Take a Loved One to the Doctor Day With Beth Sandy, MSN, CRNP

Beth Sandy, MSN, CRNP: Hi, my name is Beth Sandy. I am an Oncology Nurse Practitioner in the Cancer Center at the University of Pennsylvania, in Philadelphia, and I'm glad to be here to talk about this topic about taking our loved ones to the doctor.

Oncology Data Advisor: Thank you, Ms. Sandy, and thank you again for taking the time to talk about this important subject. So, why is it important that we take or encourage our loved ones to visit the doctor?

Ms. Sandy: Well, I think it's the obvious. I mean, I work in oncology, but this is really more down to the primary care level. Anyone can have medical problems, including myself. There is a joke that we have sometimes in the medical community, "Well, I'm my own nurse practitioner, or I'm my own doctor." I'm not. I see a nurse practitioner because not all of us specialize in each different thing. So, I think my doctor wanted to check my vitamin D level, and I was like, "Well, what are you going to do about that if it's low?" So, I think we need to explain to our loved ones that the doctor's not a bad person. They're out to look out for you, and there are so many things that can easily be done to manage even the most minor to significant health problems at this point. We should practice what we preach. We are in the medical community, so it's important for us, for our own loved ones to take advantage of medical care that's available just as anyone else would.

Oncology Data Advisor: Definitely, and how would you approach encouraging our loved ones to take the step to make that appointment, and particularly for individuals who are seemingly healthy or against visiting the doctor?

Ms. Sandy: There's a lot of questions within that. So, I think the first one is taking the step to make an appointment. And, I think, it's fair game to warn people that you may have to deal with a menu. You may have to press one, two, or three—whatever it is. To say, "Hey, just call the phone number. You may have a menu, bear with it and follow the prompts." And then for the most part, just have your insurance information available so that you can have that when they're asking that question. So, kind of prep them as to what there might be when you make the step to make an appointment. The other side of that is the, "I'm against visiting the doctor," or, "I'm healthy. Why do I need to?" And that all goes back to, again, you may feel healthy, but hypertension, most people don't feel that.

So, I always go back to the hypertension as being something that's easily managed and can prevent a lot of chronic illnesses, but you wouldn't feel it. You may feel healthy and still have hypertension. Now whether you're against visiting a doctor, that's going to be a different argument. You can ask why. Why are you against visiting the doctor? Did you have a bad experience? Do you prefer a male or female doctor? In which case you can request that. At the University of Penn, we have certain physicians that are specialized in LGBTQ issues. So, do you want to find a doctor that specializes in that subset of patients? Do you want a doctor who is of your own race or gender? You can request all of these things now. So, I think addressing that and getting down to the reason why they're against visiting a doctor is really important.

Oncology Data Advisor: Definitely. And I think that's really incredible that UPenn offers that individualization to your treatment. That's really, really incredible. Why are you, in particular, passionate about this day and this topic?

Ms. Sandy: I think for me particularly there are two things. One is that I am a nurse practitioner and there are a lot of nurse practitioner or advanced practice provider (APP)–led clinics. Physician assistants, as well, lead a lot of these primary care clinics. So, the access now hopefully is improving as legislation improves to allow advanced practice providers, such as nurse practitioners or physician assistants, to become involved and give you more access. Certainly if it's something that is of a more sub-specialization, then we would refer you to a physician. So, I think it's particular for me because I am a nurse practitioner and this is something that is within our scope to manage some of these early-line diabetes, hypertension, things that can be well-managed and prevent chronic illness. That's number one.

Number two is the fact that in the past two years, my mother has been diagnosed with cancer and my father had a sudden cardiac arrest, which he survived. And these were issues where both of my parents do their annual doctor's visit. Neither one of them had felt any of the symptoms prior to being diagnosed with these diseases. I'm glad that they go to the doctor every year, but perhaps they may have needed more testing or someone to look after them more. They live many states away from me. I don't live close to them, so it's not something where I can see them every day. So I think all of us can relate to that and having, whether it's aging parents or whomever it is, that this is something that we can say. These things are available to you, and if not, if there's an insurance barrier, look into that. There are other types of insurances or ways to get access to primary care, especially.

Oncology Data Advisor: Definitely and thank you for sharing that with us. Speaking on the topic of insurance, do you have any advice on how to navigate the financial anxiety individuals may experience when going to make a doctor's appointment?

Ms. Sandy: Yes. Even I have financial anxiety when going to make an appointment. I'm getting physical therapy right now for my ankle, and I have a $20 copay every time I go. So, if I go twice a week, that's $40 a week. My goodness, I'm adding a car payment, but I know about this upfront and I can sort of plan for this. And I think that's the biggest thing here, to plan for it. Call your insurance plan ahead of time and say, is this covered? To what extent is it covered? Look at your card. It will say your copay for primary care and what your copay is for a subspecialist, such as seeing oncology. When you come to my office, we're considered a specialist. So, your copay might be higher for a specialist than it is for primary care. What about screening? Almost all screening in the United States is free. That's been a mandate to say that things like mammograms save lives, and it actually benefits the insurance company for you to get your screenings so that they have to pay less rather than you getting diagnosed at a later stage. So, a lot of that are federal laws that some of these things should be free to you. Also know your deductible, especially early in the year—so January, February, March—some people haven't met an out-of-pocket deductible. And sometimes until you meet that, some of these things won't fall into place with full coverage. So, I would call your plan and just ask.

Oncology Data Advisor: Definitely. You began to mention oncology and screening. So, I wanted to ask you, regarding oncology patients in particular, why is it important that we help and encourage them to continue going to the doctor to stay on top of both their screening and treatment?

Ms. Sandy: Screening is huge. It's interesting because most of us women don't miss our mammograms, but colonoscopies, people are a little less likely to do it. It's a lot more prep for sure. It's invasive. There are other things now that can be done for colon cancer screenings such as using stool specimens to test for blood or abnormalities within the stool. That's less invasive. You don't have to actually prep for it or go to a doctor. But those are things that you can discuss with a primary care doctor or a doctor who's performing screening techniques. There are other forms that may not be as invasive. As technology improves, we're finding different ways to screen people that are less invasive. The other thing that I always bring up is lung cancer screening, since lung cancer is my subspecialty. The uptake is very low on lung cancer screening and computed axial tomography (CAT) scans. Low-dose CAT scans are approved as a screening tool annually for patients who are at risk.

Now, the at-risk population depends on age, it depends on how much you've smoked over your lifetime, and how long ago you quit if you've quit. So, there are a lot of parameters that go into the screening. But again, if you see your primary care doctor, they should go over what those parameters are, and, if you're eligible, make the recommendation. There's absolutely data that shows that screening for lung cancer saves lives. It detects it earlier and saves lives just as mammograms and colonoscopies do as well. So, the best way to stay on top of it is to visit your primary care doctor.

Oncology Data Advisor: Definitely. Final question that I have for you, how do we combat the potential guilt we may feel when a loved one is diagnosed?

Ms. Sandy: This is something that is, again, personal to me because this year my mom was diagnosed with metastatic lung cancer, which is what I do for a living. And I had a lot of guilt at first thinking, wow, how did I miss whatever signs? And the only symptom that she had was back pain. My mom is 70; 70-year-olds have back pain for lots of reasons, who would have thought? And as a never-smoker, it wasn't top priority on my list to think that she would have this. She wasn't being screened, of course, because non-smoking patients are not eligible for lung cancer screening at this time. So, I had to let go of that guilt and I want that to be the message of this as well, that just because your loved one may develop heart disease or cancer or something like that, you can't force them to go to the doctor, number one.

And number two, even if they go every year, there may be illnesses that were not going to be found. They were going to present whether or not you took your loved one to the doctor or whether or not you pressed them. So, we have to let go of that guilt. You can try as much as you want, but you may have a father or father-in-law who says, "I hate doctors. I'm not going, no matter what you say." Okay, you tried. You have to let go of that.

You can do all the things that we talked about. Talk about reducing the financial anxiety by knowing and planning ahead. You can say, "Hey, there are doctors that maybe specialize in what's important to your exact needs." You can go through all of these different things and help them make appointments, but in the end, if they're not going to go and they develop an illness, it's not something that we as medical providers for our own loved ones can say, "It's my fault. I should have made you go." We need to let go of that sometimes. No matter what your best intents are, things are going to happen, but we can do our best. With all the things that we talked about to get our loved ones to see the doctor, we're not bad people. We really aren't.

Oncology Data Advisor: Definitely, and thank you so much for sharing that and being so open about this topic. Thank you so much for your time today, Ms. Sandy, and all your insight.

Ms. Sandy: Thank you, Lyn. It was a pleasure.

About Ms. Sandy

Beth Sandy, MSN, CRNP, is an Outpatient Thoracic Oncology Nurse Practitioner at the University of Pennsylvania Abramson Cancer Center in Philadelphia, Pennsylvania. She specializes in the treatment and supportive care of patients with lung cancer and other thoracic malignancies. Ms. Sandy has authored and coauthored numerous peer-reviewed publications, posters, and book chapters, and has been a speaker at several national and international conferences. She is a member of several professional societies and is active on committees and editorial boards for APSHO, IASLC, MASCC, ONS, and SITC.

Transcript edited for clarity. Any views expressed above are the speakers' own and do not necessarily reflect those of Oncology Data Advisor.