Sharing a Passion for Teaching, Effective Communication and the Field of Phlebology A Conversation with Helane Fronek, MD, FACP, FACPh

by Andrea B. Epstein

Following your passion in pursuit of true career satisfaction is a goal that most would agree is not easily attained. In the case of Dr. Helane Fronek, a love for teaching, patient care and education have helped her transition from 11 years in a private phlebology practice and a decade as the Director of the Varicose Vein Clinic at Scripps Clinic in La Jolla, California to a teaching position at University of California, San Diego (UCSD) School of Medicine, where she now leads courses focused on communications and the doctor-patient relationship. VEIN Magazine caught up with Dr. Fronek to learn more about pursuing her passion to enhance provider-patient communication, and to help advance the acceptance of phlebology as a recognized specialty in the U.S.By way of introduction, please briefly share your background and how your career evolved into a private phlebology practice.

My greatest love during internal medicine residency was critical care, and I hoped to eventually become the director of an ICU. (Thank goodness that we don’t always get what we want!) However, following residency, I took a position as a primary care physician in an HMO setting and was unhappy for a number of reasons. My father-in-law, Dr. Arnost Fronek, was active doing sclerotherapy at both the University and at Scripps Clinic, where I was working, and volunteered to teach me how to “inject varicose veins.” Being someone who loves to learn, I jumped at the chance and began to see patients with venous disease. Since this predated our ability to use ultrasound to visualize superficial veins, we had little understanding of venous hemodynamics, anatomy, or pathophysiology and even fewer good treatment options. After several years and the introduction of ultrasound, the field exploded with better diagnostics and therapeutics; the excitement of exploring the field as it grew and the satisfaction of being able to help this huge group of patients was very compelling.

Tell VEIN about your decision to move away from this practice and re-channel your energies into education.

One challenge for anyone who remains in a specific job or field of medicine is to keep it interesting, stimulating, and fulfilling. Participating in the Annual Congress of the ACP and other meetings re-energized me, and discussing challenging cases with a superb group of phlebologists who I had met through these meetings helped me to maintain a high standard of clinical care. However, the burdens of running a solo office eventually diminished my own satisfaction. I have always felt that a person should try, if possible, to do something that he or she loves. I love mentoring and developing skills and positive attitudes in people, as well as developing curriculum and experimenting with teaching formats. The interactions with my patients were still the favorite parts of my day, and I felt that effectively communicating with patients was something that I did particularly easily and well.

Medical education is currently undergoing an enormous shift, with more emphasis being placed on the practical aspects of being a doctor. While it’s crucial that physicians have the knowledge and skills to diagnose and treat correctly, if you don’t also know how to develop a rapport with your patients, earn their trust, and communicate effectively, it doesn’t really matter how “good” you are, because your patients won’t do what you suggest. I felt that I might be helpful in a teaching role that focuses on these aspects of medical care.

Can you further elaborate on your passion for teaching and your current focus, particularly as it relates to phlebology?

Teaching young doctors and medical students is both inspiring and expanding. It is so encouraging to see the idealism of the students and the dedication that they have to learning and becoming great physicians. And, as the saying goes, you find out what you don’t know when you have to teach something, so it keeps me searching and learning as well. I am currently involved in several courses at UCSD School of Medicine that deal with communication, ethics, the doctor-patient relationship, and effective professional interactions in medicine. I hope that I will be helping other practitioners to gain important skills and understanding that will enhance their satisfaction with medicine and improve their effectiveness in interacting with their patients. I am also excited about the prospect of bringing these concepts to the upcoming ACP Congress.

As a leader in Phlebology, what do you see as the biggest challenges to the field moving forward? Please touch on both the challenges surrounding educating providers about venous concerns and medical school education.

The field of phlebology has made impressive strides in a very short time - we have developed the specialty, increased the understanding of venous hemodynamics, anatomy, and pathophysiology, and pioneered new and better treatment options. All of this has resulted in the elevation of the standard of care and wider availability of this improved care for many patients. We have fostered more research activity by focusing attention on these problems and acquiring funding from our industrial partners, medical organizations, and foundations. I’m sure that everyone who has been a part of this incredible movement feels a sense of excitement and pride in what we have jointly accomplished.

As we continue all of these activities, we now also need to develop training programs that provide a thorough curriculum in phlebology, so that phlebologists will be able to provide comprehensive evaluation and treatment based on the best options for each patient and won’t be limited by what they may or may not have learned in their primary residency. First, we must expand the number of fellowship programs, and in time, it is possible that a primary residency training program will be appropriate. All of this will require time, funding, and enormous dedication from those in the field.

We also need to get the word out to our non-phlebologist colleagues that things have changed - that venous disease is important and quite treatable. Thus far, it has been an uphill struggle to convince physicians outside of phlebology that venous disease is something worth understanding and knowing about. I believe that it will take all of us, doing our part, to educate our colleagues - through informal conversations, grand rounds and other intramural presentations, as well as presentations at other specialties’ meetings. These efforts will be best focused on the specialties whose practitioners see most patients with vein disease - family physicians, internists, obstetricians, dermatologists, and vascular surgeons. I hope that those involved in medical school, residency programs and fellowships will make every attempt to have topics in phlebology included in those curricula. It will undoubtedly take many more years and effort along all of these lines before venous disease will be consistently recognized by the medical establishment as a serious and worthwhile concern.

We understand that you’ll be leading an instructional course at this year’s ACP Annual Congress focused on enhancing physician-patient communication and limiting your risk of malpractice. Can you share any tips with VEIN on this subject (and maybe a preview of what you’ll be covering)?

The course I will be leading is entitled “Enhancing communication: how to easily improve clinical outcomes, enjoy greater satisfaction from your practice and lessen your risk of malpractice”. Medical communication has been an interest of mine ever since I got into an argument with an interviewer during an interview for a residency position (I
didn’t get selected by that program!) over the importance of being able to develop rapport with patients. There is now a great deal of emphasis in medical education on enhancing communication skills, and approximately 95% of medical schools include this training in their curriculum. An enor-mous body of data, derived from studies performed over many decades, clearly shows that communication skills are teachable and learnable, and that improvement in those skills results in better clinical outcomes, greater satisfaction of the physician with the practice of medicine, and lowered malpractice risk. The data is quite compelling and the results are reproducible. Although many physicians cringe at the thought, and assume that they are only going to be told to ask “open ended questions,” there are really many simple concepts and techniques that will improve the efficiency of consultations (allow us to get more information from our patients in less time) as well as the accuracy of our explanations (leading to improved clinical outcomes).

While nurses are given management training during nursing school, doctors are provided with none of this information, in spite of the fact that we usually have to manage a staff, deal with a broad range of personalities among our patients, and communicate important information under stressful conditions. I’m excited to present this type of information at the upcoming ACP Congress. In addition, as measurement of patient satisfaction is increasingly performed and is now widely available, patients and insurers are using this information to select health care providers and offer more attractive reimbursement to those with higher scores. Small improvements in our ability to communicate effectively and in a manner most acceptable to our patients will, therefore, yield benefits in many facets of our practice.

What is most rewarding in your current role as educator and what do you hope to accomplish in the next few years?

While I love developing lectures and talking to large audiences, it is the small group and one-on-one interactions that I find most fulfilling. Each person has something to offer and something to teach, and the combination of their ideas and mine usually results in greater learning and growth for both of us than simply stating what I know or believe. In the next few years, I hope to contribute to the widespread acceptance of phlebology as a specialty and a greater understanding of the concerns of patients with venous disease, as well as appropriate management of these concerns within the medical community. I hope to also assist other physicians in using the power of improved communication to achieve what they have dedicated their lives to - caring for their patients and finding satisfaction with their practice.