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Friday, August 10, 2012

The Big Wait

By Heather Millar

Woman with Doctor

As I mentioned in a previous post, I went in for my six-month oncology check-up last week. Everything went fine. There is no sign of cancer. I had nice chats with the mammogram tech and the oncology nurse practitioner. Then, as everything was winding up, the NP said, “Wait just a minute. I’m going to go find Dr. Rugo.”

Dr. Hope Rugo is my oncologist at UC San Francisco. She is high-powered. She somehow manages a full clinical practice while publishing a flurry of academic papers each year, flying around the world to conferences, meeting with reporters, presenting patient education forums, and helping to run the UCSF Breast Care Center. I often wonder if she sleeps. I had absolutely no expectation that I would see her at my check-up.

Let me back up: When the pathology came back after my lumpectomy and it became clear that I would probably need to do chemo, my breast surgeon gave me quick profiles of the various oncologists at UCSF. Here were my options as she put it: one was gruff, but very smart; another was very focused on taking care of patients but didn’t do much research; another tried to balance the demands of research and the demands of patients and so on, through the roster. Then, my surgeon said, there was Dr. Rugo: brilliant, caring, at the forefront of her field. She will give you as much time as it takes at the beginning, my surgeon explained, then she will manage your case through her team of nurse practitioners.

I mulled over these options for a couple days. Having an oncologist who was involved, and personally there at every step, sounded wonderful. I know of oncologists who personally administer the chemo to their patients, who provide massage, acupuncture, and other complementary treatments during, or after, infusions. I call it the “spa” model of oncology, and it sounds lovely.

But after a lot of thinking, I decided that what I wanted more than a soulful, high-touch doctor was a big, big brain to figure out how best to stamp out my cancer. Once this big brain had outlined a game plan, nurses and nurse practitioners could handle the play-by-play issues of my case. For the rest, I figured I could find my own masseuse or acupuncturist if I needed those services.

A few days later, my family and I met with Dr. Rugo. She explained my options, explained the science, explained what further tests I might need, explained the process of chemo. She gave us a full two hours, an eternity for a doctor. She was focused, caring. I saw her again, for about 45 minutes, just before my first chemo infusion. She was just as smart and focused as she had been the first time. When I was worried about side effects after that first infusion, I emailed her. She responded in less than an hour, from a conference in London.

But as the chemo settled into a rhythm, I saw less and less of Dr. Rugo. I didn’t have any dramatic emergencies, so I dealt with her terrific nurse practitioners when I had questions about things like mouth sores or joint pain. That’s what I’d signed up for, and that’s what I got. I think I still got terrific treatment.

Fast forward to last week’s check-up. As the nurse practitioner left the exam room to get Dr. Rugo, I figured that there must be some policy that oncologists see their patients at least once a year. So I waited, and waited. I flipped through one magazine, and then another, and then another. Then I started reading The New York Times on my iPhone. Then my phone died. Then I heard the med techs in the hall wishing each other good night. Then it got very quiet. I looked at the clock, and realized I’d been waiting more than an hour. It was dinnertime for most people.

So I stepped out of the exam room and decided to try to find Dr. Rugo. I ran into a housekeeper vacuuming the carpet and asked her if there were still any doctors in the clinic. She said yes, and motioned to the end of the hall. I checked down there, but saw no one. I retraced my steps and bumped right into Dr. Rugo and her NP.

“I’m so, so sorry!” Dr. Rugo said. “I was trying to get another patient admitted to the hospital.”

I guess I should have been annoyed, but I wasn’t really. Dr. Rugo was being absolutely consistent: She had another patient who obviously was having an emergency. She was focusing totally on that patient and lost track of time. If I’d been having an emergency, I know she’d focus on me. But I’m not a crisis right now, thank goodness.

I explained this point of view to Dr. Rugo. She looked relieved and gave me a hug. I guess she was glad not to have a cranky follow-up patient in addition to everything else.

What do you think? Would you have been angry if you’d been kept waiting that long? Would you rather have an oncologist who’s high-powered or one who’s high-touch?

Photo: Polka Dot

Posted by: Heather Millar at 5:20 am

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