Compassionate Scheduling
 

During a recent self-examination, Colleen found a new lump in her breast near the area of the initial surgery. I think it could be nothing more than scar tissue, and therefore nothing to make a big fuss about. (Plus, being the caregiver, it is my job to be reassuring and not inflame a pretty scary situation.) Colleen disagrees with me and thinks it could be a return of the cancer and is worrying a whole lot (I don't blame her) and she thinks I am not taking this seriously enough. I do take it seriously. It has me scared but inflaming her fear is not going to make things easier for her.

She went to her primary care physician, and he scheduled the high resolution mammogram and he told her he thinks it is just scar tissue. Colleen ordered the mammogram and was initially scheduled to have it taken on March 23rd. After worrying for several days, she called back and asked if she could get an earlier appointment. The radiologist said that he is allowed an exemption to a training seminar that he didn't want to go to anyway for compassionate care, so he moved the appointment up to March 18th, which is still ten days away.

Because of this, I thought about a way in which the HMO can change their scheduling policy so that people don't have to wait several weeks worth of emotional anguish to find out if they have a return of cancer or not. Today I am going to the customer service representative at the HMO to present to them what I call compassionate scheduling.

First off, it is important to realize that all mammograms are not equal. Someone waiting to find out if they have cancer should be able to have some priority in scheduling in order to relieve mental anguish. A routine mammogram for screening purposes isn't going to have the same importance or the same emotional value.

So I suggest that when people schedule a routine screening mammogram, they have the option of signing up for compassionate scheduling. If someone with the fear of cancer hanging over their heads needs a mammogram, the person who comes in for a routine screening mammogram has the option of trading their scheduled time with someone with a greater emotional need who was scheduled for a later date.

The routine screening patient would only be asked to trade once and only once and they would have the satisfaction of knowing that they are doing a tremendous thing for someone who is emotionally stressed.

To me, it seems like a win-win situation. The only down-side I see is a little bit of added paperwork for the HMO and it may add to non-compliance of women who are reluctant to get a mammograms in the first place.

My question to you, is this a policy that is worth pursuing? Is there some down-side that I do not see? What would be some stumbling blocks to implementing the plan so that I may have some answers to resistance I may encounter?

Your feedback is going to be very helpful to me. Thanks!

Lee

Re: Compassionate Scheduling
 

I love it! What a great idea!

The only problem I see it is how to convince the non-anxious patients to trade up appts with the anxious ones? For example, when airlines oversell their tickets they offer money to a passenger to give up a seat on the plane. What would be the incentive for the non-anxious patients? Perhaps the way to do it is to make the trading-up appts transparent to the non-anxious patients, or come up with some kind of incentive for them.

Another idea is to reserve a slot at the end of the day for the urgent cases, similar to what pediatricians do for kids. I always manage to get a same day appt for one of my children if they fall sick - we should be able to get same day mammograms too. Since it's almost always technicians that do the mammograms, I don't see how this can't be done.

Re: Compassionate Scheduling
 

That is a great idea!!!

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Ditto on that. My HMO already does something in that respect. I know I would not have to wait 3 weeks for a mamogram if we suspected a return of cancer.

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What a great idea. I agree with Marcia; pediatricians have daily time reserved for sick kids. I think both would be nice; have a standing time and if needed allow someone to give up their scheduled time. Maybe they could have keep an indicator on a patient's account that they could be contacted to re-schedule an appt if there is an emergency.
Kris...

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Bejuce:

Thanks for your input. I was hoping that the act of doing something kind for someone else would be enough incentive. A monetary incentive may kill the idea for the HMO because they are going to necessarily incur a little bit more paperwork costs.

I am sure someone who has had breast cancer would gladly trade dates, but would just an average person be willing to trade for compassionate reasons? I am betting that a good percentage of people are really pretty decent and would be willing to trade.

Thank you everyone for your input! I think I will go to customer service later on in the week because you have given me something more to think about. I am probably going to only get one chance to sell the program so I better be as prepared as possible.

Re: Compassionate Scheduling
 

I bet a brief explanation of the circumstance, even just alluding to an "emergency" need would make most accept the reschedule. I suspect the main problem with reschedules is if it seems random or done solely for someone else's convenience. The patient in dire need could sign/send/have forwarded a thank you card.

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This is the way they do it at my place. No waiting if you have a "diagnostic" mammogram, PET, CT etc prescription. In the beginning, I had scar on one side and a cyst on the other (different times) and I was in the next day for a digital mammo and ultrasound. So, some places do things differently.

For my normal once a year, if I need it in July, I have to call the end of May to stay on track (cuz its just a normal test and not "diagnostic").

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Hi Lee,

I sure hope that Colleen's test shows everything okay.

Take care, Catherine

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Can't get a wink of sleep so I'll weigh in...brilliant idea and I am sure it will work. Here's another twist - The doc's office can merely select (2) time slots each day and when they book those slots tell the patient that they are CATS - compassionate appointment time slots, meaning someone with cancer may NEED to come in that day, explaining they would need to give up their appointment but would not be "bumped" again. That way, when a "regular" patient is making an appointment, they could decide if they are ok with the CATS. I know this sounds like a bad set up for a joke, but I am serious. Woman are extremely superstitious about their mamograms and would see it as a good omen/good kharma to give up an appoinment free of charge. I think it would for sure work. Meanwhile, being a bit superstitious myself, tell Colleen that in Hebrew, numbers are also words and 18 = Chai which is the word for LIFE. Oh, and one more thing - what about going back to the surgeon and let him feel what she felt. He may be able to reassure her even further. Flori

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Re: Compassionate Scheduling
 

I hope Coleen's scan will be benigh. It is always hard to be in the 'waiting' situation...

The 'non-urgent' patients most likely have had their appointment made 3-6 months or even 12 months ahead of time. In many cases it's probably hard for them to change their appointment especially if they are working full-time and/or have other care-giving duties.

Our hospital has a system called 'urgent care' which falls in between a regular appointment and an emergency room visit. We can call the 'on-call' nurse line about our concerns and the nurse 'oncall'will advise us to either go to the emergency room, call our family doctor, or make an appointment with urgent care. I have found that getting care in the ER is not necessarily faster than seeing the family doctor...

In contrast -

The 'country' dentist we go to is a one man show. He would take 'emergency' appointment if the problem needs immediate attention or the patient is anxious about something. He simply opens the door to the waiting room and gestures the 'extra' patient to go in (especially when his receptionist/secretary is busy.) While he's working on our teeth, he talks non-stop asking about our family members...

We usually can get an appointment within 2 weeks. But a couple of times we just called ahead and then walk into his office in the same day - then walk out after being examed for less than 1 minute.

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I love the idea and wish my hospital would do this. I also agree that most people are kind enough to consider an urgent case and wait for another appt.
However, Pinkgirl 's comments also got me thinking, why tell the non urgent cases at all??? Maybe just a re sheduling appt would suffice??

Lee, good luck to Colleen and hope it's B9 !!

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I'd be very UNhappy if my doc's office rescheduled me without explanation. I think if your appointment is bounced, you deserve to know why. Many times my onc is running very late and I have to wait, sometimes almost two hours. BUT I know that when I have an emergency, she always fits me in, so I gladly wait, knowing that in this setting you cannot always stick to the schedule. But getting bounced, like my dentist did to take a "celeb" in my place, well, I bounced right over to another dentist!

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Lee,

Just checking in to see how everything went on test day. Are the results in or are you still playing the waiting game? Be sure and let us know.

All my best to you and Colleen.

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Sorry about the delay. We went in to the mammogram and were told that they weren't sure what was going on so they immediately scheduled an ultrasound. The ultrasound showed nothing but scar tissue. Colleen was told that she had quite a bit of edema in her breast after the lumpectomy and it took two years for the swelling to subside enough to actually feel any scar tissue which was what Colleen was feeling.

As for the scheduling, the HMO liked the idea and the assigned a management group to see how the project could be implemented. I also learned that Colleen could have gotten in to mammography within three days of discovering the suspicious lump, but she asked for a female doctor to do a PAP test three years ago. Because of this, the HMO didn't schedule her for the first available appointment, but the first available time a female doctor of radiology was available.

After all of the stuff Colleen has been through, and having male surgeons, ultrasound techs, male nurses, male oncologists and all of that, why they chose to insist on a female radiologist is baffling.

Oh well! I am so happy that there was no cancer that I am not going to be upset about a scheduling mess.

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Great News! Happy for the two of you :-)

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So happy to hear that everything came out okay. Now you can stop planning for "what if" and concentrate on having some Spring-time fun.

Glad to hear that the HMO listened to your idea and are looking into implementing it. Colleen may not have benefited from your idea, but many others will.

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Oh, I'm so glad to hear that all is well! Let us know how things go with compassionate scheduling....it's a wonderful idea. Hope it flies!

Barb A.