The Waiting

“The waiting is the hardest part
Every day you see one more card
You take it on faith, you take it to the heart
The waiting is the hardest part.”
Tom Petty and the Heartbreakers

 

I’ve never been good at waiting for anything. Instant gratification has been my middle name, and I’ve gotten in lots of trouble because of it. I think that I have improved with age—I am less likely to become apoplectic when the stoplights fail to coordinate to green, or when the driver in front of me creeps along at a snail’s pace, or when the line at the movie theater is longer than I expected, or, God forbid, the line for the heavily buttered newly roasted popcorn AFTER I’ve gained entrance to the theater means that I might miss the opening scene. Knowing that the popcorn is always better than the movie, I wait.
When it comes to my patients, though, the waiting is still unacceptable. We have a rule in my office—a referral MUST be seen within a week of getting the phone call or faxed request—sooner if that patient is in pain, or has symptoms of airway obstruction or spinal cord compression or is bleeding from his cancer. The problem for many of my patients, especially here in Southern California, is that they have often waited far too long already. The paperwork and time and energy spent making phone calls and filling out forms is staggering. Primary care doctors are overwhelmed. Insurance companies are obstinate. It is not uncommon for a patient to have been diagnosed for over a month or longer before they are seen by me.

 

When we moved here from Massachusetts in 1993, I had already grown accustomed to patients having to wait for treatment. Massachusetts is a “CON” state, meaning “Certificate of Need”. In order to purchase and install new radiation therapy units, which are considered “high tech” and very expensive, one had to petition the state, and undergo scrutiny and a series of tedious hearings held by self-important politicians who clearly never had a close friend or relative with cancer. I remember treating upwards of fifty patients a day on the linear accelerators, and having to triage patients with cancer into urgent, and less urgent cases. Lung cancer and brain cancer first, prostate cancer last, and everything else in between. How does one place a value on a life hanging in the balance?

 

When I arrived in California in 1993, and joined a private practice, the founder of the practice, Dr. Jack Abrams, who hired me had a very simple philosophy: “See ‘em, sim ‘em and treat ‘em.” Meaning that if we got a call from a referring physician, we were to see the patient within 24-48 hours, perform their simulation, otherwise known as the treatment planning session, the same day or the next, and start their treatment the day after that, or even the same day if necessary. This was SERVICE, defined as I had never seen it defined before. The referring physicians and the patients were very grateful and I am quite certain that this philosophy cured more cancer than the waiting, and the wading through mountains of paperwork.
Jack Abrams is long gone now, but the philosophy of service that he ingrained in me twenty years ago remains. If you are one of my primary care physicians who needs your patient seen TODAY, just call me on the phone. I will stay late and see your patient, and so will my wonderful oncology nurse. My superb chief radiation therapist will do that CT simulation the same day if necessary, and my dedicated physics staff and radiation therapists will stay as long as is necessary to get your patient– no, OUR patient treated. No one will suffer needlessly on our watch. This, I promise. The waiting is the hardest part.

 

Dedicated to Dr. Jack Abrams—we did not always agree, but you were a fine example of our breed.

12 thoughts on “The Waiting

  1. Also agree this is a wonderful philosophy and, I am sure, goes far to alleviate stress for patients. Several years ago while dealing with a health problem that was seriously affecting my physical and mental status and thus affecting my job as a “side effect”, I seriously have no doubt that the stress of dealling over and over c red tape of HMOs etc, sometimes over a month at a time – well, I became a bundle of nerves just from that aspect alone. I could feel my BP rising. It was truly terrible, as silly as that may sound…

  2. How unusual…….in human medicine these days.

    Much more common in veterinary medicine.

    Why do you suppose that is? Probably because we are paid directly by that patient (or rather the patient’s owner).

    • Thank you for your comments, everyone. Specialty physicians cannot help what happens BEFORE the patient is referred to them, but they can be responsible for what happens after that. But please remember my age! I was brought up in a different time, when medicine was considered a calling, and not just a job. I am not blaming the insurance companies entirely–much responsibility rests without ourselves. My husband and I both feel, along with many older physicians, that part of the change in attitude began with the Libby Zion case, which led to legislation limiting working hours for interns and residents. Now these laws are strictly enforced, and lend a sense of entitlement amongst young MD’s. Now, the attitude is, “it’s 5 pm, my shift is over.” And sadly, none of that legislation prevented medical errors the was it was supposed to. Carelessness is still carelessness, and an extra hour of sleep didn’t solve the problem. M

  3. My primary care doc, a “Gen X”-er, will return anxious emails the same day; maybe the first I have had that would (for readers– I am virtually the same age as Miranda, lived almost 30 years in Massachusetts and over 30 in New Mexico, for the record).

    My neurologist returns calls or email almost as swiftly but is slower to schedule which is absolutely fair as their is nothing acute about my neurological problems.

    Also for data– both are connected to the same University hospital system; not being an MD I have no idea whether that means a little or a lot.

    • I think that if you have an unusual or rare problem, it’s ALWAYS better to be seen by physicians who work in a University system. There is just better access to the latest medications, and the opportunity to participate in clinical trials. In my experience here in San Diego, it’s not always easier to navigate through the system, or to get appointments, however. M

  4. Hi,
    I realize that this is an ‘older’ post of yours, but I can really relate to your sentiments expressed here. According to the young medical oncologist I now work alongside, waiting rooms, waiting lists and incoming referral logs should not exist. His is an emergent, solo medical oncology practice–and University affiliation, clinical trials, and even a practice partner are still very much works in progress. Moreover, having been a not-always-very-patient ‘patient’ for my entire life, I can certainly appreciate and empathize with his perspective. Recently, I needed to see a breast surgeon to exclude malignancy in a suspicious lesion/abnormality which was seen on routine, screening imaging studies. Thanks to ‘professional courtesy’, I was evaluated quickly, and my biopsy and subsequent (benign) pathology was expedited. No waiting. No delay. No ‘room’ for denial. At least, not for me. However, the system is incredibly daunting for even the most seemingly capable and pragmatic of patients. For now, for my part, I’m happy to have discovered this little ‘haven’ of insights and experiences of Oncology — and will be sure to return back to read, often. Thank-you!.

    • Thanks Annabel! I am happy that your breast biopsy was benign, and also happy that you are working with an oncologist you respect. I do hope you return to read my blog. Miranda

  5. I am a Radiation Therapist at Spears Cancer Center, Grants Pass, Oregon. I am proud to say that we always put our patients first. Every member of our team will stay late or come in early to ensure at the end of the day that our patient’s needs have been met. I have left four centers due to the lack of quality of patient care that has become the norm. When people ask me why I chose this profession, I simply tell them that I consider it a blessing to have the opportunity to be a compassionate presence to another human’s difficult journey. As an added bonus I get thanked for saving one’s life!
    Thank YOU for sharing your journey!
    Shelley

    • Thanks for writing, Shelley. I have friends in Grants Pass. Now, if they get cancer, I’ll know where to send them! Miranda

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