Friday, September 28, 2012

Thinking Outside the Box


Over the years medicine has somehow become “for-profit” and the days of the “non-profit” hospitals have fallen to the wayside. You see more and more administrators vs. actual caregivers (i.e. doctors and nurses). So it’s amazing to me that although they have embraced the business-way of thinking and wanting to see the bottom line increase, they haven’t quite caught on to the common sense approach to looking at things. In medicine I am finding that it’s either black or white. There is no room for gray or even multi-color thinking.

Case in point – I arrived for my chemo appointment on Wednesday and checked in as usual. I was to see the doctor first and then go over for chemo afterward. Because my chemo is an experimental drug it is not mixed in the Cancer Center Pharmacy. It is done in another U of C pharmacy dedicated to research a few blocks away. Due to the cost of the drug (my guess is +$50,000 per treatment) they will not call in the order until I physically show up. I have learned to speed up things I go over to the Infusion area and let them know I’m there and seeing the doctor first otherwise I could wait and have waited up to 2.5 hours and a 2:00 appointment turns into a 4:30 appointment. When I checked in I was told the doctor cleared my for chemo based on the blood work that was done the day before and faxed to her that morning.

Because U of C is a teaching hospital and my doctor is a Professor of Medicine and Director of Medical Oncology she routinely has Residence and Fellows working with her. (A Fellow is a doctor who is pursing a specialized field). As I wait to see my doctor one of the Fellows working with her comes in and starts explaining my blood results. Not that I’m a brain surgeon but after a while you get familiar with what things mean and the terminology so I engage her in a conversation on what she is telling me. Unfortunately she takes this as a threat instead of a well informed patient who has taken charge of her medical treatment and now has to assert herself even more. She points out my Bilirubin is high of which I reply it has been as high in the past. Her reply - “well maybe you shouldn’t have chemo today, I’ll talk to Dr. F”.

After a few minutes my doctor walks in (a little sheepishly) and says that the Bilirubin is a concern and she needs to check protocol for the trial. So they both leave and a little while later the Fellow comes and announces they aren’t going to do the treatment today and I should come back next week to make sure everything is normal. OK, I admit that now I’m mad and tell the Fellow that I don’t have time to waste by coming back next week. I think she was a little taken back and didn’t know what to say so she said she would get my doctor to come back and talk to me. My first question was why, when they had the blood test at 8AM that morning and Infusion has told me I was cleared for chemo was there a change in their thinking. Of course there was no good reasoning and a lot of dancing around the question.

OK – here’s where the theme of this weeks blog comes into play. What I failed to mention that the other numbers measuring liver function (and was calculated into the Bilirubin count) showed being normal or slightly out of range. Nothing stood out as being a problem. So using my business/engineering background I had to ask why didn’t they re-run the test in case the data was incorrect. To me this is a “no brainer”. The response was that it took 2 hours to get the lab to process blood samples (yes – a major hospital takes 2 hours to run blood work which is why I have the test done offsite the day before). My response back was I’d rather wait 2 hours then to come back the following week. So it was agreed that I would have another blood draw to confirm the results.

After the draw I went back to the infusion area to wait for the results. Thanks to one of the nurses, Susan, who I’ve known the whole time I’ve been going she kept calling the lab to get the results STAT. The next I know they are calling me into the Infusion area because “surprise” my test results have improved.

There of course is a lot more to this story. Why did my doctor change her view from looking at the results in the morning until I saw her at 1:30? My guess is that she knows me (and my medical history) and although the count was higher then normal knew I could tolerate the treatment. Because the Fellow questioned it my doctor had no choice then to follow protocol.

Even though this whole situation was very frustrating I still can’t comprehend why the first thought would have been to re-run the test rather then send me home. Medical professionals no matter how much they want to turn medicine into a business still cannot understand thinking outside the box.

The good part of all of this was it gave me material for the blog.

Here’s hoping that some day intelligence and common sense will meet.

Keep on Dancin’

Wednesday, September 12, 2012

I'm sorry I haven't posted anything sooner but between not feeling good and being super busy I haven't had a chance to gather my thoughts.

I had my CT Scan last week Tuesday.  Imagine my surprise when the CT Tech told my I was "famous" within their department due to the last scan I had and the exploding IV (see posting around Aug 16 for more details).  Seems they had a big department meeting and changed IV protocol due the little mishap.  Glad I'm famous for something.  CT scan went without a hitch and I was in and out in 30 minutes.

Chemo was the next day.  I have to admit I nervously sat waiting for the doctor and the results trying to keep a brave face.  Imagine my relief when the doctor told me that the tumors in my liver, lung and chest area showed shrinking.  It had stayed stable for the last several months and I was happy with that.  I had thought that maybe the chemo had met it's match and was just holding off the enemy.  Remember stable is good.  I'm never going to complain about stable.  But shrinking is better - buys me more time.  As I said before, although relieved and happy I don't get too excited since I know how fast things could change and knock you off that high.  Let's just all put on our party shoes and do a quiet little happy dance and then back down to business,

Unfortunately they forgot to schedule an ECHO and I have to go back Monday to have it done.

Otherwise I've been tired and have had flu like symptoms which may be due to the Xgeva they give me for the bones.

Until I have more to tell you - enjoy the end of summer before we ave to trade in our flip flops for Uggs!

Keep on Dancin'