Holistic Art and Science of Healing
Healing is more than a technical skill. It’s an art focusing on the whole person-mind, body, and spirit. That’s the philosophy of St. Vincent’s surgeon Dr. Susan Winchester.
“In many ways,” she said, giving a bottle to her two-month-old daughter, Sue, “my caring and compassion are as important as the physical treatment.”
The genesis for Dr. Winchester’s holistic approach to medicine was a chance encounter with a woman scheduled for a mastectomy when she was working as an OR technician. “The woman was in tears, and there was no one there to comfort her. I noticed a failure of anyone to interact with her about her emotional situation. There seemed to be a reluctance to get involved with someone on a deeper emotional level, because it would take too long and they would have to get personally involved. The tendency was to spin down to the technical and not to deal with the whole person.”
Winchester bristles at the current tendency to fragment care by sending the patient to a number of different specialists. “A patient deserves a single physician who will provide comprehensive treatment and close follow-up. Multiple referrals erode continuity of care and the entire physician-patient relationship. Not only that, but a patient’s care can be compromised if their history, physical exam, diagnostic studies and pathologic findings are not correlated by a single physician. Somebody has got to step in and put everything together for the patient, to spend the time it takes to talk with them and their families, and explain what’s going on. And, if they cry and they are upset, then somebody has to be there to sit and hold their hand. It makes me angry when someone wants just to perform a procedure, file for reimbursement, and let someone else take care of the patient’s emotions. Emotional support is a vital part of healing.”
Still haunted by the mirror of that tearful, frightened woman many years ago, Dr. Winchester has a special passion for breast care. “I want to make sure that a woman is dealt with in an understanding, caring way; that she has a thorough, careful physical exam and a timely, minimally invasive biopsy. That way I can put her at peace as soon as possible.”
One advantage Dr. Winchester offers her breast care patients is the ability to perform diagnostic procedures in her office. She takes a more conservative approach to diagnosis, in sharp contract to more traditional approaches, which has favored removing any abnormality and then determining if it represents a malignancy. This means general anesthesia and invasive surgery, for which there is a longer recovery.
“This ‘let’s-take-it-out-and-look-at-it’ method of diagnosis has contributed to the high cost of health care,” said Dr. Winchester, “especially when you consider that three out of four biopsies prove to be benign. This means that three out of four women are having needless surgery.” For women with a palpable mass, needle biopsy is the first option Dr. Winchester explores. This procedure uses a local anesthetic and a tiny incision over the mass. Tissue samples are extracted through a needle for analysis. Dr. Winchester also completes ultrasound-guided biopsies and cyst aspirations when the abnormality is best approached with ultrasound guidance. If the lesion is detected on ultrasound exam, a patient can have a biopsy on her first visit.
Dr. Winchester also performs stereotactic biopsy in her office using the Intact(tm) Breast Lesion Excision System. In this procedure, mammography locates the abnormality. A computer than generates coordinates for the non-palpable abnormality. Then, a small probe is inserted to takes an "intact" sample of the abnormality.
Though open breast biopsy - the more invasive approach - is still prevalent, Dr. Winchester’s results suggest that her conservative approaches are accurate. “Generally, we expect 15 to 20 percent of abnormalities detected by mammography to represent a malignancy,” she noted. Of 712 mammotests completed between 1989 and 1996, 108 were positive for cancer, or 15 percent. Of 368 ultrasound guided biopsies during that same period, 78 were positive, or 21 percent.
“Our results, then, compare favorably to the expected.” There are many advantages to needle biopsy. “We have been able to spare a large number of women the emotional and physical trauma of general anesthesia and surgery.” Frequently, it takes several weeks for the imaging workup prior to seeing Dr. Winchester. She tries to give a woman a definite diagnosis as soon as possible. “There is a tremendous emotional stress during the workup and I allay those concerns many times on her initial visit.”
Once a cancer diagnosis has been made, Dr. Winchester spends whatever amount of time is necessary to discuss treatments and to help alleviate fears and worries of disfigurement. Whenever possible, she takes a conservative approach to treatment – lumpectomy and sentinel lymphadenectomy followed by radiotherapy – breast-conserving surgery. If mastectomy is medically necessary, she schedules her patients to see a plastic surgeon to discuss options of immediate breast reconstruction on the day she delivers the diagnosis. “I tell her what has to be done – that we have to remove the breast. But, I don’t leave her with that. I tell her, ‘Here, look at what we can do to get your life back to normal and restore your sense of wholeness and symmetry.’ We have a determined optimism in treating our patients.”
“My family is involved with my practice. Medicine has become so depersonalized with huge practices and patients pushed to facilities or doctors by their insurance company. I want my patients to know me and my family. It is these relationships that offer perspective and serve as an environment for healing and reassurance.”
Especially valuable is the spiritual support offered to those patients that request it. Dr. Winchester believes strongly that spirituality is a vital ingredient in the healing process. It comes back to her belief that the emotional, physical, and spiritual are inseparable. For her, surrendering to a loving, good God is a powerful tool in healing. “We are finding increasing scientific evidence that our beliefs [and] prayer impact our physical and emotional well being.”
Dr. Winchester has the hands of a skilled surgeon, trained to perform delicate surgical procedures. But skilled hands and rigorous training are just a fraction of what makes Dr. Susan Winchester a physician. Her most remarkable distinction is a healing spirit.
“In many ways,” she said, giving a bottle to her two-month-old daughter, Sue, “my caring and compassion are as important as the physical treatment.”
The genesis for Dr. Winchester’s holistic approach to medicine was a chance encounter with a woman scheduled for a mastectomy when she was working as an OR technician. “The woman was in tears, and there was no one there to comfort her. I noticed a failure of anyone to interact with her about her emotional situation. There seemed to be a reluctance to get involved with someone on a deeper emotional level, because it would take too long and they would have to get personally involved. The tendency was to spin down to the technical and not to deal with the whole person.”
Winchester bristles at the current tendency to fragment care by sending the patient to a number of different specialists. “A patient deserves a single physician who will provide comprehensive treatment and close follow-up. Multiple referrals erode continuity of care and the entire physician-patient relationship. Not only that, but a patient’s care can be compromised if their history, physical exam, diagnostic studies and pathologic findings are not correlated by a single physician. Somebody has got to step in and put everything together for the patient, to spend the time it takes to talk with them and their families, and explain what’s going on. And, if they cry and they are upset, then somebody has to be there to sit and hold their hand. It makes me angry when someone wants just to perform a procedure, file for reimbursement, and let someone else take care of the patient’s emotions. Emotional support is a vital part of healing.”
Still haunted by the mirror of that tearful, frightened woman many years ago, Dr. Winchester has a special passion for breast care. “I want to make sure that a woman is dealt with in an understanding, caring way; that she has a thorough, careful physical exam and a timely, minimally invasive biopsy. That way I can put her at peace as soon as possible.”
One advantage Dr. Winchester offers her breast care patients is the ability to perform diagnostic procedures in her office. She takes a more conservative approach to diagnosis, in sharp contract to more traditional approaches, which has favored removing any abnormality and then determining if it represents a malignancy. This means general anesthesia and invasive surgery, for which there is a longer recovery.
“This ‘let’s-take-it-out-and-look-at-it’ method of diagnosis has contributed to the high cost of health care,” said Dr. Winchester, “especially when you consider that three out of four biopsies prove to be benign. This means that three out of four women are having needless surgery.” For women with a palpable mass, needle biopsy is the first option Dr. Winchester explores. This procedure uses a local anesthetic and a tiny incision over the mass. Tissue samples are extracted through a needle for analysis. Dr. Winchester also completes ultrasound-guided biopsies and cyst aspirations when the abnormality is best approached with ultrasound guidance. If the lesion is detected on ultrasound exam, a patient can have a biopsy on her first visit.
Dr. Winchester also performs stereotactic biopsy in her office using the Intact(tm) Breast Lesion Excision System. In this procedure, mammography locates the abnormality. A computer than generates coordinates for the non-palpable abnormality. Then, a small probe is inserted to takes an "intact" sample of the abnormality.
Though open breast biopsy - the more invasive approach - is still prevalent, Dr. Winchester’s results suggest that her conservative approaches are accurate. “Generally, we expect 15 to 20 percent of abnormalities detected by mammography to represent a malignancy,” she noted. Of 712 mammotests completed between 1989 and 1996, 108 were positive for cancer, or 15 percent. Of 368 ultrasound guided biopsies during that same period, 78 were positive, or 21 percent.
“Our results, then, compare favorably to the expected.” There are many advantages to needle biopsy. “We have been able to spare a large number of women the emotional and physical trauma of general anesthesia and surgery.” Frequently, it takes several weeks for the imaging workup prior to seeing Dr. Winchester. She tries to give a woman a definite diagnosis as soon as possible. “There is a tremendous emotional stress during the workup and I allay those concerns many times on her initial visit.”
Once a cancer diagnosis has been made, Dr. Winchester spends whatever amount of time is necessary to discuss treatments and to help alleviate fears and worries of disfigurement. Whenever possible, she takes a conservative approach to treatment – lumpectomy and sentinel lymphadenectomy followed by radiotherapy – breast-conserving surgery. If mastectomy is medically necessary, she schedules her patients to see a plastic surgeon to discuss options of immediate breast reconstruction on the day she delivers the diagnosis. “I tell her what has to be done – that we have to remove the breast. But, I don’t leave her with that. I tell her, ‘Here, look at what we can do to get your life back to normal and restore your sense of wholeness and symmetry.’ We have a determined optimism in treating our patients.”
“My family is involved with my practice. Medicine has become so depersonalized with huge practices and patients pushed to facilities or doctors by their insurance company. I want my patients to know me and my family. It is these relationships that offer perspective and serve as an environment for healing and reassurance.”
Especially valuable is the spiritual support offered to those patients that request it. Dr. Winchester believes strongly that spirituality is a vital ingredient in the healing process. It comes back to her belief that the emotional, physical, and spiritual are inseparable. For her, surrendering to a loving, good God is a powerful tool in healing. “We are finding increasing scientific evidence that our beliefs [and] prayer impact our physical and emotional well being.”
Dr. Winchester has the hands of a skilled surgeon, trained to perform delicate surgical procedures. But skilled hands and rigorous training are just a fraction of what makes Dr. Susan Winchester a physician. Her most remarkable distinction is a healing spirit.