Takeaway
Transportation may be a barrier to healthcare, especially for procedures requiring sedation. Sometimes we need to think creatively and partner with others in order to find solutions.
Lifelong Learning in Clinical Excellence | November 21, 2023 | 2 min read
By Megan Murphy, MD, Johns Hopkins Medicine
“And as a reminder, you’ll be receiving anesthesia. Because of this, you can’t drive yourself and you’ll need someone to drive you home.” As a gastroenterologist, I said this phrase frequently at the end of a visit. Diagnostic and screening procedures such as endoscopies and colonoscopies are common in my world. Usually, the patient nods, knowing that a family member, loved one, or close friend will be with them.
“Then I can’t do it. I have no one to ask,” replied the patient and kind woman. “My husband is dead, my son lives in California, and my daughter can’t take off work. Can I take a taxi? Can I do it on a weekend?”
I realized how inconsiderate I was about transportation home. Before we do a colonoscopy we ask that patients complete a bowel prep, take a day off work, drive to our facility after completing bowel prep, and also ask a friend or family member to take time off work. It’s a lot to ask.
We have rules about leaving after receiving anesthesia. Patients can take public transit or a ride share, but are required to have an escort. The rules are designed for patient safety, but clearly not for patient convenience.
I chatted with the patient a bit longer. After brainstorming, she remembered that her senior center has volunteer ride shares where other seniors escort each other to appointments/procedures. I said that was a great idea and we booked her colonoscopy.
There are many barriers to accessing healthcare, including routine screenings, like colonoscopies. Whether it’s finances, insurance, health literacy, internet access, or transportation, for some patients these challenges can seem insurmountable. As clinicians, we must remember this and always keep the patient’s ability to access healthcare resources in mind.
Things to consider before scheduling a procedure:
1. Is it absolutely necessary?
There are several non-invasive validated methods for colon cancer screening for average-risk individuals.
2. Is it urgent/an emergency?
Can it be timed when loved ones are available?
3. What community resources are available to your patient?
Senior centers or religious groups sometimes have volunteer ride shares.
4. Does your practice offer extended hours?
Some offer occasional weekend or extended hours to accommodate more patients.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.