Twenty years ago as a newly trained oncologist, I faced the same challenge that many cancer patients and their families do as they try to figure out where to turn when my mother was diagnosed with ductal carcinoma in situ– or pre breast cancer. Her surgeon, who had come highly recommended by her family doctor,told her she needed to have a lymph node dissection, which can result in lifelong disability due to lymphedema or swelling of the arm. As an oncologist, I knew it was not recommended for ductal carcinoma in situ, but she resisted my suggestion to get a second opinion. Despite the fact that I—her daughter—am an oncologist, her first thought was, “I can’t go against what my family doctor told me to do.”
It is still not part of our general culture to question physicians and, in a sense, to discuss health care options. Many patients are shell shocked by a cancer diagnosis and don’t think beyond what they are immediately told to do or where they are told to go for treatment. Some highly motivated patients dig deeper to research their options for cancer treatment, but these motivated patients are still a minority.
This weekend the NYTimes published an editorial titled 
“The pessimist complains about the wind; the optimist expects it to change; the realist adjusts the sails.” —William Arthur Ward
Leonard Kish talks to Douglas Fridsma, President and CEO at American Medical Informatics Association, about his work in the Office of the National Coordinator for Health Information Technology, or ONC, and the barriers to implementing MIPS in the most useful and transparent way. In order to communicate the data, of course, we’ll need informatics; but how will that work? And which comes first, policy or technology?
