By Frederic Ivan Ting, MD
It was a typical Monday morning at the outpatient clinic of the University of the Philippines – Philippine General Hospital (UP-PGH) Cancer Institute, where I am finishing my fellowship in medical oncology in a couple of months. One of my patients, John*, was coming in for his follow-up consult. He has germ cell tumor which has metastasized to his lungs and bones. He finished second-line chemotherapy 3 months ago and experienced a partial response; now his tumor markers are rising again and he is beginning to be symptomatic.
I presented John’s case to my consultants here at UP-PGH to get their input, and I also emailed Dr. Lawrence Einhorn and Dr. Nabil Adra, who are both genitourinary cancer specialists at Indiana University (IU) Simon Cancer Center, for their expert opinion. I was fortunate to have Dr. Einhorn and Dr. Adra as my mentors since last year through ASCO’s International Development and Education Award (IDEA) program. After hearing the thoughts of my mentors at IU, I discussed their recommendations with my mentors here in my institution, and we came up with treatment options for John.
John is one of the many patients I have discussed with both my consultants here in UP-PGH and my mentors from institutions outside of the country. My co-fellows and I are also very fortunate to have visiting consultants from other countries who make rounds with us regularly. One of them is Dr. Edgardo Faylona, a hematologist/oncologist from Las Vegas who is both an alumnus of UP-PGH and a former fellow of Dr. Einhorn at IU. Dr. Faylona visits us quarterly and does sit-down rounds with us where we can openly ask questions about difficult and rare cases that we see in the clinics. It is always a pleasant experience to hear anecdotes of his patients having a response to novel treatments which are yet to be available in our country.
Above: Dr. Ting (standing, far right) with cofellows (standing and local mentors (seated) at UP-PGH.
I think having mentors locally and globally allows me to have these five advantages, among others:
I can hear expert opinions from different settings and different perspectives.
My global mentors would always suggest the latest treatment options available from recent U.S. FDA-approved regimens, which we very seldom get to use in the Philippines because they are either not yet approved/available, or they are too expensive for our patients. While this information keeps me up-to-date and gives me a sense of the real patient experiences behind the articles I read in The ASCO Post, my local mentors help me choose the best treatment options for my patients in the context of the available resources that we have.
The learning goes two ways.
Not only do I learn from all the expert opinions of my mentors, but my mentors also learn from and through me. Oncology is one of the fastest changing medical subspecialties in terms of treatment innovation. It is beyond human capacity to read and comprehend all the recent studies in all oncologic specialties. As a trainee, my thirst for theoretical knowledge allows me to share my new readings with my mentors—most of the time they already know about the articles, but some are new to them. Also, in cases where my local and global mentors have differing opinions about treatment for a particular patient, we all learn together when I update them on the current status of that patient.
Fruitful linkages are made.
Through referrals from both my local and global mentors, productive professional relationships are made and nurtured, which has helped me get advice from experts around the world with regards to patient care and career development, and has offered opportunities for me to collaborate on research.
I become a better physician.
Being mentored by both local and global leaders inspires me to always maximize the learning opportunities that come my way. Because of the wonderful experiences I have with my mentors, I too am excited and looking forward to having my own mentees in the near future.
My patients receive better care.
The different perspectives of my mentors instilled in me a habit of always taking a look at how other countries treat a particular patient, compare the results, and offer the best care possible to my patients in the context of our local setting.
I previously wrote about my ASCO IDEA experience in an article titled “No Man Is an Island.” The war against cancer is tough and we can never do it alone. One good strategy to maximize our oncologic potential is to have mentors who can guide us to be “glocal” physicians, who think globally but act locally.
*Name and identifying details changed to protect patient privacy.
Dr. Ting is a graduating medical oncology fellow at the University of the Philippines – Philippine General Hospital. He will soon relocate and serve the people of his hometown, Bacolod City, Negros Occidental. His research interests are in quality of life, palliative care, and health systems. Follow Dr. Ting on Twitter @fredtingmd.