Friday, March 06, 2015

Why is this news? Why is it new?

Dana-Farber Cancer Institute, our local comprehensive cancer center, deserves the greatest respect and appreciation for its many contributions to the community, the region, and the world.  But when this press release was issued on February 26, I had to wonder why it was news, and why it was new. Excerpt:

New patients with cancer can now see a specialist as soon as the following day at Dana-Farber/Brigham and Women’s Cancer Center in Boston. 

“A cancer diagnosis creates tremendous anxiety and uncertainty for both patients and their families,” said Dr. Craig Bunnell, Chief Medical Officer at Dana-Farber. “Not everyone wants or needs to come as quickly as the next day, but for people who do, such quick access to the expertise, care and support they need is tremendously reassuring.”

“Providing next day access immediately following a cancer diagnosis is part of our commitment to patient-centered care,” said Michael J. Zinner, chairman of the Department of Surgery at Brigham and Women’s Hospital (BWH). 

Well, sure.  We all understand that.  The opposite is awful, as I related in this 2012 story about my late friend Sonya from St. Thomas, VI, after her visit to DFCI, which I did not identify at the time:

In the winter of 2010, when I was still CEO of Beth Israel Deaconess Medical Center, Sonya called me to say she was in Boston for some tests. Biopsy results received on a Friday afternoon indicated two forms of cancer. She was in a turmoil. The people at one of Boston’s most distinguished cancer centers had given her this verdict and then told her they would set her up to meet with a medical oncologist in ten days.

Ten days? You give a woman test results showing two forms of serious cancer; she is over a thousand miles from home, staying alone in a hotel; and the best you can do is get her an appointment ten days hence? It is hard to imagine a more cruel act. We had dinner the next night, and she told me the story. I said, “We will do better for you.” I took her medical records and sent an email at 10 pm that night to several doctors at BIDMC, asking them to think about how we could help.

I called Sonya the next day, Sunday, at about 1pm, saying that someone was likely to be in touch. She replied, “Dr. Awtrey [our gynecological oncologist] already called me. He spent two hours on the phone with me this morning telling me what to expect and possibilities for treatment and promising to coordinate my care with the other departments. His secretary will pick up my medical records from your office tomorrow morning.” 

The next morning, Chris Awtrey’s secretary came by the office, and I asked her to express my appreciation to him for reaching out to Sonya on a Sunday. She looked at me with great seriousness and said, “Oh, there is no reason to thank him. Dr. Awtrey believes that the most important part of his job -- before performing any treatment -- is to spend as much time as necessary with a woman to help her be less anxious about her disease. That is the way he is. I can’t think of a more admirable person. It is such a privilege to work with him.”

Now, I know in my heart that DFCI doctors are also kind and caring. Why it took until this month to revise their procedures to give the kind of care that we would want for any member of our family is a puzzle to me. I hope and trust that their past standard of care was an anomaly among cancer centers, that their new approach is a long-standing norm around the country.


beverly said...

Their advertisement does seem to smack of an airline advertising "Our plane has wings."

Peter Yang, MD said...

I haven't worked at DFCI, but I believe one reason why they needed time before seeing new patients is that they had a standardized process for obtaining records and reviewing outside data prior to the first consultation. Most notably, they would obtain the outside pathology/biopsy sample and have their own staff review it to confirm the diagnosis. That IS an important part of the second opinion process and different conclusions have certainly influenced treatment choices, so a tradeoff to the faster appointment--if they sacrifice requiring that review beforehand--may be that there will be an incomplete set of information available at that first appointment to discuss or the possibility that the treatment recommendation will need to change.

Paul Levy said...

Sorry, I don't buy that. This is not about reviewing an "outside" path report. It was produced by their own folks.

Also, there is still room for the second opinion if you have an immediate appointment with the patient.

pheski said...

I think this illustrates a nearly universal problem: our health and illness care systems are organized largely to meet the needs of the system rather than patients.

Health care is not unique. I think John Gall in Systemantics summed it up well when he pointed out that complex systems inevitably end up working against the purposes for which they were initially intended.

It would not be a perfect solution, but I think a start would be to have patients as a large and powerful (i.e., not token) participant in planning and governance of all health care institutions. If they are not at the table, it means they are on the menu.

Bob said...

"I hope and trust..."

Surely, Paul, you know your trust is misplaced. Most doctors, even those treating cancer, care first and foremost about their own comfort and their own schedule. Sad but true.

A friend had esophageal cancer diagnosed just over a year ago, and I couldn't believe how relaxed they were when treatment would start, etc. Their own schedules came first!

Peter Yang, MD said...

1. I misunderstood that this involved patients with cancer diagnosed at BWH/DFCI being able to get more timely appointments. I agree with that, and we strive to provide appointments as soon as possible after diagnosis so patients can have the needed discussion & planning. When slots are not available, other doctors and I find ways to accommodate urgent cases.

2. My prior experiences with referring patients to DFCI for second opinions sometimes did require some extra time because of outside specimens needing to be transported to their pathologists for review.

Anonymous said...

I will say this, sadly, better late than never. The first thing a person wants is a warm hand, start the ball rolling in whatever manner. Pity we couldn't do that now where I'm at.