I was born and raised in Hawaii. I’ve had the opportunity and great privilege of training at outstanding academic centers abroad, but I always wanted to come home. I’m so glad to be in Hilo.
I was born and raised in Hawaii. I’ve had the opportunity and great privilege of training at outstanding academic centers abroad, but I always wanted to come home. I’m so glad to be in Hilo.
In the middle of my intern year in Denver, my mother called to tell me Tutu, my grandmother, was “bleeding.”
“Did she see her doctor?” I asked.
“Yes, but she doesn’t know what he said,” she replied.
“Where is the blood coming from? Mom, you’ll have to ask her if it’s vaginal or anal.”
My mother sent me a picture of Tutu in her palaka shirt, sitting at her kitchen table, scowling with her fingers plugging her ears with the caption, “She doesn’t discuss such things with me.”
At my insistence, Tutu immediately was moved from Kauai to Oahu where she was evaluated and treated for endometrial cancer by some of the best specialists in Hawaii. Still, I despaired as I realized Tutu was falling through the cracks.
My mother and father, well-educated, extremely busy business owners and respectable community members, were doing their best with the new, added responsibility of being full-time caregivers. Even so, keeping track of Tutu’s dozens of doctor appointments, tests and her course of treatment was hard.
Later that month, I received a phone call that finally calmed my anxiety. My Tutu and mother had met Maile, a patient navigator at The Queen’s Medical Center. Tutu’s appointments now were in order with all of her specialists. She no longer had her blood drawn three times in one week for identical blood tests duplicated by three specialists treating her. The severe confusion Tutu had been experiencing at the onset of her chemotherapy improved after Maile told the oncologist Tutu had not been doing well after her first few sessions and he adjusted her dose accordingly.
“Patient navigation” is becoming increasingly accepted as an important part of caring for seriously ill patients who are lost and bewildered in the complexity of our healthcare system. It refers to a process of clinical advocacy and care coordination, increasing the appropriate and efficient utilization of resources that already exist in order to optimize the outcomes in health care.
It involves training nonmedical, community-based personnel to assist patients in the navigation of the complex medical system of appointments, referrals, follow-ups, testing and treatment.
Also of paramount importance, it identifies personal barriers to health care that patients might not share with their doctors, and helps surmount such barriers. The impact of patient navigation already has been demonstrated through more timely access to care, a decrease in unnecessary testing, improvement in overall clinical outcomes and subsequently reduced health care spending in the treatment of cancer patients. It now is a requirement for federally funded cancer centers in the United States.
As a new doctor in Hilo, I’ve had a roller-coaster experience. I have been brought to tears by the extreme generosity and aloha of this community.We truly are blessed to have such a beautiful gem of a community in East Hawaii. I also have been brought to tears by the disparities in health care outcomes that are evident. A greater percentage of our diabetics end up on dialysis or with limb amputations. Our heart failure patients are admitted to the hospital more frequently and often have shorter life spans and higher complication rates than on the mainland or even other parts of Hawaii. Why is this so?
I have been here for nearly a year. The great majority of the doctors, nurses and other health care personnel here are as competent and capable as any I have worked with elsewhere. What I have noticed, however, is this challenge in the coordination of efficient care.
I cannot help but imagine what our medical system would look like if we had navigation services across all realms of medicine. What would happen if our existing resources were used efficiently, if barriers to doing “what the doctor said” were removed? Might we be able to improve health outcomes in East Hawaii? I think so, and I see Community First as one of the most important resources and integral components of the process toward developing this future.
Dr. Seren Tokumura is a resident physician at the Hawaii Island Family Health Center in Hilo. She is a graduate of the John A. Burns School of Medicine in Honolulu and has completed training in surgery and acute critical care in Colorado.
This column was provided by Community First, a nonprofit organization headed by KTA’s Barry Taniguchi, and supported by a volunteer board of local community leaders. Community First was established to help the community respond to the health care cost crisis and support initiatives that change health care from just treating disease to caring for health.