The Edmond Sun

Opinion

April 8, 2014

To get quality care, it helps to be the right kind of patient

I am a family physician. Sometimes I must step out of the comfort of my clinical role and into that of patient or family caregiver. Generally, these trips to the other side of the exam table inspire a fair amount of anxiety.

During visits to the doctor, I find myself noticing many details and comparing the quality of care to that in my own practice. My most recent such experience came via a family member, Humphrey.

A lump in the skin of Humphrey's lower abdomen had been detected. It was smooth, firm, mobile and ovoid. There was no history of trauma, and it wasn't bleeding or painful, but over time, it grew.

When it reached more than a half-inch in size, Humphrey's primary-care doctor removed it. To everyone's surprise, the growth turned out to be a rare form of cancer.

Humphrey was referred to the nearest specialty hospital, two hours' drive from home. I was to accompany him.

Before Humphrey's first trip to the hospital for an appointment with the oncologist, we received detailed instructions on what to expect and what preparations to make; when we arrived, we found that parking for patients was free and convenient.

The oncologist carefully reviewed Humphrey's history and preventive health measures. She had discussed his pathology findings with several other oncologists and had studied the literature on this rare form of cancer.

She ordered some tests for Humphrey, and he went to have them. The hospital staff gave me a list of nearby attractions and restaurants so I could explore the area in the meantime.

Later that day, Humphrey and I met again with the oncologist for a follow-up visit. She told us that she'd already contacted Humphrey's primary-care doctor to discuss her recommendations and would send her a detailed consult note and copies of the relevant research literature.

I drove Humphrey back home, feeling pleased at how easily things had gone.

A week later, having reviewed Humphrey's pathology slides again, the oncologist contacted us to go over the different treatment options - their risks and benefits, pros and cons. To save us travel time, she did this by phone.

She recommended a wider re-excision of the original cancer site, and we agreed that this made sense, so she arranged for Humphrey to be seen by the hospital's surgical team. To minimize travel time, the visit was scheduled for the day before the surgery.

Members of the surgical team indicated that they'd spoken to Humphrey's primary-care doctor and oncologist and reviewed the treatment options, the pathology slides and the recommended treatment plans. One of the surgeons again reviewed Humphrey's full chart, including preventive measures, then examined Humphrey carefully and admitted him to the hospital overnight.

The surgery took place the following morning. Before and after, I received regular phone updates on Humphrey's progress.

When I arrived to take him home, the receptionist said, "You've driven a long way to get here. If you'd like a cup of coffee while the resident prepares the discharge instructions, there's a pot in the waiting room."

After only a few minutes' wait, Humphrey and I departed, equipped with complete discharge instructions and follow-up procedures.

Our final contact with the hospital came five days later, when the oncologist called to tell us that the pathology findings on Humphrey's excision were negative. He's considered cured.

What and where is this excellent hospital, which features such smooth communication between specialists, primary-care doctors and patients?

It is the Cornell University Hospital for Animals, in Ithaca, N.Y. Humphrey is my 3-year-old black-and-white cat.

I adopted him from the Humane Society six months before he got sick, on the heels of losing two elderly cats to very prolonged illnesses. Humphrey is gregarious and affectionate, and I'd looked forward to several years of worry-free feline companionship, so I found his cancer diagnosis extremely frightening.

As a physician, I was extremely impressed with his care; as Humphrey's family caregiver, I was tremendously relieved and grateful.

I found it deeply reassuring that the hospital scheduled consultations so that we could have closure with each one. There were no long delays in the diagnosis and treatment process; only a short time elapsed between the health-care providers' recommending and getting approval from me for Humphrey's tests, administering the tests and responding to the results.

I'd let Humphrey's pet insurance lapse the month before his lump was discovered, figuring that he was young and healthy, so insurance wouldn't be cost-effective. While his total treatment costs were significant, they were a tiny fraction of what the equivalent would have cost in a human hospital.

By scheduling Humphrey's exam and follow-up visit for the same day, by clearly communicating a follow-up plan for his primary veterinarian and by giving a phone consultation, Humphrey's caregivers acted in the spirit of a patient-centered medical home.

For this, I will be forever grateful. But my gratitude is tinged with sadness, because very often the efficient, patient-centered care Humphrey received is not available to human patients who face similar illnesses.

Most people's medical insurance will not reimburse medical providers for two visits on a single day; nor can you obtain ultrasounds or CT scans on the same day as a consultation. Delay is often the norm, not the exception.

Recently, for instance, a patient of mine who has lung cancer waited nine agonizing days before her insurer approved her CT scan; her work-up spanned three weeks and five separate appointments at the tertiary-care center.

My experience with Humphrey's doctors showed me that veterinary medicine and human medicine, although very different branches of healing, hold similar values and priorities: the importance of efficient, patient-focused care; clear, timely communication between team members; the need to show kindness to the patient's whole family.

And I wonder: What if we could set up the human health-care system so that the communication, competence and kindness that made Humphrey's care so special - that made it so humane - were not only valued but also reimbursed?

Pierce is a clinical associate professor of family medicine at the University of Rochester. This is an edited version of a story that originally appeared in Pulse - Voices From the Heart of Medicine, an online magazine of stories and poems from patients and health-care professionals.

 

1
Text Only
Opinion
  • OTHER VIEW: Newsday: Lapses on deadly diseases demand explanation

    When we heard that the federal Centers for Disease Control and Prevention had created a potentially lethal safety risk by improperly sending deadly pathogens — like anthrax — to other laboratories around the country, our first reaction was disbelief.

    July 22, 2014

  • Holding government accountable for open meeting violations

    A few weeks ago I wrote about the recent success of three important government transparency proposals which will go into law this year.

    July 21, 2014

  • GUEST OPINION — Oklahoma GOP voters want educational choices

    A Braun Research survey released in January showed that Oklahoma voters — Republicans, Democrats, and Independents alike — favor parental choice in education.

    July 21, 2014

  • HEY HINK: IRS interferes with citizens’ rights of free speech

    The patient is gravely ill. We have detected traces of a deadly venom in the bloodstream. We don’t know how widespread the poison is, but we know, if not counteracted, toxins of this kind can rot the patient’s vital organs and could ultimately prove fatal.

    July 19, 2014

  • 130408_NT_BEA_good kids We're raising a generation of timid kids

    A week ago, a woman was charged with leaving her child in the car while she went into a store. Her 11-year-old child. This week, a woman was arrested for allowing her 9-year-old daughter to go to the park alone. Which raises just one question: America, what the heck is wrong with you?

    July 17, 2014 1 Photo

  • RedBlueAmerica: What should the U.S. do about illegal immigrant children?

    The crisis along the southern U.S. border has politicians and immigration officials scrambling. More than 52,000 children, mostly from Central American nations, have arrived so far this year. The Department of Homeland Security is running out of space to hold them all.
    President Barack Obama is asking Congress for $3.7 billion in borrowed money from taxpayers to cover the growing “care, feeding and transportation costs of unaccompanied children and family groups” when our own veterans are not taken care of. Texas Gov. Rick Perry criticized the president’s plan, saying more money should go toward securing the border.

    July 17, 2014

  • VA scandal highlights the need to change Pentagon spending priorities

    The ongoing Department of Veterans Affairs scandal raises an important question: When our veterans are being denied access to basic health care, why is the Pentagon squandering billions of dollars on programs that do not benefit our military forces? Is there a link in organization attitudes?

    July 16, 2014

  • For better politics, it’s time for some raging moderates

    Like more than 20 percent of my fellow Californians, I am now classified as a no-party-preference voter, registered to vote but with no affiliation to any of the state’s political parties.
    I am for lower taxes and for marriage equality. I am tough on crime and I am anti-abortion. I believe that a pathway to citizenship is a necessary part of immigration reform and that student test scores should be a critical component of teacher evaluations.

    July 15, 2014

  • Father on mission to stop gun violence

    Since his son died six weeks ago as collateral damage to a troubled young man’s wish for vengeance, Richard Martinez has been asked whom he holds responsible.
    “I’m responsible,” the California lawyer answers, referring to most Americans’ failure to push harder to change gun laws after earlier mass shootings. “All those kids died and none of us did anything.”

    July 14, 2014

  • The Kansas City Star: Obama must end the public information barriers

    Mr. President, you have a public information problem. Again. Several months ago, journalism organizations complained about a lack of access for news photographers to pertinent presidential events.

    July 14, 2014

Poll

If the Republican runoff for the 5th District congressional seat were today, which candidate would you vote for?

Patrice Douglas
Steve Russell
Undecided
     View Results