1
00:00:00,017 --> 00:00:02,600
(upbeat music)

2
00:00:05,550 --> 00:00:07,410
- This is Lab Medicine Rounds,

3
00:00:07,410 --> 00:00:09,510
a curated podcast for physicians,

4
00:00:09,510 --> 00:00:11,700
laboratory professionals, and students.

5
00:00:11,700 --> 00:00:14,850
I'm your host, Justin Kreuter,
the Bow Tie Bandit of Blood,

6
00:00:14,850 --> 00:00:17,880
a transfusion medicine
pathologist at Mayo Clinic.

7
00:00:17,880 --> 00:00:21,180
Today we're rounding with Cori
Berg, instructor in nursing

8
00:00:21,180 --> 00:00:23,730
for the Center for Individualized Medicine

9
00:00:23,730 --> 00:00:26,130
at Mayo Clinic in Rochester, Minnesota,

10
00:00:26,130 --> 00:00:29,400
to talk about the importance
of patient education.

11
00:00:29,400 --> 00:00:31,950
So thanks for joining us today, Cori.

12
00:00:31,950 --> 00:00:34,620
- Hi. Thank you for
having me, Dr. Kreuter.

13
00:00:34,620 --> 00:00:37,050
It's a privilege to be here.

14
00:00:37,050 --> 00:00:37,883
- This is wonderful.

15
00:00:37,883 --> 00:00:40,200
I love kind of getting
different perspectives

16
00:00:40,200 --> 00:00:41,760
on this podcast.

17
00:00:41,760 --> 00:00:45,210
And I think for many
of us, as pathologists,

18
00:00:45,210 --> 00:00:47,970
sometimes we like to call
ourselves the doctors' doctors.

19
00:00:47,970 --> 00:00:51,987
Certainly that extends out
for allied health medicine

20
00:00:51,987 --> 00:00:53,520
and lab medicine as well.

21
00:00:53,520 --> 00:00:55,680
We're really educating a lot of the people

22
00:00:55,680 --> 00:00:58,650
that we work with, including
sometimes patients.

23
00:00:58,650 --> 00:01:02,850
And so I'm kind of really
excited to explore this with you.

24
00:01:02,850 --> 00:01:05,940
But maybe to start off,
what's your origin story?

25
00:01:05,940 --> 00:01:08,250
How did you come to kind of work

26
00:01:08,250 --> 00:01:11,283
in this unique health setting
of educating patients?

27
00:01:12,180 --> 00:01:13,740
- Sure.

28
00:01:13,740 --> 00:01:18,300
As a young girl, my mom's
only sister was diagnosed

29
00:01:18,300 --> 00:01:20,760
with breast cancer at a young age.

30
00:01:20,760 --> 00:01:22,770
She was in her early 30s.

31
00:01:22,770 --> 00:01:25,680
And so I remember treatment

32
00:01:25,680 --> 00:01:29,850
would often leave her
lethargic and nauseated.

33
00:01:29,850 --> 00:01:34,850
And after a brief stint
of being cancer free,

34
00:01:35,130 --> 00:01:37,320
she ended up having a recurrence,

35
00:01:37,320 --> 00:01:40,080
and she ended up dying in her early 40s.

36
00:01:40,080 --> 00:01:44,940
So in March of 2010, a
few years after her death,

37
00:01:44,940 --> 00:01:47,130
I was 25 years old, newly married,

38
00:01:47,130 --> 00:01:52,130
and I had picked up a magazine
article in a small clinic,

39
00:01:52,320 --> 00:01:56,610
and I read about a young female

40
00:01:56,610 --> 00:02:00,030
who got tested for a genetic mutation

41
00:02:00,030 --> 00:02:02,190
that increased her risk of breast cancer.

42
00:02:02,190 --> 00:02:04,653
And she had a prophylactic mastectomy.

43
00:02:05,760 --> 00:02:09,420
And she also had Jewish ancestry,

44
00:02:09,420 --> 00:02:12,180
Ashkenazi Jewish ancestry.

45
00:02:12,180 --> 00:02:15,157
And so I immediately
called my mom, and I said,

46
00:02:15,157 --> 00:02:18,210
"Is this something that Aunt
Rosalie could have had?"

47
00:02:18,210 --> 00:02:20,377
And we were unsure, but I said,

48
00:02:20,377 --> 00:02:22,800
"If this is something that I could have,

49
00:02:22,800 --> 00:02:25,590
I'd wanna do the same
thing and reduce my risk

50
00:02:25,590 --> 00:02:28,710
because I was severely impacted by it."

51
00:02:28,710 --> 00:02:32,670
So I immediately called my physician

52
00:02:32,670 --> 00:02:35,070
and scheduled an appointment.

53
00:02:35,070 --> 00:02:39,510
And at the appointment,
I was not a nurse yet,

54
00:02:39,510 --> 00:02:42,660
and I didn't have any
information about genetics

55
00:02:42,660 --> 00:02:46,440
or any risks associated

56
00:02:46,440 --> 00:02:49,380
with getting tested or anything like that.

57
00:02:49,380 --> 00:02:52,260
And the doctor was
supportive of my decision,

58
00:02:52,260 --> 00:02:54,420
and honestly he said, "Okay,

59
00:02:54,420 --> 00:02:56,520
I'll get the genetic test ordered,

60
00:02:56,520 --> 00:02:58,950
and if you're positive, you snip, snip,"

61
00:02:58,950 --> 00:03:02,430
like, holding scissors
right in front of his chest.

62
00:03:02,430 --> 00:03:07,430
And although I was familiar
with the doctor, looking back,

63
00:03:08,940 --> 00:03:12,150
I just don't think that that
was the most professional

64
00:03:12,150 --> 00:03:15,360
or informative way of
conducting an appointment.

65
00:03:15,360 --> 00:03:16,470
I was a young female,

66
00:03:16,470 --> 00:03:19,090
and I was still very emotional

67
00:03:21,510 --> 00:03:22,830
from the death of my aunt,

68
00:03:22,830 --> 00:03:25,470
and I would've benefited from statistics

69
00:03:25,470 --> 00:03:30,470
or risks from any genetics information

70
00:03:31,080 --> 00:03:32,640
or even information on GINA,

71
00:03:32,640 --> 00:03:37,050
which was enacted in
2008, and this was 2010.

72
00:03:37,050 --> 00:03:38,820
And then I went straight to the lab

73
00:03:38,820 --> 00:03:41,460
without talking to my husband or my mom.

74
00:03:41,460 --> 00:03:44,310
And I knew the lab tech as well.

75
00:03:44,310 --> 00:03:46,530
And she looked at me and she said, "Honey,

76
00:03:46,530 --> 00:03:47,363
do you know what you're doing?"

77
00:03:47,363 --> 00:03:49,680
And I told her, "Yep, this
is what I plan to do."

78
00:03:49,680 --> 00:03:52,230
And she goes, "Well, those
are part of your womanhood."

79
00:03:52,230 --> 00:03:56,340
And I just collected all of my
winter gear, and I went home,

80
00:03:56,340 --> 00:03:58,560
and I called Mayo Clinic Rochester,

81
00:03:58,560 --> 00:04:03,390
and I scheduled an appointment
with the breast clinic,

82
00:04:03,390 --> 00:04:05,910
met with them, and they
scheduled an appointment

83
00:04:05,910 --> 00:04:07,800
with a genetic counselor.

84
00:04:07,800 --> 00:04:10,290
And the genetic counselor was able

85
00:04:10,290 --> 00:04:12,030
to create my family pedigree,

86
00:04:12,030 --> 00:04:16,320
and it showed my Jewish
ancestry on both sides.

87
00:04:16,320 --> 00:04:18,870
And the GC said, "Cori,

88
00:04:18,870 --> 00:04:23,870
we see that you have
cancer in your family,

89
00:04:24,480 --> 00:04:25,313
but not enough.

90
00:04:25,313 --> 00:04:28,850
So I just don't think
you're gonna have BRCA."

91
00:04:28,850 --> 00:04:32,460
'Cause that's all that they were aware

92
00:04:32,460 --> 00:04:35,823
of at the time that increased
your risk of breast cancer.

93
00:04:36,750 --> 00:04:39,393
I said, "That's fine, I wanna get tested.

94
00:04:40,350 --> 00:04:42,420
I don't care if I have to
pay for it out of pocket.

95
00:04:42,420 --> 00:04:44,130
I just wanna know.

96
00:04:44,130 --> 00:04:45,810
And just call me with the results

97
00:04:45,810 --> 00:04:47,310
'cause I live two hours away."

98
00:04:47,310 --> 00:04:49,800
So the genetic counselor called me,

99
00:04:49,800 --> 00:04:51,960
I remember she was crying,

100
00:04:51,960 --> 00:04:55,533
and she said that I was
indeed BRCA2 positive,

101
00:04:56,880 --> 00:04:59,520
and my surgery was a month later.

102
00:04:59,520 --> 00:05:00,353
Yeah.

103
00:05:00,353 --> 00:05:02,670
- It's a really powerful origin story

104
00:05:02,670 --> 00:05:04,860
of getting into patient education.

105
00:05:04,860 --> 00:05:06,273
And as you were telling it,

106
00:05:07,152 --> 00:05:09,840
I was reflecting on all the times

107
00:05:09,840 --> 00:05:13,020
where I have failed the way

108
00:05:13,020 --> 00:05:16,113
that I talk with patients.

109
00:05:18,000 --> 00:05:21,510
And in my case, I see a
lot of that coming out

110
00:05:21,510 --> 00:05:25,050
because of how I'm
maybe more often talking

111
00:05:25,050 --> 00:05:27,360
with different groups of people

112
00:05:27,360 --> 00:05:28,830
and sort of get used to talking

113
00:05:28,830 --> 00:05:31,680
about things in certain ways

114
00:05:31,680 --> 00:05:35,610
and not making that reset
and that connection.

115
00:05:35,610 --> 00:05:38,490
And so I think sometimes
that's where my failures come.

116
00:05:38,490 --> 00:05:40,320
And hopefully, when I catch them,

117
00:05:40,320 --> 00:05:43,147
I try to see if I can try to say,

118
00:05:43,147 --> 00:05:45,810
"I apologize, I think
I'm saying this wrong,"

119
00:05:45,810 --> 00:05:47,100
and trying to catch that.

120
00:05:47,100 --> 00:05:48,393
I'm kinda curious,

121
00:05:49,530 --> 00:05:52,890
now being a nurse for several years

122
00:05:52,890 --> 00:05:56,250
and really taking a frontline
in educating patients,

123
00:05:56,250 --> 00:05:58,050
what are some of the the common ways

124
00:05:58,050 --> 00:06:01,260
that you see healthcare really fail

125
00:06:01,260 --> 00:06:04,860
to successfully educate patients?

126
00:06:04,860 --> 00:06:05,790
- Sure.

127
00:06:05,790 --> 00:06:09,360
So yeah, that really inspired
me to go into nursing.

128
00:06:09,360 --> 00:06:12,870
So after that, you know,

129
00:06:12,870 --> 00:06:15,780
after my surgery, I
moved back to Rochester.

130
00:06:15,780 --> 00:06:18,540
For various reasons, I was
born and raised in Rochester.

131
00:06:18,540 --> 00:06:22,590
And I worked at Mayo Clinic
while I was going back

132
00:06:22,590 --> 00:06:23,640
to school for nursing,

133
00:06:23,640 --> 00:06:26,340
and I didn't stop until I got my master's.

134
00:06:26,340 --> 00:06:28,500
And eventually I did get a job

135
00:06:28,500 --> 00:06:30,360
at the Center for Individualized Medicine

136
00:06:30,360 --> 00:06:32,190
where now I can teach patients.

137
00:06:32,190 --> 00:06:35,927
But obviously, besides my own mishaps

138
00:06:39,180 --> 00:06:41,580
with my experiences,

139
00:06:41,580 --> 00:06:44,970
I know that primary care
providers have very little time

140
00:06:44,970 --> 00:06:46,650
to stay up to date with everything,

141
00:06:46,650 --> 00:06:49,530
especially genetics or genomics,

142
00:06:49,530 --> 00:06:52,740
and the latest in genetics
and their associated risks.

143
00:06:52,740 --> 00:06:56,850
In 2010, we were really only privileged

144
00:06:56,850 --> 00:07:00,480
to know about BRCA1 and BRCA2,

145
00:07:00,480 --> 00:07:02,580
and it was patented at the time.

146
00:07:02,580 --> 00:07:06,840
So Myriad did have that advantage.

147
00:07:06,840 --> 00:07:10,110
And now we're so much more aware

148
00:07:10,110 --> 00:07:13,710
of other genes that increase our risk,

149
00:07:13,710 --> 00:07:15,570
but not only for breast cancer,

150
00:07:15,570 --> 00:07:18,240
but for other cancers as well,

151
00:07:18,240 --> 00:07:20,580
and there's a major overlap.

152
00:07:20,580 --> 00:07:22,830
And then some of those genes,

153
00:07:22,830 --> 00:07:25,980
we are aware that they maybe indicate

154
00:07:25,980 --> 00:07:29,190
that we should be getting
preventative surgeries, correct?

155
00:07:29,190 --> 00:07:32,010
And then other ones, maybe
it's just surveillance.

156
00:07:32,010 --> 00:07:35,100
So when we're going to
a primary care provider,

157
00:07:35,100 --> 00:07:37,140
maybe they don't have
the latest information

158
00:07:37,140 --> 00:07:39,420
because it's not because
they're not proficient,

159
00:07:39,420 --> 00:07:41,850
it's just that they don't have the time.

160
00:07:41,850 --> 00:07:46,530
So I do think that it would be great

161
00:07:46,530 --> 00:07:48,240
if they could have a genetic specialist,

162
00:07:48,240 --> 00:07:52,680
if they're a smaller
area in their department

163
00:07:52,680 --> 00:07:54,180
or in their hospital,

164
00:07:54,180 --> 00:07:57,600
but if not, stay, you know,

165
00:07:57,600 --> 00:08:00,420
refer to a genetic counselor.

166
00:08:00,420 --> 00:08:01,710
That is what I would say.

167
00:08:01,710 --> 00:08:05,460
At Mayo Clinic, our
genetic counseling teams

168
00:08:05,460 --> 00:08:07,200
across the enterprise are growing,

169
00:08:07,200 --> 00:08:10,470
and they can help
patients assess for risk,

170
00:08:10,470 --> 00:08:14,490
understand their risk, the implications,

171
00:08:14,490 --> 00:08:18,513
the testing process,
results, treatment options,

172
00:08:19,350 --> 00:08:22,020
address emotional concerns,

173
00:08:22,020 --> 00:08:24,813
not only for the patient,
but for their family members.

174
00:08:25,980 --> 00:08:27,570
They're used to advocacy,

175
00:08:27,570 --> 00:08:30,840
and they can refer
patients to support groups.

176
00:08:30,840 --> 00:08:35,280
So I am obviously an advocate

177
00:08:35,280 --> 00:08:38,433
for utilizing genetic counselors.

178
00:08:39,270 --> 00:08:41,790
We are also obviously

179
00:08:41,790 --> 00:08:44,580
at Mayo Clinic privileged

180
00:08:44,580 --> 00:08:47,340
to have the Center for
Individualized Medicine,

181
00:08:47,340 --> 00:08:48,570
where I work.

182
00:08:48,570 --> 00:08:52,140
It's built clinics to allow opportunities

183
00:08:52,140 --> 00:08:55,890
for patients to be seen
sometimes the same day

184
00:08:55,890 --> 00:08:58,680
instead of waiting months to be seen

185
00:08:58,680 --> 00:08:59,910
for a genetic counselor

186
00:08:59,910 --> 00:09:02,910
because this enables
patients to be seen faster.

187
00:09:02,910 --> 00:09:07,910
And we both know that genes
can determine the type

188
00:09:08,340 --> 00:09:12,330
of chemotherapy or treatment
that patients need to be seen,

189
00:09:12,330 --> 00:09:16,110
so precision medicine, or
individualized medicine,

190
00:09:16,110 --> 00:09:20,730
as many people call it, and
the regimens that we follow.

191
00:09:20,730 --> 00:09:24,570
But I've said this before,
and I will say it again,

192
00:09:24,570 --> 00:09:28,440
that I think healthcare
providers can get desensitized.

193
00:09:28,440 --> 00:09:32,670
And, you know, as a nurse,
I see it quite a bit.

194
00:09:32,670 --> 00:09:36,030
We continue to see the same
indication over and over.

195
00:09:36,030 --> 00:09:40,320
We may think it's the same
patient over and over.

196
00:09:40,320 --> 00:09:45,090
I think of each patient as someone,

197
00:09:45,090 --> 00:09:46,590
you know, I think of each patient

198
00:09:46,590 --> 00:09:48,030
as someone I love very, very much.

199
00:09:48,030 --> 00:09:52,470
And I think of all of my
education as my grandma.

200
00:09:52,470 --> 00:09:54,453
So would this benefit her?

201
00:09:56,190 --> 00:09:58,560
How does she deserve to be treated?

202
00:09:58,560 --> 00:10:01,740
So put a person behind every indication.

203
00:10:01,740 --> 00:10:04,533
Put your special person
behind that indication.

204
00:10:05,940 --> 00:10:08,010
So in lab medicine,

205
00:10:08,010 --> 00:10:11,100
this would be similar
to a specimen, you know?

206
00:10:11,100 --> 00:10:14,820
Keep that in mind behind every specimen

207
00:10:14,820 --> 00:10:16,980
that special individual to you.

208
00:10:16,980 --> 00:10:19,350
So you're spending that time

209
00:10:19,350 --> 00:10:21,600
on that special individual to you.

210
00:10:21,600 --> 00:10:25,260
It's not just blood,
saliva, whatever it may be.

211
00:10:25,260 --> 00:10:29,820
And in that case, every
indication is a patient.

212
00:10:29,820 --> 00:10:32,910
- You know, a theme I
hear in your answer there,

213
00:10:32,910 --> 00:10:35,490
you know, when you're
talking about time and,

214
00:10:35,490 --> 00:10:38,940
you know, that's not to
say people aren't competent

215
00:10:38,940 --> 00:10:42,030
in their work, but just
there are challenges

216
00:10:42,030 --> 00:10:44,070
that we're trying to navigate.

217
00:10:44,070 --> 00:10:49,050
Time, the complexity, the
rapid pace of innovation.

218
00:10:49,050 --> 00:10:53,850
And I think your wisdom there
of making sure we connect

219
00:10:53,850 --> 00:10:56,400
with people who may know
the latest and greatest,

220
00:10:56,400 --> 00:10:59,910
and just verifying, you know,
is this information correct?

221
00:10:59,910 --> 00:11:01,950
Is there something more to offer?

222
00:11:01,950 --> 00:11:04,290
I think always that reaching out for help,

223
00:11:04,290 --> 00:11:07,740
that's something certainly
we should probably do more of

224
00:11:07,740 --> 00:11:11,550
in our practices as a cautionary thing.

225
00:11:11,550 --> 00:11:15,870
I'm kind of wondering about,
you know, given your work

226
00:11:15,870 --> 00:11:18,033
in the Center for Individualized Medicine,

227
00:11:19,020 --> 00:11:21,690
in talking about educating patients,

228
00:11:21,690 --> 00:11:24,630
I imagine two things I'm
kind of curious about.

229
00:11:24,630 --> 00:11:25,860
How do you navigate, I mean,

230
00:11:25,860 --> 00:11:28,380
the complexity of stuff
that you're talking about?

231
00:11:28,380 --> 00:11:29,940
I mean, and you're individualizing it,

232
00:11:29,940 --> 00:11:33,120
so it's really talking
to that specific person,

233
00:11:33,120 --> 00:11:36,210
as you're putting it, that special person.

234
00:11:36,210 --> 00:11:40,230
And also, these things
might change over time.

235
00:11:40,230 --> 00:11:41,790
And so like, you know,

236
00:11:41,790 --> 00:11:45,930
maybe somebody should revisit
this at some point in time.

237
00:11:45,930 --> 00:11:48,990
I'm kind of curious
how you navigate those.

238
00:11:48,990 --> 00:11:51,630
- Mm-hmm. Yeah, that is complex.

239
00:11:51,630 --> 00:11:54,540
So things do change quite often.

240
00:11:54,540 --> 00:11:56,400
Especially, you know, with technology,

241
00:11:56,400 --> 00:11:57,540
things change as well.

242
00:11:57,540 --> 00:12:02,540
So we find that that happens a lot.

243
00:12:02,610 --> 00:12:04,920
So we have to revisit things.

244
00:12:04,920 --> 00:12:07,530
Education materials need to change.

245
00:12:07,530 --> 00:12:10,650
We find that we're
going more and more away

246
00:12:10,650 --> 00:12:12,030
from print materials.

247
00:12:12,030 --> 00:12:17,030
So that means that they
want to do more PowerPoints,

248
00:12:17,130 --> 00:12:20,430
but that gets away also from face-to-face.

249
00:12:20,430 --> 00:12:23,880
So that can take away from

250
00:12:23,880 --> 00:12:28,140
that hands-on communication
with the patient as well.

251
00:12:28,140 --> 00:12:32,220
So that can become a challenge

252
00:12:32,220 --> 00:12:33,270
because you don't know

253
00:12:33,270 --> 00:12:35,310
if they're absorbing the information

254
00:12:35,310 --> 00:12:37,710
also that you're teaching them.

255
00:12:37,710 --> 00:12:41,220
So that is difficult,

256
00:12:41,220 --> 00:12:43,170
but, you know, making sure

257
00:12:43,170 --> 00:12:45,990
that you're hopefully
answering any questions

258
00:12:45,990 --> 00:12:46,823
that you have.

259
00:12:46,823 --> 00:12:49,320
And that's when you wanna make sure

260
00:12:49,320 --> 00:12:52,620
that you're delivering
different models of education.

261
00:12:52,620 --> 00:12:57,620
So written and oral.

262
00:12:57,630 --> 00:12:58,560
- I hear what you're saying.

263
00:12:58,560 --> 00:13:02,373
I think that this idea of,

264
00:13:05,130 --> 00:13:08,640
by innovating and like, instead
of having printed materials,

265
00:13:08,640 --> 00:13:10,620
you're then able to really update stuff.

266
00:13:10,620 --> 00:13:13,020
I imagine that the PowerPoints

267
00:13:13,020 --> 00:13:16,140
that you're doing are
a lot more up to date

268
00:13:16,140 --> 00:13:18,120
than like, something
that was on a print run,

269
00:13:18,120 --> 00:13:20,010
and it's like, well, that
was the previous edition.

270
00:13:20,010 --> 00:13:21,610
We haven't run out of those yet.

271
00:13:22,620 --> 00:13:23,610
But then at the same time,

272
00:13:23,610 --> 00:13:25,080
you're bringing up the
point that, you know,

273
00:13:25,080 --> 00:13:28,770
with this innovation, which
has some good side to it,

274
00:13:28,770 --> 00:13:31,617
there's new challenges that
are introduced in that.

275
00:13:31,617 --> 00:13:33,420
And what I'm hearing you say

276
00:13:33,420 --> 00:13:36,510
is that impersonalization that then comes

277
00:13:36,510 --> 00:13:39,510
into the relationship.

278
00:13:39,510 --> 00:13:40,343
- Yeah.

279
00:13:40,343 --> 00:13:42,720
And another thing is in
education we're advised

280
00:13:42,720 --> 00:13:45,990
to build education at
an eighth grade level,

281
00:13:45,990 --> 00:13:48,550
which is difficult when you have been

282
00:13:49,740 --> 00:13:52,380
in education beyond an eighth grade level.

283
00:13:52,380 --> 00:13:54,120
And then not everyone is

284
00:13:54,120 --> 00:13:56,220
at an eighth grade level
of education, right?

285
00:13:56,220 --> 00:14:00,150
So we have to understand
that that is fluid.

286
00:14:00,150 --> 00:14:04,080
And so I think that it also comes down

287
00:14:04,080 --> 00:14:07,230
to just having a conversation
with your patient, right?

288
00:14:07,230 --> 00:14:09,630
So understanding where they're at.

289
00:14:09,630 --> 00:14:12,660
Maybe the patient isn't ready to learn.

290
00:14:12,660 --> 00:14:13,920
Maybe they're still stuck

291
00:14:13,920 --> 00:14:15,720
on the information that they learned

292
00:14:18,600 --> 00:14:20,070
in the last appointment.

293
00:14:20,070 --> 00:14:21,840
You know, maybe they just had

294
00:14:21,840 --> 00:14:24,390
to navigate a difficult diagnosis.

295
00:14:24,390 --> 00:14:26,730
Maybe they're understanding

296
00:14:26,730 --> 00:14:29,250
that they just received a diagnosis

297
00:14:29,250 --> 00:14:31,680
that they are, you know,

298
00:14:31,680 --> 00:14:34,410
did get a BRCA-positive diagnosis

299
00:14:34,410 --> 00:14:35,730
that they could have passed on

300
00:14:35,730 --> 00:14:39,060
to five children or 50%.

301
00:14:39,060 --> 00:14:41,160
So they could have passed it on

302
00:14:41,160 --> 00:14:44,970
to three of five children or
two of five children, right?

303
00:14:44,970 --> 00:14:47,130
So they have multiple appointments,

304
00:14:47,130 --> 00:14:49,290
possible screenings, possible surgeries.

305
00:14:49,290 --> 00:14:52,350
So we have to keep that
into consideration too.

306
00:14:52,350 --> 00:14:53,430
So that's why I do think

307
00:14:53,430 --> 00:14:57,000
that having the print
material with the pictorials.

308
00:14:57,000 --> 00:15:00,510
And I am a strong advocate of analogies

309
00:15:00,510 --> 00:15:03,990
because I think when you are
with your family members,

310
00:15:03,990 --> 00:15:07,740
you're not always bringing
those brochures with.

311
00:15:07,740 --> 00:15:10,980
And so having an analogy
stuck in the back of your head

312
00:15:10,980 --> 00:15:13,747
is sometimes helpful
because then you're like,

313
00:15:13,747 --> 00:15:16,560
"What did that nurse say,
or what did that doctor say?

314
00:15:16,560 --> 00:15:18,120
Oh yeah, I can pull that out."

315
00:15:18,120 --> 00:15:20,880
And then that's a good explanation.

316
00:15:20,880 --> 00:15:23,280
I think one thing that we do see a lot,

317
00:15:23,280 --> 00:15:25,200
to relate it back to the lab,

318
00:15:25,200 --> 00:15:28,050
is we see that patients really struggle

319
00:15:28,050 --> 00:15:32,040
with the difference between
somatic and germline testing.

320
00:15:32,040 --> 00:15:37,040
So like, to think about grandma again.

321
00:15:38,190 --> 00:15:43,190
So let's say a 78-year-old
grandma goes into the clinic

322
00:15:44,010 --> 00:15:47,790
and is diagnosed with
breast cancer, right?

323
00:15:47,790 --> 00:15:50,730
So as an educator, it's an important

324
00:15:50,730 --> 00:15:53,820
to give her multiple
learning styles, right?

325
00:15:53,820 --> 00:15:56,430
But we are probably gonna be doing tumor

326
00:15:56,430 --> 00:15:59,010
or somatic testing on her.

327
00:15:59,010 --> 00:16:00,990
But she goes home

328
00:16:00,990 --> 00:16:03,927
and tells her 18-year-old
granddaughter about this.

329
00:16:03,927 --> 00:16:06,637
The 18-year-old granddaughter
came home and said,

330
00:16:06,637 --> 00:16:11,637
"Well, my best friend's mom
who's 43 just got diagnosed

331
00:16:11,970 --> 00:16:15,990
with breast cancer, and
they're gonna do germline

332
00:16:15,990 --> 00:16:18,210
and somatic breast cancer testing

333
00:16:18,210 --> 00:16:20,610
'cause they're not sure that her,

334
00:16:20,610 --> 00:16:23,010
you know, family has breast cancer."

335
00:16:23,010 --> 00:16:26,430
So grandma should probably have
a little bit of information

336
00:16:26,430 --> 00:16:28,980
to explain to the 18-year-old

337
00:16:28,980 --> 00:16:31,620
that they don't think that this,

338
00:16:31,620 --> 00:16:34,380
that grandma's breast cancer,

339
00:16:34,380 --> 00:16:38,430
is a germline variant, right?

340
00:16:38,430 --> 00:16:41,700
So the 18-year-old doesn't have
to get too anxious about it.

341
00:16:41,700 --> 00:16:46,260
But I also think that, you know,

342
00:16:46,260 --> 00:16:49,230
we also struggle in education

343
00:16:49,230 --> 00:16:52,050
that there are only certain
resources we can put

344
00:16:52,050 --> 00:16:53,073
in print, right?

345
00:16:55,835 --> 00:16:57,918
We can put certain things

346
00:16:59,160 --> 00:17:01,200
that they can refer to, but as a provider,

347
00:17:01,200 --> 00:17:02,400
I think that it's important,

348
00:17:02,400 --> 00:17:04,800
if you feel like something is
gonna be a helpful resource,

349
00:17:04,800 --> 00:17:07,830
that patient may appreciate,

350
00:17:07,830 --> 00:17:09,450
if you think it's gonna
be helpful for them,

351
00:17:09,450 --> 00:17:11,610
for you to physically write it down there.

352
00:17:11,610 --> 00:17:14,670
And then when they're ready
to absorb that information,

353
00:17:14,670 --> 00:17:17,730
they'll go to it because
they felt like you thought

354
00:17:17,730 --> 00:17:19,140
it was gonna be helpful for them.

355
00:17:19,140 --> 00:17:22,590
So if I feel like a
support group was helpful,

356
00:17:22,590 --> 00:17:23,850
I'm gonna write that down.

357
00:17:23,850 --> 00:17:26,280
But Mayo Clinic may not have vetted

358
00:17:26,280 --> 00:17:30,663
that support group per se
or a different institution.

359
00:17:31,560 --> 00:17:34,830
You know, then-

360
00:17:34,830 --> 00:17:35,760
- It really seems to come back

361
00:17:35,760 --> 00:17:39,169
to you're advocating for that person.

362
00:17:39,169 --> 00:17:40,002
- Yeah.

363
00:17:40,002 --> 00:17:42,760
So I think that there's
just different avenues

364
00:17:46,957 --> 00:17:48,030
that could be taken,

365
00:17:48,030 --> 00:17:50,523
and it's not always
black and white, right?

366
00:17:51,780 --> 00:17:54,180
- You know, that kind of touches

367
00:17:54,180 --> 00:17:56,130
on this question I have

368
00:17:56,130 --> 00:17:58,350
that I think probably
all of us can relate to,

369
00:17:58,350 --> 00:18:00,453
is when we're educating somebody,

370
00:18:01,380 --> 00:18:03,660
you know, sometimes we're
not getting the sense

371
00:18:03,660 --> 00:18:05,280
that they're understanding
the information.

372
00:18:05,280 --> 00:18:06,907
Or if we're asking them to,

373
00:18:06,907 --> 00:18:08,550
you know, say back to me,

374
00:18:08,550 --> 00:18:12,270
explain to me what we've
been talking about,

375
00:18:12,270 --> 00:18:15,300
it's clear that they're
not making the connection.

376
00:18:15,300 --> 00:18:17,190
And I'm curious, you know,

377
00:18:17,190 --> 00:18:20,490
how do you navigate
those situations, right?

378
00:18:20,490 --> 00:18:24,240
Because you really are doing a complex set

379
00:18:24,240 --> 00:18:26,400
of skills there of, you know,

380
00:18:26,400 --> 00:18:29,130
kind of understanding, diagnosing,

381
00:18:29,130 --> 00:18:34,110
or trying to figure out
what the challenge is

382
00:18:34,110 --> 00:18:35,130
with the information.

383
00:18:35,130 --> 00:18:37,080
How do you navigate that?

384
00:18:37,080 --> 00:18:40,200
- Again, I think that's
having that conversation

385
00:18:40,200 --> 00:18:43,980
with the patient and
doing a teach back method.

386
00:18:43,980 --> 00:18:45,630
I mean, it goes back to that.

387
00:18:45,630 --> 00:18:49,230
It's just not quizzing them

388
00:18:49,230 --> 00:18:52,200
because they're gonna feel
uncomfortable, you know?

389
00:18:52,200 --> 00:18:54,540
Anytime you have a quiz or test at school.

390
00:18:54,540 --> 00:18:56,460
Maybe some people like that. I did not.

391
00:18:56,460 --> 00:19:00,810
But just so you know

392
00:19:00,810 --> 00:19:03,120
that they're retaining something, right?

393
00:19:03,120 --> 00:19:05,370
And again, providing resources

394
00:19:05,370 --> 00:19:08,460
'cause they may not be ready
to obtain that information

395
00:19:08,460 --> 00:19:11,250
or to soak it in, and that's okay.

396
00:19:11,250 --> 00:19:13,050
But also, you know,

397
00:19:13,050 --> 00:19:17,830
we have the patient
portal providing material

398
00:19:19,417 --> 00:19:22,050
in the language that they understand.

399
00:19:22,050 --> 00:19:25,950
So we do have a diverse community,
especially in Rochester.

400
00:19:25,950 --> 00:19:30,370
So we wanna be giving materials

401
00:19:31,500 --> 00:19:34,200
in a language that they understand, right?

402
00:19:34,200 --> 00:19:37,740
We want to be providing
materials for family members.

403
00:19:37,740 --> 00:19:41,490
So I've worked on BRCA for males.

404
00:19:41,490 --> 00:19:45,210
So if we are gonna be diagnosing a female

405
00:19:45,210 --> 00:19:47,460
with a BRCA2 mutation,

406
00:19:47,460 --> 00:19:51,280
we do want to let her know
that that is something

407
00:19:53,310 --> 00:19:55,890
that she could have passed
on to her sons, right?

408
00:19:55,890 --> 00:19:57,810
Or that her brother could have.

409
00:19:57,810 --> 00:20:02,790
So maybe we give her a pamphlet
to hand to her brother,

410
00:20:02,790 --> 00:20:06,060
or to hand to her sons, if
they are old enough, right?

411
00:20:06,060 --> 00:20:09,330
So those are things to consider as well.

412
00:20:09,330 --> 00:20:11,460
It's not just the patient themselves,

413
00:20:11,460 --> 00:20:12,840
but care for their families

414
00:20:12,840 --> 00:20:15,960
because that's what
they're gonna think about.

415
00:20:15,960 --> 00:20:19,653
I know that, as I've gotten older,

416
00:20:21,725 --> 00:20:23,460
my thoughts have changed too now

417
00:20:23,460 --> 00:20:26,070
that I have children of my own, right?

418
00:20:26,070 --> 00:20:28,080
So yeah.
- It's wonderful.

419
00:20:28,080 --> 00:20:30,810
You know, so the importance of education,

420
00:20:30,810 --> 00:20:34,260
educating patients,
has always been around.

421
00:20:34,260 --> 00:20:37,560
And like you say, you
have your own family now,

422
00:20:37,560 --> 00:20:40,230
and you've seen a lot of things advance

423
00:20:40,230 --> 00:20:43,440
with the Center for
Individualized Medicine.

424
00:20:43,440 --> 00:20:45,420
And I'm curious,

425
00:20:45,420 --> 00:20:50,190
what does the future of patient
education look like to you?

426
00:20:50,190 --> 00:20:54,000
- Yeah, so kind of as evidenced
of us sitting here right now

427
00:20:54,000 --> 00:20:57,030
on a podcast over the computer,

428
00:20:57,030 --> 00:20:58,770
it's definitely enhanced,

429
00:20:58,770 --> 00:21:02,730
this last few years was
enhanced by technology, right?

430
00:21:02,730 --> 00:21:05,760
So it has taken away some

431
00:21:05,760 --> 00:21:08,550
of what I appreciate
most about healthcare,

432
00:21:08,550 --> 00:21:10,290
some of the personal touch.

433
00:21:10,290 --> 00:21:11,790
I'm giving you a little clue

434
00:21:11,790 --> 00:21:13,500
into what my love language is.

435
00:21:13,500 --> 00:21:15,603
I'm huge into the love languages.

436
00:21:17,130 --> 00:21:20,280
I appreciate everyone else's
love language, though,

437
00:21:20,280 --> 00:21:22,260
if it's not what mine is.

438
00:21:22,260 --> 00:21:23,640
But in all seriousness,

439
00:21:23,640 --> 00:21:25,980
I do think that there's
something to be said

440
00:21:25,980 --> 00:21:29,820
for the personal touch experience provider

441
00:21:29,820 --> 00:21:34,560
and even nurses are taught
to educate their patients.

442
00:21:34,560 --> 00:21:37,590
You know, it may not be
like opening up a book

443
00:21:37,590 --> 00:21:39,870
like a teacher educator,

444
00:21:39,870 --> 00:21:44,870
but our time with nurses
and doctors has decreased

445
00:21:45,300 --> 00:21:49,380
over the years, and it
will continue to decrease.

446
00:21:49,380 --> 00:21:51,900
I know our time with genetic
counselors has decreased

447
00:21:51,900 --> 00:21:55,260
because we just don't have the teachers

448
00:21:55,260 --> 00:21:57,030
to teach genetic counselors,

449
00:21:57,030 --> 00:22:00,870
so they can only take so
many in their programs.

450
00:22:00,870 --> 00:22:04,470
So we need to be more creative

451
00:22:04,470 --> 00:22:09,180
and find more efficient
ways to educate patients.

452
00:22:09,180 --> 00:22:11,850
It means utilizing more technology.

453
00:22:11,850 --> 00:22:15,270
And I understand this must
change with the times,

454
00:22:15,270 --> 00:22:17,793
and hospitals are driven
by reimbursements.

455
00:22:19,260 --> 00:22:23,880
I realize that it may affect
patient satisfaction as well,

456
00:22:23,880 --> 00:22:26,190
but we have to be,

457
00:22:26,190 --> 00:22:29,430
we have to not hit them in
the face with the technology,

458
00:22:29,430 --> 00:22:32,130
but establish relationships
with them first.

459
00:22:32,130 --> 00:22:35,820
So meet the patient first
before we're just like,

460
00:22:35,820 --> 00:22:38,103
throwing the technology in their face.

461
00:22:39,720 --> 00:22:42,333
It's important to establish
those relationships.

462
00:22:43,380 --> 00:22:45,750
Another factor is patient expectations.

463
00:22:45,750 --> 00:22:48,330
Those are only increasing,
especially with COVID.

464
00:22:48,330 --> 00:22:52,230
I think that everything's
at their fingertips, right?

465
00:22:52,230 --> 00:22:54,150
So we've raised the bar.

466
00:22:54,150 --> 00:22:58,053
And providing everything
digitally with that,

467
00:23:01,650 --> 00:23:04,770
we have to address varied health literacy,

468
00:23:04,770 --> 00:23:09,630
digital access with patient engagement

469
00:23:09,630 --> 00:23:12,000
in their healthcare and their literacy.

470
00:23:12,000 --> 00:23:13,470
Patients not only will expect

471
00:23:13,470 --> 00:23:16,020
to see the information delivered directly

472
00:23:16,020 --> 00:23:17,740
to their personal devices

473
00:23:19,380 --> 00:23:22,380
and in their preferred
language, like I talked about,

474
00:23:22,380 --> 00:23:24,063
but at their reading level,

475
00:23:24,990 --> 00:23:27,000
and in terms that are actionable

476
00:23:27,000 --> 00:23:31,410
and meaningful to their
understanding and their situations.

477
00:23:31,410 --> 00:23:35,010
So it really has to be patient centered

478
00:23:35,010 --> 00:23:37,230
and patient geared and to them.

479
00:23:37,230 --> 00:23:40,920
So it cannot be, it's on their terms.

480
00:23:40,920 --> 00:23:43,320
And I understand this makes it difficult

481
00:23:43,320 --> 00:23:46,090
for us as educators to gauge

482
00:23:47,220 --> 00:23:48,300
if they're understanding

483
00:23:48,300 --> 00:23:51,990
or comprehending what we
are delivering to them

484
00:23:51,990 --> 00:23:55,080
because it's not face-to-face
all the time, right?

485
00:23:55,080 --> 00:24:00,030
So we can't always,

486
00:24:00,030 --> 00:24:02,220
you know, get a great assessment.

487
00:24:02,220 --> 00:24:04,230
So we want to make sure

488
00:24:04,230 --> 00:24:06,360
that they're still communicating
with their providers.

489
00:24:06,360 --> 00:24:08,280
So we want to make sure

490
00:24:08,280 --> 00:24:10,410
that they're doing the face-to-face,

491
00:24:10,410 --> 00:24:13,110
engaging maybe, you know,

492
00:24:13,110 --> 00:24:15,150
via the portal or those kinds of things.

493
00:24:15,150 --> 00:24:19,170
And I know that there can
be sometimes a disconnect

494
00:24:19,170 --> 00:24:21,540
when it comes to electronics as well.

495
00:24:21,540 --> 00:24:23,850
So we have to make sure

496
00:24:23,850 --> 00:24:27,270
that not too much gets
lost in translation.

497
00:24:27,270 --> 00:24:30,570
Overall, I think just
healthcare just needs

498
00:24:30,570 --> 00:24:34,170
to continually focus on strengthening

499
00:24:34,170 --> 00:24:37,890
and providing insightful ways

500
00:24:37,890 --> 00:24:39,843
to deliver patient education,

501
00:24:40,920 --> 00:24:44,520
which will be essential in
improving patient experiences

502
00:24:44,520 --> 00:24:47,670
and outcomes for today and in the future.

503
00:24:47,670 --> 00:24:49,020
- Absolutely.

504
00:24:49,020 --> 00:24:51,870
I think that really resonates with me

505
00:24:51,870 --> 00:24:55,500
about these key things for all
of us to take home with us,

506
00:24:55,500 --> 00:24:57,900
about, you know, the creativity

507
00:24:57,900 --> 00:25:00,120
that we're gonna have
to pull going forward,

508
00:25:00,120 --> 00:25:04,830
valuing the skill of being an educator,

509
00:25:04,830 --> 00:25:07,380
the idea of making things actionable

510
00:25:07,380 --> 00:25:09,810
and meaningful for the person.

511
00:25:09,810 --> 00:25:12,360
'Cause we understand
that for adult learning,

512
00:25:12,360 --> 00:25:16,710
that is so fundamental for
that learning to happen.

513
00:25:16,710 --> 00:25:19,350
And then also, I think you're spot on,

514
00:25:19,350 --> 00:25:21,420
I see this, and I struggle with it myself,

515
00:25:21,420 --> 00:25:25,440
this idea of, you know,
disconnected education.

516
00:25:25,440 --> 00:25:27,240
There's not that opportunity to check

517
00:25:27,240 --> 00:25:28,830
in with the learner in the same way.

518
00:25:28,830 --> 00:25:32,749
And so it really demands creativity.

519
00:25:32,749 --> 00:25:35,040
- Mm-hmm. Yeah.

520
00:25:35,040 --> 00:25:38,133
- So thanks for rounding
with us today, Cori Berg.

521
00:25:39,000 --> 00:25:40,830
- Thank you.
- Thanks to all the listeners

522
00:25:40,830 --> 00:25:44,850
for taking the time to
round with us today as well.

523
00:25:44,850 --> 00:25:48,060
We really appreciate
you sharing your story

524
00:25:48,060 --> 00:25:51,870
and also helping us remember
some of these key factors

525
00:25:51,870 --> 00:25:54,900
that make our education with colleagues

526
00:25:54,900 --> 00:25:57,270
and patients so important.

527
00:25:57,270 --> 00:25:59,070
- Thank you, Dr. Kreuter.

528
00:25:59,070 --> 00:26:00,210
- So to all of our listeners,

529
00:26:00,210 --> 00:26:01,320
thank you for joining us today.

530
00:26:01,320 --> 00:26:02,820
We invite you to share your thoughts

531
00:26:02,820 --> 00:26:04,890
and suggestions via email.

532
00:26:04,890 --> 00:26:06,450
Please direct any suggestions

533
00:26:06,450 --> 00:26:09,480
to mcleducation@mayo.edu

534
00:26:09,480 --> 00:26:10,950
and reference this podcast.

535
00:26:10,950 --> 00:26:13,440
If you've enjoyed Lab
Medicine Rounds podcast,

536
00:26:13,440 --> 00:26:16,350
please subscribe, and until
our next rounds together,

537
00:26:16,350 --> 00:26:19,140
we encourage you to continue
to connect lab medicine

538
00:26:19,140 --> 00:26:22,208
and the clinical practice
through insightful conversations.

539
00:26:22,208 --> 00:26:24,791
(upbeat music)