Patient Navigator

It sounds like a Gary Cooper movie from World War II, but it’s not that kind of patient…or navigator. Rather, it is about patient advocacy in modern healthcare.

For those of us who have reached an age where we have collected physicians like the baseball cards of our youth, here is a sensible solution to the virtually unnavigable bureaucracy that has been created by consolidation in medicine.

Over the last two decades, hospital systems have bought up most independent doctors’ practices, creating bureaucracies that have dehumanized and severely limited our doctor-patient interactions. Call centers and schedulers are now the gatekeepers of medicine. They are the first points of contact for most patients. Younger generations may think nothing of it, but those who grew up in the Marcus Welby era (ask your grandparents) were used to easy access to, and direct communications with, their doctors.

Fear of malpractice law suits and the high cost of insuring against them have hospital systems on high alert for possible liability. Thus, gatekeepers have a limited script with narrow parameters when it comes to answering patients’ questions about procedures and protocols, leaving many confused and frustrated.

What that we could all enjoy “concierge medicine” where every patient gets personal treatment. But even where available, it is optional at substantial extra cost in our world of consolidated, commodified healthcare. The less interaction patients have with their physicians, the faster the docs can move through their workload, satisfying the bean counters who now seem to determine the nature of our healthcare. But things are a little different at UC San Diego Health, at least where some ear, nose and throat patients are concerned.

This brings us to the rarified world of teamwork and patient advocacy. It mostly exists at specialty hospitals like The University of Texas’s MD Anderson Cancer Center. But right here at UCSD Health, Dr. Rick Friedman, his surgical partner, Dr. Marc Schwartz, a Physician’s Assistant, and Program Coordinator, Kris Siwek, form a team that brings high-touch to the Division of Otolaryngology and the Department of Neurological Surgery.

My experience began simply enough with a routine visit to Dr. Elina Kari, a surgeon and professor in the ENT department. I say simple, but getting the appointment was hard, because as you may have experienced, it’s not easy to get a timely doctor appointment in some big hospital systems. You need a little luck getting an appointment or heaven forbid, talking to a doctor. So I was delighted when Dr. Kari came into the exam room and introduced herself and her RN, Michelle Panganiban (I said, “Ah, Batman and Robin,” to which Dr. Kari humorously and self-effacingly replied, “Except that I’m Robin, and Michelle is Batman!”) Afterwards, Dr. Kari did that rare thing—she told me to contact her directly. I did and she replied in person, also a rarity, and she told me that she tries to emulate the patient navigator system Kris Siwek runs for Drs. Friedman and Schwartz.

I mentioned that I appreciated the teamwork that was immediately apparent, and in my experience lacking at so many institutions. Like some of my contemporaries, I have experienced the entire gamut of medical care, beginning way back when you could actually get your doctor on the phone, to present day when everything goes through a call center that’s staffed by people we could generously say are not there for their passionate desire to administer the most personal health care available on the planet.

The concept of a dedicated advocate who shepherds patients through the maze of consultations, diagnostic testing, and treatment, varies widely nationwide. In some venues, the navigator is used primarily for scheduling, while in more advanced settings, the navigator could—and should—be called a patient advocate, because they take the time to explain options and discuss treatment plans in detail, and, importantly, in layman’s terms, resulting in better informed patients who are prepared for their outcomes, good or bad.

Ms. Siwek has the passion and dedication of a convert, which she comes by honestly: when she was seven months pregnant, she was diagnosed with a large acoustic neuroma (brain tumor). Knowing it required delicate surgery, she sought out Dr. Friedman, a leader in the field. The tumor was benign and he and Dr. Schwartz successfully removed it in a seven hour surgery. Shortly thereafter, Dr. Friedman asked Kris, the owner of an ebullient and optimistic personality, to join his team, which was then at USC.

Modern medicine is increasingly complicated, and the concept of a dedicated Sherpa to navigate the system from patient intake to the end of follow-ups is not system-wide at UC San Diego Health, nor is it standard fare nationally, but it should be.

Patient advocates re-humanize medicine, and in an age that is more high-tech than high-touch, and that’s a very good thing.