Week 1 - Jon Albo
For my clinical immersion term, I plan to work primarily in oncology to determine if this is the direction I’d like to focus my graduate research in. I’ll mainly be working with Dr. John Leonard in lymphoma at Weill Cornell Medicine. During this week, Dr. Leonard had numerous administrative things he had planned so he connected me with various clinicians and researchers. I spent a large portion of my time shadowing Dr. Christine Garcia doing inpatient rounds in the morning and learning from the decisions she makes with the residents and physician assistant’s for lymphoma service. I’m also shadowing Dr. John Allan in clinic this week and learning how patients with chronic lymphocytic leukemia (CLL) are treated.
We had multiple patients that had undergone chemotherapy treatment but were dealing with other debilitating issues that were preventing them from going home. One patient in particular had a really bad case of jaundice and needed a stent added in his liver due to a really narrow passageway. The doctors attempted to perform an endocopic retrograde cholangiopancreatography (ERCP) and were able to take x-ray images but could not place the stent due to the narrowness of the passage. They stopped the procedure and are planning on performing another ERCP from a different location to get that stent placed properly and resolve his jaundice. A separate patient had an iron level 140 times higher than the average iron level which was a lot higher than an iron level that would be indicative only of inflamation so he’s being screened for hemophagocytic lymphohistiocytosis (HLH). It was super interesting and useful to listen to the doctors, residents, and physician assistants talk through treatment plans and next steps to get patients out of the hospital.
I also never realized the extent that doctors take insurance and drug prices into consideration when trying to treat patients. It’s definitely clear that these ethical decisions are a big consideration when treating patients and seems pretty limiting in certain cases. One patient was ready to go home but needed one last scan to make sure that his issues were cleared, but because of a denied pre authorization for the scan by the insurance company, the doctors had to debate about the best course of action. They ultimately decided to set up a visit with the patient in clinic to get the scan done which would have to be covered by the insurance company since it would be considered outpatient and requested by his doctor. Fortunately they were able to discharge him the same day but he wouldn’t have needed to make another trip back to the hospital if the insurance company would have approved the scan request.
Austin also invited me to join him for two neurosurgeries this week where I watched Dr. Schwartz perform minimally invasive endonasal pituitary surgeries where he removed a small tumor from one patient and a very large tumor on the other. It was a great opportunity to be in the OR with a friend so we could discuss a lot of the technology that was being used and potential innovations that could be made.
In addition to my inpatient shadowing, I’ve spent a good amount of time attending grand rounds and tumor board zoom meetings. The grand rounds meetings had some great talks this week where I learned a bunch about oncology and certain directions of fellows in the field. The tumor boards have been super helpful to understand how doctors of various areas get together to discuss new patient tumors and treatment plans/directions for individual patients. It’s interesting to hear radiologists, pathologists, and clinicians in each respective field analyze the images in real time and discuss why certain information in the images matter more than others. It’s also interesting to hear certain doctors on the call request more information or more scans and then be told that the patient’s doctor tried but couldn’t due to insurance denying the request.
Outside of seeing patients, I witnessed how chemotherapy treatments are given, met with Dr. Olivier Elemento to discuss collaborations for my lab back at Cornell with his precision medicine group here in NYC, and have worked on setting up more meetings with more clinicians/researchers.
We had multiple patients that had undergone chemotherapy treatment but were dealing with other debilitating issues that were preventing them from going home. One patient in particular had a really bad case of jaundice and needed a stent added in his liver due to a really narrow passageway. The doctors attempted to perform an endocopic retrograde cholangiopancreatography (ERCP) and were able to take x-ray images but could not place the stent due to the narrowness of the passage. They stopped the procedure and are planning on performing another ERCP from a different location to get that stent placed properly and resolve his jaundice. A separate patient had an iron level 140 times higher than the average iron level which was a lot higher than an iron level that would be indicative only of inflamation so he’s being screened for hemophagocytic lymphohistiocytosis (HLH). It was super interesting and useful to listen to the doctors, residents, and physician assistants talk through treatment plans and next steps to get patients out of the hospital.
I also never realized the extent that doctors take insurance and drug prices into consideration when trying to treat patients. It’s definitely clear that these ethical decisions are a big consideration when treating patients and seems pretty limiting in certain cases. One patient was ready to go home but needed one last scan to make sure that his issues were cleared, but because of a denied pre authorization for the scan by the insurance company, the doctors had to debate about the best course of action. They ultimately decided to set up a visit with the patient in clinic to get the scan done which would have to be covered by the insurance company since it would be considered outpatient and requested by his doctor. Fortunately they were able to discharge him the same day but he wouldn’t have needed to make another trip back to the hospital if the insurance company would have approved the scan request.
Austin also invited me to join him for two neurosurgeries this week where I watched Dr. Schwartz perform minimally invasive endonasal pituitary surgeries where he removed a small tumor from one patient and a very large tumor on the other. It was a great opportunity to be in the OR with a friend so we could discuss a lot of the technology that was being used and potential innovations that could be made.
In addition to my inpatient shadowing, I’ve spent a good amount of time attending grand rounds and tumor board zoom meetings. The grand rounds meetings had some great talks this week where I learned a bunch about oncology and certain directions of fellows in the field. The tumor boards have been super helpful to understand how doctors of various areas get together to discuss new patient tumors and treatment plans/directions for individual patients. It’s interesting to hear radiologists, pathologists, and clinicians in each respective field analyze the images in real time and discuss why certain information in the images matter more than others. It’s also interesting to hear certain doctors on the call request more information or more scans and then be told that the patient’s doctor tried but couldn’t due to insurance denying the request.
Outside of seeing patients, I witnessed how chemotherapy treatments are given, met with Dr. Olivier Elemento to discuss collaborations for my lab back at Cornell with his precision medicine group here in NYC, and have worked on setting up more meetings with more clinicians/researchers.
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