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Faculty Focus

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

"My goal is to make sure that we have the conversations and at least hear each other's perspectives and review the data," says Collins, who feels her training as a plastic surgeon—with its emphasis on patient satisfaction and quality of life—helps when communicating with colleagues in other fields.

"What one specialty preaches isn't necessarily what another specialty practices," she points out. "You have to be willing to step back and examine the evidence across the board and not just from a specialty perspective."

Collins has also made it a priority to balance the CBP's emphasis on patient-centered care with a commitment to creating a work culture that supports the whole team providing that care: from physicians and other health-care professionals to the administrative staff who coordinate the effort. "The nature of the program is to ease the patient's journey through treatment by having a single phone number to call and having care coordinators available to help the patient through it," explains shared decision-making project coordinator Caroline Moore, who began working with Collins in 2001. "From the perspective of the administrators who answer that phone, they're doing a ton of coordinating behind the scenes [to] make it all seemseamless for the patient."

To ease the strain on those staff members, and foster relationships that can enhance collaboration, Collins instituted an informalmonthly luncheon to honor administrative assistants throughout the program—people who might otherwise never interact face-to-face. The effort has been a huge success, says Moore, opening doors and creating a sense of teamwork.When there's conflict, Collins assumes that the person causing it is under stress. "If we can figure out what's behind the stress, we can usually work [the conflict] out," says Moore. "She really believes in the goodness of everyone."

Collins is a tough taskmaster when it comes to herself, however. Eliminating her own bias in patient counseling, for example, hasn't been easy. "I found it really hard to do," she admits. "You believe what you believe, and even when you try really hard to be factual, you choose information that reflects your bias." The difficulty should be no surprise, she admits—it's a physician's job to consider the facts in each patient's case, integrate them with what you know based on your past experience and training, and then counsel that patient accordingly.

Ultimately, the effort requires balancing the objective and subjective particulars of a patient's situation against objective data

Grew up: Atlanta, in a family with seven boys and three girls
Education: Eckerd College, St. Petersburg, Fla., '80 (B.S. in biology); Emory University '89 (M.D.); Dartmouth Center for the Evaluative Clinical Sciences '98 (M.S.)
Training: Washington University, St. Louis, Mo.
On that mysterious first initial: "It stands for Eva. In the south, it's common to go by middle names."
On reactions to her gender-neutral middle name: "As a resident I considered switching to Eva—but I just decided I couldn't get used to being called by another name. Even today, I'm assumed to be male."
Children: Daughters Moskoula (almost 4 years old) and Isabella (almost 4½), both adopted as newborns from Arizona
Social life:"With my career, I gave up a social life. You can't get to work at 7:00 a.m. and go to dinner and be really good at conversation past about 8:30 at night."

The insight sparked Collins's quest to develop bias-free methods to help patients understand their diagnoses.

about the pros and cons of a full range of treatment options and the specialist's expert intuition. Collins seems to have a knack for it, says Nancy Speck, who grappled with whether to have radiation following a lumpectomy, or reconstruction following a mastectomy, in her own fight against breast cancer. "[Dale] was very helpful in helping me think through the decision," says the biochemist, "presenting the risk factors for recurrent cancer and how that might or might not be averted with mastectomy."

In 2002, Collins began experimenting with urging newly diagnosed breast-cancer patients to watch a neutral video on treatment options before she presented her recommendations. An information technology aficionado (she serves on the steering committee for DHMC's Information Survey Systems), she had developed an electronic survey to evaluate the concept. She invited her colleagues in the CBP to test the video approach and survey.

But given their jam-packed schedules, and their gut instinct that they were already providing patients with objective recommendations, some of the doctors weren't enthusiastic about testing something new. To counter their skepticism, Collins incorporated questions on the survey to elicit information that she knew her colleagues would find useful—such as any points of confusion a patient had about her

diagnosis and the patient's individual treatment preferences—and began generating a patient-specific report before each appointment.

In the end, Collins got her colleagues hooked on the new system, while simultaneously generating vast amounts of valuable patient data. "Dale is a master at demonstrating the value of an initiative by wrapping things into it that can benefit the providers," saysMoore. "It was all linked with her goal to provide the patient with decision support."

Ironically, it wasn't until she was well along in hermedical education at Emory that surgery even made it onto Collins's list of career prospects. In fact, she originally enrolled there as a Ph.D. student in the neuropharmacology program. "I was very problem-focused," says Collins, and "love puzzles, finding solutions." But the program lacked any clinical application or relevance so, after a year, she transferred to Emory's medical school. There, she discovered a fascination with dissections. "I kept saying, 'This is really interesting,' she recalls. " 'It's too bad I wouldn't want to be a surgeon.' " But when she did her first rotation—in surgery—she happened to be assigned a terrific mentor and her perspective began shifting.

Today, Collins makes a point of returning the favor granted by that long-ago surgeon. She provides counsel and mentorship to the whole range of individuals with whom she works—from administrative assistants seeking out new professional opportunities, to undergraduates and medical students looking for research opportunities, to residents or colleagues searching for clarity in their careers. Among CBP staffers, says Moore, that attitude has engendered passionate loyalty and low turnover. "With Dale, you never feel like there's a totem pole," says Moore, who started out with the program as a part-time secretary. "She's very team-oriented, makes everyone feel valued, and pushes everyone to develop their own goals and careers."

Back in 2001, Amy Alderman was a resident in plastic surgery at Michigan who wasn't quite sure what career path to take. Her division chief recommended that she spend a week at Dartmouth observing Collins, who was already nationally recognized in the field. Alderman took the advice and now counts Collins among those who've had the most influence on her career over the past six years. "Dale is the kind of person who tries to make other people look great," says Alderman. "She's a very giving person and really tries to help people. . . . There aren't many Dales in the world."

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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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