Tahlequah Daily Press

Get the scoop!

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
Get the scoop!
  • mama.jpg What we get wrong about millennials living at home

    If the media is to be believed, America is facing a major crisis. "Kids," some age 25, 26, or even 30 years old, are living out of their childhood bedrooms and basements at alarmingly high numbers. The hand-wringing overlooks one problem: It's all overblown.

    July 22, 2014 1 Photo

  • Wal-Mart to cut prices more aggressively in back-to-school push

    Wal-Mart Stores plans to cut prices more aggressively during this year's back-to-school season and will add inventory to its online store as the chain battles retailers for student spending.

    July 22, 2014

  • An oncologist uses scorpion venom to locate cancer cells

    Olson, a pediatric oncologist and research scientist in Seattle, has developed a compound he calls Tumor Paint. When injected into a cancer patient, it seems to light up all the malignant cells so surgeons can easily locate and excise them.

    July 22, 2014

  • Hospitals let patients schedule ER visits

    Three times within a week, 34-year-old Michael Granillo went to the emergency room at Northridge Hospital Medical Center in Los Angeles because of intense back pain. Each time, Granillo, who didn't have insurance, stayed for less than an hour before leaving without being seen by a doctor.

    July 21, 2014

  • Starved Pennsylvania 7-year-old weighed only 25 pounds

    A 7-year-old Pennsylvania boy authorities described as being so underweight he looked like a human skeleton has been released from the hospital.

    July 21, 2014

  • Sparring justices find little disagreement at the opera

    Justice Ruth Bader Ginsburg revealed a different view of U.S. Supreme Court on Saturday when she described about her passion for opera, one she shares with Justice Antonin Scalia.

    July 21, 2014

  • Malaysians wonder 'Why us?' after second loss of airline jet

    It was all too familiar. Grieving families rushing to airport. The flashing television graphics of a plane's last radar appearance. The uncomfortable officials before a heavy thicket of microphones.
    For many Malaysians, the disappearance of Flight 370 in March has been a long trauma from which the nation has not yet recovered.

    July 18, 2014

  • Your chocolate addiction is only going to get more expensive

    For nearly two years, cocoa prices have been on the rise. Finally, that's affecting the price you pay for a bar of chocolate - and there's reason to believe it's only the beginning.

    July 18, 2014

  • A quarter of the world's most educated people live in the 100 largest cities

    College graduates are increasingly sorting themselves into high-cost, high-amenity cities such as Washington, New York, Boston and San Francisco, a phenomenon that threatens to segregate us across the country by education.

    July 18, 2014

  • The terrible history of passenger planes getting shot out of the sky

    What is more clear is that, if initial reports are true, this would be the deadliest incident of a civilian passenger plane being shot down in modern memory. In some instances, the causes of the disaster are still shrouded in mystery. Here are some of the worst events.

    July 17, 2014

  • Facebook tests button to let people shop from its website

    Members on desktop computers or mobile devices can click a "buy" button to make purchases through advertisements or other posts on the world's largest social network, the Menlo Park, California-based company said Thursday in a blog post.

    July 17, 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

  • web_starbucks-cof_big_ce.jpg Starbucks sees more Apple-like stores after Colombia debut

    This week Starbucks opened its first location in Colombia — a 2,700-square-foot store with a heated patio, concrete columns, mirrors on the ceiling and walls of colorful plants.

    July 17, 2014 1 Photo

  • Screen Shot 2014-07-16 at 2.12.33 PM.png Gunshots narrowly miss TV reporter

    A reporter for a West Virginia television station narrowly escaped injury or worse Monday while covering a fatal weekend shooting in Beckley.

    July 16, 2014 1 Photo

  • 20110929_bowling.jpg Why fewer people go bowling

    Like other industries facing tough economic times, America's bowling centers are trying to reinvent themselves.

    July 15, 2014 1 Photo

Poll

Do you believe school administrators and college presidents in Oklahoma are paid too much?

Strongly agree.
Somewhat agree.
Somewhat disagree.
Strongly disagree.
Undecided.
     View Results
Tahlequah Daily Press Twitter
Follow us on twitter
AP Video
EPA Gets Hip With Kardashian Tweet Bodies of MH17 Victims Arrive in the Netherlands Biden Decries Voting Restrictions in NAACP Talk Broncos Owner Steps Down Due to Alzheimer's US, UN Push Shuttle Diplomacy in Mideast Trump: DC Hotel Will Be Among World's Best Plane Crashes in Taiwan, Dozens Feared Dead Republicans Hold a Hearing on IRS Lost Emails Raw: Mourners Gather As MH17 Bodies Transported Robot Parking Valet Creates Stress-free Travel Raw: MH17 Bodies Arrive in Netherlands Raw: Fight Breaks Out in Ukraine Parliament Disabled Veterans Memorial Nearing Completion Last Mass Lynching in U.S. Remains Unsolved Home-sharing Programs Help Seniors Ex-NYC Mayor: US Should Allow Flights to Israel Clinton: "AIDS-Free Generation Within Our Reach" Judge Ponders Overturning Colo. Gay Marriage Ban Airlines Halt Travel to Israel Amid Violence Police Probing Brooklyn Bridge Flag Switch
Stocks