I once shared a tiny slice of an office with a medical director and a pediatric social worker. The office had one door, ran maybe 15 feet deep, and was 6 feet wide. A single desk, really more of an extended platform, with three computer workstations, ran along a glass wall. Guess who sat aaaaalllll the way down, between an upright file cabinet and the back wall? Even if no one else was in the office, I had to shimmy-shimmy and tango my way around my colleagues’ chairs to reach my own. It was rare that all three of us were in the office, but when we were, we had an agreement that if there was an earthquake, please tell my family that I love them because there was no way I was making it out alive.
Hospital humor is very, very dark.
The office was wedged in a far corner of the patient wait area for pediatric primary and urgent care. Even if you weren’t directly involved in a patient’s case, you were aware when there was some sort of drama around a patient. One family in particular often comes to mind: two moms, one dad, two kids born maybe weeks apart. To say that these ladies hated each other is an understatement. They wore their contempt like cologne. We all knew when their kids had appointments. Before you clutch your pearls at this baby-daddy-drama, take a deep breath. Life happens. People fall in and out of love (or get played) all the time. People make the best choices they can with the data available to them. And whether you live on Russian Hill or in the Bayview, situations like this one aren’t unique.
I was sitting at my little workstation, minding my own business, and one of the front desk staff burst into our office deathtrap and said, “Maureen, come quick, there’s a fight.”
My physician office mate tucked herself against the desk (maybe grateful that she hadn’t been summoned?), and I slid out.
I look back, and I can’t tell you why front reception ran to me, but I can tell you that if I were in that situation today, I might say, “No, call Security, and be ready to get under your desks.” But that day, I ran over to try to help.
There was no mistaking where this fight was going down. You could hear the ladies shrieking at each other from the elevator bay. The gentleman that they were presumably fighting over just stood looking at the floor, probably praying that he was anywhere but there. One woman very theatrically started taking off her rings as both children looked up woefully from their (separate) strollers. A former Alabama high school lineman who was also one of my favorite nurses (ever) arrived on the scene just as I did. He drawled a phrase that, to this day, ranks as one of the funniest things I’ve ever heard a nurse say:
“Now, don’t go whipping out the Vaseline just yet!”
I told the ladies to stop because they were scaring their children. Just as they spun around, glaring, hospital security (thankfully) arrived. Mr. Alabama and I slinked away and went back to work.
I returned to my workstation. My officemate, a very elegant, Ivy-educated physician, tapped at her keyboard, whispered a sigh, and asked, perhaps to no one,
“Why do they always schedule their appointments together?”
Her question bewildered me. How could anyone think that this was a choice? Maybe she did. She was one of the kindest, most open-minded people I knew. I responded, perhaps not-so-elegantly,
“Dude. He’s the only one with a car.”
I’ve written before about luck and health. Some subscribe to the belief that we are reincarnated and revisit this life repeatedly until we learn a lesson. If you asked me what my assignment for this life is, I would say it’s the realization that the only thing that separates us from each other is random chance. I haven’t seen it in a million years, but I loved the film “Sliding Doors” when it first came out: very different life journeys decided only by a closing train door.
Speaking of cars and trains, I (and two very different clients) have been talking about transportation a lot lately. Many factors can limit patient access to care. Biotech, Pharma, and Medical Device manufacturers most often focus on:
- Financial barriers (insurance coverage, assistance with patient out-of-pocket costs, free medications for low-income or the uninsured)
- Patient education (how to administer injections at home, how your implanted device functions, which pharmacies are in a manufacturer’s distribution network)
But sometimes (or often), the hurdles patients must jump are logistical. Sometimes, just getting to and from the doctor’s office will knock a patient off therapy. While the expansion of telehealth and telemedicine under COVID has permitted some patients to access new kinds of care, other patients sit on the sidelines, waiting. COVID vaccine rollout has been so very complicated thanks to a multitude of reasons. Travel, specifically patients’ ability to reach vaccination centers when public transportation has been curtailed, and shelter in place orders keep family members apart, often has been overlooked. And COVID’s impact on clinical trial design and participation still unfolds.
In the case of the family described earlier, COVID didn’t repo anyone’s car. And COVID cannot claim credit for the distance between infusion centers and rural patients, or that some cutting-edge treatments are available at a select few academic medical Centers of Excellence. As many as one-third of Medicaid patients put off an appointment due to transportation issues.
Is there anything manufacturers can do to assist patients with travel? Bad consultant moment: I don’t know. I’m in the thick of it right now, and trying to figure the landscape out. Anecdotally, I’m seeing health systems (i.e., providers and sites of care) partner with rideshare companies to help patients attend medical appointments in person. Health systems can also assist patients with coordinating Nonmedical Transportation (NMT) and Nonemergency Medical Transportation (NEMT) with the patient’s health plan (including Medicaid).There are independent charities that provide medical air transport for patients. And of course, there are independent patient and advocacy groups that offer financial assistance towards patient travel costs. But other than informing patients about these programs (and being very careful to not refer patients to any one specific charity program), I’m struggling to find innovative solutions for patients that don’t put the manufacturer at risk. If you feel like bragging about an awesome patient support or transportation program, please feel free to drop me line (please and thank you). I would love to learn more.