I had just finishing my evaluation of a potentially problematic patient. Ben (not his real name), a 52yo 2 pack per day cigarette smoker, had presented with a mass in his throat which was, unless proven otherwise, most likely cancer. He was scheduled to undergo a biopsy procedure to obtain a definitive diagnosis and I was formulating an anesthesia management plan. Coincidentally, I had just read a blog on KevinMD entitled “Who coordinates patient care? Maybe no one.”1 Then I was presented with the answer to that question for cancer patients treated at our institution.
A diminutive woman was standing in the doorway in polite deference while I completed my preoperative assessment. Once I told her that I had finished she took control of the situation with a no-nonsense demeanor that instantly spoke of competence and engendered confidence. She directly stated that the mass in Ben’s throat appeared to be cancer and that the biopsy would determine whether or not that was the case. She informed him that this was the beginning of a process and that she would be helping to guide him and his family through that process. She assured him that he was “not alone” and that she would be with him “at every step of the way!”
I was so impressed with Candace (another alias) that I reached out afterwards to learn more about her. In the years since her graduation with a Bachelor of Science degree in Nursing she has worked solely with cancer patients. She has cared for patients in both inpatient and outpatient settings. In addition she has participated in clinical trials that research innovative cancer treatment regimens. So she brings a tremendous wealth of knowledge to her approach to cancer patients.
She believes that the paramount strategy begins with an attempt to “take the fear out” of the experience. Most if not all of her patients are “scared to death”. Her goal is to let them know what to expect because she believes that knowledge is the key to their surviving the experience successfully. Once the biopsy confirms the diagnosis as cancer the treatment process begins. It is a complicated journey that includes enduring numerous consultations with many different doctors, and submission to a multitude of lab tests and imaging procedures. It may also include undergoing one or more surgical procedures as well as chemotherapy and radiation therapy. Through this maze Candace is the one constant link. She communicates among the various providers so that all involved in a particular patient’s case are up to speed as to what has been their respective input into the patient’s care as well as that patient’s progress. In addition, she addresses the multiple concerns of the patients and their families. Not only does she act as an interpreter, explaining the often complex nature of cancer therapy, but she also helps deal with what she terms as “barriers to treatment”. These are such practical issues as “transportation to the numerous appointments, securing a babysitter, or paying bills”.
Providing such comprehensive care is wrought with frustrations. Among the most vexing issues are the various “hoops” that she has to “jump through”. These include the fact that Medicare and other payers do not provide transportation to and from appointments. But perhaps the most frustrating “hoop” is the specter of prior authorization. This is the process by which approval is sought from an insurer to perform a certain diagnostic or therapeutic procedure or provide medication. Without prior authorization, payments for these services are withheld. This approval is too often illusive and the decisions are seemingly arbitrary and the approval, when obtained, can be revoked retroactively.
This emotionally and professionally taxing job can lead to exhaustion and “burnout” among its providers. Candace was quick to provide the answer to the question, “Why am I doing this?” The answer is “staring her right in the face”. It is the gratitude that she sees in the faces of her patients and their families. It is appreciation that is well deserved!
- kevinmd.com/blog/2017/01/coordinates-patient-care-maybe-no-one.html
