Respecting Patient Needs

Every person has their own comfort zone and needs which need to be met to ensure that they are able to cope with their medical appointments. Sometimes your comfort zone gets invaded but you also have to cope.

At my first cancer surgery, I was mortified to find out I woke up after the operation wearing a different gown than when I was sedated. Did they see me naked???? I didn't dare ask. I also remember the first time I went for a gynecological exam and it was a male doctor!!!! I had grown up with a female pediatrician and wasn't used to male doctors. I coped and was okay with it but mortally embarrassed.

In the case of Muslim men and women where there are strict guidelines on men and women being in the same room, never mind touching each other, if they are unmarried, medical exams can be restricted or just very difficult. It is not just Muslims that have this issue where their religion forbids it but anyone who's comfort zone does not allow for someone of the opposite sex to touch them. Some people are also just very modest and don't want someone of the opposite sex to touch them.

When my husband needed a primary care physician, I asked him his preference - male or female - and he definitely wanted a male doctor. To this day, I usually prefer a female doctor myself. Currently, the only male doctor I have is my back pain doctor. I think all the others are female, some by my decision and some by chance.

If you think about it, boys and girls are different (in many ways) and I prefer a doctor who has the same body parts I have. Ovarian cysts don't happen to boys. Hysterectomies don't happen to boys. I want a doctor who can understand my body better and what is going on with it.

I am not saying women should only have female doctors and men only have male, I am saying that this is what I am comfortable with personally. This is my comfort zone. If someone has the added issue of religious dictates, they should be respected as much as possible.

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I don't like this idea

I understand the desire to rein in health care costs. I understand that cancer is a very expensive illness to treat. I understand that having standard treatment protocols is a usual practice. I don't understand why insurance companies are trying to get involved with deciding doctors need to follow standard protocols for cancer treatments as a way to control costs.

One of the things you learn with cancer is that every cancer is different. You can take two patients with the same cancer diagnosis and their treatments may differ. Tumor aggressiveness, lymph node status, tumor size, age of patient, other health issues, etc.

In cancer staging, there is some wiggle room. For example with my diagnosis of Stage IIA breast cancer it is defined as one of these three conditions:

'The tumor is 2 cm or less across (or is not found) and either:

* It has spread to 1 to 3 axillary lymph nodes, with the cancer in the lymph nodes larger than 2 mm across , OR
* Tiny amounts of cancer are found in internal mammary lymph nodes on sentinel lymph node biopsy, OR
* It has spread to 1 to 3 lymph nodes under the arm and to internal mammary lymph nodes (found on sentinel lymph node biopsy).

OR

The tumor is larger than 2 cm across and less than 5 cm (T2) but hasn't spread to the lymph nodes and the cancer hasn't spread to distant sites (M0).'

So with this range of possibilities, it opens up a lot of different treatment options based on tumor size and lymph node invasion alone. The insurance companies are working with groups of doctors to create treatment protocols that might be less costly. Any doctor would agree there are multiple ways to treat a cancer and that the choice of which chemo drugs, the most costly part of cancer treatment, is dependent on many factors. I think the doctor involved in the treatment should be the one making the decisions not a panel of doctors who haven't ever met the patient.

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Pay for performance

Pay for performance is a good idea. Right? I mean you do a job and they pay you. You do a job perfectly and they pay you more. How does that sound? It makes sense.

But what about paying doctors for their performance? Well the problem is that its paying doctors for their performance with patients. So its not just the doctors that should be paid but perhaps the patients as well.

Seriously, what if your health premiums were lower if you went for annual check ups and preventive tests such as mammograms and colonoscopies as scheduled? Also, if you had a condition, if you actually went for treatment as prescribed by your doctor?

I think that people with health conditions which require monitoring - anything from diabetes and heart conditions to post surgical follow up - it is up to them to get the treatment prescribed. If the doctor wants to follow up six weeks after surgery, go to the appointment so you don't end up in the emergency room because something that didn't heal quite right caused other problems. This should also include lifestyle changes to an extent. If a doctor says, you are going to develop diabetes or have a heart attack unless you eat healthier, get exercise, and lose some weight, you need to make an effort there as well.

Basically, it takes two to tango. The doctor needs to do their job and the patient needs to theirs as well. Maybe because human beings react positively to payment, money needs to be added to the mix. But then isn't money the root of all evil?

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The doctor filter

You have a doctor appointment coming up. To get prepared you come up with a list of all your medications. Then you come up with a list of questions or issues to ask the doctor about - and possibly write them down so that you remember to ask them all. If you are really good you might bring someone to write down the answers.

You get to your appointment and start asking all your questions. Is your doctor taking notes then or are they going to write down their notes after the appointment? I think this is a matter personal preference on the doctor's part. How much are they really writing? What are they saying? What are they disregarding as non important or irrelevant? How much are they filtering out?

I think there is a doctor filter in play. If you say, sometimes you are sore after working out - does that count as a health problem or something that is expected? Or if you ask about allergy issues - runny nose and sneezing - are they just going to write down allergy symptoms or lots of details?

They do need to filter to some degree. I mean sometimes you ask questions that they answer and they don't require further comment or action. Other times, a question may lead to more checking or follow up. It is their professional opinion of what is important and what isn't.

But it is you, the patient, who needs to keep track of the questions and their answers and is the issue now closed for you or does it require follow up? Or was it previously closed and now reopened? Part of your question for the doctor might include 'I had this problem two years ago and it stopped and I was fine but its been back for the past two months.'

I think the doctor filter is further proof that we the patients need to keep track of what is going on with our bodies. The doctors see hundreds of patients, you see yourself. Its your body and you need to be in charge.

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