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As her last bit of advice for me during my first day “running” an ambulatory surgery clinic, Vanessa said, “I like to say ‘Good luck’ to the patient before handing over a copy of the consent form and directing them to pre-admission testing.” I balked at this. Luck? These were men about to undergo a laparoscopic prostatectomy, not about to play in a soccer game.
That day I clumsily said, “Good luck with everything,” to a middle-aged patient, almost as an afterthought while the man collected his paperwork and oriented himself toward Pre-surgical Testing. He turned around, looked me in the eyes and said, “I really appreciate that.” Of course I had not done much, and that was the first and most likely last time our paths would cross. Yet he had undoubtedly become well-versed with people like me, the hospital, its procedures, and the terminology – staff ushering him in and out of exam rooms, phlebotomists drawing blood for another PSA test, the ultrasound-guided transrectal needle biopsy, the probe-assisted MRI. “Radiology.” “Pathology.” “Diagnosis.” “Malignancy.” And then he stood before me, facing major surgery and its accompanying anxiety. After that, he would have a whole new set of concerns: catheters, recovery, erectile dysfunction, nocturia, additional PSA tests, the fear of recurrence (and then the prospect of radiation therapy, chemotherapy, and/or hormone therapy).
With the slightest gesture and even less intention, I had shown this man some much-needed empathy. The complicated nature of a patient and his needs had always been a topic stressed at the human resource meetings at Memorial Sloan-Kettering, but in my administrative role, it sometimes sounded trite. The reality is much more powerful. Once I took a good look around the urology and genitourinary clinics in which I worked, it became impossible to ignore the patients’ experience: long queues for the cystoscopy room, extended wait times for follow-up visits, unavailable CAT scan appointments, the bald testicular cancer patients lined up for another day of high dose etoposide cisplatin, stoic men sitting alongside their hand-wringing wives, and the steady flow of new patients every single day. And while each patient brings his own set of issues, he also collects the daily stressors and trauma that the perseverance of undergoing cancer treatment will inevitably entail.
This revelation was more than enough to promote my interest in Quality of Life research through the Department of Psychiatry. Here the HR tag lines and maxims are realized scientifically. Through our collaboration with surgical and medical oncologists, we study the psychosocial and neuropsychological issues facing patients undergoing treatment for prostate cancer. The overall aim is to utilize our results to establish interventions that can assist clinicians in better recognizing comorbid diagnoses such as anxiety and depression, and thus facilitating the appropriate referrals. The benefit is not only seen in the doctor’s efficiency and efficacy of care, but also in the patient’s physical and mental health, as well as his overall cost of treatment.
If I have learned anything from my work in health care, it is that patients’ needs tremendously outnumber the system’s resources. To be part of research that endeavors to maximize patient care while minimizing cost has only wetted my appetite to help more. And to that end, I would like to become a resource myself – to help offset the enormity of the health care system’s limits and inequality and to further empathize with patients and the complexity of their needs.
I want to do much more than say “Good luck.”
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