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In Pursuit of Excellence (Prologue)

June 25, 2023
by Mark David Siegel

Hi everyone:

Late in the day on a recent Step-Down rotation, we convened a family meeting to discuss treatment goals for a young cancer patient. He was actively dying. His malignancy was high grade, widely metastatic, and impervious to treatment. He knew the end was near, but family members clung to hope.

In a small conference room outside the unit, we sat in a circle: parents and siblings, the palliative care team, the resident, and me. It was a Sunday afternoon and the oncology attending had gone home before we planned the meeting, so she joined on FaceTime.

We sat quietly while the palliative medicine fellow secured tissues. After she returned, we introduced ourselves. The family shared what they understood and voiced hope that their loved one might stabilize and pursue more chemotherapy. The resident and I then described the patient’s downhill spiral, which we had no way to stop.

Next, it was the oncologist’s turn. I recognized her because she’d attended previously on NP12. She’s an excellent teacher. Once, a few years ago, she called me to discuss an intern who was overwhelmed by the suffering she’d encountered on the rotation.

Overcoming the challenges of FaceTime, the oncologist gazed into the eyes of the grieving family. She was not the primary oncologist, but she knew the essential details. She used simple, kind words to describe the tumor’s rapid progression. She explained why more chemotherapy would only cause harm, especially now that the patient was dying. She patiently embraced questions about a pre-clinical study the family found on the internet.

The oncologist spoke for the team, expressing disappointment that we had no treatment left to stop the cancer. She supported shifting the focus to comfort. The family listened intently, thanked us for our time and care, and embraced the plan.

I left the room feeling grateful for the team, especially the oncologist, whose input transformed the discussion. Her expertise, judgment, communication skills, and compassion epitomized Smilow Cancer Center—and our profession—at its best.

In our residency, we pursue medical excellence. Excellence includes many core elements, including deep knowledge, learning from experience, rational thinking, clear communication, teamwork, advocacy, professional virtue, and kindness. Over the next few weeks, let’s use these Sunday Program Director’s Notes to explore excellence in medicine.

We’ll begin next week by considering excellence in note writing.

Have a wonderful Sunday, everyone. This morning, we’re going to brunch in Fairfield at Isla and Co.



P.S. Yesterday on East Rock, after the rain stopped.


Submitted by Mark David Siegel on June 25, 2023