential risk of tumor lysis syndrome and to
report any signs and symptoms associated with this event to their
healthcare provider for evaluation [see Warnings and Precautions
(5.10)].
Tumor Flare Reaction
Inform patients of the potential risk of tumor flare reaction and to report
any signs and symptoms associated with this event to their healthcare
provider for evaluation [see Warnings and Precautions (5.11)].
Early Mortality in Patients with MCL
Inform patients with MCL of the potential for early death [see Warnings
and Precautions (5.14)].
Dosing Instructions
Inform patients how to take REVLIMID [see Dosage and Administration
(2)]
• REVLIMID should be taken once daily at about the same time each
day,
• REVLIMID may be taken either with or without food.
• The capsules should not be opened, broken, or chewed. REVLIMID
should be swallowed whole with water.
• Instruct patients that if they miss a dose of REVLIMID, they may still
take it up to 12 hours after the time they would normally take it. If
more than 12 hours have elapsed, they should be instructed to skip
the dose for that day. The next day, they should take REVLIMID at
the usual time. Warn patients to not take 2 doses to make up for the
one that they missed.
Manufactured for: Celgene Corporation
Summit, NJ 07901
REVLIMID ® and REVLIMID REMS ® are registered trademarks of Celgene
Corporation.
Pat. www.celgene.com/therapies
©2005-2017 Celgene Corporation, All Rights Reserved.
REV_MM_MAINT_HCP_BSv.24 12_2017
Writing stories hones our craft as physi-
cians. If I’m engaging in narrative medicine,
I’m asking, “I know what my experience was,
but how is my patient thinking about what
happened?” That means that the next time
I go into an interaction with that patient, or
even with a different patient who has a simi-
lar story, I’m going to carry that perspective
with me and I’m going to practice more em-
pathy. That’s going to make me a better doc-
tor. So, the better the storytelling, the better
the care we provide; the more complete the
story, the better doctors we become.
Dr. Ofri: I think medical journals recognize
the importance of the narrative, and that’s
why they publish physicians’ stories and
poems. These have much more in com-
mon with how we live our lives as doctors
than the results of a big mega-trial, no
matter how clinically relevant the data are.
I always laugh at the term “hospitalist,”
because we are taking care of patients, not
hospitals. Stories and poems speak to the
experience of the human connection.
Dr. Sekeres: These creative pieces are often
the most read within a journal, and I think
that is because the stories and poems reflect
our commonality of experience. People may
not be able to appreciate that through the
staid narrative of a research study. If I see a
research article in Blood from an interna-
tionally renowned leukemia doctor, I may
read that article and say, “That’s research that
I’d never be able to do.” But, if I read an essay
from a cancer specialist about how hard it is
at the end of a day of seeing patients to tuck
those emotions away, go home, and face
your family, that’s something I can relate to.
Dr. Ofri, can you give readers a preview
of what will you be sharing with
attendees in your presentation?
Dr. Ofri: We often think of patient commu-
nication, or “bedside manner,” as a kindly
afterthought in medicine. Actually, the
doctor-patient conversation is the single
most powerful tool in medicine. Both doc-
tors and patients need to put communica-
tion at the top of their expectation lists, so
I will be sharing some simple steps we can
take to improve communication. ●
The Story Is the Story: Using
Narrative Medicine to Cure
Disease
Monday, December 3, 2018,
10:30 a.m. - 12:00 p.m.
San Diego Convention Center, Room 6E
CHAIR
Mikkael A. Sekeres, MD, MS, Cleveland Clinic Taussig
Cancer Center, Cleveland, OH
SPEAKERS
Danielle Ofri, MD, PhD, New York University, New York, NY
Jay Baruch, MD, Brown University, Providence, RI
Ilana Yurkiewicz, MD, Stanford University, Stanford, CA
December 2018