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Hurry Up and Wait!
Ernest H. Rosenbaum, MD and Isadora H. Rosenbaum, MA
The doomsday scenarios you conjure up during stressful waiting periods are usually far worse than reality.
Waiting for appointments and test results can turn living with cancer into a full-time occupation and preoccupation. You count the weeks and days until your next appointment and make note of every ache and pain, thinking it might be a symptom of cancer. On the day of your appointment, you are so anxious that you arrive early at your physician's office, only to discover that he is behind schedule, increasing your waiting time as well as your apprehension. During your visit, your physician orders the required tests and tells you to go home and wait for a phone call - or suggests that you call back in a few days or a week to get your test results.
You are always waiting for something: the initial diagnosis following surgery, a biopsy, mammogram. or fine needle aspiration, the results of treatment and. when in remission, your next checkup. The most difficult aspect of waiting is the open-ended uncertainty of not knowing what is happening inside your body. Conversely, knowing can be a relief, even when the news is not good. because you and your physician can then take action and discuss therapeutic alternatives.
You should also he aware that the time you spend waiting for appointments and for information on your medical status is often determined by circumstances beyond your control or that of your physician. For example, because of economic pressures, most physicians see more people per hour today than they saw in the past, resulting in shorter office visits that can make you feel you have received insufficient consideration of your psychosocial needs. Physicians' increasingly heavy workloads also lead to longer waiting periods for an appointment, whether for an initial consultation or for subsequent therapy.
The operating procedures of insurance companies and Health Maintenance Organizations (HMOs) can also lead to delays that, in turn, increase your apprehension. These organizations generally require that physicians get an authorization from them before ordering certain types of tests, therapies and surgical procedures. You or your primary physician must also request permission from the insurance company or HMO to consult with a specialist -- although you must, of course, choose one who belongs to their plan. If you choose a specialist who is not on their plan, you may find that they will not pay for the services. Any or all of these negotiations can mean added hours or days of fretfulness for you.
In short, many delays are endemic to the treatment of cancer today, but with a little mutual understanding and effort, you and your physician can attempt to deal with those that are occasioned by heavy patient loads, complex diagnostic tests, and insurance company and HMO requirements. Hopefully, in the last instance, future legislative action will streamline some of the medical management procedures that currently prolong certain waiting periods and exacerbate what is already a highly stressful time in anyone's life
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