Myrna and Bob Merowitz Endowed Fund for Clinical Decision Making
What do we do next?
This is often the first question on the minds of both patients and their physicians when reviewing results from diagnostic tests. Receiving a new diagnosis can be an anxious time for patients, but John Wong, MD (pictured right) is on a mission to help put patients at ease by making them the center of their care decisions, sharing his evidence-based knowledge about treatment options and likely outcomes, and involving them each step of the way. As the Chief of the Division of Clinical Decision Making and a longtime primary care physician at Tufts Medical Center, Dr. Wong is always working with patients to determine the best care path going forward, and passionately believes that engaging patients in their care decisions lead to better health outcomes.
Established in 1980, the Tufts Medical Center Division of Clinical Decision Making has been described as the only unit in the world that applies the logical principles of decision analysis to optimize the care of individual patients by identifying strategies that may maximize the length and quality of their life while enhancing their participation in their care decisions. These conversations involve care choices, such as tests or treatments, chances for particular outcomes and the consequences of the decisions on a patient’s health, based on searches of medical literature, the assessment of patient preferences for possible health outcomes and the development of computer simulations. Upon completion, the results are explained to the patient to provide them with critical understanding, not only on which strategy is optimal, but also why. This then informs shared decision-making for determining next steps.
One long-term patient who can attest to the effectiveness of this approach is Bob Merowitz. Bob and Dr. Wong have built a trusting, mutually-respectful relationship over the years. Whether for scheduled primary care visits, unexpected health issues or highly-complex treatments in collaboration with Tufts MC specialists, Dr. Wong is always there for Bob, as he is for all of his patients, to advise on the best possible treatment options both for a specific disease or condition, and for Bob’s overall health.
In appreciation, Bob and his wife, Myrna (pictured left), wanted to honor Dr. Wong in a meaningful way while also supporting his efforts to grow the influence of clinical decision making in the delivery of patient-centered care. The Myrna and Bob Merowitz Endowed Fund for Clinical Decision Making, which they created with a gift of $100,000, will help ensure that this work continues for years to come. Under the leadership of Dr. Wong, the fund will support an annual Grand Rounds lecture and other educational opportunities centered on the practice of clinical decision making and the significant potential it has to improve the patient care experience, and outcomes, across all medical specialties.
Bob says, “The caregivers at Tufts Medical have always put my health before anything else. They saved my life in 2000 when I had a liver transplant there, and have continued to help me live a healthy, high-quality life. Having the chance to support the innovative work of my primary care physician, and to give back to future generations of patients and their caregivers is exciting to Myrna and me.”
Says Dr. Wong, “I’m so grateful to Bob and Myrna. Through their generous support, they have provided us with an important opportunity to enhance our clinical decision making initiatives and further educate clinicians here at Tufts Medical Center and beyond. Their thoughtful gift will have an impact on the delivery of better patient care for years to come.”
Clinical Decision Making in Practice
Tufts Medical Center has long been a leader in the field of clinical decision making. In 2001, Dr. Wong, in collaboration with the late Marshall Kaplan, MD, then Chief of Gastroenterology, showed that in the case of a patient with a non-resectable small liver cancer and cirrhosis, a living-donor transplant from a family member would extend the patient’s life by 4.5 years versus waiting for an organ from a deceased donor, for which there are significant shortages. Similarly, they answered the question on whether a patient should consider accepting an expanded criteria donor liver that carried a higher risk for initial organ rejection or wait for a standard criteria liver. Dr. Wong and Dr. Kaplan found that accepting an expanded criteria donor liver improved patient survival overall. Both of these analyses not only affected patient decisions but may have also contributed to the subsequent growth in living-donor liver organ transplants and the acceptance of expanded criteria donor organs.