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Yet Another Type of Healthcare Professional Who Focuss on Patient Support

Posted Jun 18 2010 12:00am

I have been developing a list of of new types of healthcare professionals who interact directly with patients. Here's how it currently stands: coach, counselor, telephone booster, and nurse-information-triage(ist) (see: The Emerging and Expanding Role of Counselors in Healthcare ; Telephone Calls and Emails as Key Components of Primary Care ). To this list, we can now add patient navigator (see: Patient Navigators: A Different Viewpoint ), Quoted below is an opinion piece by an oncologist, Dr. Barbara McAneny, who reacts to a previous article in the Journal of Oncology Practice that advocated the use of patient navigators in physician office settings:

The authors suggested that patient navigators would be a valuable addition to any practice and described their use in several settings. If we are not careful, we may be witnessing the birth of a new allied health provider. Practices today cannot afford additional staff providing unreimbursed services, but this is only one of the reasons I am bothered by the navigator trend....It is crucial to have another friendly set of ears present to help the patient recall the discussion. I feel this role is best played by a family member, loved one, or close friend, not a stranger assigned as the patient navigator. The untrained friend or family member may get details wrong.... It is the job of oncologists to educate patients and families at their levels and to realize that emotional reactions are part of patients' hardwiring. We can set up another appointment, take the time to overcome that barrier, or provide the patient and friend or family member with written materials. Abdicating this function to a patient navigator will work only if the navigator has sufficient medical training and specific qualifications. The services provided by navigators become expensive quickly and are not reimbursable, adding to the already burdensome overhead of oncology practices. If we were to decide to employ patient navigators, how many patients could one navigator navigate....The other aspect of patient navigation involves helping patients get all the appointments, tests, procedures, and information needed and ensuring that the insurance companies pay for all of these....This is the part of patient navigation I find most alarming. We have created such an inefficient system that we need to invent a new medical specialist to help us cope with it. If our system necessitates navigators, we need a new system.

I must admit that I find myself generally sympathetic to the concept of a patient navigator working in the office of an oncologist. Ideally, and as emphasized in Dr. McAneny's comments, the role of sympathetic patient advocate is best filled by a relative or friend of the patient. However, not all patients understand this need or have ready access to such people. Therefore, having a member of the office staff who can function as a patient advocate and second set of ears strikes me as an advantage. Now you may well ask at this point, why do you not consider physicians themselves as the key and sufficient patient advocates? My response is that I believe many, if not most, oncologists view their goal as treating cancer patients, often with chemotherapy. How much latitude is there in an oncology practice for a patient who does not want to be treated at all or does not place the same value as the oncologist on extending his or her live by a couple of months.

The general tone of Dr. McAneny's comments is somewhat imperious. She is distressed by "the birth of a new allied health provider." She concedes that "emotional reactions are part of patients' hardwiring." She also appears to be overly concerned that the "services provided by navigators become expensive quickly and are not reimbursable." Finally and perhaps most inappropriately, she suggests that the need for patient navigators is based on our "inefficient system." Although I would not doubt that this is frequently the case when scheduling new appointments, lab tests, and imaging procedures, I also believe that the need for the new patient intermediaries discussed above is largely the result of the complexity and aloofness of modern care, particularly for cancer patients.

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