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P&S Journal

P&S Journal: Spring 1997, Vol.17, No.2
The Human Portrait of Breast Cancer
Efficiency Gone Full Circle

 In recent years, health care experts have emphasized the importance of the medical team, the group of practitioners--from surgeon, to mammographer, to pathologist, to nurse, to medical oncologist--who work together to achieve the best level of care. CPMC's breast center is a study in that sort of cooperation, down to the facility's design and layout.
Dr. Estabrook
Dr. Alison Estabrook, chief of the CPMC breast surgery service

 An endowment from Herbert and Florence Irving, long-time supporters of clinical care and research at CPMC, has reorganized the medical center's cancer programs under the umbrella of the Herbert Irving Comprehensive Cancer Center. The breast cancer component of the cancer center was the first to undergo extensive renovation and redesign to maximize convenience for patients and ease of communication for the team of care providers.

 The breast center occupies the 10th floor of the Atchley Pavilion. Whether the patient's appointment is with a surgeon or medical oncologist, she first enters the center through the main waiting area that overlooks the Hudson River. From there, she is called to see her physician--down a corridor to a surgeon's office or through a French door into the suite for medical oncologists.

 From the waiting area for the mammography service, patients enter mammography through a dressing area with private dressing cubicles and lockers for clothing and other personal items. Each mammography patient is issued a fluffy pink terry robe and directed to a private waiting area that looks out onto a peaceful scene of the Presbyterian Hospital garden and chapel. This quiet setting is blocked from view of the public so patients can wait in privacy while reading or sipping complimentary coffee or tea. In mammography screening rooms, technicians take the appropriate films.

 The films are developed quickly, while patients wait. If it's a diagnostic screening, a radiologist reads the X-ray and then lets the patient know if it's normal or if she needs to stay longer for further investigation. For example, if an abnormality is detected on the mammogram, the woman may then have a needle aspiration the same day to see whether the lump is benign or cancerous. That saves her from having to make another appointment and also gives her a diagnosis quickly to spare her days--or even weeks--of worrying.

 Dr. Alison Estabrook, professor of clinical surgery and chief of CPMC's breast surgery service, and Freya Schnabel, assistant professor of surgery and co-director of Women At Risk, were instrumental in the design of the new floor. "We looked at some of the best centers in Los Angeles," says Dr. Estabrook. They took ideas they liked while incorporating some of their own. "This new floor is much more efficient--it's better for patients and infinitely better for the clinicians," she says. "For instance, we get reports right away from radiology and the patient doesn't have to wait long. She can get dressed while we read the report and then we can go over the findings."


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