The doctor’s ‘mission’ is to ensure that every patient undergoes cancer screening

Source:

Healio interviews

disclosures:
Nicholas does not report any relevant financial disclosures.


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Angela M. Nicholas, MD, says no patient she sees over the age of 45 leaves her office without discussing cancer screening.

“It doesn’t matter if you came in for a cut on your finger or a full physical treatment,” Nicholas, a primary care provider who also serves as the medical and administrative director of Einstein Physicians Montgomery, told Healio. “We’re going to have the discussion and we’ll continue to have the discussion because the only way we can get people screened is to help them understand the risks and the benefits.”

“It's a matter of people listening and being observant when you hear something that isn't right.  Every American deserves to be screened for every cancer we can screen for.

In addition to her underlying motivations as a primary care physician, Nicholas said part of her push for more cancer screening is personal. Her husband was diagnosed with stage IV colorectal cancer at age 45 and died 5.5 years later. Without screening, Nicholas said he likely would have died much earlier.

“It’s a matter of people listening and being observant when you hear something that’s not right,” Nicholas said. “Every American deserves to be screened for every cancer we can screen for.

“I’ve heard that ‘mission’ is the sixth stage of grief, and my mission now is to make sure every person I know is screened and that every patient I meet understands and knows the facts and has a chance to to be screened,” she added.

Screening for colorectal cancer

Research data has shown that lockdowns related to the COVID-19 pandemic have reduced the number of diagnosed colorectal cancers by about 40% in 1 year. At the height of the pandemic, colorectal cancer screening rates fell by about 90%, Nicholas said.

“The outcome of the pandemic will be felt in the coming years,” she said. “The downstream effect is that patients are diagnosed at later stages. Generally, 1 or 2 years won’t make such a huge difference, but when that patient who should have had their colonoscopy never gets it, that’s the patient we’re talking about.” 3, 4 or 5 years of seeing who has now become symptomatic.”

Nicholas said her organization has been “pretty aggressive” to let patients come in for makeup screenings, leading to high CMS star ratings for all cancers. But overall, it’s been hard to catch up to that screening backlog when new patients, in addition to the patients to be rescheduled, also need to be seen.

“On a positive note, the lockdowns have allowed us to promote the use of the screening test at home, but because some patients need a follow-up colonoscopy, scheduling those patients has been a real challenge,” Nicholas said.

To increase overall colorectal screening, Nicholas said home tests, such as Cologuard (Exact Sciences), offer a “fantastic opportunity” to reach patients who may be hesitant or too busy to undergo colonoscopy. Such a test is available for average-risk adults aged 45 and over.

“People go back to work and come back to life, and time is a precious commodity,” Nicholas said. “We have been able to promote the use of home screen testing to increase screening uptake. We walk them through all the steps of receiving and returning the kit so they understand what happens next.”

Starting that discussion early is so important given the alarming trend of colorectal cancer diagnoses occurring at a younger age, which led the United States Preventive Services Task Force to lower the recommended screening age from 50 to 45 years old last year.

This trend has forced a mindset shift in the medical community, Nicholas said, although more needs to be done to raise awareness.

“These are patients that we would have said before, ‘Oh, it could just be hemorrhoids.’ But in my practice I don’t do that anymore,” she says. “Now we refer these patients to gastrointestinal doctors and they have colonoscopies.

“The challenge is we need to get that message out to the community to educate everyone,” Nicholas added. “If patients think something is wrong, they should go to a doctor who will listen to them. If they are not comfortable with the plan, they should speak up. We need a medical community that will listen.”

The power to say yes

Nicholas said she has been fortunate to have her “passions collide” in her dual roles as a doctor and executive. Not only does she get to see and care for patients, but her experience also allows her to lead a practice group for physicians.

She admitted that part of her career path involved being “in the right place at the right time,” but she also took on various positions that interested her and equipped her with the skills to serve as a leader. In addition to her clinical duties, Nicholas has over the years served as hospital vice president, chief medical information officer and senior director at Siemens, with a focus on electronic health record development, among other things.

“These different positions have allowed me to be involved in some really great projects,” Nicholas said. “It has kept my interest and added some really nice things to my day that makes me want to keep doing what I do.”

Nicholas warned female doctors not to look for a “work-life balance,” but to find jobs that allow flexibility for what’s important to them.

That flexibility allowed Nicholas to maintain her position as a full-time physician and health system executive while caring for her husband, even if that meant working from his ICU room.

“Whether you’re single or have a family, a spouse or elderly parents, you have to stand up for yourself and figure out what works best for you,” Nicholas said. “There are creative ways to handle any situation and find a position that’s right for you.”

In addition to praising female vice presidents and business leaders who acted as her mentors in the beginning, part of Nicholas’s success came from her eagerness to try new roles.

“We hear all the time to say ‘no’ and know our limits,” Nicholas said. “But for me, the answer is never ‘no’, it’s ‘yes’. If I want to do something, how can I achieve it? What are the things I can take off my plate and give to someone else for my “Growing the team and taking on more responsibility? Educating someone to take on your job is part of being a good leader. I try to give people as much responsibility as possible so I can do more.”

Nicholas said her mantra throughout her career has been: When it’s not fun anymore, it’s time to do something new.

“If I read a job description and think, ‘I could do that job,’ then I should apply for that job,” she said. “It’s easier to say no. It’s harder to say yes and figure out how to make this happen. There will always be challenges for us as women in medicine, but we must try to keep growing, meet expectations and have fun in what we do.”

References:

For more information:

Angela M. Nicholas, MD, can be reached at angela.nicholas@jefferson.edu.

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