Linsey Gold, DO, FACS, FACOS, is fellowship-trained breast surgeon practicing at Comprehensive Breast Care in Troy, Mich. She entered practice in 2006, and previously served as the clinical director of the Michigan Center for Breast Health and the director of the comprehensive breast center at Genesys Regional Medical Center. She is actively involved in the American Society of Breast Surgeons, and has been certified in breast ultrasound since 2007.
Q: Why did you pursue a career in breast surgery?
Dr. Linsey Gold: Where I received my general surgery training, there was a notable gap in the level and quality of care in the area. As a resident, I had noticed quite a discrepancy between what I would read or hear at meetings and what was being taught. That was disturbing to me. I was voicing my frustration about these issues to a mentor who suggested I look into doing a breast surgery fellowship. And here we are.
There was a definite need in the area. In a prior job I was at for 10 years, I was the only breast surgeon within a 60-mile radius. I felt like my services were needed in the area. Other than wanting to provide support for other women, I think I do well in a field that allows women to choose the best treatment plan for themselves.
I need the patient to be a partner in the decision making and take an interest in their own healthcare. Breast lends itself to that because it is such a personal field. In addition to the medical aspects of breast cancer care, there are personal and emotional elements to a lot of the different decisions people need to make.
Q: How do you view the role of patient navigation in improving breast cancer care?
LG: I feel it is absolutely essential for good patient care. Without navigation, patients cannot possibly get the highest quality care. It is literally impossible. They will fall through the cracks, they will not get the appropriate follow up, they won’t be offered clinical trials. It will be traumatizing.
By completing a breast fellowship in a great place with organized care and more than one navigator, I saw and trained in an arena which represented how healthcare should be run. When I came to private practice, there was nothing like navigation already in place for me. I had to create it.
Q: What was that experience like?
LG: It can be very difficult in private practice to provide navigation because navigation is considered somewhat of a soft service. It’s not reimbursable per se, unless you have an advanced practice nurse performing tasks. For the most part, it goes into the expense column.
When you’re in private practice, if you are not employed by a hospital and you work at multiple hospitals, then how do your patients get navigated? My solution to this problem was to employ enough staff and increase my overhead so I could make sure my patients got navigated appropriately. It’s probably not an ideal business model, but it’s the right thing to do for patients.
Q: Why was it so important for you to make this investment?
LG: Patients are like deer in the headlights when they are diagnosed with breast cancer. Nobody likes to be diagnosed with any cancer, of course, but for some reason, breast cancer seems significantly more emotional. It’s so visible as a disease.
As a result, you can’t possibly expect to be able to tell the patient here’s the plan for your treatment and you need to do this, this, this and this. They won’t be able to do it. They’re in shock. In the realm of breast cancer, I think that’s asking too much of a woman.
This is why I feel like it needs to be the physician’s, the practice’s responsibility to get patients where they need to be for their care. We schedule 100 percent of whatever is needed for patients, whether it’s follow-up visits, radiographic studies, follow-up imaging, etc. — whatever it is, we schedule it for the patient. We never leave anything or would leave anything as the patient’s responsibility because there is the chance that it may not get done, and we are not willing to put our patients at risk.
I have been known to say that it’s irresponsible for healthcare providers to care for breast cancer patients without an infrastructure that provides a multi-disciplinary care team. I understand that that this isn’t always possible in some parts of the country, but in major metropolitan areas where there are these resources available, navigation should be a requirement.
Q: What do you hope for as the future for care coordination/patient navigation?
LG: It would be wonderful if those philosophies around navigation were standard of care and you could not get reimbursed for your service unless a patient was in a system being navigated. But, unfortunately, in medicine, it comes down to who is going to pay for the services. That’s the problem on a national basis.
If navigating patients were reimbursable, it would be much better for our healthcare system. While I don’t know how that would be structured, I do believe that, in the long run, it would save money and would prevent duplication of services.
One of the components that is awry in our healthcare system is the inability to communicate. It’s outrageous that somebody can wind up in an ER in Texas and not be able to get that patients medical history from their doctor in Michigan. There has to be a way to access and help patients even if they are not in your immediate vicinity.
When you have a way for people to communicate and transfer information, then 100 percent of the time your care is going to be better and it’s going to cost you less money. Communication is the key to everything. A navigator’s job — a huge portion of it — is harnessing the patient’s plan and being the hub of the wheel, with all of the specialists as the spokes. The navigator is what grounds the patient and assists with the transfer of information.
Q: How have you seen navigation evolve?
LG: Interestingly, in the beginning of navigation, navigation was considered emotional support — just a nurse holding a patient’s hand. Don’t get me wrong: These folks still do provide a lot of emotional support, but I think navigation has gone way beyond that. People can get emotional support from friends, family, physicians, and support groups.
The nurse navigator has become a contact person. It is a person patients trust. Even if a patient isn’t thrilled with one of their providers for any number of reasons, the navigator is a go-to person that allows this patient to feel comfortable with their care team. This is what I have experienced with the navigators I’ve worked with. They’re very passionate about their jobs.
I feel like we couldn’t live without our navigator. She coordinates all the breast tumors, does multi-disciplinary clinics, and communicates with the patients. It’s just hard to imagine giving breast care at all without her services. Without our navigator, I don’t know how we would get anything done.