Friday, June 16, 2017

A Referral for a Referral for a Referral

I'm curious: what must have happened to provoke the powers that be to make the health care system so inanely bureaucratic that wait times for life-saving surgeries are dramatically increased because of all the referrals for referrals required? Who could it possibly benefit?

I've written before about the system. After seeing an oncologist, to get a second visit to arrange to get a referral to a surgeon requires another referral to the oncologist from a family doctor. The same is true of many specialists.

It makes sense to have the family doctor as a first step to point people in the right direction. Some people might call an oncologist direct because they have a headache and think it's a brain tumour. I get that level of primary intervention. But how many mistakenly call their oncologist for a follow-up appointment?? That just doesn't make sense.

Imagine the savings to the health care costs if, on the first visit to the oncologist, you were given your options WITH the names and numbers of various doctors to see depending on the decision you make, and then you were allowed to actually call them all by yourself! So once you decide to go with the hysterectomy before the mastectomy, then you DIRECTLY call the gynecologist!!  That would be amazing!!  But instead, it's a bizarre, circuitous route from the family doctor to the oncologist to the family doctor to the oncologist (who says this should have been done months ago) and finally to whatever surgeon you need to save your own life.

AND the support staff of the family doctor and the necessary specialist set up an appointment time without having a clue about your schedule, so sometimes you end up having to change it, which pushes it all back even further. My daughter has a weird skin thing going on, nothing life threatening, but it's a similar set-up. Months ago, the family doctor said she should see a dermatologist. Just last week we got a call out of the blue from the dermatologist with a reminder for an appointment time for this week. I don't know who slipped up and didn't call me about the appointment in the first place, but it's not the first time that's happened. These receptionists are crazy busy! This week is way too late in the term for me to take a day off, so I asked for another appointment time. Next November is the best they can do.

Here's the thing. Sure it's a problem that some doctors can't see patients for six months. It will cost a fortune to get more doctors in the system, so I see why that could take some time and political wrangling to change. But it could actually SAVE money if patients could be allowed to make some of these appointments directly instead of having a separate appointment that prompts support staff to make arrangements on their behalf that end up not working for them anyway.

I recognize that if patients can call specialists directly, the problem would become how to differentiate the patients that are allowed to call directly from the ones that still need to be assessed by the family doctor. That will be tricky. But the question is, then, would the increase in the number of patients who slip through and directly call a specialist unnecessarily cost more than is saved by the decrease in the number of doctor visits set up just to be allowed to get permission to see the specialist that's actually needed? How many people would actually call a surgeon directly because they have a headache? And how many people have two or three extra doctor visits that are solely to get permission to see the doctor they need to see?

There should never be an appointment with a family doctor that's just to get them to sign off on a referral without the patient actually needing an examination or assessment to figure out which specialist is needed. In other words, if the doctor's specific skills aren't being used, then that appointment is a waste of the taxpayers' money. When an oncologist tells me to come back with a decision so we can get started with surgery, then it's a sham to force patients to make three different appointments with three different doctors before getting to the actual surgeon.

Sunday, June 11, 2017

On Bertrand Russell's The Conquest of Happiness

Some  Russell quotations have been floating around lately, so I read The Conquest of Happiness, first published in 1930, and, boy, did I need this right now! The main ideas and some bits I liked are below by chapter. The book is really just a mix of Stoicism and Epicureanism, so you could just read that instead, but they're not nearly as palatable. This summary is really long, but not nearly as long as the book!

Part I: Causes of Unhappiness

1: What Makes People Unhappy? 

This chapter has some racist bit, but I imagine he was still more progressive than most at the time. We won't throw the baby out with the bathwater at any rate. He raises his thesis here: we can only be happy by being prudent with desires and by focusing outward. 

Lymphedema: A Research Study Overview

I'm cancer free, but very anxious about lymphedema. It's become a bit of an obsession, so, for anyone googling it, here are all the studies that I really should have researched before consenting to the Axilliary Lymph Node Dissection (ALND) surgery that half my doctors told me I didn't need, and the other half convinced me I should have had done months ago. In all that back-and-forth discussion, nobody gave me the harsh facts about lymphedema. They were all too focused on the cancer, so much so, that I really wasn't able to give informed consent based on their cheery consolations: "We don't see that so much; I wouldn't worry about it." The risk is small, but it's about as small as having cancer in my lymph nodes to begin with (somewhere between 15-30%). And the potential effect on my life is enormous. As far as I can tell, I basically agreed to risk being permanently disabled in order to have peace of mind that my cancer won't spread. Writing about it at least will briefly keep me from insanely measuring the circumference of my arms over and over.

My surgeon has taken a very Epicurean approach. He's quite convinced that there's no rhyme or reason as to why some people get it, so I should just live my life, without a compression garment, and not worry about it unless it becomes a problem. I asked about booking a kayaking trip eight-weeks post surgery, and he gave me his blessing. However, while it's true that there are risk factors beyond my control, there are also some things I can do to prevent this condition - things that patients should be told to do to decrease the risk. I believe he's negligent in not sharing the latest research. All of these doctors were. It shouldn't be up to patients to seek out studies to determine how to proceed. That's why they get the big bucks!!