By Dr. Andrew Albert, CMO
One in 20 people will get colon cancer. It’s the second most common cause of death in men and third most common cause of death in women.
Colon cancer arises from small polyps that generally take up to 10 years go grow. Ten years, that’s quite a long time. Some patients have few polyps and others have many. Unfortunately, colon cancer requires just one polyp to rear cancer’s ugly head. I would venture a guess that most of my patients–90% or more–have one polyp after the age of 50. Guidelines by the American Gastroenterology Association suggest Colonoscopy for all patients over 50 (some before then). There are multiple options provided patients to prevent colon cancer; none as effective as Colonoscopy. A Colonoscopy takes 30 minutes of procedure time. Unfortunately, studies have shown (over the past 5 to 10 years) that 30-40% of patients proceed with Colonoscopy. The remainder fails to comply—the one in 20 to get colon cancer.
Why Aren’t More Patients Following Up and Getting Colonoscopies?
Why is this case? What causes such a discrepancy? Polyps and lack of treatment equals colon cancer. Isn’t this intuitive? Fear, apprehension, and angst about the procedure affect compliance with recommendations for screening. At times, patient may exhibit denial. “There is nothing wrong with my health, I feel perfectly fine”. As a physician, these words send waves of anxiety through me. Aside from walking the patient to the gastroenterology suite, there are few options in addressing these barriers. These barriers know no socioeconomic or cultural boundary.
The Patient Referral Process is Broken
What about physicians? With the development of shared risk, there is greater attention paid to the referral process; more significant focus on “measures” and “outcomes.” Referrals to gastroenterologists have increased significantly. Approximately 69% of primary care physicians (PCPs) report they send specialists patients’ medical history and reason for consultation at time of referral, though only 35% of specialists report that they receive such information. Moreover, nearly 81% of specialists claim to send notifications about test results back to referring PCPs, though only 62% of PCPs report receiving such information. Ultimately, only 50% of referrals actually lead to a completed appointment and most referring physicians have no idea whether their patient was seen in the first place.
Unfortunately, it’s because of ineffective scheduling. The referral process is broken. Hospital systems across the nation describe an “abyss,” a chasm between the referring and receiving physicians’ offices. The boundaries of this abyss can often be measured in feet not necessarily miles. The issue is so simple and clear. Walking across the hall or driving the few blocks from one office to another can present a challenge. Patients get lost and it’s out job to help them find their way.
There are numerous additional issues with completing colonoscopy. A multivariate analysis from the Journal of General Internal Medicine identifies barriers including those of female sex, younger age, and insurance type. Patients also perceive colonoscopies as being painful and have concerns about modesty and bowel preparation. As a result, adherence to colonoscopy is low. Ultimately, better communication with patients and resolution of barriers will increase compliance. Making the process of scheduling easier will decrease the impact of such barriers.
This past year, I had the unfortunate experience of diagnosing three colon cancers on the same day. Three women presented to the gastroenterology lab. These lovely and relatively young women were 60, 62, 65 years of age. All three came in for screening colonoscopy. None of them had symptoms. All were found to have colon cancer; a situation that could have been avoided.
Colon cancer is preventable beatable and treatable. Imagine looking at the warm, kind, anticipatory faces of those patients. Then imagine your patient’s smile disappear as you inform them they have cancer. Continue to imagine that pit in your stomach when you realize that if they presented sooner, these conversations would never have taken place.
Thinking about the situation, everyone is affected by this outcome. Aside from the obvious consideration of the patient, one also needs to consider the family, the primary care provider, and the insurance carrier. How could we let this happen!? Colon cancer is “preventable” and all I can think about is how we could have done better for our patient. With all our knowledge, what could we have done differently?
Let’s Start Fixing the Referral Process by Automating it
The referral process is broken and we can no longer rely on patients to make the right decisions with their care, even if informed. We, as providers, need to take responsibility for safety and outcomes. We need to do better for our patients. It’s time to focus on processes at hand and improve healthcare with each attributed life. We need to address these barriers head-on.
An automated referral management platform eliminates patients “falling through the cracks.” The referring doctor or the doctor’s staff would be able to refer at the point of care and schedule the referral, increasing the likelihood that patients will follow through with the procedure. We have seen this with plastic surgery and weight loss referrals in particular. An automated referral management platform would help ensure timely diagnosis and treatment for patients, decreasing the subjectivity of the process overall. Does one really choose to have a colonoscopy? No. Will patients follow through if their physician facilitates the process? Absolutely.
Since the referring doctor schedules the required appointment before the patient leaves the office, the referring doctor can ensure that the specialist within the appropriate time frame will see the patient. Manually tracking referrals is not only difficult and time-consuming, but it also draws health care staff away from other critical tasks. An automated referral management platform takes care of this problem by allowing providers in the referral chain to see whether patients attended their appointments. The coordination of care would no longer be an issue. Such technology would further advance the referral process by sending automated appointment reminders via email or text messages, further promoting patient attendance.
Fibroblast facilitates patient care, improves outcomes, improve safety and quality for healthcare systems. The benefit is clear. It’s time to take the next step!