“The biggest risk lies in keeping the problem to yourself for too long, without anybody else even knowing that there is a problem.” Find each other and share your dilemmas with other professionals, is what Schelto Kruijff means to say. “People love solving problems, they greatly enjoy the challenge. I recently read Obama’s autobiography and what was striking to me is how often he grouped people together to work on solving problems. What a wondrous process that is: simply by sitting at a table and linking each brain together, as it were, solutions will present themselves.”
“In the end, you will always need to brainstorm with other people to come up with ideas to move forward.”
The average OR in the Netherlands is not yet fully equipped to make use of these new techniques. Furthermore, the collaboration between biochemicals and imaging makes it highly complex. The circumstances differ for each type of cancer and each individual patient. In fact, you need a specific substance for every type of cancer to make the tracer adhere to the cancer cells, Schelto explains. “For each type of tumour you need to do separate research. Do you have the right tracer? At what moment do you need to inject the tracer, and at what specific speed? What is the right distance between the camera and the patient in the OR? How much light do you need in that specific OR? We are still in the research process to fully identify the ways in which all these factors differentiate. You can compare it to the development of the PET-scan forty years ago.”
HTRIC can play a part to speed up the process, Schelto thinks. “It is important that others know these dilemmas I am facing. In the end, you will always need to brainstorm with other people to come up with ideas to move forward. HTRIC can be the stage on which scientists, developers, and people from the industry are forced to work together to think about ways to tackle a problem.”
“Dare to be vulnerable.”
Do not try to muddle through on your own, is the advice. Even though it might be difficult for some professionals to admit they need the expertise of others. It is a matter of work culture, Schelto thinks. In some specialties, it is more uncommon to ask for advice outside of one’s own department. Working together with a colleague from outside a scientific institute might be uncomfortable. And if that colleague works for another university, it might even be unthinkable. In that regard, surgeons have it easier already, according to Schelto. Working together in a team is drilled into their professional DNA already: during surgery, they have to work together. “That makes you accustomed to being vulnerable and having to grub together.”
HTRIC could play a part in breaking through this culture of silence as well, even though it will not be easy. “The most important motivating factor for cooperation is people realising that they cannot accomplish anything by themselves. The people who realise that early will achieve more”, Schelto says.
He calls it executive power: to achieve something you have to prioritise it, sacrifice time to work on it, and not be afraid to fall flat. Do not sigh in exasperation to one another and say “something should really be arranged for this” and then do nothing about it.
Schelto Kruijff has organised various symposia about thyroid cancer together with endocrinologists, nuclear physicians, and pathologists. Seperate from the regular associations that the occupational groups all have already. “We treat patients with up to five disciplines. I know a lot about surgery, but not about the other areas of expertise. There was a very apparent need to talk things over together.”
HTRIC will not simply change everything in one go, Schelto warns. “Expectations are the mother of all disappointment”. Of course, you have to be ambitious in your goals. But my expectations are different. HTRIC will be a complex social process, so I will be satisfied if every now and then I am caught out of the blue by someone with information that I would never have found out about otherwise.” Personally, he has a concrete goal with HTRIC as well: “I want to bring fluorescence into the clinic. That is something that has to be done together with the industry.” We have to get rid of the taboo on cooperation between doctors, science and business, is Schelto’s opinion. “Provided that you are open about your occupation and expectations, you can just work together.”
HTRIC can propel this executive power. “As a doctor, it is easy to hide behind the argument of a lack of time – which is very real – to choose to focus merely on existing patients. And there is nothing wrong with that, by the way. But that will mean that once you have retired, you might have helped a lot of people individually, but you did not change the outcome for a larger group.”
Prof. dr. Schelto Kruijff is an oncological surgeon at the UMCG specialised in endocrine tumours such as thyroid and adrenal gland tumours and peritoneal metastases in colorectal cancer. Besides this, he is head researcher at Optical Molecular Imaging Groningen (OMIG).