Highlights from SF and the Breast Care Center

Hello everyone!

I apologize that this blog post is extremely overdue. I have been living a full life in San Francisco and to date haven’t taken as much time as I should to reflect and write about my experience. As I (hopefully) settle into a more steady pace of grown-up living, I will make this blog-writing a routine part of my coming months as a fellow.

I moved to San Francisco’s Inner Sunset neighborhood on July 3 and began work at UCSF’s Breast Care Center (BCC) on July 5. In the past three months, I’ve learned about the work of the BCC at a rapid pace, immersed myself in a couple of different projects, and met some incredible clinicians and staff. The BCC is full of visionary and integrative initiatives and is a wonderful learning environment. Below are a few words about the experiences that have been highlights for me here so far.

Decision Services

I devote about 20% of my time working for a program at UCSF called Decision Services. In this role, I work most closely with patients and this service has become my favorite part of the internship. Through Decision Services, we help patients to come up with a list of questions that will help them to choose between complex treatment options with multiple risks and benefits. We then give the list to the patient’s doctor and accompany her to the appointment. After the appointment, the patient receives our typed summary and a CD recording of the appointment, with the hope that these resources will allow her to make thoughtful treatment decisions based on what matters most to her. Through working for this program, I have learned about the diverse factors that are important to women who are choosing, for example, between a lumpectomy and a mastectomy or between different types of reconstructive surgery. Accompanying patients to their appointments also offers a perspective on a wide range of different styles of doctor-patient interactions. I’ve witnessed unusual appointments (such as one where a patient was accompanied by 12 of her family members) and very difficult appointments (for patients struggling with various other diseases or breast cancer that has progressed to metastatic disease).

Athena Project

The Athena Breast Health Network is a project pioneered by the BCC’s director, Laura Esserman. It intends to be a “Framingham 2.0” of breast cancer, alluding to the seminal Framingham Heart Study that established many of the correlations between lifestyle and heart disease. Furthermore, the project is trying to spearhead a culture shift to break down some of the barriers that separate clinical care and research in breast cancer. Ultimately, the Athena network will include 150,000 participants across 5 UC medical centers. Now, I’m working a great deal on some of the nitty-gritty details surrounding a questionnaire that accompanies participation in the network, but I cherished the opportunity to learn about the big picture vision at a conference a couple weeks ago in San Diego.

Tumor Board

Tumor Board is the weekly meeting that convenes all the BCC doctors and staff to discuss difficult cases to diagnose or treat. I find it fascinating to learn through observing the clinicians’ different personalities and clinical approaches at play in interpreting ambiguous cases (often, it seems that the two are linked).

Outside of work, I hang out a lot with my fantastic class of eleven “pre-medical interns.” We are currently making preparations to compete in the annual Halloween costume contest at UCSF – apparently, we have an esteemed reputation to defend. On the less festive end of things, I spend a lot of time these days studying for the MCAT :-/.

In my free time, I try to keep up my violin playing. I’ve joined an orchestra called Symphony Parnassus, which is rehearsing for a November concert. Once a week, during my lunch breaks at the Medical Center, I am starting to play my violin through a music program at the Hospital. Last week I played a song for a man who was on his way being wheeled into the OR. I also love playing chamber music and joined a friend from Princeton ’09 yesterday for a chamber music sight-reading party. Finally, I have been trying to keep up my Spanish-speaking skills through this “Conversation Exchange” program, where I talk with a conversation partner from Costa Rica each week. She is also in the health care field, so our Spanish and English conversations have been really fun.

I hope everyone is having a great fellowship and enjoying autumn!