The Clinical Excellent Podcast, sponsored by the Bucksbaum Institute for Clinical Excellence is a biweekly podcast hosted by Drs. Adam Cifu and Matthew Sorrentino. The podcast has three formats: discussions between doctors and patients, discussions with authors of research pertinent to improving clinical care and the doctor-patient relationship and discussions with physicians about challenges in the doctor-patient relationship or in the life of a physician.
[00:00:00] Dr. Cifu: On today's episode of The Clinical Excellence Podcast, we have Dr. Chadi Nabhan taking us through the cancer journey.
[00:00:12] Dr. Nabhan: Ultimately, we have to put ourselves in the patient's shoes because in my book, in the preface, I did say we're all patients. I mean, if not today, it's tomorrow or yesterday. And I think that nobody is invincible. We know that. And listeners know that.
[00:00:41] Dr. Cifu: We're back with another episode of The Clinical Excellence Podcast, sponsored by the Bucksbaum-Siegler Institute for Clinical Excellence. On this podcast, we speak to patients and doctors about all aspects of excellence in clinical medicine. I'm Adam Cifu, and today I'm joined by Chadi Nabhan. Dr. Nabhan is currently the Chief Medical Officer and Head Strategy of Wright Incorporated, a generative artificial intelligence company, focused on bringing AI technology into conducting clinical research and accelerating clinical trials. Prior to joining Wright, dr. Nabhan was at Caris Life Sciences as a senior vice president. He is also an affiliate in the Department of Clinical Pharmacy and Outcome Sciences at the University of South Carolina where he mentors fellows and junior faculty while participating in oncology outcomes research. Dr. Nabhan is a hematologist and medical oncologist with a special interest in malignant hematology. He completed his residency at Loyola University here in Chicago and a fellowship at Northwestern University and Robert H. Lurie Comprehensive Cancer Center. He holds an MBA in healthcare management from Loyola University Quinlan School of Business. Chadi and I first met when he was the medical director of the Clinical Cancer Center at the University of Chicago, where he was also an associate professor of medicine. Chadi has been incredibly busy otherwise. He's a primary investigator on many clinical trials and has over 300 peer-reviewed original articles. He currently hosts a competing podcast, which I'll try to steer you away from, Healthcare Unfiltered. Dr. Nabhan has authored two books: Toxic Exposure: The True Story Behind the Monsanto Trials and the Search for Justice, and the one we'll be discussing today, The Cancer Journey: Understanding Diagnosis, Treatment, Recovery, and Prevention.
Chadi, thank you so much for taking the time to join me.
[00:02:37] Dr. Nabhan: It's a pleasure to be here, and it's not a competing podcast. It's a complimentary podcast. Complimentary.
[00:02:43] Dr. Cifu: People only have time for a certain number of podcasts though, you know, you don't want people to jump ship from one to another, right?
[00:02:49] Dr. Nabhan: That is true. That's why it's always about the content. And this is a very nice production here, Adam. I mean, for folks who are not... Who are just listening, Adam's podcast definitely way surpasses mine in terms of production. We are in a real studio right here.
[00:03:04] Dr. Cifu: Real studio, otherwise known as my office. So I asked you on the podcast not just because I just like talking to you but because of your new book, The Cancer Journey, but before we get to that, can you kind of take me briefly through your career? It's not a traditional one for a doctor or an oncologist.
[00:03:23] Dr. Nabhan: No, it's not. And I wish I can tell you any of this was planned because a lot of times these career transitions occur by chance, serendipity, and with opportunities that get presented to you.
I genuinely never thought I would leave clinical medicine where I just take care of patients. It's really what we are trained to do, and it's our comfort zone but there comes a time where I felt maybe, maybe I could help patients or have an impact on healthcare and patient care in a larger and a bit more broad way, outside of the exam room.
I'll say this, Adam, that nothing will ever replace a card that you get from a patient, a family, a hug, it's just different, but there is a limit to how much you can impact healthcare broadly, in one institution or in one room. So all of the transitions I've done were simply to see, is there anything I could do differently and more that might have an impact on patient care?
And maybe down the road, I'll look back and I say, this really was worthwhile, the transitions. Yeah. So right now, as an example, I work at an artificial intelligence company. As you and I know, I'm not an AI guy, right? I'm not trained, but it's interesting.
Now I've been there for eight months, and I can throw a couple of terms that will, you know... You'll be impressed, but it's really... Part of the reason is AI is here to stay. And I strongly believe that there is an opportunity to bring technology and innovation into clinical medicine in a good way, because every technology is a double-edged sword.
And if I'm able to bring that technology to accelerate clinical trials, clinical research, faster, good drugs to market because sometimes there are bad drugs out there, then it's great. So...
[00:05:38] Dr. Cifu: Well, it's also inspiring to have someone like you with a clinical background, a research background who, you know, has always been clearly committed to sort of, I don't know, patient welfare, you know, patient treatment, kind of working on the technological side of advancement because I think we need people like you in those fields so we kind of get the right thing out, right?
[00:06:04] Dr. Nabhan: Yeah. No, thank you. And look, I mean, I get a lot of calls on a monthly basis from various friends, colleagues, sometimes people I don't know that they get my name and they just want to talk for half an hour and just ask about what you just asked me, career transition.
And the first question, I tell them is you have to know why you're doing this. My view is very simple. If you're running from something, you probably will make mistakes. If you're running towards something, you probably are making the right choice. And you know, I was very happy at the University of Chicago and we're colleagues here. And it was not easy to leave, to be honest, but I felt there's something different I could do, and I also... Part of this was maybe an opportunity for personal growth. And it's the comfort zone, the hospital. People get intimidated with these buildings and everything, but it's our home, like, my goodness, we spend so many hours here.
So I asked myself, is it possible I can make it outside of my comfort zone? And I think so far, so good.
[00:07:19] Dr. Cifu: Good. So let me ask you a question. And this is a little bit off-topic and I promise we will get to your book in a second but this is actually a question that I have for the person who will be on the next episode and you really talked exactly to that. I think it's true that I see those who are sort of most successful with career transitions are the people who, as you say, are not running away from something, but who are running to something. Given that you've, you know, mentored a lot of people over the years, how do you think people should make good decisions when they are running away from something? So, you know, there are a lot of people in medicine who kind of figured out late that, "Ah, you know, this isn't really the right thing for me, but I've had incredible education, incredible training, I've got value to give someplace else." You know, is there advice you can give to those people to sort of make intelligent decisions about where to put their skills in a place that they'll be happier?
[00:08:18] Dr. Nabhan: I think my view is that you have to first know what your attributes and talent is. I think it's key. You know, if you self-reflect, it's depending on when you are in your career, you kind of know what you are good at and maybe what you're not great at. Some folks are wonderful public speakers.
Others may not be, but both of them could be good clinicians. Not every clinician need to lecture to an audience of a thousand people, right? So the first thing, the first advice I would say is try to understand and be honest with yourself what you're good at and what you're not, and then let's tailor the career transition to what you're actually good at because you're going to position yourself for success.
I think everyone who's listening knows, you are a wonderful communicator and a great educator. That's in addition to obviously being clinician and researcher, but being an educator and communicator means that you're able to convey the science and the information to others. While I've been in lectures with folks who have so many degrees and so many letters after their name and I am falling asleep.
So, my advice to folks who are thinking about this is self-reflect. The second thing I would say is, there's a lot of opportunities in medicine, in healthcare, that are not just in the exam room. You know, there is the publication world and being, again, in the medical journals and all of this.
There are folks who could make a career just simply doing programs like this, right? I mean, podcasts and things like that and others.
[00:10:07] Dr. Cifu: I think those are great points, and I think the sort of self-reflection and honesty, as I think of it, as you say that, is maybe the most challenging thing, right? Because it's being honest with yourself, you know, what am I actually good at and what do I actually enjoy...
[00:10:22] Dr. Nabhan: Because you have to know what you're not good at.
[00:10:24] Dr. Cifu: Right, right. And also admit to yourself that like, "Well, you know, I've always seen myself as this, but maybe that's not actually true." And at some point you just need to accept like, this is who I am. This is what I can do well. Or maybe this is what I can grow into.
[00:10:41] Dr. Nabhan: Yeah. And that's okay. And I think we all need to have that honestly, in every career. I'm reading currently a book, and the author was talking about differentiating between talent and passion.
[00:10:54] Dr. Cifu: Okay.
[00:10:56] Dr. Nabhan: Interesting. You're saying you may be passionate about watches but maybe that's not your... You're not talented at making the watch. So leave your passion for the weekends in this, but you have to know what you're talented in because that's what's going to define your career.
[00:11:12] Dr. Cifu: Yeah. Yeah. Terrific. So let me tell you, the book, The Cancer Journey really impressed me. I'm not completely done with it, but I've been sort of frantically reading it for the last two weeks. It's really a quite broad scope. It begins by kind of defining what cancer actually is. It then talks about kind of screening and diagnosis, but I feel like the focus of the book is really what a patient's entire experience might be, sort of from diagnosis, you know, through disease, through all of their kind of contacts with the medical establishment today.
I certainly see how the book would be a useful, like a gift to patients but as I was reading it, I also see it as useful to anyone who's sort of like in a medically adjacent career. You know, doctors certainly, but actually like people working in policy and law and journalism, really whatever. It's got a very broad audience to me. As you were writing it, like sort of who is the reader you were imagining? Like who are you writing for specifically?
[00:12:14] Dr. Nabhan: Yeah. And as you know, you also have written books, the first thing is defining your audience because you have to tailor the book to your audience. And that's a double-edged sword because sometimes if your audience is very broad, people will critique you that you're a bit not specific enough, right? Not narrow enough. You're not focused enough, but I actually intentionally wanted to write a book that anyone could read. And it is written for general audience.
It is written for layman people. This is not a textbook. It's not meant to be. I think textbooks could be boring if you are not a medical student or somebody who is immersed in the medical establishment. I wanted to write a book that anyone who is interested in this topic would pick up and learn a few things that they did not know before. Now, what they are going to learn and how much they're going to learn depend on their baseline level of education. So for someone like yourself, Adam, probably it's not learning about the science, it's probably the other aspect that you did not get to see because you're not a medical oncologist and where I talk about communication, about other things that it may make you pause like, "Okay, well, I get that part."
But I think patients, families, nurses, pharmacists, caregivers, anybody in my opinion will see a nugget or two in there. My goal was to reach as broad of an audience as possible.
[00:13:56] Dr. Cifu: Yeah, I think you achieved that because reading it, what struck me was sort of like the intelligent lay audience, you know, seems like who would be interested in this.
Not just cancer patients, but you know, everybody who's been touched by cancer, which in a way is everybody but I was surprised as a physician, you know, that I got quite a bit out of it. And similar to how you say, there were things that, you know, I know, that I thought about skipping over. I mean, you talk about cancer screening and, you know, we've argued about that.
[00:14:29] Dr. Nabhan: That was the chapter I was most nervous about. I was reading it, I'm like, what? Because this is such an important topic for patients and lay audience, but it's tough to discuss it in a book.
[00:14:40] Dr. Cifu: Right but the beauty is that as I read that, as, you know, an opinionated, informed reader, I still got stuff out of it because what I got was, you know, another physician's intelligent view of it, coming at it from a different perspective, and sort of learned a lot about things that I already know, which for me is, you know, the height of compliments for a book. So I really appreciate your work.
[00:15:05] Dr. Nabhan: I appreciate it.
[00:15:06] Dr. Cifu: So my next question might seem kind of ridiculous, but I was really interested in asking you this as I read the book. You know, there's so much about being a patient with cancer that is just dreadful, you know, the disease, the therapy, the fear. And you do a really nice job talking about that in the book in a way that's not, you know, kind of grim and frightening, but a way that's just useful and truthful, but I wondered about, are there things that you think we kind of don't appreciate enough about the patient's experience? Either things that are difficult that we often don't think about, or even parts of the journey that are kind of valuable.
[00:15:47] Dr. Nabhan: It's really interesting. I think all of the above. Part of the motivation for the book, I've always felt that there's more patients could learn that they may not always feel comfortable asking in the exam room.
It may sound silly, but I've seen this in my own family, and I've mentioned that in the book. You're sitting in the doctor's office and they're nodding, nodding, nodding, and then you walk out and there's not a lot of comprehension to what happened. So I think the people's experience goes through phases, maybe we'll highlight just a couple of them because we can't highlight all, but one of the things that is really critical is when a patient gets a diagnosis until they see the oncologist.
It is really a tough time for patients and families. They are anxious, they are nervous, and they are Googling, they are searching, they're calling friends, and sometimes the oncology visit is in 10 days, sometimes in a week. I think we could always try to do it yesterday if we can, but the reality is it's not practical.
And it's very different for us as medical professionals because, God forbid, if I have something, I'll just text my friend like, "Hey, can I just get on a call? I have a question for you," and I'll probably get some answers in half an hour about certain things I want. Patients don't have the luxury, and I think we underestimate that as physicians because we are living in a hospital so it's just very easy for us, that's really not for patients. The second thing that I think is probably key is second opinions. I think I am a big proponent of second opinions. I think patients and families, they worry about even suggesting this. They don't want to embarrass the doctor. They feel this is the doctor that my primary care physician sent me to, he must trust him or her. And so that's why getting this out in the open and just saying, "Hey, look. Getting a second opinion is fine, and let me tell you who I would send you to if it were me." So trying to put ourselves in the patient's shoes is really critical. And I think the last thing I would say that I believe that we need to probably pay extra attention to is the caregivers.
I strongly believe there is caregiver fatigue. There's compassion fatigue. I've seen it in my clinic. You've seen it in your clinic. We both have seen it in caring for the people we love. It's not easy. I mean, just shutting your schedule, shutting your life, going back and forth, your entire life revolves around that one individual.
We do it with love and compassion, but it takes a toll on us. So do we have a role as healthcare professionals to be attuned to that component because we want to make sure that patients get the proper psychosocial support that we talk about. And that's way more than one hour with this man in the hospital. That's the rest of the time.
[00:18:56] Dr. Cifu: Those are all terrific points, Chadi. There are like three things that I just wanted to highlight and then reflect back to you. The first, just to sort of say it, is the second opinion issue. I think it's such a disconnect between doctors and patients because, I don't know, like, doctors are not offended by the idea that someone's going to get a second opinion.
And as you say, I am happy to tell people, you know, "Oh, you know, here's someone else you can see," you know, someone in my group, someone outside of my group, whatever. And most of us at this point are so well connected that we can find somebody almost anywhere, right, for the patient to see.
[00:19:34] Dr. Nabhan: I think it's a perception that patients have.
[00:19:36] Dr. Cifu: Yes, absolutely, absolutely. Your comment about, you know, that time between diagnosis and seeing the oncologist is such a difficult one, and it would be great to see the oncologist yesterday. I recently came off a stint on the inpatient service. And with technology, things are so sped up that sort of, even in the hospital, one patient who I'm thinking of that we were making the diagnosis of lymphoma and you know, we're waiting for, you know, further diagnostics to be done, and just her waiting you know, the 24-36 hours for that extra information while she was sitting in a hospital room, you know, on her iPad, figuring out everything she could, you're not going to take that away from patients but it becomes more sort of incumbent on us to assist people, you know, during that period of uncertainty.
[00:20:34] Dr. Nabhan: And even during the care. I recently taped a podcast with a patient and his wife who read the book and really the... About his journey with cancer. And one of the things that they commented on was even after they established care throughout the process, they felt whenever, you know, they don't... The access issue.
[00:20:59] Dr. Cifu: Yes, yes.
[00:21:01] Dr. Nabhan: There is an expectation, we should do always better. And I think it's fair. We have to be attuned to this, but you know, how much better can we do? So as an example, if you send an in-basket, let's say, through your patient portal, an electronic health record to your physician, how soon should you get the return and should it be you or your nurse or somebody else?
From a patient perspective, I think the expectations are 24 hours. That's what they expect, unless you're on vacation and then somebody else will respond. And I think their expectations are... Probably you will drop the note as the physician. Otherwise they would have addressed it to the nurse. That doesn't always happen. Sometimes this goes on for several days and sometimes somebody else responds and things like this. So there is this disconnect of expectations and I think some of this is because things have gotten very busy. You know, I mean, you're on inpatient service, you're doing research, education, traveling, lecturing, and taking care of patients, so it's not... So there's some of that issue, and some of this, I believe, we are trained to immediate access. As we're just taping this podcast, I've gotten 10 texts, you've gotten 10 texts already and the people who texted us probably are expecting an answer in like five minutes, five seconds, I mean. So I don't know if there's a solution to this but I've seen that with patients and caregivers.
[00:22:39] Dr. Cifu: Yeah, I have two responses to that. And I think it could probably be an entire episode. One of the most, I think, important experiences for me as a physician happened very early in my career when I got appendicitis, you know, realized that myself in clinic, called my doctor. And the guy was on the phone with me in 90 seconds and that had such an impact on me that, to some extent, it's made me a better doctor. It's also probably, you know, ruined my life in some way.
[00:23:15] Dr. Nabhan: It spoiled you.
[00:23:16] Dr. Cifu: Right because I feel like that's the kind of access I need to provide. Sometimes I live up to that, often I don't. The other thing is that, you know, we are so used to having a conversation with a patient in the office feeling like we covered everything.
And then when we call the patients 24 hours later, you know, to give a lab result or clarify an appointment, then we get the 25 questions that the patient has. And often we as the physician are sort of not equipped for that because it's like, okay, I have an hour, I'm going to make 10 phone calls now but really, what that patient needs at that point is a whole 'nother visit, right?
And I think that as we design care going forward, we have to be intelligent about, right, how we design access in that makes sense for patients and makes sense for doctors, so we don't sort of burn out the doctors and have doctors giving poor care to their patients because they can't afford you know, both financially and psychologically, right?
[00:24:19] Dr. Nabhan: I mean, it could be maybe for follow-up visits, could be like a quick 15-minute virtual visit. And I think there are ways to do it but ultimately, we have to put ourselves in the patient's shoes because in my book, in the preface, I did say we're all patients. I mean, if not today, it's tomorrow or yesterday. And I think that nobody is invincible. We know that and listeners know that. So when we are in that chair, what level of communication access do we expect? And we need to provide that. And I'm not saying when we say 'we,' it's not just you, it's really the system. So we have to be conducive to this. You know, I think we are doing a great job, much better than before. And hopefully, there is room to improve for patients' sake.
[00:25:12] Dr. Cifu: Chadi, I wanted to thank you again, not just for coming on and talking to me today, but really for the book. I don't give out easy applause. I don't...
[00:25:24] Dr. Nabhan: You're not being paid. Folks, he's not being paid.
[00:25:26] Dr. Cifu: I'm not being paid. And I don't read a lot of medical books, I hate to admit it but I really actually think that this one is an important contribution certainly to patients but I think actually to sort of, you know, the general audience of people who work in healthcare, people who work adjacent to healthcare. I think this will help.
[00:25:48] Dr. Nabhan: No, I appreciate it. And, again, I mean, I think what I did in this book, I used my ability to tell stories. It's really about storytelling and about plain language. And you know, I think that wherever you are in the healthcare ecosystem, you will find something that you like or something you did not know.
And if anything, you will actually learn some stories where I thought I messed up in my communication skills with patients, but I wanted to.... It was cathartic to write that because it reminded me to always stay grounded, humbled, and that we always can do better.
[00:26:25] Dr. Cifu: Before we finish up today, a quick addition about this year's National Clinical Excellence Award.
As you know, the Bucksbaum-Siegler Institute for Clinical Excellence at the University of Chicago is dedicated to fostering compassionate doctor-patient relationships and advancing clinical care. Each year, the Institute recognizes extraordinary healthcare professionals through the National Clinical Excellence Award.
To learn more about the award, and nominate a deserving clinician, please visit the Bucksbaum Institute webpage. That's bucksbauminstitute. uchicago. edu.
Well, thanks for joining us for this episode of The Clinical Excellence Podcast. We are sponsored by the Bucksbaum-Siegler Institute for Clinical Excellence at the University of Chicago.
Please feel free to reach out to us with your thoughts and ideas via the Institute webpage. The music for The Clinical Excellence Podcast is courtesy of Dr. Maylyn Martinez.