Report by Dr. Lucie Blouin (submitted 10/27/11)
There were two parts to the CAGPO Scholarship that I was awarded in 2010. The first part consisted of familiarizing myself with the more common Hematologic Malignancies and their management including performing bone marrow aspirations and biopsies and familiarizing myself with the chemotherapy protocols and their adverse effects.
The second part consisted of developing counseling and psychotherapy skills for helping cancer clinic patients cope with the emotional issues associated with their illnesses. I was awarded a scholarship for two weeks instead of the proposed four weeks. Nevertheless, I did try to meet these objectives to some degree, albeit not fully.
I spent several sessions with one of the Peterborough Cancer Clinic’s medical oncologists learning how to perform bone marrow aspiration and biopsies. I then began to perform these and received referrals from the hematological oncologists including Dr. Anthony Woods and Dr. Koushie Parasmothy.
However, the need for my services was short lived when a new hematologist arrived in Peterborough to take over the practice of the retired community hematologist. He assumed responsibility for this diagnostic procedure and appears to be meeting the demand for this service. However, it may be that he might require my assistance in the future if his workload becomes too onerous.
I was also able to spend a short session with one of the hospital’s pathologist looking at bone marrow slides. I would like to have a few more sessions with her or another pathologist as I think it would help me understand the malignancies better.
I attended the Princess Margaret Hospital Cancer Conference last fall for one day, mostly attending sessions on the hematologic malignancies which included topics such as: New Agents and Approaches in Lymphomas, Evolving Therapy for Hematologic Malignancies including Myelodysplastic Syndrome, Myeloma and Leukemia and The Importance of Thrombosis in Cancer.
I did a lot of reading on the hematologic malignancies – this included information available on the National Cancer Institute website as well as patient materials.
I spent two days in Ottawa – the first with a General Practitioner in Oncology who cares for patients in hospital who are undergoing autologous as well as donor stem cell transplants. The second day was spent with another GPO in the outpatient clinic seeing patients either before or after they had undergone their transplants. This experience was very much appreciated as it gave me insight into the myriad of complications that patients undergoing this intervention face. Stem cell transplant has become a large part of managing a number of hematologic malignancies including multiple myeloma.
Lastly I have shadowed one of the hematologists on a couple of days in his oncology outpatient clinic to gain a practical understanding of the care of this population of patients, including use of transfusions and chemotherapy. I would still benefit from a couple of more days of this kind of experience and have spoken to our new hematologist about shadowing him, as he is now the clinician caring for the bulk of these patients in our community.
This would allow me the opportunity to familiarize myself with his style of practice.
I have already been able to put my new knowledge and skills to use, covering for the hematologists in their absence due to conference leave, illness or vacation. Our new community hematologist will soon be dropping a day in the Peterborough clinic to run a clinic at another nearby community hospital and I anticipate that my services will be further required to cover for him when he is less available in our clinic.
I was less successful in meeting the objectives I set out in this part of my scholarship proposal. I think that I did make some headway but the means by which I acquired some counselling skills had to be adjusted due to the fact that the courses I had hoped to take were not offered this past year by the GP Psychotherapy Association. These courses have been suspended indefinitely.
I therefore looked elsewhere and decided instead to enroll in the Foundations and Tools course offered in Medical Cognitive Behaviour Therapy by Dr. Greg Dubord (Canada CBT).
This course was developed by Dr. Dubord specifically with busy medical practitioners in mind. It helps us to develop skills that we can easily incorporate into a typical patient encounter that will enable us to help our patients deal with maladaptive behaviours. These include behaviors that might be interfering with a patient embarking on treatment that would be beneficial to them. I found the course to be very practical and very helpful in day to day patient encounters.
It was not what I envisioned when I made the scholarship proposal. I envisioned learning skills that I could use during an appointment dedicated to helping patients address their emotional issues. Instead this course provided “tools” that could be used during a regular clinic appointment. The “medical cognitive behavior therapy” could then be followed up in subsequent appointments, either set aside for this purpose or as part of a regular follow-up appointment for cancer or chemotherapy. I did feel that the course was worthwhile and plan to take another course offered by Dr. Dubord specifically addressing Anxiety and Depression.
These courses are combined with the opportunity to vacation and in my case I had the added benefit of spending time on the beautiful “Garden Hawaiian Island of Kauai.
I want to very much thank CAGPO for giving me the opportunity to embark on these learning opportunities. The scholarship made it possible for me to develop these new skills that I think will benefit my patients and community.