When the winter cold fronts blow through the wide-open spaces of Guandu, the temperature dips well below that of downtown Taipei. Entering the lobby of the Koo Foundation Sun Yat-sen Cancer Center does nothing to shake the chill. The long marble corridors seem sparsely populated, a complete departure from the barely restrained chaos extant at ordinary local hospitals.

Dorris Wang, a petite figure in a white lab coat, is all smiles as she approaches at a brisk pace. She is constantly full of life and energy, and one would hardly guess from her countenance that she works daily with gravely ill cancer patients.

A 20-year veteran of her profession, Wang studied community medicine and residential care in Australia, where she also worked for a time. She's now serving as head nurse at the Sun Yat-sen Cancer Center's Department of Nursing – Community Health and Care Management Unit, leading a team of 17 senior nurses licensed as care managers, who perform care management duties for patients with cancer, diabetes and other chronic conditions.

Care managers are different from ordinary nurses. From the time of diagnosis confirmation and a patient's opting for treatment at the center, care managers like Wang must maintain constant close contact with the patient, acting as a bridge for the patient in navigating the complex maze of the center's various treatment units.

Prior to treatment, Wang confirms with the patient whether any diagnostic testing has been overlooked and what preparations are required prior to treatment. During treatment, she briefs the patient on each step of the treatment process ahead of time, detailing how long the treatment will last and what side effects might be expected. Following treatment, she closely monitors the patient's progress and condition. And, of course, much of a care manager's work involves providing emotional comfort and support as well as encouragement throughout the process.

Patients become deeply reliant on their care managers, who work so closely with them to fight their cancer. Sometimes patients even first seek Wang's advice before making a decision regarding treatment recommendations their doctors have made.

Care managers are the advocates of the patients, consolidating each phase of the treatment process on their behalf. A fringe benefit of that advocacy is a reduction of considerable unnecessary waste of medical resources.

For example, if a patient has had a pathologist from another hospital perform a biopsy, the patient's individual care manager will be sure to help gain access to the original hospital's sample for doctors at the center to reanalyze. That's because the results of such an analysis could influence the later course of treatment.

But this entails a lengthy process – the exchange of documentation alone takes two weeks. For the cancer center, it's a cumbersome process and one not reimbursed through National Health Insurance. Sometimes even the patients are not understanding about the delay, as they are worried their condition may worsen in the interval.

But this sort of joint effort can help conserve medical resources, and the patient need not undergo another surgery to obtain a second biopsy sample.

Given the extensive health consultations the individual care managers provide throughout the course of treatment, patients are relatively less fearful of the inevitable side effects. For example, care managers may inform patients that a side effect of their cancer medication is blood in the urine, or that their chemotherapy treatment may reduce their white blood cell count, making a patient more susceptible to infection and fever.

What's more, when patients encounter these symptoms at home, they need only telephone their individual care manager for consultation at the first sign of trouble. This spares the patient undue anxiety and unnecessarily taxing their weakened bodies by rushing to the emergency room.

Multi-unit Integration Reduces Medical Errors

The Sun Yat-sen Cancer Center puts considerable effort into providing comprehensive medical services for its patients. Aside from employing individual care managers like Dorris Wang, the center has also put together an inter-disciplinary team integrating multiple treatment units. Various medical professionals jointly cooperate in treating patients while simultaneously avoiding excessive medical treatment.

At 4 p.m. more than a dozen doctors and registered nurses in white lab coats are crammed into a B1 conference room at the center. Those gathered in the darkened conference room watch intently as a succession of black and white medical images are projected onto a wall.

The center holds these meetings of the inter-disciplinary integrated patient treatment group weekly. Today's meeting is discussing lung cancer and cancer of the esophagus.

The dozen or so participants include the lead physicians from the pathology, surgery, internal medicine and nuclear medicine units as well as representatives from the pharmacology and nursing units, who spend at least an hour discussing the details of treatment plans for anywhere from five to ten patients and whether treatment procedures should be revised.

The center boasts a total of 17 of these integrated teams. One of the tactical advantages of these teams lies in filtering out the possibility of mistakes that can occur with individual diagnoses so that patients can avoid unnecessary or even counterproductive treatments.

For example, one patient with stage one cervical cancer was advised to undergo both a hysterectomy and chemotherapy treatment. Or in other cases, aging patients with poor liver functions have been prescribed medications potentially toxic to the liver.

During the meetings, the teams discuss situations such as these, and seek solutions. In the meetings, pharmacists and RNs are on an equal footing with physicians in offering their views.

"You have to go through peer review. You can't go it alone," Wang says.

The integrated services that the Pharmacology Department provides the center's inpatients are another example.

About a quarter of the patients at the center come packing their own medications. Center pharmacists look over the medications patients bring with them and send them to center doctors for reappraisal and potential re-prescription.

Medications that are to be continued must be reorganized, labeled and packaged by the pharmacist. This helps doctors avoid duplicating medications a patient already has.

Once a patient's medications have been reevaluated, a determination can be better made as to which medications may require dosage adjustments and which may be contraindicated with regard to other medications doctors have prescribed, which could cause adverse effects, and should be halted.

The effort is wide ranging down to the tiniest detail. Sporting a crew cut and a pair of black-framed glasses, cancer center pharmacist Jiang Shao-ching estimates that the patient medication integrations his team performs each day increase their workload the equivalent of one additional staff pharmacist.

"There's really no benefit for us. It means more work, and it isn't covered under National Health Insurance. But from the perspective of patient safety, this is the way it should be done," he says.

The prevailing standards at the Sun Yat-sen Cancer Center are perhaps unique, but their efforts to reduce excessive medical treatment should not really be out of the ordinary.

"Although we may ultimately be unable to save the life of a patient, at the very least, during the course of treatment we must do our utmost to take care of them, and not subject them to pointless medical procedures, so that their suffering is kept to a minimum," Dorris Wang says. "Helping patients and their family members accept their condition can also be a positive contribution."

Despite the emotional pain that accompanies the loss of a patient, Wang continues to maintain a consistently sunny outlook, because she does gain a sense of accomplishment from her work.

Translated from the Chinese by Brian Kennedy