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Faculty Focus

E. Dale Collins, M.D.: A helping hand

By Sharon Tregaskis

Nancy Speck was initiated into the sisterhood of breast-cancer survivors five years ago, when a colleague took the professor of biochemistry to lunch, answered the questions a doctor can't, and even showed Speck her own post-mastectomy reconstruction. "I could live with that," Speck remembers thinking. So she called to make an appointment with Dartmouth plastic surgeon Dale Collins, M.D., director of the Comprehensive Breast Program at DHMC's Norris Cotton Cancer Center.

Now Speck often finds herself returning the favor bestowed by that colleague—sharing her own story and showing women grappling with treatment options how her body fared. "People tell me, 'That's the nicest reconstruction I've ever seen,' " says Speck, who never fails to give Collins credit for the work. Even her primary-care practitioner was impressed, Speck adds. She has since served on DMS committees with Collins and now counts the plastic surgeon as a close friend. "One of the things I like most about her is her perfectionism," says Speck. "She does a really beautiful job."

It wasn't long after Collins arrived in Hanover in 1995 that she expanded her hand and microsurgery practice and began to offer breast reconstruction. Two early breast-cancer patients alerted Collins to an issue that has since become the focus of her career: providing patients with clear, objective information about their treatment options and supporting their autonomy as they pursue their own best interests. Those two patients "both elected [to have]mastectomies, and both felt upset that they had disappointed their [oncological] surgeon," Collins recalls. "It was distressing to me that they were made to feel judged for their decisions. They were informed, understood the issues, and elected mastectomy." The sad part, adds Collins, is that the surgeon who treated them probably didn't realize that he had so clearly telegraphed his disappointment when both women decided not to follow his recommendation to have a lumpectomy and radiation.

That insight sparked Collins's quest to develop bias-free methods to help patients understand both their diagnoses and the full range of treatment options open to them. It's a quest that led her to complete Dartmouth's master'sdegree program in the evaluative clinical sciences, so she could learn more about shared decision-making. And it's what guides her ongoing work with DHMC's Comprehensive Breast Program (CBP).

Plastic surgeon Dale Collins, a member of the DMS faculty since 1995, is a national leader in applying shared decision-making and outcomes studies to her specialty.

Today, the associate professor of surgery heads a $3.5-million multispecialty investigation of shared decision-making, serves on the DHMC Board of Governors, and chairs the American Society of Plastic Surgeons' Committee on Performance Metrics. Last year, the Institute for Women's Health and Leadership at Drexel University's College of Medicine named Collins a Hedwig van Amerigen Executive Leadership in Academic Medicine Fellow—an honor that is accompanied by an intensive training program aimed at grooming women faculty for institutional leadership roles.

"Dale is one of the smartest and most accomplished people I know," says University of Michigan plastic surgeon Amy Alderman, M.D. "She has excelled in a male-dominated specialty, but she's very much kept her femininity. To me, Dale is the perfect female leader in that she has excelled because she's really smart and very hardworking and has just enormous amounts of integrity. She hasn't changed who she is to try to succeed."

Most of the nation's comprehensive breast-cancer programs are headed by oncologists. As far as she knows, Collins is the only plastic surgeon in such a role. A comprehensive program is one in which the patient has a single point of contact for every part of her treatment—from diagnosis to surgery to reconstruction or radiation. Oncologists, social workers, nutritionists, radiologists, pathologists, nurses, and plastic surgeons all coordinate their schedules behind the scenes for the convenience (and peace of mind) of the patient, rather than the patient needing to make multiple phone calls to coordinate her own care.

Since her 1999 appointment as themedical director of Dartmouth's CBP, Collins has been relentless in implementing, investigating, and evaluating shared decision-making—an approach to treatment that incorporates the vantage points of all those specialists, as well as the patient's own preferences and values. Inevitably, conflict emerges as those perspectives collide.

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Sharon Tregaskis is a freelance writer in Ithaca, N.Y., who specializes in health care, the environment, and higher education. She wrote a feature for the Summer 2007 issue of Dartmouth Medicine on DHMC's leadership in the "green" health-care movement.

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