From East to West; the Pain of Waiting Is the Same.

Jul Bul Img Charkhchi

The last time that I was in Ann Arbor, Mich., my Uber driver asked me where my home was. I truly didn’t know the answer. I was born and raised in Tehran, Iran, where I graduated from medical school. Then I moved with my family to Toronto, Canada. And now I’m living in Baltimore, Md., where my husband works. And, every month, for one week, I travel to the University of Michigan in Ann Arbor for research. I think my driver was as confused as you are right now about my home!

Living in different countries and cities has allowed me to experience vastly varying health care conditions in these different settings. There is not much to talk about regarding patient- and family-centered care (PFCC) in Iran. Iran is a country in the Middle East and has a population of about 80 million. The majority of people in Iran seek their health care in university hospitals (which have little or no co-payments), as they can’t afford the costly private hospitals. To give you a perspective of the workload at a university hospital: Have you watched movies from World War II, where, at the health care center, all the soldiers are lying back-to-back in the aisles? That’s what you find at current ERs in most university hospitals in Iran. When I was an intern, I visited a patient with forearm cellulitis. We couldn’t admit him for IV antibiotics because the hospital didn’t have any available beds. He came in for four consecutive days with his giant hand, and then he stopped coming back — probably he ended up with sepsis, or he borrowed money to be admitted to a private hospital. So maybe PFCC in a setting like Iran seems impossible. But I would like to talk about my own experience as a patient in Iran, as well as in Canada and the United States, and the similarities they share.

There is a term called medical-student syndrome.…When you are rotating in the oncology department you have a high suspicion that you have some type of cancer; then you go to the neurology department, and you think you have Multiple Sclerosis (MS); and in Gastrointestinal rotation you are sure you meet the criteria of Irritable Bowel Syndrome, at least! One time my symptoms seemed to be serious. I had left arm numbness for about ten days, so I went to my professor. Besides my symptoms, she found signs related to my differential diagnoses, of which MS was at the top of the list. She ordered brain and spine MRIs with and without contrast. I was genuinely stressed out. I couldn’t focus on anything. My professor recommended doing the MRI in a private clinic where they have renowned radiologists. It took about two weeks to book the appointment. I was dying to know the result of the MRI. I remember lying for about an hour in the MRI tunnel — once I came out from the tunnel, I asked the first person I saw, “What did you see?” He answered, “I’m only a technician. You have to wait for the radiologist’s report.” It took two weeks to get the report and another two weeks to see my neurologist. My MRI result was fine; but the entire time — from making the MRI appointment until my follow-up visit with the neurologist — was a nightmare for me.

About eight months ago, I was diagnosed with subacute thyroiditis in Toronto, Canada. My primary care physician ordered a thyroid ultrasound (US) for a post-treatment checkup. After the technician had performed the US, I asked her multiple questions: “Any nodules? Any abnormality? What was the thyroid size?” She looked at me strangely and all she said was, “It was fine.” Well, I waited about two weeks to see my primary care physician to discuss the details of my US. To be honest, this time I had only a little stress because it was a post-treatment checkup, but I was as curious as the other time to know my imaging findings right after it was performed.

I know you are tired of hearing about my ailments, but I’ll share one more with you. About two months ago, I received a CT and an MRI at Johns Hopkins Hospital in Baltimore, Md., for a broken femoral bone and meniscus tear. Coming from a developing country to a developed country my expectations were higher for the care I would receive in the United States. When I came out of the MRI tunnel, I asked the same question: “Did you see anything?” and got the same answer as I got in Iran: “You have to wait until your physician contacts you.” It seems East and West have something in common! Whether you are in a country with impossible workload due to poor health policies, or in a developed country, in which excellent health care readily is available, you have the same patient experience. As a patient, each time you go through the diagnostic imaging process, it is time-consuming, most likely expensive, and may be the most crucial part of your disease diagnosis. The entire event can cause enormous stress. I think the least I expected each time was to have an expert right after the imaging to explain the result. I desperately wanted my radiologist to be there after the long procedure (brain and spine MRI), to sit with me and discuss my radiologic findings. I believe this is a patient right. Having an immediate discussion with the radiologist about findings would help patients to be better informed about their diseases and more prepared for their follow-up visits to their primary care doctors. Immediate communication of basic results will help to form better shared decision-making between doctor and patient, and, at the same time, save the patient from the stress of the worried wait.

 By Paniz Charkhchi, MD, Post Doctorate Research Fellow at the University of Michigan, Ann Arbor

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