Thursday, July 10, 2008

Finding Time

Right now I have a young man (40ish) with end stage metastatic prostate cancer who had a tooth out while undergoing chemotherapy including bisphosphonate drugs (an anti-osteoporosis medication also used to minimize bone pain and the spread of metastatic disease).

One of the side effects is that if you take a tooth out while someone is on a bisphosphonate they can develop persistent dead bone where the tooth came out (osteonecrosis of the jaw). If you do it while they're on intravenous doses during chemo it can be especially bad.

He has a bad case but has decided to forgo any more treatment (of any kind). I see him about once a month, talk for 1/2 hour and see him again a month later*. We talk about the tooth, how he's doing and what's planned for the coming month. The one thing we've agreed not to discuss is the prognosis. There's not a lot of purpose to our talks other than to make sure he's doing OK. I don't think we have many appointments left. Unfortunately, this is not the first time this sad scenario has played out in our clinic.

Because our wait times are under control being able to spend extra time with patients like this is guilt free. It does not increase another persons wait.

I often write about the amount of time that can be saved but a major benefit I don't mention is the amount of time that can be spent. The ability to spend our time as caregivers with someone that can really use it is an often overlooked benefit of efficiency and something that is lost in translation to the charts and graphs of the non-clinical administrative world. How do you measure compassion?

*so that no-one thinks that I'm bilking this man or his insurance plan his appointments are always done on my dime. One of the quirks about our system is that unless an Oral Surgeon sees a patient in hospital medicare will not cover it.


Barbara K. said...

Just found your excellent blog through Grand Rounds.

I appreciate this post. When I was in the thick of an uncontrolled pain condition, my PCP, although unable to cure me, saw me once a month to support and coach me. I attribute my getting better to not only eventual specialist expertise, but to the caring and hope my PCP offered along the way.

Kim said...

I've never looked at efficiency this way before: as something that allows you to do what you want (spend time with patients) as opposed to forcing you do to things solely for expediency.

Great post.

Ian Furst said...

thanks to you both.

Pranab Chatterjee said...

This is indeed inspiring for a med student like meself!