When it comes to my patients, waiting is unacceptable

The waiting is the hardest part
Every day you see one more card
You take it on faith, you take it to the heart
The waiting is the hardest part.

-Tom Petty and the Heartbreakers

I’ve never been good at waiting for anything. Instant gratification has been my middle name, and I’ve gotten in lots of trouble because of it. I think that I have improved with age—I am less likely to become apoplectic when the stoplights fail to coordinate to green, or when the driver in front of me creeps along at a snail’s pace, or when the line at the movie theater is longer than I expected, or, God forbid, the line for the heavily buttered newly roasted popcorn after I’ve gained entrance to the theater means that I might miss the opening scene. Knowing that the popcorn is always better than the movie, I wait.

When it comes to my patients, though, the waiting is still unacceptable. We have a rule in my office — a referral must be seen within a week of getting the phone call or faxed request — sooner if that patient is in pain, or has symptoms of airway obstruction or spinal cord compression or is bleeding from his cancer. The problem for many of my patients, especially here in Southern California, is that they have often waited far too long already. The paperwork and time and energy spent making phone calls and filling out forms is staggering. Primary care doctors are overwhelmed. Insurance companies are obstinate. It is not uncommon for a patient to have been diagnosed for over a month or longer before they are seen by me.

When we moved here from Massachusetts in 1993, I had already grown accustomed to patients having to wait for treatment. Massachusetts is a “CON” state, meaning “Certificate of Need”. In order to purchase and install new radiation therapy units, which are considered “high tech” and very expensive, one had to petition the state, and undergo scrutiny and a series of tedious hearings held by self-important politicians who clearly never had a close friend or relative with cancer. I remember treating upwards of fifty patients a day on the linear accelerators, and having to triage patients with cancer into urgent, and less urgent cases. Lung cancer and brain cancer first, prostate cancer last, and everything else in between. How does one place a value on a life hanging in the balance?

When I arrived in California in 1993, and joined a private practice, the founder of the practice, Dr. Jack Abrams, who hired me had a very simple philosophy: “See ‘em, sim ‘em and treat ‘em.” Meaning that if we got a call from a referring physician, we were to see the patient within 24-48 hours, perform their simulation, otherwise known as the treatment planning session, the same day or the next, and start their treatment the day after that, or even the same day if necessary. This was SERVICE, defined as I had never seen it defined before. The referring physicians and the patients were very grateful and I am quite certain that this philosophy cured more cancer than the waiting, and the wading through mountains of paperwork.

Jack Abrams is long gone now, but the philosophy of service that he ingrained in me twenty years ago remains. If you are one of my primary care physicians who needs your patient seen today, just call me on the phone. I will stay late and see your patient, and so will my wonderful oncology nurse. My superb chief radiation therapist will do that CT simulation the same day if necessary, and my dedicated physics staff and radiation therapists will stay as long as is necessary to get your patient — no, our patient treated. No one will suffer needlessly on our watch. This, I promise. The waiting is the hardest part.

Dedicated to Dr. Jack Abrams — we did not always agree, but you were a fine example of our breed.

Miranda Fielding is a radiation oncologist who blogs at The Crab Diaries

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