Desirae Ehley - Patient Centered Ethics: Pathography

Jan 21, 2022 at 02:29 pm by pj


     Outrage. Frustration. Terror. Fear. Anxiety. Helplessness.

      These are some of the numerous emotions that were palpable on the man’s face, whom I shall call Tyler from now on. Tyler had previously been diagnosed with a malignant thymoma – a cancerous mass in his chest. His story is heartbreaking on so many levels. First of all, he was diagnosed in his early 30’s. His oncologist decided to treat the thymoma with chemotherapy, so Tyler has had three cycles of chemotherapy so far. Unfortunately, his insurance company did not approve the PET scan that his oncologist ordered. PET scans are integral in Tyler’s case because they have the ability to track the chemotherapy’s progress to see if the treatment is working. Because Tyler wasn’t able to get a PET scan, he was not able to start the fourth cycle of chemotherapy after his appointment that day.

     While in the exam room with Tyler and his oncologist, I noticed that the physician was very kind and caring toward Tyler. During the exam, the oncologist took the time to make several phone calls to Tyler’s insurance company to try to get the PET scan approved. I also noticed outrage and frustration on the physician’s face during this process as he battled with the insurance company and struggled to understand why the insurance company denied the PET scan. After much debate, the insurance company finally approved the PET scan. Once he hung up the phone, the oncologist explained to Tyler that he can have surgery to remove the mass if the PET scan shows that the thymoma has decreased in size with chemotherapy. If the thymoma does not shrink with chemotherapy, the oncologist will need to pursue other treatment options besides surgery. Tyler listened patiently as his physician explained all of this to him, but he appeared anxious and scared during the discussion. His oncologist noticed this, however, and he took the time to pat his hand, maintain eye contact, exhibit positive body language, and demonstrate empathy throughout the entire discussion.

      On a more personal note, during the exam I learned that Tyler has an extensive family history of numerous types of cancer. He also has several children and a wife, whom he loves very much. He wants his family to be provided for after he passes away, and he just wants them to be happy when he’s gone. He expresses gratitude for his own health insurance in addition to his wife’s health insurance through her work. He notes that cancer is expensive, but he is still grateful that he has two types of health insurance because they help cover his cancer treatments and doctors’ appointments. Without his insurance plan, he would not be able to afford all of the medical bills. Unfortunately, his tumor has recently started to negatively impact his quality of life. He went on a vacation with his family a couple of weeks ago, but he was not able to fully enjoy it because his condition is slowly getting worse. He tells me that he just wants to walk his children to school without becoming short of breath. This is why it is integral that Tyler receives proper medical treatment and imaging modalities, and it is also essential that the imaging studies be approved by his insurance company in a timely manner. That shouldn’t be too much to ask, should it?

      Thankfully, Tyler’s most recent PET scan ended up showing that the thymoma had slightly decreased in size, so he was able to get another round of chemotherapy. My last time seeing Tyler was actually during his fourth chemotherapy treatment at the doctor’s office, which was a couple of weeks after our initial encounter. He recognized me from our previous meeting, waved at me, and smiled. During this last encounter with Tyler, he seemed weaker than before, and I could see the wrinkles around his eyes and mouth. He appeared tired and a little sad, but he still wished me luck in my future. He was the epitome of kindness and positivity, even during numerous frustrating obstacles. He knew that he likely only had one year or less left to live, but he did not let this discourage him and he continued to put on a brave face for his family.

      Overall, this experience showed me numerous tasks that occur behind the scenes but are nonetheless very important to patient care. It was disheartening to see how insurance companies sometimes deny orders from physicians solely from a monetary perspective without thinking of the impact that their decisions will have on the patients. Patients need to be regarded as actual people with feelings rather than a financial burden to insurance companies. Patients definitely deserve better. Thankfully, there are many physicians in the world who fight for their patients, just like Tyler’s oncologist. Lastly, listening to Tyler’s story helped me understand some of the thoughts that go through patients’ heads who have a cancer diagnosis. This experience was not a normal doctor’s appointment where I just took Tyler’s history and performed a physical exam. I was able to spend quality time with Tyler and he truly showed me the kind of man that he is by opening up to me about his life and his emotions. I still think about Tyler from time to time and I wonder how he is doing. I strive to be as strong, caring, and formidable as Tyler when I am a future physician.









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