Binging a series on Netflix is obviously a stress release, and often my job revolves around helping people who are ill, or overwhelmed, or suffering, and often all of those emotions. So, releasing stress is an important part of my day. But I can’t turn off my patient advocate head, even during those moments.
Case in point, Season 3 of the Netflix series Dead to Me.
Now, you’re probably wondering how on earth my patient advocate brain would be triggered by this soapy drama.
Well, in the first episode, Judy (one of the main characters for those of you who have not watched this show yet), gets some news, belatedly and through her friend, more about that later, that they saw some “shadows” on her CT and that she may want to have them get checked out.
She then has to get another CT (or is it MRI – not clear in the show), to confirm, or dismiss?, the diagnosis. Then, she needs to wait till the end of the business day to get a call back from the radiologist as to whether or not these ‘shadows’ mean cancer.
Let’s break this down for a second, because this is television, but some of this is so real!
Stage 1: In the ER – the attending dr accidentally gives Jen (other main character) the possible bad news about the ‘shadows’.
Problem 1) One should NOT delivery potentially bad news while standing at the curtain, (instead of sitting down together quietly), and orally (instead of handing the person a written summary of the findings in a language they can understand) regarding results of a test that they were doing to look for something else entirely.
Solution – Yes, the ER is busy, but if an attending dr spots something that could be potentially devastating for the patient, s/he needs to make the time to accurately identify the patient and then sit down and review the results in a way that the patient can understand. Plus, don’t use vague words like shadows. Only someone who has experience with cancer knows that shadows could mean tumors or lesions.
Stage 2: Here is where it does get a bit television-y cause Jen tells Judy that she needs to get this follow-up appointment, and the next scene is Judy waiting for her CT.
In reality, well in Israel reality, Judy would need to: 1) make an appointment with her family dr, 2) get a referral for a CT based on the attending ER’s written summary of finding possible cancer, 3) get a voucher from the HMO (kupah) for this test, 4) call up any number of hospitals to make an appointment, and hopefully get one within a few weeks.
Problem – This has become a challenge for our fragmented medical system. The doctor in the hospital sees a potential problem but can do nothing to act on it (because the action must take place in the community, which is a different system), and has no ability to make the actual appointment for the patient. But the patient doesn’t know how to make an appointment for such a test that isn’t usual. So now, the patient is stuck with an extremely stressful piece of news (I may be dying) with no real way to act on that information quickly or efficiently.
Solution – There needs to be a logistics person within the system, whose job it is to proactively be responsible for this situation. So, in a case like Judy’s, the doctor would say here, call Ricki, she’s in charge of liaising with your HMO (kupah), and she will make an appointment for you and make sure you have the right paperwork.
Stage 3 – Judy has the test done, by the technician, which is the way of the world. But the technician is not allowed to ‘officially’ read the results.
I’m going to guess that most technicians would be able to determine whether a shadow is a cancerous tumor or not, but only a radiologist can read, interpret and communicate the information to the patient.
I love the technician’s expression here. She so obviously wants to tell Judy something, but she knows she can’t, so she has to hold on to what is, obviously, an uncomfortable disclosure.
Problem – After this exam, where Judy is basically waiting to hear if she has metastasized cancer, she needs to wait until the end of the day to hear the results. Again, this is television, because in real life, this process usually takes 10 days, and in Israel, the news must be given in writing, and not directly to the patient but rather to the attending physician of the patient.
Solution – For most people, this waiting is an eternity and causes an enormous amount of stress for the patient (obviously). We need to figure this out better. Corona brought us video chats with a doctor and improved digital health management. The system needs to figure out how to communicate important (sometimes bad) news to the patient in a timely fashion, with a face connected and not a disembodied stranger’s voice over the phone.
Stage 4 – After the radiologist delivers the bad news to Judy, they both hang up, and she is left with a possible diagnosis, and, well, yes, and, nothing.
Problem – This happens all the time. News is received, sometimes via a phone call or a piece of paper, with no guide for what to do next. Yep, looks like cancer. Better call an oncologist. But who? How? When? Where?
Solution – Here again, we need either a written set of explanations that is automatically sent to the patient when such an event occurs, or a link or even an e-mail of Ricki, or someone like her, who can make an appointment, explain the paperwork and make the event happen. So the patient is not left on the cliff, and has to figure how to get off of it (alone).
So, no spoilers here, to find out how it ends you’ll need to watch the show, but to find out how to be a patient advocate, take a look at this post!