In terms of preventive healthcare, the only thing worse than a colonoscopy is a mammogram. Every year, I was a willing participant in a dehumanizing error-prone system, which added a miserable dose of anxiety to an already painful procedure. The systemic inefficiency I observed drove me crazy. So I went in search of a better way where I could have it all – the best technology, efficient service, respect for my time and above all, doctors who use numbers but don’t treat me like one.
Here’s how it typically goes: you show up for the appointment you made a year ago and walk into an enormous waiting room where, with a sharp intake of breath, you observe 40 other women seated ahead of you involved in a variety of diversionary activities trying to allay their nerves — flipping through magazines, watching the local storm report on closed circuit TV, listening to the zen-like sounds of the faux electric water feature.
Despite the era of the electronic health record, a customer service rep hands you a clipboard and you are asked to provide all of your insurance information plus 3 generations of family medical history, even though you have done the exact same thing, at the same location for the previous 10 years, and you have just handed the clerk your insurance card to be scanned for their records.
After surrendering the genetic profile of your first born, the clerk explains the highly complex “process” – wait an hour until your name is called. You will be escorted down the hall, be given a temporary locker for your valuables (although the hospital takes no liability for anything lost or stolen) and change into a gown. After waiting a little more and verifying your name and birthdate for a second and third time, a technician will take you into a freezing cold room and manipulates some extremely sensitive body parts into a variety of positions you haven’t even seen at a Cirque de Soleil show. You will be told to hold your breath while images are taken. No words are exchanged while the technician reviews the scans. In fact, you wonder if they actually have any idea what they are looking at. You are told to wait some more. If the images are clear, that is, legible enough to be read by the radiologist, you can leave.
The waiting doesn’t end at the hospital. You will then wait two weeks to see if a letter comes in the mail that will either indicate you are fine and can come back in a year and do it all over again, or that something is horribly wrong and you need to come back immediately for additional images. Or, three weeks…their next available appointment.
Feel like a number? Do you think about the radiologist sitting in a dark room peering at hundreds of nameless, faceless grainy images for eight hours at a time, day after day, looking for a miniscule shadow? Do you think, what are the chances that this system will actually work? I did.
My fears were compounded when I read about a medical study in which a polaroid picture of the patient is attached to the films; forcing the radiologist to look first at the photograph and then at the images to determine if humanizing the images increased the accuracy of their findings. Guess what? It did.
Guess what I did? Quit the Top Breast Center at the Finest Teaching Hospital in my state in search of a different way. I wanted to find a practice where I could see my own films and sit with a medical professional as soon as they are taken, and compare them with those from previous years. Where if I needed additional images, I would be told in real time and they would be taken right away. Where if I wanted an additional test performed to give me peace of mind because the constantly changing guidelines are impossible to interpret, I could discuss the pros and cons of doing so with a physician. Where I receive a text message reminding me in advance of my upcoming appointment and can review and update my medical history online, a practice that would electronically send my report to both my GYN and PCP.
In other words, a setting where technology, data and patient-centered care all come together in service of providing state of the art health care. For the same price.
And I found one. I now go to a small, physician-owned facility, equipped with the latest technology. Where the staff have worked year after year because they love their jobs, and they know their patients by name. Where a top-notch surgeon sits beside me in a darkened room comparing this years’ images to last years’, patiently asking me about lifestyle changes and reassuring me that although all looks good she understands my decision to have an additional test. It will be performed immediately, and I will know the results simultaneously. And I am finished in less than an hour.
Although there are typically several people in this waiting room, they are there for different procedures. In other words, the office does not triple-book appointments. When they confirm your appointment, time for additional tests is included should they be required, instead of relying on the postal service to deliver news of your results – good, bad or indifferent.
They do have a water feature, but somehow, in this setting, it actually does the trick. Here I feel respected, heard and confident that the person interpreting my future knows that a fellow human being – a mother, daughter, sister and friend – is hoping for good news, but also preparing herself for the day when it may not come.