Lisa K. Fitzpatrick MD, MPH, MPA’s Post

John Wilkerson Usha Lee McFarling who might be interested in covering this policy issue? I wonder how many people are not getting screened because of bad process and system barriers like this. Yet, so many are talking about addressing disparities.

Many issues of problems and the inability to solve problems in our healthcare system, but on this specific issue, the whole mammogram system is ridiculous. As a patient they always find something on my mammo, then I need the ultrasound which is right in the room around the corner, but because the Dr didn’t write the separate order for the US I sometimes have to leave and come back, or wait an hour for the order. Every state is different on that as well. I also am on a 6 mth cycle of these tests because I always have a lump that they are watching. Which STILL didn’t allow my new provider here in CA write for the mammo and the US at the same time. I will still go through the same ridiculous wait whenever they decide to call me back. They called to make this appt 3 weeks ago but said they will need my results from Virginia before they can make my appt. 3 weeks and still no appt. As a provider I am embarrassed that this “should be so simple” process is still so convaluted. We build breast care centers with all the machines and staff and pretty pink scrubs but yet we hamstring ourselves with these bumps in the road. I direct and redirect enough of my own care because of these issues and my knowledge on the system.

Thanks for sharing. Unfortunately, this is the norm for too many doctor visits. Often not everything goes as planned and there are conflicting agendas that need to be negotiated. As your story illustrates this can range from getting the needed procedure to getting the right referral to switching to more tolerable meds to just basic respect for you as a person. It is especially difficult if you are not a physician or health care worker. This is in part structural as the US is profit driven with codes and orders and what is or is not allowable or billable can dominate service delivery. No one but everyone's fault as--perhaps we should look to other countries that seem to have the ability to keep the emphasis on service delivery as opposed to revenue stream. Of course, there are millions of visits to health care providers that go well every day--and super dedicated and competent providers who leave it all on the field for patients--but when it goes wrong the scars and microaggressions can acummulate and translate into avoidance and mistrust of the health care providers and system with resulting poor health outcomes. Just compare our healthcare stats with any industrialized country and it is clear we have a major problem.

A growing part of the problem is that Private Equity "owns" more and more hospitals, physicians, and facilities. No matter what the "investors" say, Private Equity doesn't care about people unless it's about short-term return. Almost all have a single focus - balance sheet. And since most (not all) CFOs at private equity treat any training around customer service as a "cost" rather than an investment, the front line health workers don't really get much, if any. They become numb, with angry patients and cost-cutting processes all around them. They want to do a good job but they get no help from their "owners". Sad, actually cruel, all round. I would love to hear from the CEO or CFO of an enlightened PE firm. There are lots of ways to make money and still be decent and caring.

Getting the patient experience right is at the heart of coming up with a disease screening paradigm that truly works in the real world. Because in order for health outcomes to be truly transformed, the screening process needs to be not just “tolerable” but it needs to be a distinctive experience designed with the patient at the center. Access is the very first step in that equation and it’s discouraging you were denied access when seeking appropriate care to which you are entitled. Your experience illustrates why the time is now for direct to consumer testing, especially when it comes to preventative services. There are lots of cool things happening in this space. For example the recent FDA approval of self-gathered specimens for HPV to identify those at risk for cervical cancer. https://pressroom.cancer.org/releases?item=1325

And we wonder why so many people don’t follow up with their cancer screening. This shouldn’t happen to anyone, and I appreciate you posting this to help raise awareness of how a broken system increases risk for poor patient outcomes (rather than blaming patients for missing appointments or not following up). Imagine if a person had to take unpaid time off for that appointment and now must decide between feeding their children and paying bills versus rescheduling the appointment again. I know what I would chose- my family, but at the potential long-term risk of my health and the health of my family (if I am not well or around to care for them). The smallest things matter in healthcare and can often have a profound impact on the future. 🙏🏻

Lisa, first I am sorry this happened to you. Trust is the foundation of our health system along with empathy and humanity. Trust used to to be a given, something we all understood as integral to our practice but more importantly we used to take the time to see our patients as people. The business of healthcare has stripped out the most fundamental element’s in an effort to increase productivity and profitability. We all have pause long enough to call this out-because you are right without trust, curiosity, humanity and empathy value based care doesn’t work. We can change the system-one person at a time. I hope the technicians who did your mammogram leaned something about how to treat patients…like people.

We need a health delivery system that focuses more on human beings and treats them as a consumer worthy of their time and attention.

Recently, I've gotten so many notes from my PCP's office indicating that sorry we're going to have to cancel the appointment I made 2 months ago because he/she isn't available. And to call the appointment line to reschedule or through patient portal. Then the courtesy Thanks. No voice of apology or attempt to even call. I quickly go to see in the patient portal when his/her next available is... 2 more months away. This is the system we have. And I, like you, are knowledgable more than the average person about how/what to do. I cannot fathom how someone tries to navigate/schedule up a series of visits that need to happen and get done in order to move forward in their course of treatment or care plan.

Glad you stood up for yourself. As a breast radiologist, I find it frustrating when I can't get the necessary imaging for my patients or it gets delayed because of incorrect orders.