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Life at the intersection of health and mental health: Coordination of care

January 15, 2014
by Sue Bergeson
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I see my oncologist tomorrow for the first time. By now I have had two surgeries, nine tests and seen 29 professionals for my breast and uterine cancer. I am still at the beginning of my journey – just seven weeks out from diagnosis. Tomorrow will mark the 30th professional called on to help me with these two illnesses with an unknown number yet to go. 

A few obvious thoughts:

  1. This is exhausting. I have long since lost any sense of modesty. After a while it’s all kind of a blur, anyway. When I go for a test or procedure I have to look at a printed list I carry with me when they ask me my doctors names as I have so many of them (and it’s a relatively uncomplicated disease and diagnosis). Every time I interact with another professional I need to ask questions, to engage, to think. I feel like I have to invest and form a bond to ensure the best outcome for each interaction. I am tired – tired of dealing with strangers, tired of explaining, tired of answering the same questions over and over again. But I really cannot afford to show this because I need the professionals I interact with to be as committed as possible to the procedure they are doing, the forms they are filling out, the work they are doing that will move my case along to the next set of professionals. 
  1. This is depressing. So every time something happens with me, my records are shipped back and forth between surgeons and radiologists and cancer specialists and goodness knows who. There are just two people on my healthcare team who know nothing about what is going on with me, who have no access to my physical healthcare records: my psychiatrist and my psychologist/therapist.

We have long known about the co-morbidity of cancer and depression. For example an article published in 1996 states, “Studies show that half of all CPs (cancer patients) have a psychiatric disorder, usually an adjustment disorder with depression. Effective psychotherapeutic treatment for depression has been found to affect the course of cancer. Psychotherapy for medically ill CPs has reduced anxiety and depression, and often pain. In 3 randomized studies reported previously by D. Spiegel et al (1989), psychotherapy resulted in longer survival time for patients with breast cancer (18 mo), lymphoma, and malignant melanoma compared to controls. The treatment of depression in CPs may be considered a part of medical as well as psychiatric treatment.”(PsycINFO Database Record (c) 2012 APA, all rights reserved) Cancer and depression. Spiegel, David; The British Journal of Psychiatry, Vol 168(Suppl 30), Jul 1996, 109-116.

The importance of psychiatric treatment for people with cancer is fairly well known yet as far as I can tell, no one ever has even thought to ask me/my family if I 1) feel depressed or 2) have a psychiatrist or therapist who should be involved in my care. Ironically, my psychiatrist’s office is located less than 500 feet from the front door of the hospital where I went for both surgeries.

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Sue Bergeson

Serves as the Vice President of Consumer and Family Affairs for a large managed care company

@@BergesonSue

Sue Bergeson is a behavioral health consumer and a family member of behavioral health consumers...