We all have them: the needy patient who takes an extraordinary amount of your time and effort.
They show up late. They miss appointments. And when they finally do come, they seem to have little understanding of their disease, its treatments, and goals of therapy (although you’ve discussed this a thousand times before). And so you launch in, for the umpteenth time, how their cancer can be curable if they follow the plan, adhere to the pathway, participate in their own care, self advocate, or whichever is your language of choice to urge patients in doing their part. But they don’t seem to ever get it. Every visit, the same, but unlike Groundhog Day, no overall growth or self-actualization.
“Can you call my sister?” the patient asks, bewildered.
“Sure, I can.” And after the appointment you somehow manage to squeeze in a call to the sister, who incidentally lives two time zones away (surprise). She seems to understand the issues, but due to distance, defers all decision making to the patient’s son, who, after calling him (at 8:00 PM because he works), can find no earthly way to help care for his mother.
And you wonder, “Why can’t she be more like Betty?” Betty* is diagnosed with the same disease, the same stage, and the same treatment plan. But Betty has it together. Even though Betty is 84 years old, she and her daughter actively participate in treatment. They arrive promptly for appointments, usually early. Questions posed are dutifully jotted within a notebook, leaving room for my answers, which are penned in as the session proceeds. Prescriptions are filled promptly and treatment sessions completed. Betty will likely be cured.
The truth of the matter is, though, in study after study, cancer disproportionately affects the disenfranchised: the poor, the isolated, the needy. And even more tragic, this same group suffers from an increased disease burden, advanced stage of cancer, and lower cure rate. The deck is stacked against them. Add to this limited social support, inability to pay for medications, transportation, or copays, and a generally lower education level. The results easily describe the behaviors of our needy patients. That which we may often attribute to poor choices may be situational and unavoidable.
Better said, these patients are in need.
And we can often help. Identification and breakdown of barriers improves the entire health care delivery process and will likely improve compliance and overall patient outcomes. Plugging our patients in need into social support systems can begin the process of better understanding the patient’s psychosocial situation. If you have a patient navigator program, even better. National cancer support programs such as the American Cancer Society can help provide transportation. Other agencies such as the Leukemia and Lymphoma Society can provide individual patient mentoring by a survivor who has already completed therapy. Treatment of concurrent psychiatric conditions such as depression or anxiety disorders will not only improve the patient’s quality of life, but will also allow them more capacity to cope with the overwhelming demands of cancer protocols.
Cancer preys upon those least capable of managing it. They appear in our offices befuddled and lost, confused and out of control. Their ineffective management of the situation and repeated missteps result in being labeled a needy patient. And quite frankly, the whole situation drives most practitioners crazy. But please recognize that these patients truly need us. They need our care. They need our kindness. They need our direction. And they need our patience.
So the next time your eyes begin to roll after reexplaining the disease and treatment plan for the hundredth time to the same patient, look for help and ways to remove these barriers. Then take a deep breath and remember what a gift it is to be needed by someone.
*Name and details changed for privacy.