I recently attended the David Stroud Adolescent and Young Adult [AYA] Symposium at Keck Medicine of University of Southern California. It was a very interesting symposium with experts in adolescent and young adult cancer presenting on many different topics important for this population. There was also a panel of young adult cancer survivors, and this, for me, was a definite highlight of the day. Four highly articulate and dynamic panel members told their cancer stories. There were stories of delayed diagnosis (common in this age group) because they “are too young for cancer.” There were also stories of appropriate and timely investigations when a lump was felt in the shower. And, there were stories of great empathy and caring for young people who indeed were too young for cancer, but for reasons of biographical disruption rather than diagnostic improbability. One young man on the panel talked about his experience that was clouded by fear and uncertainty. He was alone, his family of origin far away, and everything happened in a blur. He talked movingly about a specialist who came to see him late on a Friday night soon after he was admitted for surgery. The physician sat with him and answered his many questions. The young adult man knew that this was taking time away from his family and that this was not something that the physician had to do — but his appreciation was profound. Something he said provoked a great deal of introspection on my part. When asked what oncology care providers could do better for our patients, he said: “Give me your cell phone number. I’m not going to call you, but just having that number comforts me.” Do I ever give my cell phone number to patients? No. Why not? I’ve thought long and hard about this. Patients call me all the time on my office line. I make a point of spending as much time as I can answering their questions, or, I ask if I can call them back later if I don’t have the time in that moment. The work I do, sexuality counseling and treatment decision making, does not lend itself to telephone conversations, so I often ask patients to come in to see me (and patients do not pay for my services; I am on salary so actually seeing the patient doesn’t make a difference to my income). What would it mean to me if patients could reach me on my private cell phone? Would I be wakened in the middle of the night by patients in crisis? That is highly unlikely. Would dinner be interrupted on a regular basis? Also, not likely. Would having a “work only” cell phone make a difference? I’m not sure, and I don’t relish the idea of keeping two phones with me, ensuring that the batteries are charged, and that I don’t lose one or both or forget to take them with me wherever I go. The work I do as a sexuality counselor is highly unlikely to result in crisis calls (although, I could imagine a sexual situation gone wrong as being a crisis for a patient) as opposed to my oncologist and nurse practitioner colleagues who work with acutely ill patients. Giving one’s cell phone number to a patient can, of course, lead to abuse of what some might see as a privilege. Oncology care providers are entitled to down time, and call groups and emergency phone numbers exist to deal with patients outside of regular hours. Perhaps there are some more vulnerable patients who need more support than normal. I suspect we all see patients whom we recognize having this need for greater reassurance. The question is how we respond to that perceived need. We can identify many barriers to providing patients with our cell phone numbers. Many of these barriers can be overcome or at least mitigated. What has stayed with me so vividly since I heard that young man talk is the comfort that knowing his doctor’s cell phone number brought him. In the midst of providing care and hopefully cure for our patients, surely comfort is just as important. Source
