Bryant Lin, MD, MEng, enjoyed a warm introduction from his fellow Stanford colleague, Beth Beadle, MD, PhD, FASTRO, professor of radiation oncology at Stanford and chair of ASTRO’s Annual Meeting Education Committee. Dr. Beadle had the challenge of condensing Dr. Lin’s extraordinary achievements into just a few minutes, including his education at MIT, Tufts and Stanford, with many years spent studying electrical engineering and medicine. Dr. Lin is currently based in neighboring Palo Alto and is a primary care physician and researcher. In addition to those roles, he’s had a few more at Stanford: professor, patent holder, advocate with a focus on Asian health, director of Medical Humanities, and most recently, patient.
Dr. Lin came to the stage, enthusiastic and ready to share his experience. Although he quipped, “I never thought I would present my own case to physicians,” he came prepared. To start, he characterized himself as a then-49-year-old Asian male physician, with a cough that was easy to explain away and no other symptoms for six weeks. His case quickly escalated through a series of unhelpful over-the-counter treatments, then chest X-rays and more detailed imaging, and from imaging to pathology. Ultimately, the turnaround time from imaging to diagnosis of stage 4 never smoker lung cancer was six days. With his passion for access apparent, he noted, “Six days should be something everyone gets, not just me.” His MRI revealed 50 metastases in his brain, and further analysis conveyed a difficult diagnosis. Thankfully, Dr. Lin shared that he responded well to the treatment plan with no disease progression for 15 months.
Dr. Lin was especially grateful to give the graduation speech at Stanford University School of Medicine a few months ago, and even more so to be with his mentor Paul Wang, MD, reflecting that twenty years ago, he, as a patient, would not have been able to do so. He also had the benefit of being able to consider, then, what has been the most important to him.
Dr. Lin shared the facets most important to him upon diagnosis, which included spiritual care, nutrition, caregiver support, mental health support, access, alleviating adverse effects of treatment, and information on new treatments and clinical trials. He noted that, as doctors, they do not see 99% of a patient’s life in their 15-minute appointments, and yet it is important to show interest and find out what a patient’s priorities are. He himself was surprised to discover, especially as a non-religious person, that spiritual care contributed to his well-being. Receiving guidance on nutrition was also helpful for him to reduce symptoms.
Dr. Lin cited the gaps between his experience — where he speaks English, has high health literacy , is employed with flexible work, is insured, owns a car, and has great family support and professional connections — and a standard random patient, who might not find out his diagnosis for six months, has limited English proficiency, receives health information online, is laid off from work, whose COBRA has run out, who doesn’t have local family and certainly no physician connections.
Regardless of the individual, Dr. Lin noted that we all carry bias with us into the exam room and suggested having a family member there to advocate. He encouraged asking for help, for everything ranging from meaningful translation services to dietitian referrals. Wired as an engineer, Dr. Lin’s impulse might be to focus on statistics. But he shared that human nature isn’t always logical, and that maintaining hope is critical. He shared that, as a physician, it’s important to spend a little more time to understand a patients’ life goals. For example, one of his goals upon diagnosis was to take an extended trip with his family. Having that understanding can inform how to administer treatment and respect the patient’s wishes.
Dr. Lin always sensed there was a stigma around sharing cancer stories, with a cloak of privacy over the topic. But he has shared his story to be helpful to other people, and to students, to offer continuity in seeing how a patient’s experience evolves. His story has resonated with patients, students, physicians and family members of those with cancer, and provided solace and comfort. He shared a favorite quote by Jonas Salk: “Hope lies in dreams, in imagination and in the courage of those who dare to make dreams into reality.” Upon that Dr. Lin expanded, “We need that hope. I want to thank you for giving people like me a little hope back.”
Dr. Lin continued with his own experience, noting that he is the beneficiary of years of both basic science and clinical research — for example the FLAURA study and applications of Osimertinib. Citing study after study, he shared that so much progress is attributed to the NIH, and that it is amazing what we have done in this country to support cancer research. He gave a quick history lesson on cancer research. Starting in 1937, the National Cancer Institute (NCI) was founded by President Franklin D. Roosevelt; SEER was founded in 1973, and most recently, Cancer Moonshot was established in 2016 to accelerate cancer research. However, Dr. Lin noted that the current climate is challenging for cancer treatment. After all, cancer research is hugely funded by NCI. “I want there to be a next line of treatment for me. If we shut down cancer research, we will lose a generation of research and scientists,” Dr. Lin said.
Amidst these research challenges, Dr. Lin acknowledged his position of privilege, having a multidisciplinary team to which he has timely access and, although he has medical knowledge, he admitted that he would not be able to catch up to the expertise of the specialists on his care team. Yet, “having that faith [in the care team] is important; we won’t know as much as the specialists know. I’m lucky that I have that faith, but not all patients will have that.”
Communication is yet a different type of challenge when considering AI. How can it enhance the patient experience and not replace physicians? At a recent gathering of generally pro-AI attendees, Dr. Lin explored the general opinion about AI’s potential role in medicine. When he polled his audience to find out their comfort level for having an AI “doctor” for a routine issue, many raised their hands. As he incrementally posed more severe scenarios, fewer raised their hands, and ultimately, when confronted with mortality, patients wanted a human doctor. “Something AI can’t provide is comfort,” he stated. “It’s a facsimile of empathy. It’s not true empathy.”
Dr. Lin shared that his processing and grief was frontloaded at the diagnosis phase, and now with his more recent news of progression, he acknowledges that his support needs might shift. Meanwhile, he prioritizes doing what he enjoys, whereas other competing demands in years past might have won out. This means he spends time reading in his backyard, continuing to avoid yardwork, and intentionally carving out time to spend traveling and be with his family. He also grapples more with asking himself each day how he should spend his time, which has led him to advocate, and even speak to groups such as ASTRO. Seeing patients is second nature to him, and he derives energy from teaching the “medical humanities stuff – storytelling, it’s just fun, fun to help students and teach.”
Dr. Lin wants his students, as clinicians, to remember this and other aspects of connection, which is why he continues to teach, sharing his own patient journey. He designed a class to share his patient experience real time. Dr. Lin’s enthusiasm was palpable, ever the life-long learner, stating that “half the reason I start new classes is because I will learn as much as the students.”
Dr. Lin, when pondering how to communicate more effectively to patients and also engage in advocacy for increased research funding and access to cancer care, shared “We have to add our voices to the conversation, which is a tremendous challenge, but considering the risk of misinformation, as a profession, we need to be out there offering OUR tools, OUR information.”
Dr. Lin suggested that we learn how to meet patients where they’re at if we are to combat misinformation. He understands the reluctance of physicians to put themselves “out there,” but the dangers of false information outweighing accurate science should compel us to harness the strengths of social media.
Dr. Lin closed with heartfelt gratitude, saying “I want to thank you for all you do, for all the clinical care you provide. My mission since I’ve gotten sick is to express my gratitude. Thank you for taking care of patients like me.” The audience returned his gratitude with a standing ovation for the vulnerability and reminders of purpose he offered today.
