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Submitted: 25 February 2015
Three sessions: 5 February 2015, 13 February 2015, 18 February 2015
Total approximate duration: 5.5 hours.
Interviewer: Tacey A. Rosolowski, Ph.D.
For supplementary materials:
Please contact, the Historical Resources Center, Research Medical Library:
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About the Interview Subject:
Dr. Michael J. Fisch (b. 11 June 1964, Queens, New York) joined MD Anderson in 1999 as an Assistant Professor in the Department of Palliative Care and Rehabilitative Medicine. In 2004 he became Director of the Community Clinical Oncology Program and in 2009 became Chair of the Department of General Oncology. He is tenured in that Department. This interview is conducted shortly before Dr. Fisch’s departure from MD Anderson for a new opportunity.
Dr. Fisch is known for research has focused on symptom experience, symptom management and cardio-oncology. He conducted a landmark study of chemotherapy and depression. His equally important survey of the management of symptoms related to cardio-toxicity of anthracyclines contributed to the formation of the new field of cardio-oncology.
Dr. Fisch helped establish MD Anderson’s program in palliative care and worked on programs that led to the formation of the new Department of General Oncology.
Major Topics Covered:
Personal and educational background
History of and observations about the evolving field of General Medical Oncology
Relationships between general medical oncology, supportive care, and palliative care
Integrating these practices into MD Anderson treatment programs
Research into patient experience and symptom management
Anecdotes about work with patients at MD Anderson and VIP patients overseas
Social media and its potential for use in healthcare
The views expressed in this interview are solely the perspective of the interview subject. They are not to be interpreted as the official view of any other individual or of The University of Texas MD Anderson Cancer Center.
Interview Session One: 5 February 2015
An Interest in Sports Shapes a Fascination with the Body
Chapter 01 / Personal Background
An Early Desire to Become a Doctor and a Range of Interests and Gifts
Chapter 02 / Personal Background
Challenges in College and Medical School Seeking a Specialty
Chapter 03 / Educational Path
Early Research Experiences Leads from Infectious Diseases to Hematology/Oncology
Chapter 04 / Educational Path
Bringing Focus to Patients’ Emotions
Chapter 05 / The Researcher
Entering the New Field of Symptom Experience
Chapter 06 / The Researcher
Coming to MD Anderson to Learn Palliative Care on the Job
Chapter 07 / Joining MD Anderson/Coming to Texas
Building a Palliative Care Program at MD Anderson
Chapter 08 / Building the Institution
A Precarious Time for the Palliative Care Program
Chapter 09 / An Institutional Unit
Building the Reputation of Palliative Care
Chapter 10 / An Institutional Unit
Interview Session Two: 13 February 2015
Defining the Scope of General Medical Oncology
Chapter 11 / Overview
The Community Clinical Oncology Program (CCOP)
Chapter 13 / Building the Institution
The Community Clinical Oncology Program (CCOP) Transitioning to Research in Cancer Control and Prevention
Chapter 14 / Building the Institution
The Community Clinical Oncology Program (CCOP) Finances, Organization of Research, Some Examples
Chapter 15 / An Institutional Unit
A New Department of General Medical Oncology
Chapter 16 / Building the Institution
Concern about the MD Anderson Brand as the Satellite System Grows
Chapter 17 / Institutional Change
Accomplishments at MD Anderson and a New Career Opportunity
Chapter 18 / Professional Path
Interview Session Three: 18 February 2015
International Travel and Providing Team Care to VIP Patients
Chapter 19 / The Clinical Provider
The PREDICT Trial: A Unique Study of Biomarkers for Cardiotoxicity
Chapter 20 / The Researcher
A Landmark Study on Chemotherapy and Depression
Chapter 21 / The Researcher
An Emerging Field of Cardio-Oncology
Chapter 22 / The Researcher
Chapter 23 / The Researcher
The Schwarz Rounds at MD Anderson and Mindful Medical Practice
Chapter 24 / Building the Institution
Exploring Uses of Social Media
Chapter 25 / Institutional Processes
MD Anderson’s Focus on Patient Experience
Chapter 26 / Building the Institution
Interview Session One: 5 February 2015 (listen/read)
Interview Identifier (listen/read)
Chapter 01 (Personal Background)
An Interest in Sports Shapes a Fascination with the Body (listen/read)
Dr. Fisch begins the interview by sketching his family background and then talking in detail about his lifelong interest in sports. He explains that he “understands the world through sports and sports metaphors.” He explains the process of visualizing how to execute a series of plays and links this to mindfulness skills he would become interested in as a medical professional. He cites his mentor, Dr. Waun Ki Hong [Oral History Interview] who told him (ironically) that his job is “easy,” since meeting healthy goals is a step-by-step process. He observes that his interest in sports probably led to his fascination with the physical body.
Chapter 02 (Personal Background)
An Early Desire to Become a Doctor and a Range of Interests and Gifts (listen/read)
Dr. Fisch recalls that he decided to become a physician at the age of eleven, inspired by physicians on TV shows. He notes that his grandmother took his interest very seriously and bought him Gray’s Anatomy. He also observes that he was “drawn to complexity” very early and that this interest became a theme in his career.
Dr. Fisch talks about his high school experience, recalling that he was a motivated, hard worker with many extracurricular activities. He also explains why he considers himself a creative person, noting that his style creativity lends itself to working in groups, a characteristic important for conducting team science. Dr. Fisch explains that he loves team science for the way it brings together people from different disciplines. He makes observations about his inspirational style of leadership, noting that his love of leadership roles began in high school. He also notes that he is at his best when he is in the state referred to as “flow.”
Challenges in College and Medical School Seeking a Specialty (listen/read)
In this chapter, Dr. Fisch talks about selecting his college (University of Virginia at Charlottesville, BA conferred 1986) for financial reasons and explains the value of a state education. He notes that he was not a top student and had to work very hard as an undergraduate. He notes that he discovered his lack of visual/spatial ability, which made certain courses very difficult and caused him to consider a career in nursing.
Next, Dr. Fisch talks about his medical education at the University of Virginia Medical School (MD conferred in 1990), noting how he loved surgery, but his lack of visual/spatial ability made this specialty impossible for him. By working with surgeons, however, he learned to love clinical medicine and post-operative patients in particular because they were “endlessly complicated.”
Chapter 04 (Educational Path)
Early Research Experiences Leads from Infectious Diseases to Hematology/Oncology (listen/read)
Dr. Fisch describes the evolution of his interests leading to his focus on oncology.
He discusses a college research projects and tells an anecdote about an ethical mistake he made while interacting with participants.
Next, Dr. Fisch explains that he discovered hematology/oncology during his rotations and he was attracted to the field because it afforded the opportunity to build long-term relationships with patients and their families.
[The recorder is paused about five minutes.]
Dr. Fisch explains why he tracked into hematology/oncology and was always focused on academic medicine and a career in research. He describes his studies in medical school reflects on his residency (Internal Medicine, University of Virginia, 1990-1993).
Chapter 05 (The Researcher)
Bringing Focus to Patients’ Emotions (listen/read)
In this chapter, Dr. Fisch describes the process of entering a fellowship program in Hematology/Oncology and General Internal Medicine at Indiana University at Bloomington. He then explains that it was during this time that he became interested in “things that were happening to cancer patients that we weren’t talking about.” He gives examples, first discussing the problem of depression in cancer patients. He then explains that on the transplant service, patients were uniformed about treatments and he did a project on the effect of informed consent on emotions.
Chapter 06 (The Researcher)
Entering the New Field of Symptom Experience (listen/read)
In this chapter, Dr. Fisch explains how his career path evolved once he decided, during the second year of his fellowship, to focus on symptom experience. He was involved in a research project on cisplatin adducts when he decided to focus on quality of life research and realized he needed additional training to work in this new field. He took another fellowship in general internal medicine and worked with Dr. Robert Diddis, who advised him to do a Masters in Public Health (Indiana University, Bloomington, Indiana MPH conferred in 1997). He explains how this training benefited his approach to quality of life problems.
Chapter 07 (Joining MD Anderson/Coming to Texas)
Coming to MD Anderson to Learn Palliative Care on the Job (listen/read)
In this chapter, Dr. Fisch explains how he moved to MD Anderson from a position as Assistant Professor at the University of Virginia Health Science Center in Charlottesville. He recalls management issues in Charlottesville that helped convince him to take another position. He talks about presenting a paper on cancer and depression at a conference held by the American Society of Clinical Oncology. There he met Dr. Eduardo Bruera, who had been recruited to set up a palliative care program at MD Anderson. Dr. Fisch describes the advantages of the offer he was made to join MD Anderson to help establish that program, working from the Department of Critical Care and Anesthesiology.
Chapter 08 (Building the Institution)
Building a Palliative Care Program at MD Anderson (listen/read)
In this chapter, Dr. Fisch talks about the challenges faced as he and others set up palliative care program at MD Anderson from scratch. He defines palliative care, which he stresses is much broader than pain management. He also explains how the culture of MD Anderson worked against acceptance of palliative care. Dr. Fisch notes that the palliative care program stressed quality of life and that a decision was made to change the name to the Supportive Care Center to help overcome resistance . He gives examples of how he and other palliative care providers would figure out how to “create an interface” with treating oncologists, so they would integrate a palliative care provider into the team.
Chapter 09 (An Institutional Unit)
A Precarious Time for the Palliative Care Program (listen/read)
In this chapter, Dr. Fisch talks about a period when the Palliative Care Program seemed less valued than anesthesiology and the administration was splitting off groups from the department of Anesthesiology and Critical Care. He recalls that Dr. Bruera interviewed for a new job and he himself began calling about positions in Virginia. He tells an anecdote about where he was on 11 September 2001. He explains why he remained at MD Anderson and how, after a meeting with leaders, the situation for the department and program seemed to improve.
Chapter 10 (An Institutional Unit)
Building the Reputation of Palliative Care (listen/read)
In this chapter, Dr. Fisch sketches how the talented team in palliative care was successful in securing regular referrals from a few oncologists, building the program’s reputation. He tells anecdotes about the surprising and positive results they would get from integrating palliative approaches into treatment protocols.
At the end of this chapter, Dr. Fisch shares lessons he learned about how to interact successfully with oncologists to ensure they would call on him as a palliative care providers.
Interview Session Two: 13 February 2015 (listen/read)
Interview Identifier (listen/read)
Chapter 11 (Overview)
Defining the Scope of General Medical Oncology (listen/read)
Dr. Fisch begins with an explanation of why he felt like a disciplinary “refugee” when he arrived at MD Anderson and joined the Department of Critical Care and Anesthesiology.
He then defines the purpose and scope of General Medical Oncology as a practice: the long-term care of patients with cancer when overall care is the focus, including delivery of pharmaceuticals and injections and after care following surgery, radiation or chemotherapy. The GMO clinician work with a patient over a lifetime. He notes some controversy in the field over when the GMO clinician “lets go” of a patient who is transitioning to survivorship.
Chapter 12 (Overview)
Reimbursement for General Medical Oncology the Value of Generalists in a Field of Subspecialties (listen/read)
Dr. Fisch begins this chapter by explaining the challenges of arranging insurance reimbursement for services and value that general medical oncologists deliver. He also notes that losing connection with the GMO clinician can be very setting for a patient, and he gives examples of problems that can arise.
Dr. Fisch also explains that “people’s health stories are not completely oncology.” They often have co-morbidities and challenges can arise in bringing together specialists to fully treat a patient. In a fragmented system organized by subspecializations, often the patient must serve as “project manager” of his or her own care.
Next Dr. Fisch talks about the value of having a generalist perspective in this situation. He then talks about LBJ Hospital. He comments that eventually generalists will define the pathways into a patients care and then specialists will take over.
Chapter 13 (Building the Institution)
The Community Clinical Oncology Program (CCOP) (listen/read)
In this chapter, Dr. Fisch talks about the history of the Community Clinical Oncology Program (CCOP). (He has served as Medical Director since 2004.) He notes NCI involvement providing funds for community based initiatives and explains the purpose: to develop clinical trials linked to the community contexts where eighty percent of patients are treated. He characterizes MD Anderson’s reputation as a “solution shop” driving treatment, with the CCOP’s different approach to treatment and research, including that community practice has something to teach about treatment.
He then notes that, as Medical Director, he served as a facilitator and broker for trials. He talks about how CCOP trials and research worked at MD Anderson, including how biases against randomized trials worked into the planning process, with efficacy trials conducted with MD Anderson patients and Phase 3 trials conducted in the community. He gives an example.
Chapter 14 (Building the Institution)
The Community Clinical Oncology Program (CCOP) Transitioning to Research in Cancer Control and Prevention (listen/read)
In this chapter, Dr. Fisch explains how research conducted via the CCOP transitioned from a focus on treatments to a focus on prevention, cancer control, and symptom management.
He first talks about his role as a facilitator setting structures for research collaborations. He notes that community settings offered a comprehensive view of patients, driving his own interest in symptom management. He talks about the overlap of different specialties whose borders are all debated. He illustrates with the example of pain management.
Next he sketches the factors that led to his decision to “sunset” the treatment focused trials. He was partnering with Dr. Blyer, who shared his vision. The NCI was also requiring that more research focus in these areas. Many regional research groups were putting together trials focused on prevention and control.
Chapter 15 (An Institutional Unit)
The Community Clinical Oncology Program (CCOP) Finances, Organization of Research, Some Examples (listen/read)
Dr. Fisch begins this chapter by noting that he began looking for experts to begin developing the new focus of the CCOP. He explains why MD Anderson physicians need community based patients.
He explains finances: the program pays for the infrastructure, not the drugs and other related costs. He discusses strategies researchers use to address this challenge. He gives an example of a trial run by Dr. Lorenzo Cohen comparing the impact of meditation versus relaxing music on patients’ inflammation cascade. He discusses how to convince community physicians of the value of such studies.
Dr. Fisch notes his role as facilitator and stresses the importance of being respectful of the research issues that behavioral scientists confront. He gives some examples.
Chapter 16 (Building the Institution)
A New Department of General Medical Oncology (listen/read)
Dr. Fisch notes that the Community Clinical Oncology Program (CCOP) offered a platform to create a new Department of General Medical Oncology. He tells the history of how the department was formed. He explains how the program at LBJ Hospital was involved as well as Dr. James Cox’s [Oral History Interview] mandate to expand radiation oncology services beyond MD Anderson proper.
Given this complexity, Dr. Fisch notes, it made sense to put all generalists together in a new department. He lists the functions included and talks about the challenges of creating cohesion in the diverse department.
Chapter 17 (Institutional Change)
Concern about the MD Anderson Brand as the Satellite System Grows (listen/read)
Dr. Fisch responds to a question about the growing acceptance of General Medical Oncology at the institution.
He first explains the concerns about brand and quality of care that faculty have had as the satellite system grows. Dr. Fisch explains decisions that had to be made about protocols offered in satellite centers. He talks about his own view of the controversy and notes that it takes skill to work with community people and subspecialists alike.
He notes that “the MD Anderson story has been about subspecialization” and “becoming like our competitors is difficult.” He explains that MD Anderson’s general medical oncologists have raised the bar of care in the community and at the satellite centers. He also stresses the importance of building shared research programs and harmonizing budgets to stress that satellite centers create a shared win for MD Anderson rather than competition.
Chapter 18 (Professional Path)
Accomplishments at MD Anderson and a New Career Opportunity (listen/read)
Dr. Fisch notes his contributions to MD Anderson: faculty recruitments, the growth and success of each program within the department and their acceptance by the administration. He next talks about his growth as a leader.
Dr. Fisch then talks about his plans to leave MD Anderson for a position as Medical Director of Medical Oncology Solutions at Ames Specialty Health in Chicago, Illinois. He notes that, with changes at the institution, general oncology and cancer control are not top priorities, and he wanted a new opportunity to rise to the next level.
Dr. Fisch talks about the skill set he will bring to Ames, where he will be assessing value-driven quality care. It is also an opportunity for him to learn a great deal, saying “It will be like doing a fellowship in managed care” and give him an opportunity to have an impact on care.
Interview Session 3: 18 February 2015 (listen/read)
Interview Identifier (listen/read)
Chapter 19 (The Clinical Provider)
International Travel and Providing Team Care to VIP Patients (listen/read)
Dr. Fisch notes that global oncology has become an increasingly important dimension of MD Anderson’s business. He explains that, as MD Anderson set up links with international partners, he helped them set up team-based treatment plans, multi-disciplinary care, and research. He gives examples of the types of research projects that might be set up.
Dr. Fisch talks in depth about his participation in international clinical care teams making “global house calls.” He explains that his role was to offer palliative care, manage anxiety, sleeplessness, and rehabilitation, sometimes spending weeks abroad. He notes that these special trips helped clarify the services he could offer as a general medical oncologist and demonstrate their value to the patients and the institution. He also describes how people would receive MD Anderson faculty overseas, which helped increase his own feeling for the institution.
Chapter 20 (The Researcher)
The PREDICT Trial: A Unique Study of Biomarkers for Cardiotoxicity (listen/read)
In this chapter, Dr. Fisch talks about the PREDICT trial, a landmark study he conducted in the late 2000s on predictors for cardiotoxicity in patients treated with anthracyclines. He explains the effects that anthracyclines can have on the heart and notes that this is a survivorship treatment issue. The study asked Can you use point-of-care biomarker testing to assess cardiac toxicity of chemo regimens. Dr. Fisch notes that when this project began around 2007, cardiac studies were very new. He describes some challenges enrolling patients (eventually enrolling over five hundred) and reports the outcomes. He says that it was a good descriptive study, unique in the realm of oncology. His role, he explains, was facilitating set up and implementation of the project and executing the trial as part of a team effort.
Chapter 21 (The Researcher)
A Landmark Study on Chemotherapy and Depression (listen/read)
Dr. Fisch begins this chapter by explaining that as Chair of the Eastern Cooperative Oncology Group’s Symptom Management Committee, he wanted to study how to manage patient symptoms, but there was a lack of basic data about symptom experience. This led to a landmark study of more than three thousand patients that surveyed a broad range of symptoms and practice patterns for lung, breast, colorectal and prostate cancers. (He observes that such long-term studies sometimes fail, discouraging some researchers in the process. )
Dr. Fisch notes that the SOAPP study continues to make a unique contribution. An unusual feature is that the study has a website (http://www.ecogsoapp.com/) to facilitate dissemination of information. Data also is available through twelve published papers, with more coming. Dr. Fisch talks about the difficulties of maintaining the website when money runs out.
Chapter 22 (The Researcher)
An Emerging Field of Cardio-Oncology (listen/read)
In this chapter, Dr. Fisch notes that field of cardio-oncology emerged over the last seven or eight years, concurrent with the PREDICT trial. He observes that the field is becoming important because new classes of drugs are cardio-toxic and many of the molecular and genetic pathways involved in cancer are also important to cardiologists. He notes that his own contributions to this field have become increasingly important.
Chapter 23 (The Researcher)
Compassionate Care (listen/read)
Dr. Fisch begins this chapter by defining compassionate care along with the division of labor required between symptom management, communication and inter-disciplinary team work. He stresses that “words matter, how you talk about things matters,” and notes the importance of learning how to ask patients questions to encourage them to tell their story, though current time pressures make this challenging. He stresses, however, that there are skills a physician can learn to make patients feel they are receiving compassionate care.
Chapter 24 (Building the Institution)
The Schwarz Rounds at MD Anderson and Mindful Medical Practice (listen/read)
Dr. Fisch talks about the Schwarz Rounds implemented at MD Anderson in 2007. He describes the focus on the experiences of the care providers and the emotions that come up for them while offering care to patients. He explains that the need for the Schwarz Rounds arose because the Medical Oncology fellows were experiencing fatigue and burnout. Dr. Fisch explains why the program stopped.
Next, Dr. Fisch talks about mindful medical practice, which helps reduce burnout and fatigue among. He gives examples of the stresses of an oncologist’s job. He notes that the value of awareness is increasingly recognized in medicine. He has worked to bring visibility to the issue at MD Anderson by drawing attention to research that shows how mindfulness can ensure delivery of high quality care.
Chapter 25 (Institutional Processes)
Exploring Uses of Social Media (listen/read)
Dr. Fisch talks about his fascination with social media and his attempts to introduce its creative use at MD Anderson to communicate more effectively with patients and the public.
[the recorder is paused]
Dr. Fisch talks about his introduction to Twitter and his efforts to use it in healthcare, beginning with the Community Clinical Oncology Program. He explains why ASCO now has a Social Media Working Group. (Dr. Fisch serves on that committee.) Dr. Fisch explains the impact that social media can have on individuals and institutions and stresses the importance of making education about social media part of medical curricula. He states that MD Anderson has made some headway in this area, and he lists the consequences of not keeping up.
Dr. Fisch next talks about his involvement in a clinical trial that proposed to use social media to increase patient enrollment. He contributed to the grant, which the South Western Oncology Group has funded.
Chapter 26 (Building the Institution)
MD Anderson’s Focus on Patient Experience (listen/read)
Dr. Fisch talks about two initiatives to involve patients as partners in planning processes: the Patient Experience Steering Committee and the Patient and Family Advisory Council. Dr. Fisch notes that though he received invitations to serve on both committees, he was given no charge or mission and there is no natural momentum on patient experience at the institution. He talks about the advantages to the institution of addressing patient experience and notes that MD Anderson’s attention to this matter is a response to an Institute of Medicine report that other institutions are moving ahead.
Dr. Fisch then observes that if an institution is not patient-centered, shifting focus is difficult. He suggests ways in which MD Anderson communicates that it is not patient centered. He then talks about Leadership Rounds, which help leaders see the institution from a patient’s perspective. He acknowledges that the institution is listening to patients more and coming up with creative ways of reorganizing care.
At the end of the session, he makes some final comments about working at MD Anderson.
This interview with Dr. Michael J. Fisch (b. 11 June 1964, Queens, New York) takes place in three sessions in February 2015 (total approximate duration, 5.5 hours).
Dr. Fisch joined MD Anderson in 1999 as an Assistant Professor in the Department of Palliative Care and Rehabilitative Medicine. Since 2004 he has been the Director of the Community Clinical Oncology Program and since 2009 he has served as Chair of the Department of General Oncology. He is tenured in that Department. This interview is conducted shortly before Dr. Fisch’s departure from MD Anderson for a new opportunity. Tacey A. Rosolowski, Ph.D. is the interviewer.
Dr. Fisch earned his Bachelor of Arts at the University of Virginia in Charlottesville in 1986 and continued at the University of Virginia Medical School, earning his MD in 1990. He continued at the same institution for his Residency in Internal Medicine (1993), then went to Indiana University at Bloomington for Fellowships in Hematology/Oncology and General Internal Medicine. He earned a Master’s in Public Health from that institution in 1997, then took a faculty position in the Department of Medicine at the University of Virginia Health Science Center in Charlottesville.
Dr. Fisch came to MD Anderson to help Dr. Eduardo Bruera establish a program in palliative care. He became Principal Investigator of the MD Anderson Community Clinical Oncology Program (CCOP) Research Base, and this became the starting point for a new Department of General Oncology, which he led from its inception in 2008. The department components he has led include the Lyndon Baines Johnson General Hospital (LBJGH) Medical Oncology Program (providing cancer care to the underserved throughout Harris County), the Integrative Medicine Program, the International Cancer Assessment Center, and the Regional Care Centers (providing cancer care in suburban satellite locations). Dr. Fisch’s research has focused on symptom experience, symptom management and cardio-oncology. He conducted a landmark study of chemotherapy and depression. His equally important survey of the management of symptoms related to cardio-toxicity of anthracyclines contributed to the formation of the new field of cardio-oncology. Dr. Fisch has served as Chair of the ECOG Symptom Management Committee since 2006, and Co-Chair of the NCI Symptom Management and Quality of Life Committee since 2007. He also serves on the NCI National Clinical Trials Network (NCTN) Working Group.
General Medical Oncology is a relative new field, and in this interview, Dr. Fisch tells the story of entering this area of work before it was formally recognized as a discipline. He offers definitions of general medical oncology, supportive care, and palliative care. He also explains the currents controversies over where the borders between these fields lie and how this has an impact on funding and insurance reimbursement, for example. Dr. Fisch tells the story of how these fields took root at MD Anderson and the challenges of integrating them with traditional practice areas. He talks about his research into patient experience and symptom management and tells anecdotes about work with patients at MD Anderson and on care teams sent to treat VIP patients overseas. Dr. Fisch also talks about his fascination with social media and its potential for use in healthcare.