Working the System

"Prepare and Prevent, otherwise Repair and Repent."
-- Anonymous

My pager directed me to call a trusted colleague. Her brother had just been diagnosed with head and neck cancer, but he lived on the East Coast. Who should he see? What could he expect? We talked about his care and narrowed the options. She decided to get appointments for him to see the cancer team at the "very famous medical center" about an hour from his home. He would have access to world-class care from world-renowned experts. They were reassured and made the contacts.

The process was a challenge from start to finish. First, there were delayed reports and appointments. Next, one of the key physicians went on vacation and the office tried to re-schedule the follow-up. The family was stunned by an extraordinarily pessimistic and impersonal encounter with one of the treating oncologists.

My colleague spent hours on the phone working to bypass the system through the nursing staff and acting as an advocate for her brother, who, by this point, was terrified. Clearly, his care would have been delayed if she had not directly intervened.

"I shudder to think how people who don't understand these systems ever get through treatment there," she reflected.

Their experience is, of course, not unique. Cancer patient scheduling has both an urgency and complexity that other types of medical care do not. Even before treatment begins, there is an intricate choreography of appointments with physicians, imaging studies, laboratory testing, decision making and treatment planning. Every center in the country has grappled with the dilemma of being maximally efficient yet personal. Just read their advertisements.

The plans for the expansion of the Froedtert & The Medical College of Wisconsin Cancer Center include our own attempts at making the system work for the patient. This process has included listening to cancer survivors as well as treatment providers.

Direct intervention by "cancer navigators" is already a reality for newly diagnosed breast cancer patients; it will be expanded to provide an insider who helps move people through the system as rapidly as possible. In addition, new approaches to scheduling and multi-disciplinary care will improve access to research-based, flawlessly delivered care for both patients and referring physicians.

A cancer-care systems researcher recently commented that the process whereby a sophisticated insider can make the system work to maximum advantage might be called "bending." She asked, "How do we make the system bendable for everyone?" Great question. Great challenge.

Bruce H. Campbell, MD, FACS
Professor of Otolaryngology and Communication Sciences
Chief, Division of Head and Neck Oncology
Interim Director, Froedtert & The Medical College of Wisconsin Cancer Center

"Reflections" is a collection of essays by the health professionals of the Medical College of Wisconsin.