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It's the way you tell'em
DISSECTING ROOM
LIFELINE Kunle Odunsi After a medical degree from the University of Ife, Ile-Ife, Nigeria, Kunle Odunsi trained in obstetrics and gynaecology in the UK and USA, including a research fellowship at the Imperial Cancer Research Fund Laboratories, Institute of Molecular Medicine, University of Oxford, Oxford, UK. He now works at Roswell Park Cancer Institute, Buffalo, New York, USA, where he is an assistant professor and attending surgeon in gynaecological oncology. His research interests include the development of antigen-specific immunotherapy in ovarian cancer. Who was your most influential teacher, and why? Mr Ralph Robinson, whose example led me to subspecialise in gynaecological oncology when I was a senior house officer at Cambridge University, UK. His knowledge base was incredible, he deeply cared for his patients and colleagues, was always willing to teach, and had the most amazing surgical skills. What would be your advice to a newly qualified doctor? Always try to think out of the box. What is the best piece of advice you have received, and from whom? My father told me to persevere through the storms of life. What is your worst habit? Coffee. What part of your work gives you the most pleasure? The times when I can give hope and encouragement to my patients. What alternative therapies have you tried? Local antimalarial herbs while growing up in Nigeria. What do you think is the most exciting field of science at the moment? Tumour immunology. Describe your ethical outlook. I have strong Christian values, based on scripture. What is your favourite country? The place I live now—the USA. What, apart from your partner, is the passion of your life? My research work is a constant pleasure: finding targets for cancer immunotherapy.
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It’s the way you tell ’em e it in leaflets, on the internet, or in the pages of a magazine, information for patients is seen by some clinicians as, at best, a threat and, at worst, a whole new disease. Simply put, some more traditional doctors seem to believe that there are things physicians know that patients should not. If every Tom, Dick, or Harry thinks he’s someone from ER, your chances of getting through that morning’s list are severely depleted. But if the idea of improving, clarifying, and augmenting information for patients might seem like the medical profession shooting itself in the foot, there are several compelling arguments for upping standards. Foremost among these is that in the UK much of the pot-pourri of available information for patients is a fabulous source of humour, but little solace for worried patients or overworked health-care professionals. NHS Direct Online is supposed to provide a gold-standard for patients’ information that the public can trust; such information is intended to put the kibosh on the quacks, cranks, and selfstyled shaman with their websites and their hokum. Nice idea, but those with serious afflictions can look forward to adding splitting sides to their ailments after a quick trawl through the site. Take the humble bunion. “A bunion is an obvious swelling on the inner edge of the foot at the base of the big toe.” So far, so good, until we are helpfully reminded that “people who have never worn shoes have never had bunions . . . prevention is better than cure”. And that’s it. Advice to the nation? Don’t wear shoes. Not content with being plain unhelpful there is also the issue of how best to get the message across. For cataract surgery, NHS Direct Online offers the following delicate description: “a diamond knife is used to cut around the upper edge of the cornea . . . and the hard central part of
B
the lens is carefully squeezed from the eye. The soft remaining part of the lens is then cleared away by suction and washing.” Although this statement is clear and to the point, some patients may feel a little uneasy with that description. Moving away from the online world, one cardiology leaflet from a British hospital that shall remain nameless spent some 300 words describing an “exercise test”, warning in advance that “the technician will apply electrodes to your chest”. Not once did the leaflet mention the word heart in this description of a standard cardiac test, which might have cleared a few things up. Then there were the infamous posters that went up in a London hospital advertising a breast-feeding support group. It was felt that an Arabic translation might help, and so a translation agency was commissioned and new posters were printed. It was several months before someone noticed that the Arabic symbols on the walls were actually just the Arabic alphabet printed out from A to Z. As such the hospital was offering the following service: “ABCDEFGHIJK . . .” It’s plain that much of the problems with such information is in the presentation. It’s easy for a hospital doctor to forget just how intimidating an environment a hospital can be. Being sent away with written advice that is even more forbidding, unintelligible, or just badly written only makes things worse. Ultimately, with clear, instructive information medical outcomes are better, recovery times improve, and issues of patients’ consent are more easily clarified. For hospitals and doctors, what that means is a sop for litigious outpatients and a helping-hand for overworked consultants. And let’s be altruistic here— patients always have a right to know what is happening to them. Jane Wilson
THE LANCET • Vol 360 • November 16, 2002 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.
LIFELINE Kunle Odunsi After a medical degree from the University of Ife, Ile-Ife, Nigeria, Kunle Odunsi trained in obstetrics and gynaecology in the UK and USA, including a research fellowship at the Imperial Cancer Research Fund Laboratories, Institute of Molecular Medicine, University of Oxford, Oxford, UK. He now works at Roswell Park Cancer Institute, Buffalo, New York, USA, where he is an assistant professor and attending surgeon in gynaecological oncology. His research interests include the development of antigen-specific immunotherapy in ovarian cancer. Who was your most influential teacher, and why? Mr Ralph Robinson, whose example led me to subspecialise in gynaecological oncology when I was a senior house officer at Cambridge University, UK. His knowledge base was incredible, he deeply cared for his patients and colleagues, was always willing to teach, and had the most amazing surgical skills. What would be your advice to a newly qualified doctor? Always try to think out of the box. What is the best piece of advice you have received, and from whom? My father told me to persevere through the storms of life. What is your worst habit? Coffee. What part of your work gives you the most pleasure? The times when I can give hope and encouragement to my patients. What alternative therapies have you tried? Local antimalarial herbs while growing up in Nigeria. What do you think is the most exciting field of science at the moment? Tumour immunology. Describe your ethical outlook. I have strong Christian values, based on scripture. What is your favourite country? The place I live now—the USA. What, apart from your partner, is the passion of your life? My research work is a constant pleasure: finding targets for cancer immunotherapy.
1616
It’s the way you tell ’em e it in leaflets, on the internet, or in the pages of a magazine, information for patients is seen by some clinicians as, at best, a threat and, at worst, a whole new disease. Simply put, some more traditional doctors seem to believe that there are things physicians know that patients should not. If every Tom, Dick, or Harry thinks he’s someone from ER, your chances of getting through that morning’s list are severely depleted. But if the idea of improving, clarifying, and augmenting information for patients might seem like the medical profession shooting itself in the foot, there are several compelling arguments for upping standards. Foremost among these is that in the UK much of the pot-pourri of available information for patients is a fabulous source of humour, but little solace for worried patients or overworked health-care professionals. NHS Direct Online is supposed to provide a gold-standard for patients’ information that the public can trust; such information is intended to put the kibosh on the quacks, cranks, and selfstyled shaman with their websites and their hokum. Nice idea, but those with serious afflictions can look forward to adding splitting sides to their ailments after a quick trawl through the site. Take the humble bunion. “A bunion is an obvious swelling on the inner edge of the foot at the base of the big toe.” So far, so good, until we are helpfully reminded that “people who have never worn shoes have never had bunions . . . prevention is better than cure”. And that’s it. Advice to the nation? Don’t wear shoes. Not content with being plain unhelpful there is also the issue of how best to get the message across. For cataract surgery, NHS Direct Online offers the following delicate description: “a diamond knife is used to cut around the upper edge of the cornea . . . and the hard central part of
B
the lens is carefully squeezed from the eye. The soft remaining part of the lens is then cleared away by suction and washing.” Although this statement is clear and to the point, some patients may feel a little uneasy with that description. Moving away from the online world, one cardiology leaflet from a British hospital that shall remain nameless spent some 300 words describing an “exercise test”, warning in advance that “the technician will apply electrodes to your chest”. Not once did the leaflet mention the word heart in this description of a standard cardiac test, which might have cleared a few things up. Then there were the infamous posters that went up in a London hospital advertising a breast-feeding support group. It was felt that an Arabic translation might help, and so a translation agency was commissioned and new posters were printed. It was several months before someone noticed that the Arabic symbols on the walls were actually just the Arabic alphabet printed out from A to Z. As such the hospital was offering the following service: “ABCDEFGHIJK . . .” It’s plain that much of the problems with such information is in the presentation. It’s easy for a hospital doctor to forget just how intimidating an environment a hospital can be. Being sent away with written advice that is even more forbidding, unintelligible, or just badly written only makes things worse. Ultimately, with clear, instructive information medical outcomes are better, recovery times improve, and issues of patients’ consent are more easily clarified. For hospitals and doctors, what that means is a sop for litigious outpatients and a helping-hand for overworked consultants. And let’s be altruistic here— patients always have a right to know what is happening to them. Jane Wilson
THE LANCET • Vol 360 • November 16, 2002 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.