Dr. Michaelann Liss is a familiar face in the local oncology community. She’s worked at The Vancouver Clinic for 11 years and visits patients at both Legacy Salmon Creek and PeaceHealth Southwest medical centers.
The 50-year-old physician grew up in Pittsburgh but moved to Vancouver when she got a job at the clinic, where she specializes in oncology and hematology (blood disorders). She’s married and has three children who are all in grade school.
Dr. Liss sat down with The Columbian to answer some questions about treating breast cancer. The following Q&A was edited for brevity and clarity.
Tell me about your journey to becoming a doctor and specializing in oncology.
I had always sort of wanted to go to medical school, and I wasn’t sure about the commitment. So, I went to physical therapy school first and practiced for a while and then decided I really needed to be in medicine. The physical therapy has helped. I sort of automatically and informally do functional assessments all the time in the office. I often show my patients exercises and diagnose physical complaints and refer them on because of my physical therapy experience. I think that’s helpful for me in getting a whole picture of what the side effects of some our treatments could be doing to them day to day.
I went to medical school and I actually considered being a surgeon. There was one rotation on the inpatient oncology ward. A lot of the residents didn’t want to do it because they felt like it was sad or stressful. And, it is stressful. People are sick. At the end of that rotation, the physician I was working with said, ‘Have you ever considered oncology?’ And I said, ‘Yeah, it’s crazy, but I loved this month.’ He goes, ‘A lot of the residents avoid a lot of this. It’s distressing. You kind jumped right in and my patients benefitted from you being here. I think you should consider it. I think you should do an outpatient (rotation).’
I ended up doing that and that was my focus. I got a fellowship at Lankenau Hospital Main Line Health in Philadelphia, and I have just loved it ever since.
Why did you take special interest in breast cancer?
Initially, I think, it was because I was the only female in the practice. Some breast cancer patients want to see a female physician. It’s very much a partnership with all cancer patients, but with my breast cancer patients in particular there’s a lot of time and openness and partnership in addressing their physical health and their emotional well-being. All that is both time intensive and emotionally intensive. I actually love that part of it. The other thing is, our outcomes in breast cancer are by and large positive. There have been such advances in some of our highest-risk cancers, in particular HER2 breast cancer. We have evolving targeted therapy that is doubling our survivors in what used to be a very high-risk cancer. There are drugs now to overcome resistance to our endocrine therapies, which are our therapies targeting estrogen receptors in breast cancer. It’s good to see more and more people do well.
What brought you to The Vancouver Clinic?
When I was leaving my fellowship the issue was where to start in practice. I didn’t know anybody on the West Coast. I had a new baby and a 3-year-old and I think we were just deciding where we wanted to raise our family. I looked specifically in the Northwest and Colorado. I ended up interviewing at The Vancouver Clinic. I didn’t know anything about Vancouver; I just knew it was near Portland. I came and interviewed by myself because my husband had to be home with the newborn.
When I got off the plane the next day going back to work, I got a phone call and they offered me the job. I said ‘OK, well, you have to make sure my husband is happy. You have to fly him out.’ Usually you come out as a couple and interview, but we couldn’t do that. So, they flew him out. This is in February. It’s pouring down rain here, right? He gets off the plane and says ‘I’m here. It’s raining and you can’t see anything.’ He calls me about an hour later and says ‘Guess where I am?’ I say ‘where?’ He goes, ‘I’m someplace called Mount Hood putting on skis. I think it will be OK.’
It’s been a great move but it was somewhat of a blind move. And then the clinic was pretty amazing. The Vancouver Clinic is physician-owned physician-run, which means you always feel like you have a substantial say in what we should look like and where we should invest and how we should run our practice. It’s not being owned or employed by a hospital. When I interviewed, one of the things that struck me was how many people were there who this was not only their first job but their last job.
Could you describe your treatment philosophy?
My job is to explain options to patients and talk about what their goals are and then support them through a treatment plan. They’re really the boss. We talk about how those treatment plans can impact them because a lot of our treatments are very toxic. A lot of our treatments are over a long period of time, so we can’t have people feeling horrible through that whole treatment time. Their lives can’t come to a complete halt. I meet with them regularly, and I really want to listen to what issues they’re having with treatment, how they’re doing emotionally and what things we can change and do to support them.
Patients are amazingly brave and engaged and strong going through treatment. When all the treatment is done and kind of the dust has settled, there’s this time for them to pause. Sometimes, you see a lot of anxiety, depression. There’s a lot of making sure that they’re well-supported in their survivorship period long term, not just short term.
Is there any advice you would give patients when interacting with their oncologist?
They need to know and remember and really believe that this is about them. All their questions should be answered. All their concerns should be addressed. It helps to be organized and write down information. Always bring someone with you. Patients sometime record our conversations so they can refer to it later. My job and the job of every oncologist is to make sure they understand what the decisions are and why they’re being made. We need them to understand as much as possible about their cancer and why we do certain treatments.
It’s scary to walk in and say “Give me my chemo.” The better they understand why they’re doing their chemotherapy, the calmer they’re going to be about it. Communication takes time, so you cannot short the time with cancer patients.
Tell me about a proud or inspiring experience you’ve had as an oncologist.
There are new medications that we give that target the HER2 (human epidermal growth factor receptor 2) that have changed that landscape and brought that risk down tremendously. When patients go to surgery and there’s no cancer left in their breast because that treatment has been so effective, it’s as magical as it gets. We call it a complete response. It tells us and it tells the patient that their outcomes are much more positive.
Anything else you’d like to add?
I get to see people at their most vulnerable be the best you’ve ever seen anybody be — the bravest, the strongest, the toughest. It’s amazing.