ARLINGTON, VaIn addition to his regular family practice, Mark
Renneker, MD, plies a second career, helping other physicians
patients to understand their illnesses and seek out the best possible
therapies. He provides intensive, personalized medical research to
clients across the country and assistance in making decisions based
on that information.
I have the perspective of a physician who went over to the
other side, experimenting with taking up the patients point of
view, joining them with their disease, said Dr. Renneker,
assistant clinical professor of family and community medicine,
University of California, San Francisco. He spoke at the
Comprehensive Cancer Care 2000 conference on integrating
complementary and alternative therapies.
The problem with evidence-based medicine, he said, is that
patients have another way of making decisions. Bringing facts and
information to decisions about cancer isnt the entire
process, he said.
His intensive research and advocacy practice (which is separate from
his medical one) does not involve treating patients but, rather,
giving them the needed background to make good choices about their
care. For this, he tries to learn everything possible, not only about
the medical aspects of each case but also about the patients
themselvestheir emotions as well as their test results.
His background in family medicine (in which he is board-certified),
he said, helps him to look at the whole patient, not simply one organ
system or a collection of symptoms.
Working out of his house on the Pacific coast, Dr. Renneker consults
with patients by fax, computer, or telephone. A trained researcher
working under his direction does a literature search. Dr. Renneker
annotates this material and submits to the patient a loose-leaf book
of information tailor-made for that individual. He also talks with
specialists and with the patients physicians (most patients
have already consulted an average of six doctors before calling his
Table lists the specific areas that, he said, most often need to be
addressed in his research.
Rarely does this approach lead to confrontation with the
patients health care providers, he said. Im doing
just what doctors do for their family members, pulling out all the
stops and exploring the upper limits of care.
He said that his consultation work is well received by other
physicians, who, he believes, understand his role. Often, they say
they wish they had the time to do it themselves for their patients.
In fact, Dr. Renneker said, lack of time with their present physician
or oncologist appears to be the most common reason patients call him
to help with their cases.
A study of the first 30 patients who presented to him in a recent
year showed they had an average age of 52; half had cancer; two
thirds were women; and half had MD, PhD, or law degrees. Ninety
percent were from outside the San Francisco Bay area, and 60% of the
time, other family members joined conference calls with Dr. Renneker
and the patient.
His research frequently finds stones unturned in the patients
workup: incomplete or inadequate medical records, tests, images, or
consultations. He has found on further pathologic review of cases
that many patients have received an incorrect or absent diagnosis.
Often, their doctor has not consulted with other physicians.
Patients frequently feel a false hopelessness, often because they are
undered-ucated about their own cancer or about cancer in general, he
said. Pain is undertreated. Two thirds of these patients have tried
complementary or alternative medicine and the rest want to, although
their own physicians often wont assist them in that quest.
His job, he said, is practicing optimistic medicine. Wthout
hopefulness, its hard to work with these patients.
He works at getting the patients family involved, since too
often they have been excluded by previous doctors.
Dr. Renneker has good reason to live and work by the sea: he founded
the Surfers Medical Society in 1986 and says that surfing has
prepared him well for his advocacy role. Surfing is about the
edge, the frontier, he said, and patients have to learn
to live and navigate along the edge.