Celebrating the Small Victories

Jerome Seid, MD
ASH Congressional Fellow

With two months remaining in my ASH Congressional Fellowship, I recognize my time to experience working on Capitol Hill – and to get things done – is limited. At a recent virtual get-together for fellows, I mentioned that occasionally I have felt envious about what many in my cohort seem to be accomplishing. As they describe their “wins,” I naturally wonder how I compare. During an otherwise productive conversation with a former fellow who worked on FDA accelerated drug approvals, she related having had four bills introduced during her one-year fellowship! That didn’t help calm my anxieties – at least not at first.

Learning about her “wins” prompted me to reevaluate my own fellowship expectations as a mid- to late-career hematologist/oncologist. I reminded myself of where I was earlier in my career, when I was around the age that most of my cohort is now. With some self-reflection, I began to recognize my own fellowship “wins”– those that I tend to undervalue and underreport because they seem small to me.

In preparation for an upcoming presentation, I stumbled across an article by Atul Gawande, MD, MPH, in The New Yorker in 2017, “The Heroism of Incremental Care.” It led me to draw an analogy: The fellow, hoping for big “wins” in the form of introducing legislation, while overlooking small, incremental gains, is similar to the physician who aims for the rare “home runs” in patient care, while minimizing smaller, but more meaningful and durable “small ball” successes.

Reading the article reaffirmed my career choice to specialize in hematology and oncology. In this field, we achieve a series of cautious and methodical small wins that may require adjustment and redefinition of greater goals, but these wins are vital to improving symptoms and longevity and maintaining patients’ hope and quality of life. I reminded myself that my small intervention might just be a game changer for someone else.

Having previously worn the hat of a requesting constituent myself, I am now sitting on the other side of the table – a valuable training exercise which will influence my own future advocacy efforts.

With this self-reassessment in mind, I am pleased to report that one of my pre-fellowship goals of drafting and introducing a bill to help improve access to transfusion in hospice-eligible Medicare patients – thus incentivizing earlier hospice enrollment – has gained traction. As I work to engage stakeholders and build bipartisan support, I am hopeful that the bill will be introduced before summer recess and that these efforts will lay the foundation for further work to be done, maybe by the next ASH Congressional Fellow!

As potential cases of thrombotic thrombocytopenia associated with the Johnson & Johnson COVID-19 vaccine evolved, I felt comfortable reading journal publications and providing hematologic insight to Sen. Rosen’s health policy team. Kudos to ASH for conducting a timely, informative, and well-received briefing webinar. Having to navigate the complexity of the situation from medical, public health, and legislative perspectives to inform appropriate response and inquiry was – and is still – an exercise in expansive thinking. I now appreciate its difficulty and fragility more than I might have prior to the fellowship.

Providing background information and fielding questions for the Senator is an ongoing and enjoyable challenge. Seeking a unique health care angle for a question sends me down rabbit holes at times. Sen. Rosen’s order in the hearings leaves her exposed to being “scooped” by other Senators, and I aim to provide her with relevant yet provocative questions. Many of my suggestions do not see the Senator’s desk, but it is rewarding when they make their way into the memo and testimony.

Meeting with constituent groups was not initially part of my fellowship plan, but being in an individual office has changed my perspective. Having previously worn the hat of a requesting constituent myself, I am now sitting on the other side of the table – a valuable training exercise which will influence my own future advocacy efforts.

Remaining engaged in the Michigan legislative landscape has been a priority for me during this fellowship. Oral chemotherapy coverage parity legislation has been reintroduced in Lansing. I have testified, engaged state legislators, and retained a long-game cautious optimism that Michigan will soon join the 43 other states that have seen fit to enact such legislation. Prior authorization reform is also on the table during the current Michigan legislative session, and I continue to work with my state society and stakeholders to accomplish this.

I cannot overstate the breadth of opportunities I have been given as an ASH Congressional Fellow. Now, with two months left, my experiences are just beginning to feel like the makings of a foundation for me to more confidently foster advocacy. I look forward to these last few months and the opportunity for immersion, education, personal growth, and yes, even rest, they will provide. These other “wins” may be the most important of all!