Recently, a number of my patients have commented that they feel as if they are being “fed into a machine” as they move through the process of breast cancer screening. Between the time that an abnormality is seen on a screening mammogram and the time that definitive treatment begins, an increasing number of patients feel that they are being moved along an assembly line of repeat mammograms, ultrasounds, MRI’s and biopsies in a lock-step process which leaves them little opportunity for thought, reflection and consultation with their own physician. In this day of increased automation, corporate pressure and medical technology, it is not surprising that patients feel depersonalized by a system which seems increasingly devoid of compassionate counsel.
Patients are not the only ones who feel disempowered by the changes in medical care. Physicians, who are being strongly influenced to manage their patients in this new environment, are left frustrated as well; frustrated for their patients and by the level of patient care they are able to provide in an increasingly “managed care” landscape.
Our Breast Cancer Center of Excellence, which is composed of providers and support staff from each of the three health care systems in our community, is trying to oppose that trend. All of us are committed to giving patients in the Tri-Cities the best possible care in a setting of compassion, patient education, community support and access to the best and most hopeful clinical trials in the field. We strive to provide our clients with as much choice and understanding of their treatment plans as possible so that patients and providers feel connected and active in the decision making process.
Being diagnosed with cancer forces people to confront their mortality and question the ability of friends and family to understand what they are going through. More frighteningly, it makes each individual cross the bridge from the world in which they were a “person” to a strange and unpredictable world in which they are a “patient”. Helping these frightened and disoriented new residents become survivors in their new world takes time, understanding and communication. It is an aspect of the practice of medicine that makes sense to all involved whether or not it fits within the confines of the current managed care directives.
It takes courage to provide compassionate care and as providers, we have to stand up for what is right for our patients and for our colleagues. Historically, the concept of “Patient Advocate” has been a part of a physician’s job description since the time of Hippocrates. If a patient is confused or concerned about her breast cancer and frightened by the choices she must make as she struggles to survive, it is her physician who must comfort, educate and advise her. It takes courage to admit that sometimes there are no best answers, and even more courage to encourage a patient to seek an outside opinion. Patients today are increasingly aware that there may be other options and other providers who can help answer their questions.
Medical professionals have become used to acting as if they always know what’s “best,” or what the “standard of care” is for specific situations. But what is “best” is very individual. No two people are exactly alike and everyone has different histories and coping methods. If a patient doesn’t question the approach recommended by her physician, it may just be because she is not aware that alternatives exist, or simply because she is too afraid to ask. After all, isn’t the doctor supposed to know what’s ” best”?
The basis for our health care system lies in the belief that people (patients) are the ultimate decision-makers when it comes to taking (or not taking) medications, and having (or not having) procedures performed on their bodies. We, as physicians, try to do what we think is “best” according to our knowledge and experience. We must never forget, however, that the final decision is with the patient, and it is our responsibility to ensure that she has access to all the support and resources she needs in order to make a decision she is comfortable with, and can (perhaps!) live with. The day we stop providing that level of communication and comfort to our patients is the day we have forgotten why we’re here.
L Evans MD, PC, FACS