Behind the Scenes: A Day of a GoTreatCancer Case Manager

Every day the development of medical science allows doctors to treat even the most complex diseases more and more effectively. However, we should not forget that behind the disease there is always a person: often frightened, confused and anxious because of the sudden and dramatic changes in his life. In order to ensure that the patient is not left alone with his troubles, a new profession has emerged in the field of medicine: the case manager.

A medical case manager is a person who helps a patient get the treatment and care they need for their illness. His/her main job is to coordinate the complex process of a patient's examination, treatment, and rehabilitation, including the patient's visits to doctors, undergoing tests and procedures, and obtaining prescriptions for medications.

In addition, the case manager helps the patient to understand the complex medical information about the diagnosis and treatment plan, provides moral support to the patient, gives advice on care, social issues and organization of the patient's life in the process of treatment and rehabilitation.

Generally, a medical case manager is a kind of personal assistant to the patient, who tries to make the process of fighting the disease more organized and convenient for the patient, and helps the patient to overcome various obstacles and difficulties in the course of examination, treatment and rehabilitation.

Sounds difficult? In that case, we offer you a glimpse into one day of life of a GoTreatCancer project case manager and get to know this profession better

Sunday morning

It might seem nice to lie in bed longer, because Sunday is not a working mood at all. Alas, the peculiarity of a case manager's work requires that today, on Sunday, I should redo things and get ready for Monday.

...Back in the day, when I worked as a doctor in a hospital, I always remembered Monday as a rather crazy day, where you are waiting for a lot of new patients, who were admitted on call and whom you will have to examine, interview, make records, transfers, discharges, after - to have time to go to the operating room, to participate in the rounds with the department, to write protocols of operations and consiliums, while the coffee poured before the beginning of the shift has already had time to cool down several times, to be heated in the microwave and to cool down again.

Speaking of coffee. It's a great idea to start your Sunday morning with this flavorful beverage. Coffee allows you to take your mind off the memories of working at the hospital and focus on the tasks at hand. And they have become a little different: today, for example, we need to discuss with a patient's relative how to behave tomorrow at the doctor's office.

The case is not the most pleasant, but, unfortunately, common. A patient with cancer, who found himself in a typical situation: the disease and its treatment caused a number of complications, for which the patient was admitted to a general hospital a couple of days ago, the oncologist requires treatment of these complications in the therapeutic department, and the general practitioners are not enthusiastic about treating such a “difficult” patient, because the cause of complications is the cancer and, quote unquote, “oncologists know better how to work with it“.

I have been in the shoes of these doctors and I understand that treatment of such patient is always challenging, not only in terms of work, but also morally. I understand, but the patient must get help, and my goal is to prepare him and his relatives on what questions to ask, how to behave, and what to do if this help stalls somewhere.

Hello, Anna, how is your husband feeling today? I know you've already seen him. Okay, he's a little better, but the doctors on duty say that the chief will be there on Monday and let him deal with it...

That can really happen when a patient is admitted on a Friday night.

Now let's have a calm talk about tomorrow's plans...

When you have worked as a doctor for many years, many things seem simple and obvious: you know how the system works, what strategies and protocols are used and how to maneuver between them, trying to do your job, so that is not a weak spot anywhere, and at the same time to maximize the quality of help to the patient.

But you must always remember that Anna, the wife of cancer patient Victor, is a sixty-five-year-old pensioner who has worked in accounting all her life, and has absolutely no idea of the inner “kitchen” of health care, which she encountered when her husband abruptly began to be forgetful and complain of headaches.

Yes, if it comes to a question of discharging Victor with the reasoning that you need to see an oncologist ....

It is not so easy to explain what to do and what to say in communication with the attending physician and the head of the department of the general hospital where her husband found himself. After all, it is difficult to predict their reaction: not quite a specialized patient, in a serious condition and, perhaps, not even at the address of registration, because the ambulance assessed the situation as worse, which in their opinion required surgical assistance, and therefore took Anna's husband to neurosurgery instead of neurology.

Yes, Anna, let's run through what you will say again in case it becomes an open question that your spouse is a cancer patient and should be treated by oncologists...

That's right, Anna, we emphasize that your husband is in the hospital precisely at the insistence of the oncologist, although not in the department he recommended...

No, don't be afraid, the law is on your side. Better even write down in your notebook the number of the order that regulates this...

Of course, tomorrow we will be in touch with you and you will immediately call or write me if something changes. Remember: the main thing is to be calm and clearly say what we have just discussed with you....

Okay, it's easier now, next are the routine questions. At 14.00 we have a call with Maria, we need to clarify how the new medications are working for her, whether they have helped with her nausea and what has happened to her weight over the last 2 days. It is essential to make all necessary notes in the patient's electronic chart.

Before that we need to check Pavel's chart, he has a consultation on Tuesday for which he is now preparing. Tomorrow we will talk with him again about all the important aspects of the future consultation: what questions he would like to ask, how not to miss the most important things.

Pavel has only recently been diagnosed with cancer and he has chemo sessions ahead of him. It is very important that he understands what this treatment is, how it is carried out and why he needs it at all. The better prepared Paul and I are now, the easier it will be for him later.

I am finishing work with Pavel's card, everything is in order with all his data, I have reviewed and structured all his medical documents, checked that Pavel has undergone all the necessary examinations and tests, made a list of questions that he needs to discuss at the consultation with the doctor on Tuesday. We can plan a call with Pavel for tomorrow morning and finalize and consolidate everything important.

Hello Maria, how are you?

I agree, it doesn't sound as good as I'd like it to. Let's schedule a consultation with a palliative care specialist for you? Yes, it is better to discuss with this particular doctor how to deal with this adverse reaction if the medications you have been prescribed have not worked...

Yes, of course, I will create a consultation request in the system and you will contact the palliative care doctor and discuss what to do. The doctor will see your chart and know the reason for the referral, but let's discuss what you want to find out at this consultation. You can write down your questions in a notebook so you don't forget to ask them.

The request for a consultation has been created, the patient and the doctor will handle it from here. Our palliative care specialist is a professional in all cases, even the most difficult ones. Most importantly, he has a great way of communicating with patients and can calm them down, in addition to the consultation itself. Maria is in good hands.

Once again I catch myself thinking that it is easier to refer a person to our GoTreatCancer specialist than to a therapist in a polyclinic. Just a couple of keystrokes, you choose which doctor you want to send the person to, automatically the request for consultation is created for the specialist in our working platform and he/she receives a notification that we need his/her help.

Every time I create such a request, I get a little satisfaction from the time spent filling out the virtual medical record: now our doctor can see the whole history and there is no risk that some data will be lost or overlooked. Maria and I spent quite a lot of time to enter all the important data into her medical record, but our efforts were definitely useful. Maria herself is already an experienced patient of our project: it is not the first time she has worked with our palliative care doctor. The doctor will definitely remember her: when he scrolls through a new request on the platform, he will quickly refresh his memory of all the nuances related to Maria's health.

Maria, if anything is not clear after consulting with our doctor, please write or call me, okay?

I just got an notification for a request for help, and there's an alert on the platform that someone new has contacted us. So, by tomorrow I have enough time to study the data and understand what the person has contacted us with and how we can help him.

In general, the platform itself is quite convenient not only for me, but also for the patient, I think. A person just needs to click on "Get help", go through a questionnaire, briefly describe their problem and confirm that they agree to the processing of their data and to participate in the project, and voila: all case managers get a signal that someone needs help.

Next, my colleagues or I will simply open this request and read what brought the person to us. Maybe the person wants to talk about their illness or the illness of a loved one, maybe they are afraid of their condition and don't know what to do, maybe they want advice on how to get social aid or disability or are looking for a second opinion: all kinds of requests come in. I am ready to work with any request and I am always happy that a person has asked for help and is not alone with their illness.

So, I click “Accept Chat” and start communicating with a new patient.

The case is not an emergency, but alas, not rare. Cancer, 44 years old, was told that “everything is bad and you need to go into surgery”.

Good afternoon, we have received your request, my name is Konstantin. Let's have a talk and clarify all the questions and together with you we will try to find a way out of this situation. You said that you had a CT scan, can you tell me if you have it in electronic form?

Next, I offer the patient to call, and if it is not convenient for him, we continue chatting. Step by step, we begin to collect and systematize all the information about the disease or his condition that we have so far.

It is important to organize all the medical data together with the patient from the very beginning, upload it to the platform, creating a virtual “medical history”. Alongside this, I find out more and more details about the patient's concerns and mentally make a plan for how we can help him.

Together, we write out the entire plan for our work together, creating a roadmap that we will follow until the patient has all the answers to his questions.

Unfortunately, we cannot promise our patients a miraculous cure, we cannot take them to Switzerland for treatment, but we can be there for them in a difficult moment, we can help them cope with the first stress, give them all the information about their disease from leading specialists, and most importantly, we can stand by them when they are worried about heavy treatment, side effects of chemotherapy, uncertainty of MRI findings, or just have an emotionally difficult period of experiencing the disease.

In the evening, I will close my work laptop and exhale: another day has passed not in vain.

Tomorrow will be a new day.