VIRTUALLY THERE?

Dr. Laura Esserman leans forward and speaks with conviction, making broad gestures with her hands. Over the past couple of decades, Ive watched industries be transformed by the use of information systems and incredible visual displays, she says. What we could do is to completely change the way we workjust by changing the way we collect and share information. Sounds familiar, right? But Esserman isnt championing yet another overzealous Silicon Valley start-up shes envisioning how cancer patients will interact with their doctors. If Esserman, a Stanford-trained surgeon and MBA, has her way, patients wont sit passively on an table, listening to impenetrable diagnoses and memorizing treatment instructions. Instead, theyll have access to a multimedia treasure chest of real-time diagnosis, treatment, and success-rate data from thousands of cases like their own. Better still, they wont meet with just one doctor. There will be other doctors on the casesome from the other side of the hospital and some, perhaps, from the other side of the world. Esserman and her colleagues at the University of California, San Franciscos Carol Franc Buck Breast Care Center are pioneers in the new world of virtual teams and virtual tools, a world in which there will be real change in the way highly trained people whose work depends on intense collaboration get things done.Her goal at the Buck Breast Care Center is to use virtual tools to bring more useful information (and more doctors) into the room. Why? Because two heads really are better than one. She explains that when patients see their doctors after a breast cancer diagnosis, for example, they are handed a recommended course of treatment that involves serious choices and trade-offs. Of course, most patients dont know enough about the merits of, say, a lumpectomy versus a mastectomy to make an informed choice, so they trust their doctors to tell them what to do. But a single doctor isnt always equipped to make the best decision, especially because different procedures can have very different long-term physical and emotional impactsbut may not be all that different in their short-term medical outcomes. Very often, Esserman says, doctors recommend a particular treatment because theyre more familiar with it. But we should be advocates for our patients, rather than our specialties. Although her full-blown program is a long way off, Esserman has run a pilot project with 24 patients. She worked with both Oracle, the Silicon Valley database giant, and MAYA Viz, a Pittsburgh company that develops decision community software, to allow doctors across the country to collaborate virtually. Through Essermans approach, when a patient arrives at the doctors office to receive treatment instructions, instead of listening to a physiciansmonologue, shes handed a printout. On the top left side of the page is the diagnosis, followed by patient-specific data: the size and spread of the tumor, when it was discovered, and the name of the treating doctor. Below that is statistical information generated from clinical-research databases, such as the number of similar cases treated each year and details about survival rates. A set of arrows points to treatment options. Next, the patient reads the risks and benefits associated with each treatment. She can follow along as the doctor explains the chances that the cancer will recur after each option and the likelihood that a particular treatment will require follow-up procedures, as well as a comparison of survival rates for each one. At this point, the patient has an opportunity to voice concerns about treatment options, and the physician can explain her experiences with each one. When you share this kind of information, patients and doctors can make decisions together according to the patients values, Esserman says. This is where the network tools come into play. Drawing from stored databases of both clinical trials and patient-treatment histories local to the hospital, the physician can compare courses of action and results far beyond her own personal experience. A medical opinion is really just one physicians synthesis of the information, notes Esserman. So you need a way to calibrate yourselfa way to continually ask, Are there variations among the group of doctors that I work with? Am I subjecting people to procedures that turn out not to be useful? With a real-time, shared-data network, these questions can be answered at the touch of a button instead of after hours, weeks, or months of research. But thats just the beginning. A real-time network also presents the possibility of seeking help from other specialists on puzzling cases, even if those specialists are on the other side of the world.

Questions

1. Why does this case offer an example of a virtual team? In what ways are the team members on this team dispersed (i.e., location, organization, culture)?

2. What are the advantages of the virtual team described in this case?

3. What technological support is needed for the virtual team to meet its goals?

4. What suggestions can you offer Dr. Esserman for managing this virtual team