Geography Matters With Complex Healthcare Problems!

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The challenge for clients with complex healthcare problems is to become aware of the medical “rules” for treatment that vary with geography.

Here’s how it works:

A 62 year old professional developed angina ( heart pain with exertion). He required a triple bypass. At the time of surgery, a small lung cancer was discovered. He had this small cancer resected ( removed).

Unfortunately, four  years later, the disease had spread and he had developed many small spots of tumour (known as mets) in his brain. He had 34 spots or mets in his brain.

In most hospitals, he would be offerred whole brain radiation. Unfortunately, there are complications with whole brain radiation. He and his family did some research and wanted gamma knife therapy.

Gamma knife is a sophisticated non-invasive treatment using many highly targeted beams of cobalt 60 radiation to destroy the tumour(s).

The patient was assessed at hospital A by a radiation oncologist. The “rule” at hospital A was that they would treat 3 or fewer mets with the gamma knife. Any more than 3 mets and there would be no treatment. SOL.

The family did more research and discovered a radiation oncologist at hospital B in another city. The radiation oncologist had pioneered the development of the next generation gamma knife which was operating at hospital B.

The radiation oncologist at hospital B reviewed the patient’s case and concluded that they could treat him because their “rule” was that any number of mets was treatable as long as the total volume of the mets did not exceed 15 to 20 cubic centimeters (cc’s). In fact, they had treated a woman with about 60 mets. She is now two years post-treatment.

This “rule” worked for this patient who selected to be treated at hospital B. The patient had his mets mapped with an MRI, the physicist on the team did the math and developed the radiation treatment plan and the patient was treated at one session, albeit a very long session.

The learning is that “rules” about treatment vary with geography. There is no logic that explains the “rules”. The “rules” just exist. The process is one of working with the constraints or opportunities presented by the “rules”.  In fact, the best patient outcomes are achieved by becoming aware of these “rules” and how they can be applied.

The process at Rupert Case Management (RCM) is to seek diverse viewpoints from experts in different locations in order to learn about their “rules” and then select the treatment option that works best for our clients.

Remember geography matters for clients with complex health care problems because the “rules” vary with geography.