What a doctor can learn from being a patient

An internist’s cancer scare helps show her how care can be improved.

As an internist and infectious disease physician, I am, unfortunately, often the one who has to deliver bad news to patients and their families. But this time, as I sat in the urologist’s office in January, the dreaded words were directed at me: “You likely have cancer.”

It was ironic, I told the surgeon. In addition to being a clinician, I lead a team at the University of Massachusetts Medical School that helps state officials and health care providers implement new models of health care. Just two days earlier, I explained, I had led a retreat to kick off a pilot program for urologic cancer patients, the very thing I was about to become.

The pilot at UMass Memorial Health Care was for what’s called a “perioperative surgical home,” a model for a comprehensive type of care that starts the moment a decision for surgery is made and doesn’t end until the patient returns to the regular care of her primary care provider. The care is carefully coordinated among all the health care professionals involved in treatment, wherever that treatment takes place, and good communication is essential. The ultimate goal is to address the needs of the whole person, rather than just those of the diseased organ.

My surgeon raised his eyebrows and said, “I’d be interested in hearing how it goes for you, then.”

Here is how it went: The surgery to remove the tumor on my kidney was scheduled swiftly (I needed to get this thing out) and there were no surprises in the operating room. The surgeon said I would feel terrible and not be able to imagine going home on the second day, but that I would. He was right. In fact, he had set the expectations well, so that as I moved through the stages of recovery, I knew I was on target. This felt very reassuring.

Throughout the process, there was solid communication between the surgeon and my primary care provider, in part because my PCP had electronic access to my hospital records and I took the initiative to e-mail her myself. After my discharge, I also prompted follow-up calls with both my surgical and primary care teams. In health care reform lingo, we call this enhanced access; the idea is that you can have needs addressed without yet another trip to the doctor’s office. Was it special treatment for a doctor? New health care models would make it standard practice for everyone.

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