Opinion articles

Friday, September 27, 2013

ONLINE FIRST: Dealing with Health Care Reform and Cancer Patients




With all of the changes from the Affordable Care Act, health care reforms occurring in every insurance plan and independent practice association, and changes in attitudes and practice structures of oncologists (as well as physicians in general), patients are having increasing problems getting the very best care.  Patient confidence in the health care system and in doctors is shrinking. 


As oncologists, we see this in our practices every day. For example, we receive denials of authorization requests for therapy that we consider to be up to date and in the patient’s best interest. Physicians are often having difficulty staying current, and attendance at meetings is more variable. Many physicians are developing conflicts of interest between complying with payor guidelines, versus doing what the doctor feels is in the best interest of the patient. Many of our patients are losing insurance and having to transfer their care to other oncologists. 


Increasingly, patients are not accessing clinical trials. Often, patients continue to seek chemotherapy even when we realize and the patients’ acknowledge that it may be futile. 


In this atmosphere of changes, physicians and their staff frequently lack the time to address all of the patient’s concerns. Better resources are needed to help patients navigate the pathways of health care among their primary care physician, specialists, as well as oncologists. 


After years accumulating my patients’ stories about their problems, and developing my suggested solutions for the most common issues, I wrote a book: Surviving American Medicine. This book, with a foreword written by Fran Drescher, an endometrial cancer survivor, addresses many serious patient concerns, including:

  • How to find good insurance (as well as a details about the different types available);
  • How to find the right physician;
  • How to increase communication and the efficiency of office visits with physicians;
  • The ins and outs of getting second opinions;
  • How to access clinical trials;
  • How to successfully appeal health insurance denials;
  • How to use the Internet to improve health care;
  • Practical advice about facing cancer and other chronic illnesses;
  • How to find affordable medications;
  • What to know about genetic testing; and
  • Key recommendations about cancer prevention. 

After publishing this book, I have begun to use many of the tips mentioned with my patients to help them understand their condition, and adjust to the stress of fighting cancer. Chapters in the book emphasize the importance of using electronic health records to help each patient, and to increase the information patients receive.


In addition, my colleagues and I have recommended the tips in each of the chapters to help focus patients on strategies to be more confident in their care. Researching the book has helped us to save time in explaining the basic information about diseases, treatments, and side effects with patients, so that our medical staff can be focused on dealing with patient concerns.


Most importantly, the information has improved the efficiency of time spent with our patients resolving their issues of cancer care.


I also wanted to point patients to many of the excellent resources available online via ASCO, NCCN, ACS, and other organizations. After reading the trusted websites, my patients are encouraged to bring back questions on their next visit -- questions that otherwise might go unanswered.


I have been encouraging my health care colleagues in the communities in which I practice to read the book and evaluate how it can help them to practice more efficiently, and help their patients to have more confidence in the care they are receiving. We have recommended books to patients as well as their families whenever we feel they can benefit from it.


In today’s atmosphere of change from the Affordable Care Act, more is expected of patients to be responsible for their own care. The book provides one solution of how we can help without having to provide lengthy discussions with each patient repeating the same information. More importantly, the book also helps physicians and health care personnel to think about how they are providing the highest quality services to patients and expecting patients to improve their ability to participate in the healing process.


I encourage other physicians to engage in the process of making their recommendations available to patients and other physicians. You can begin with articles in local or national media, communicating on YouTube, and Facebook, and posting blogs. As examples, see my doctor-to-doctor oncology blog posts on Medscape biweekly, and my doctor-to-patient medicine blogs on www.survivingamericanmedicine.com to help you get started.


Proceeds from the book have been donated to the American Cancer Society, the Cancer Support Community, local hospitals, local religious institutions, and patient advocacy organizations.




CARY PRESANT, MD, FACP, is an oncologist at Wilshire Oncology Medical Group - California Cancer Medical Center – US Oncology and Professor of Clinical Medicine at the University of Southern California Keck School of Medicine. He is a Past President of the Association of Community Cancer Centers, Chairman of the Board of Medical Oncology Association of Southern California; a Past President of the American Cancer Society, California Division; and Chief Medical Officer of DiaTech Oncology Corporation.

Surviving American Medicine: How to Get the Right Doctor, Right Hospital and Right Treatment with Today’s Health Care (iUniverse, 2012, ISBN 978-1-4759-3775-6; available in hard cover, paperback, and electronic versions) won the International Book Award for the best book in health for 2012; and he also received the award for Best Humanitarian Campaign from the Book Publicists of Southern California.