Lessons learned from AACE 2014

The need for a “hand-in-glove” integration of endocrinology and endocrine surgery was a key lesson learned at this year’s American Association of Clinical Endocrinologists Annual Scientific & Clinical Congress, and this lesson will continue to be strategic for AACE over the next few years, according to R. Mack Harrell, MD, the Association’s current president.

“The Saturday program in Las Vegas was designed to kick off a new and more collaborative relationship between endocrinologists and endocrine surgeons all over the world,” Harrell said. “So we created a program that included topics that were of interest to both endocrinologists and endocrine surgeons.”

The program, titled “Integrative Concepts in Endocrine and Endocrine Surgery: A Tale of Two Cities,” was chaired by Nancy D. Perrier, MD, of the MD Anderson Cancer Center. The topics were chosen in anticipation of the joint 2015 American Association of Clinical Endocrinologists (AACE) and the American Association of Endocrine Surgeons (AAES) meetings, which will coincide in Nashville.

R. Mack Harrell

“In preparation for the May 2015 meeting, we decided to run a single day to get people used to the idea that we are working together,” Harrell said. “The idea of this symposium was to bring endocrine surgeons and endocrinologists together around key endocrine disease processes that often require endocrine surgery.”

Endocrine Today spoke with Harrell about the lessons learned from the program presented at this year’s meeting.

1. Preoperative parathyroid imaging should be a key point of collaboration — one that includes the patient.

For the first presentation, Harrell and his partner, endocrine surgeon David Bimston, MD, discussed the integrative model of parathyroid surgery they have created at Memorial Health Systems in South Florida. In particular, Harrell said, they focus on collaborative preoperative imaging in their model.

“In the thyroid and parathyroid areas, imaging is extremely important preoperatively,” Harrell said. “In our ultrasound suites, my partner and I look at the image together with the patient in real time, placing the patient at the center of the surgical planning process.” Using a 42-inch flat panel television mounted on the ceiling over the ultrasound table, Harrell and Bimston turn the ultrasound suite into a teaching facility.

“We show the patient what the abnormality is, and right in front of them, we plan the preoperative procedure and discuss issues such as whether it will require local or general anesthesia,” he said. “The patient must participate in the surgical planning process if the care is truly integrated.”

2. Some complicated thyroid cancers require more than surgery.

For the second presentation, Perrier and her colleague Naifa L. Busaidy, MD, of MD Anderson Cancer Center discussed the need for endocrinologists and endocrine surgeons to work together to treat complicated thyroid cancers that require the use of advanced oncologic drugs after surgery and radioiodine.

“Sometimes, these cancers require the use of brand new investigational drugs,” Harrell said. “That is Dr. Busaidy’s subspecialty niche, working with really advanced thyroid cancer patients and using promising investigational agents.”

PAGE BREAK

3. In treating obese patients, close communication between physicians helps determine when it is time to switch strategies.

The third presentation addressed the areas of obesity management and bariatric surgery. This topic was discussed by Jeffrey Mechanick, MD, Elise Brett, MD and William B. Inabnet III, MD, all of Mount Sinai Hospital.

“Dr. Mechanick and Dr. Brett are world-renowned experts on nutrition and obesity, and they work with patients who have advanced obesity using dietary and exercise intervention,” Harrell said. “They are careful to recognize when conventional therapy has reached the maximal benefit. When obese patients have residual medical issues in spite of maximal conventional weight loss therapy with diet, exercise and even weight loss drugs, more invasive surgical options need consideration.”

When such a situation is evident, Mechanick and Brett direct their patients to Inabnet, who then can offer a variety of surgical options.

“There is a smorgasbord of different bariatric surgeries now, depending on how much weight loss you need and what the patient’s risks are,” Harrell said.

4. The era of “compartmentalized care” is over.

Harrell said the traditional model for endocrine surgery involved endocrinologists and endocrine surgeons working in separate rooms and separate buildings with completely separate thought processes.

“The primary care doctor would send the patient to an endocrinologist for high blood calcium, and the endocrinologist would send the patient to a radiologist,” Harrell said. “And soon you have three or four different parties in three to four different spaces, all sending paper back and forth. In some parts of the country, that’s what we’ve still got.”

Harrell said the new approach seeks to more effectively coordinate a patient’s surgical care through integrated communication.

“The new approach is to bring the practitioners who have the imaging, medical and surgical expertise together at the point of care to integrate the surgical discussion so that all aspects of the care can be addressed in one encounter and one place.

Harrell said he looks forward to an ever-expanding relationship between endocrinology and endocrine surgery, as represented by the fusion of their meetings in 2015. He said when it comes to more efficient and more informed patient care, a collaborative approach basically has no down-side.

“This is the new way to improve healthcare; stop compartmentalizing it, integrate it in one place,” he said. “There are many things about Accountable Care Organizations have been difficult for doctors to swallow. This is one thing that is not so difficult.” – by Jennifer Byrne

Disclosure: Harrell reported no relevant financial relationships.