Category Archives: Meet a Library User

Meet a Library User: Dr. Lisa Diamond, MD, MPH

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Welcome to Meet a Library User. This blog series highlights some of the many MSK employees who use the Library and the fascinating work that they accomplish.

Portrait photograph of Dr. Lisa Diamond.
Image courtesy MSKCC. All rights reserved.

In this post, we’re speaking with Dr. Lisa Diamond, MD, MPH. Dr. Diamond is a member of the research faculty in the Immigrant Health and Cancer Disparities Service, a part of the Department of Psychiatry and Behavioral Sciences. Her clinical work is as an MSK hospitalist under the Department of Medicine in the Hospital Medicine Service. It is a pleasure to speak with Dr. Diamond and learn about her research and its impact at MSK.

The following conversation has been edited and condensed.

Could you discuss, in simple terms, your research agenda and a project that you’re working on now?

My research is on language barriers and how they affect quality of care and outcomes, particularly in cancer, but it’s obviously a health equity issue that crosses multiple disease states and health situations, so it extends beyond cancer. I’m particularly interested in language concordance and how when physicians and nurses speak a patient’s language, how that affects their quality of care.

I’ve looked at this in a number of ways and often look at physician behavior with using their language skills—the ultimate question being how fluent is fluent enough to use your language skills? Some of the research I’ve done has looked at this issue and has led to policy change, including here at MSK. We’re going to be implementing a bilingual proficiency program, based on evidence from the literature that I published, that helps gauge somebody’s language proficiency level and whether they are at the point where they’re ready to be using those skills with patients directly.

As for a project right now, I have a systematic review that I’m working on with some students and a predoc that’s looking at patient satisfaction in cancer care by race, ethnicity, and language. There’s a lot of lore in the health system world—where we value patient satisfaction data greatly. There’s all this lore about different groups and how they report on the quality or their satisfaction with the care that they’ve received. The lore being that Chinese speakers are less satisfied overall with their care and Hispanics are often very satisfied with their care. And I wanted to know if this lore was true by looking at a synthesis of the literature. So we looked at any paper looking at patient satisfaction and cancer.

Some of the papers are revealing that the lore has cultural implications. So maybe people are overly reporting satisfaction because culturally they would never say anything negative about a physician. Or on the opposite side, maybe the way we’ve translated the materials makes people report seemingly lower satisfaction, but they’re not actually unsatisfied, it’s just the way we ask the question and the way we translated the question. So it may have less to do with lower satisfaction and more to do with asking the wrong questions to people who don’t speak English. It’s really interesting, and we’re working on synthesizing that and publishing hopefully by the end of the year.

It’s informative to look back at previously published studies and see them in a new light that way. Could you talk about how you first became interested in health disparities among immigrant populations and non-English-language speakers?

I am a second-language-learner of Spanish. I would say I’m proficient enough to use my skills in patient care, and I’ve had testing to show that, but I’m not a native speaker. I noticed in medical school and residency that I had certain thresholds at which I would say, even though I speak Spanish comfortably, I really need to get an interpreter here. One example of that is goals of care discussions. Whenever I was talking to a patient about whether they wanted to be DNR [do-not-resuscitate] or we were going to shift goals of care, I realized that these are challenging conversations to have in English, and if I tried to then say it in Spanish, even though I could, I was worried about my word choice. I felt concerned knowing these are conversations that patients and family members remember forever, right? You hear that from families, that they remember. If I’m the person telling someone they may not survive, and we need to talk about it—the words I use are words that stay with that family forever. The nuance of language is always important, but particularly important in those sensitive and emotional situations.

I started to think, is there a threshold above which I would feel comfortable doing this or will I always feel uncomfortable doing this because I’m not a native speaker? And is that OK? I mean, is this a black and white thing? Where if I’m good enough to use my Spanish skills, I should always use them? Understanding the nuances of that spectrum was really important and interesting to me. And that’s what led to the research, let alone seeing a lot of people do what I call ‘getting by,’ which is when someone might speak a little Spanish and they’ll use it in clinical care. And it can be to the detriment of the patient care experience. I would see colleagues doing this in residency. It happens a lot where people sort of wing it, and it’s not adequate communication, particularly when you recognize that a large percentage of our diagnostic work-up comes from taking a good history and doing a good physical exam. And if you can’t do either of those things because you’re not really communicating effectively with the patient, that’s a problem. So that’s where the interest started.

What are some steps that current and future health care professionals can take now to better serve diverse populations?

I think one of the most important things is recognizing one’s own limitations in a language. If you do speak another language, no one is saying you can’t chat, greeting a patient in their primary language and building rapport is wonderful, but when it comes to talking about medical decision making or instructions or anything beyond your linguistic abilities, recognizing that those abilities are limited and getting the interpreter in to help you. I think their goal is to make sure that the communication is effective, so partnering with the interpreter to do that and maybe even having a conversation before the patient is physically in the room to say, ‘this is what I hope to get from this conversation’ so that you can set goals and have them be a part of the health care team as they should be. That’s what I would consider.

In addition to being an MD, you have a master’s in public health. Has living through the COVID-19 pandemic changed how you think about public health issues?

Yeah, there’s so much to that question. I think between being a physician during COVID, being trained in public health, and being a parent of kids in the school system during COVID, it was a fascinating lesson in the power and the weakness of population-based data to make decisions for individuals.

One of the things that we are unfortunately lacking greatly is communication, effective communication strategies between scientists and the public. That was particularly stark when it came to language barriers. Our messaging to communities who didn’t speak English was really lacking, and there’s a lot of misinformation going around, which led to further disparities that were already present when the pandemic hit. So effective communication strategy is a huge need and something that public health absolutely needs to focus on.

Final question, would you share some of the ways that you use MSK library?

Oh gosh, I constantly use the MSK library. I mean, the journals that I need to access aren’t always cancer journals, and they may not be indexed journals, so I’m regularly asking for outside articles [via Document Delivery Services]. That’s a very common, probably weekly occurrence for me. Especially because my work is cross disciplinary, I end up needing articles in all kinds of areas. I’ve lost track of how many systematic reviews I’ve done, but I’m regularly working with the library on systematic reviews. And I always send students and residents and fellows – everyone – I regularly send them to the Library for classes and one-on-one coaching with librarians. The research informationists are amazing and supportive and generous with their time.

I’ve never worked at an institution that was so well-supported by a library as this one. I brag about it all the time because my colleagues don’t have this. They may have a research librarian they can go to and ask questions, but as a team, this library is really unparalleled. And I’m not just saying that because we’re in an interview, but it is pretty remarkable what this library does to support faculty.

Many thanks to Dr. Diamond for speaking with us. If you would like to know more about MSK Library’s services, please see our Help page. And if you already use the Library and would like to be featured in this series, don’t hesitate to reach out!

Interview by Rebecca Meng, MSLIS

Meet a Library User: Dr. Sigrid Carlsson, MD, PhD, MPH

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Welcome to the first installment of the MSK Library Blog’s new series, Meet a Library User. These interviews will shine a spotlight on some of the many MSK employees who use the Library and the fascinating work that they accomplish.  

In this inaugural post, we’re speaking with Dr. Sigrid Carlsson, MD, PhD, MPH, Director of Clinical Research at MSK’s Josie Robertson Surgery Center and Assistant Attending Epidemiologist. She holds dual appointments with MSK’s Department of Surgery in the Urology Service and with the Department of Epidemiology & Biostatistics. Dr. Carlsson frequently uses MSK Library services and we are delighted to have spent time getting to know more about her and her work at MSK.

The following conversation has been edited and condensed.

Dr. Sigrid Carlsson seated in front of desk, speaking.

Image courtesy MSK Digital Asset Library

Could you discuss your research agenda, in simple terms? What current research projects are you working on that you’re particularly excited about?

Yes, certainly. I’m at Josie Robertson Surgery Center. It’s our ambulatory surgery center at MSK. Here we do surgeries where patients either go home the same day or after a night’s hospital stay. It’s within twenty-four hours, mostly. We do prostatectomies and mastectomies, and hysterectomies and all sorts of procedures. A lot of different surgeries—complex surgeries—are performed here, and of course the others are done at Main Campus. What I do here [at the Josie Robertson Surgery Center] is I am the Director of Clinical Research, so I oversee all our research activities that go on in this building. There’s urology, breast, head and neck, plastics, gynecology, anesthesia, nursing, and multidisciplinary research. It’s wonderful to be a part of. And with that in mind, we do a lot of studies, both clinical trials and also retrospective research studies. We need the literature to see what’s out there—what’s already been done and what we can do. We also put in a lot of grant proposals. So that’s where MSK Library is fantastic, and we really couldn’t do what we do without you.

That’s great, thank you. How did you become interested in cancer research, and prostate cancer research in particular?

Oh, good question, now I have to go back twenty years. I was living in Sweden, where I’m from, and I was in medical school doing a research project on evidence-based medicine. Screening in Sweden at the time, the government sent envelopes to women to get mammography screening and cervical cancer screening and I was wondering, why don’t men get an envelope to go for prostate cancer screening with a PSA test? So that’s what sparked my interest. And at the time I was in my surgery rotation during medical school and I met Professor Jonas Hugosson, who was running a large randomized trial of PSA screening versus no screening for prostate cancer. In those days, we didn’t have the same amount of evidence. So the question was, “Does early testing with this blood test really reduce prostate cancer mortality?” in the way we knew from mammography or with cervical cancer screening by doing the pap smear. And that’s really how I got into it. I’ve been an investigator of that trial—a trial in Göteborg in Sweden—for nearly twenty years. That trial really showed that screening does reduce prostate cancer mortality. And it was also part of a large European study. And now that trial has matured into another trial, the Göteborg-2 trial, which is looking at combining the PSA test (the blood test) with MRI (imaging the prostate), which is sort of the paradigm shift in prostate cancer screening today, that we incorporate blood-based biomarkers together with imaging. The field is evolving, and I’m still very curious and passionate about this topic.

Wow, that’s interesting that a government service first brought your attention to the discrepancies.

Yes, and also I think because of my parents, I mean, the apple doesn’t fall far from the tree. My dad was a doctor, and my mom is a nurse, and they were always very interested in preventive medicine—what we can do to find diseases early and prevent them and lifestyle and all of that. So it was also at home that I became interested. But then, the more I studied, the more I learned about the nuances and how complex it is because prostate cancer is such a heterogeneous disease. Sometimes we find low-grade cancers, and many of those men can live very long and happy lives without any treatment at all. Then the challenge is to find the aggressive ones early and treat those. So there’s a lot that goes into it.

You’re part of a Multidisciplinary Expert Panel convened by the Prostate Cancer Foundation to develop guidelines for prostate cancer screening and treatment for Black men in the U.S. Could you talk a little bit about the work that goes into establishing guidelines like these, and how you’ll be involving the MSK Library to support that work?

It’s definitely key that we gather the best available evidence to support any guideline recommendations on a public health scale. So that’s why the literature, the library service again is key because we need a methodologist who is an expert in searching the literature and using the keywords, which is a whole field of science in and of itself. You really know how to search multiple databases and choose the words and combine the ANDs and the ORs and which inclusion and exclusion criteria to have. And you really want to have a narrow enough search so that you don’t drown in 10,000 references to screen, but also a comprehensive enough search so that you are sure that you have included all the relevant references that are out there. So that’s why your expertise and methodology is really, really crucial. And so we work together. We are the experts of the topic and the field. We know some of those references, of course. And some of us have contributed to that evidence, but we also need an objective methodologist who can see from a bird’s eye perspective and help gather all the evidence in a smart way to synthesize it.

If you could tell the world just one thing about prostate cancer, what would it be?

I think we’ve made major headways in prostate cancer over the past years, so I think we are now very good at finding what patients need. As Dr. Scardino, the MSK urologist and former Chairman of Surgery, would say, “the right treatment for the right patient at the right time.” And I think we are very, very good at that in prostate cancer today. So, for example, if you have a man with low-grade disease, then all the guidelines say that active surveillance should be the first management option. But then if you have high-grade disease, then we know that a multimodal treatment regimen is recommended. And at MSK we have all those experts in one house. We have urologists, radiation oncologists, and medical oncologists, so we really have everybody in the field. I would say that we’ve learned so much about the biology and the natural history of prostate cancer that we know exactly who and when to treat. And also, having worked in the field of screening, we know that the blood test, PSA, is one of the best tumor markers that we have. One single blood draw can determine your long-term risk of developing lethal prostate cancer. It’s a very simple, cheap, and effective test, which is really remarkable. I don’t know of any other tumor marker that is as sensitive and specific as the PSA test.

It’s wonderful to hear you talk about this.

We all have our own soapboxes, right? But still, after twenty years, I’m still so fascinated by this field, and how it’s evolving, and what we can do to improve the lives of men at risk for this disease. It’s still the number one most common cancer among U.S. men, and especially Black men have increased risk. So we do whatever we can do to improve on that.

Could you share some of the ways you use MSK Library?

I use MSK Library all the time. For manuscripts, when we have summer students, urology fellows, postdocs, and faculty. I always reach out using the contact form, with our research question, finding out what’s been written before, because we don’t want to reinvent the wheel if somebody else has already done the work. And for grant submissions, it’s also key, and sometimes for our quality improvement projects. Say that we want to start a new clinical pathway, and we want to see what’s out there. And then this broader initiative with the guideline, it’s super helpful. And you are fantastic at systematic reviews. We work with your colleagues [at the Library] on systematic reviews, and using the Covidence software has been incredibly helpful. And the PRISMA flow chart, finding a search that’s comprehensive but also narrow enough that the scope becomes doable. I supervised two urology fellows, and they screened 3,000 papers over a couple of weeks over the summer. So it was a lot of work for the two of them, but it will be published in one of the major urology journals and will be a very highly cited paper. It’s so great, the service that you provide. And it is really a skillset that we don’t have as clinicians or researchers. It’s really a specific field of knowledge that you have as informationists. I’m your biggest supporter!

Final question for you, what’s your favorite thing about living or working in New York City?

Oh, I mean, it has everything, right? The people, the diversity, the vibrant environment—it’s the city that never sleeps! All the restaurants, the shows, the New York Philharmonic, Central Park, and especially working at MSK, it’s such a wonderful place. There’s no place like it, I would say. There are so many different departments, and we all come together to work. And I feel like everybody who’s here, we’re here for a reason and we have a purpose and a mission. I think people are very, very dedicated. And we always put patients first. We all come together for the same cause. Even the library service, you help contribute to disseminating knowledge to the world.

Many thanks to Dr. Carlsson for speaking with us. If you would like to know more about MSK Library’s services, please see our Help page. And if you already use the Library and would like to be featured in this series, don’t hesitate to reach out!

Interview by Rebecca Meng, MSLIS