Nilan Schnure - 2012-2013 BCC Intern

Nilan Schnure - 2012-2013 BCC Intern

 

When I started at the UCSF Breast Care Center in 2012 I was amazed at how definitively the experience resembled a training fellowship rather than just a job. During our first two weeks we had a series of lectures on breast surgery, oncology, and clinical trials, and it became clear that everyone cared deeply about our learning and development. This continued throughout the year as we received workshops on public speaking, traveled to lectures, and were mentored on future career decisions. We were reminded that we were to be the future leaders in healthcare and that this required certain attitudes, knowledge, and values, all of which were indelibly instilled during my time at the Breast Care Center.

One of the most remarkable aspects of the position was our time in the Patient Support Corps (then “Decision Services”), a patient navigation program for women newly diagnosed with breast cancer. In addition to their work on various clinical trials, each intern spent 20% of their time committed to shepherding patients through the complex healthcare system. We would call each patient coming in for a new appointment and offer to mail them brochures and videos appropriate for their medical situation. With one patient each week, we would talk with them on the phone before their appointment to elicit and organize all of their questions, comments, hopes, and fears for treatment. We would then accompany them to their appointment to take notes and make an audio recording, which was a tremendous service for patients going through emotionally difficult times in their lives. It was also a valuable and unique introduction to the world of medicine – we were shadowing patients, rather than shadowing the physicians. As I got to know patients on a deeper level I could see how the health system either met or failed to meet their individual needs. One woman, for example, was ambivalent about aesthetic outcome or logistical differences in treatment as long as she could participate in an upcoming community play for which she had been rehearsing. This involvement is what mattered to her, and what defined her quality of life. It unexpectedly surfaced late in our session eliciting her questions, goals, and priorities, but it defined the conversation which later took place with her physician.

I took for granted this attitude of patient-centered care and physician advocacy until I realized in medical school that my own experiences, and the knowledge and values that I had gained at the Breast Care Center, were relatively unique. Even as I applied for residency positions in Internal Medicine four years later, I encountered interviewers who were struck by the novelty of such a position for pre-medical students. I credit the Breast Care Center with shaping the course of my career in many other ways too – I am currently involved in research around shared decision-making in lung cancer screening, fueled in part by my involvement in shared decision-making work in breast cancer treatment. I've pursed work in epidemiology and questions of public health screening after being inspired by research at the Breast Care Center about overdiagnosis of breast cancer and how best to target mammography. I have also continued to stay in touch with mentors and colleagues from the Breast Care Center, collaborating with them during a reunion session on Health Care Value in 2016 and seeking their advice as I’ve applied for residency this year.

As each year passes I become more and more grateful for my time at the UCSF Breast Care Center and the experiences, values, and relationships that continue to influence the physician I will become.

Nilan Schnure
UCSF Breast Care Center Intern 2012-2013
Perelman School of Medicine at the University of Pennsylvania, Class of 2017