Medical physicists should meet with patients as part of the initial consult

These days cancer patients who have been advised to consult a radiation oncologist are generally very Internet savvy, and they are highly likely to go online and search for the “best” doctor, the “best” cancer clinic, the “best” treatment regimen, and/or the “best” available technology for their specific disease. Despite all of this Internet access and searching strategies, it is unlikely that they will consider searching for the “best” and most qualified physicists (or physics team). Frankly, most of the public probably don’t even realize the existence of medical physicists, not to mention the importance of our responsibilities in working with the radiation oncologists to provide high quality, reliable, and safe radiation therapy. As medical physicists and dosimetrists, we work with nurses, therapists, physicians, and a wide range of professionals for the care of our patients. However, since our work is largely technical and performed without patients’ present (e.g., treatment planning on computers and patient-specific quality assurance measurements on phantoms), we might be the only team members with zero direct contact with the patients. In an effort to increase the awareness of our profession and substantial role in the clinic, the AAPM Public Education Committee has been making efforts to promote public education in matters pertaining to medical physics. What more can we do? Well, would it be a good idea to increase medical physicists’ roles in patients’ consults? For this debate, we have Dr. Brad Schuller arguing for the topic that Medical physicists should meet with patients as part of the initial consult, and we have Dr. Kristi Hendrickson arguing against it. Dr. Brad Schuller received his PhD in radiation biophysics from the Department of Nuclear Science and Engineering at MIT in 2007. He then completed his postdoctoral training in therapeutic medical physics at the Massachusetts General Hospital and Boston Medical Center. He currently works for Banner Health at McKee Medical Center in Loveland, CO and is board certified by the ABR. Dr. Schuller’s current research focuses on prospective risk management and exploring new roles for medical physicists in clinical practice. He is a member of AAPM and ASTRO and serves on several AAPM committees. Dr. Kristi Hendrickson is currently an Assistant Professor of Medical Physics at the University of Washington in Seattle. She is the Director of the Medical Physics Residency Program in Therapy Physics at UWMC, which includes four total residents and 17 physics faculty mentors. Her education interests focus on medical physics residency training. She is interested in curriculum development and sharing those ideas with other institutions and programs, as evidenced in her publication and sessions created for the annual AAPM meetings. Her research interests include bioinformatics, SBRT, functional imaging, and neutron therapy. Her current AAPM committee involvement includes the Women’s Professional Subcommittee and the Medical Physics Residency Training and Promotion Subcommittee. She previously served as on the course director team of the 2014 AAPM Summer School on SRS/SBRT/SABR.

However, since our work is largely technical and performed without patients' present (e.g., treatment planning on computers and patient-specific quality assurance measurements on phantoms), we might be the only team members with zero direct contact with the patients. In an effort to increase the awareness of our profession and substantial role in the clinic, the AAPM Public Education Committee has been making efforts to promote public education in mat-  This will establish trust that their radiation treatment is being managed by a physicist who is specifically trained in the medical application of science and technology and has advanced knowledge in the use of medical radiation. As a result, the patient will identify the medical physicist as the technical authority and information resource, and as the relationship develops, the medical physicist will serve as a guide to help the patient navigate the technical aspects of their care.
This new role can contribute to a patient's increased understanding, reduced anxiety, and increased satisfaction with their healthcare experience.

Atwood et al. have invited clinical medical physicists to reject
the notion that we should only work behind the scenes, and they urge the community to establish new roles in direct patient care. 5 As a result, we will have increased visibility in front of the patient leading to increased overall visibility to the rest of the clinical staff, hospital administration, and the general public. These are the keys to ensuring a robust and enduring future for medical physicists in a rapidly changing healthcare environment. Clinical medical physicists make an intentional choice to not only be scientists in medicine, but to practice medicine itself, and if we take steps to emphasize the "medical" component of medical physics in our clinical practice, we will unlock new and rewarding roles in patient care.

| Kristi R. G. Hendrickson, PhD
The practice of medical physics is changing rapidly, and radiotherapy is increasingly technological. Safety and technological details of radiotherapy treatments are often concerns for patients considering or being advised to receive radiotherapy. Media reports on radiotherapy accidents may increase those concerns for prospective patients and their advocates. questions about their QA processes as it related to the proposed treatment. What I experienced was a "deer in the headlights" reaction and a fumbling response that did not instill in me a confidence in that clinic's radiation safety processes. The added medical physics time commitment is a valid concern, especially for busy departments, but I would challenge the community to look beyond the initial difficulty of establishing a new area of practice to the positive downstream effects for the patients. The medical physics patient consults will reveal a diverse collection of patient questions that will aid future patient education efforts. The creation of tailored educational materials that address specific question types will help improve the quality of the information provided to patients. By augmenting the initial consult with the radiation oncologist, clinical medical physicists can help reduce patient anxiety by revealing the mystery of radiation delivery.
I agree with Dr. Hendrickson that lack of training for direct patient interaction is a substantial concern for our community if we are to advocate widespread expansion into this new area of practice.
In our clinic, we recognized that it would require some practice for clinical medical physicists to feel comfortable distilling complex technical concepts into simpler language, and to do so with confidence.
One way to gain experience doing this is to deliver educational talks to patient support groups. Many of our support groups are disease specific and actively engage the community by inviting past and present patients to gather together for communal support. These groups crave new information, especially pertaining to advances in cancer treatment and new technology. Our physics group routinely gives educational talks to our support groups to help explain the technical aspects of radiation therapy. By doing so, we have had the experience of presenting to hundreds of patients and family members, and this experience has translated directly to our medical physics patient consult program by giving us experience with not only explaining technical concepts to patients but also answering questions confidently without the "deer in the headlights" effect. Without added cost to the health care system, these actions would increase visibility of medical physicists to the patient, family, and public. With this introduction, a patient or their family may be more likely to ask to meet with a physicist and have specific questions for them. That would be great! And we had better be prepared to answer those questions to avoid presenting a "deer in the headlights" look. Therefore we need to create training curricula within our residency programs and for our existing medical physics teams that will teach the necessary soft skills and explicitly train us to answer questions at the appropriate patient level.
Furthermore, we need to educate physicians, nurses, and therapists to page us when patients have questions. Anecdotally, I know that patients have more technical questions after starting their treatment or when seeing the treatment machines. At this point, they may be primarily interacting with technical staff, who might brush off the questions or not take the time to call a physicist. After we have become trained and skilled in this level of patient interaction, our colleagues need to know that we are willing and happy to answer that page and to meet with the patient.
Finally, the "Opening" argument does not address questions of the best use of time, resources, and health care dollars spent. Suggestions for changes to the clinical role of a medical physicist to include meeting with the patient at the initial patient consult must be made with a view to cost-benefit analysis impact on medical physics time and how that will translate into increased cost borne by the health care system.
What tasks will the physicist no longer be doing in order to devote time to initial patient consults? How many additional physicists will need to be hired in order for them to continue fulltime clinical tasks in addition to taking on this new consulting role?
Increased public and patient awareness of medical physicists and our role in ensuring patient safety of radiotherapy treatments is important. I recognize that increased interactions with patients can be a positive, if done judiciously and properly with training.