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The oncological diagnosis and treatment card (otherwise known as the DiLO green card) is a document aimed at accelerating the procedures of diagnosis and treatment of neoplastic diseases. It was introduced on January 1, 2015 along with the oncology package. Rafał Janiszewski, the owner of Kancelaria Doradcza, talks about the benefits of having a DiLO card in an interview with Poradnik Zdrowie.
Anna Tłustochowicz: Who issues us a DiLO card and when?
Rafał Janiszewski:The DiLO card is an element of the Fast Oncological Path, i.e. a set of provisions that guarantee the patient a special way of carrying out diagnostics and oncological treatment. The closest point on this path is the primary care physician. It is a family doctor who, in case of suspicion of cancer, issues us an oncology card, i.e. a DiLO card (also known as oncological diagnostics and treatment), and directs us to a specialist doctor.
What does this card give us?
Generally, it should make us reach a specialist faster than other patients who do not have this card. It is known that specialists deal with various diseases, apart from a specialist, of course, who is an oncologist, and here we assume that a patient with a suspected cancer has priority in the queue.
Can only a family doctor issue a DiLO card?
It can also be done by a doctor in a hospital, when, for example, during hospitalization, an imaging test was performed and a neoplastic disease was diagnosed.Remember also about an important thing: that we can go to the oncologist without a referral!In the vast majority of cases, cancer patients receive the first-time consultation on the day they come to the facility, and at the latest - a day or two later. It is then that at the oncologist they enter the fast oncological path.
So the patient has already received a DiLO card. What's next?
The card is supposed to make him obtain the diagnostic service faster.
In the case of the path of an oncological patient, diagnostics are divided into two stages.
First, we have ainitial diagnosis, , the purpose of which is to confirm the malignant neoplasm. This is done, for example, by taking material frombiopsy or during the procedure, during which the lesion is removed and the collected material is sent for histopathological examination. The second step isin-depth diagnostics . I would like to point out right away that sometimes both of these stages occur so quickly one after another that the patients do not distinguish them.
What is the purpose of an in-depth diagnosis?
By performing imaging tests, genetic tests and molecular tests, the stage of the malignant neoplasm and the type of cell are determined in order to be able to determine exactly which type of treatment will bring the optimal effect.
Diagnostics should last up to 7 weeks, but - up to 28 days there should be confirmation of neoplastic disease.
28 days to confirm malignant tumor: is it really fast?
This date has been set because the histopathological material is most often examined as part of this diagnosis, and the sameexamination lasts about three weeks . Not because of the queues. The reason is the preparation technology and the test process itself. It just has to go on.
What happens next?
When we have the initial and in-depth diagnostics, the most common isconsilium, i.e. a meeting of the interdisciplinary therapeutic team , during which all test results are analyzed. Sometimes, but not necessarily, members of the council also want to see the patient. The aim of the council is to develop a treatment plan.
You said that the council consists of many therapists. That is, of all the oncologists working in the ward?
No. The team consists of an oncologist, surgeon, specialist in the field of chemotherapy, and a radiologist. Each member of the council considers the legitimacy of using a specific method of treatment: surgery or radiotherapy.
The DiLO card aims to define and quickly implement the optimal treatment plan for a specific patient.
What are the deadlines?
The oncology package prefers that treatment be started within 14 days from the date of the consultation. One by one, the planned stages are carried out, but of course it happens that during the implementation of the treatment plan - it must change due to the fact that the patient's clinical condition changes. Sometimes the conference takes place again.
What happens when treatment ends?
The patient is referred back to his primary he alth care physician. Of course, he receives appropriate recommendations, it is necessary to monitor certain parameters that indicate whether the tumor is recurring,or not. The family doctor often treats any complications. In general, the entire oncology package is aimed at accelerating the availability of diagnostics and treatment, as well as organizing this path.
It must also be said that this path can be implemented in many institutions. In one, the patient may have surgery, in the other, he may receive chemotherapy, and in the third, he may receive radiation therapy.
But how to move quickly and efficiently between these hospitals?
This is what the coordinator does. In each hospital implementing the oncology package, there is a person who reads the treatment plan and makes appointments and indicates where the patient should go.When receiving the DiLO card, it is worth checking who is the coordinator.On the card should be his data and telephone number. In general, coordinators are proactive and try to care for their patients. The Fast Oncological Pathway was devised to organize everything related to treatment on the one hand, and to encourage clinics to stick to their deadlines on the other. The one who meets the requirements pays the National He alth Fund better, more profitably and without limits.
Is the reality really as pink as your story shows? It all sounds great!
Well, unfortunately. Life often shows us something else. Some patients come to hospitals with the DiLO card, others without. Some at an early stage of the disease, others very late. Institutions must prioritize! So they put patients in a line, on dates appropriate to their he alth condition. In practice, it may be that someone has an advanced disease and requires a quick admission, so a patient with a DiLO card, but in a less advanced stage - waits. So the hospital, despite its good intentions, may not meet the deadlines. With the DiLO card, we can go for an MRI or CT scan and in the vast majority of cases we will have to wait in line, because these are tests that are not used only by oncological patients! There are trauma patients, often in life-threatening situations, and in such a situation it is obvious that they must take precedence.
The deadlines are not always met, which does not change the fact that generally hospitals try to stick to the standard of the fast oncological pathway.
Another change in oncology awaits us soon: a network of hospitals will be created.
It is precisely because of the fact that patients with various diseases come to specialists, and this mixing of patients means that the oncology package does not work well,the row came out. It was decided to create a network of oncology hospitals, i.e. facilities that will only provide oncological services. Money is to be concentrated there, intellectual potential is to be concentrated there, and there the cancer patient will be operated on by a surgeon who deals exclusively with oncology. But this is the song of the future! Today, honestly, it must be said that the DiLO card and the fast oncology pathway are beneficial for patients, but all this does not work as efficiently and quickly as we would like.
Expert
Rafał Janiszewski, owner of the Advisory Office providing services in the field of he althcare organization to he althcare entities
Speaker, organizer of many trainings and conferences on he alth protection and patient rights. In the years 1998-1999 an employee of the Office of the Government Plenipotentiary for the Implementation of the General He alth Insurance. Author of over 20 books on he althcare organization and he alth care financing standards. In 2005-2007, he was an expert of the Presidium of the Parliamentary He alth Committee, as an advisor on he alth services. Co-author of the general study as part of the Pharmaceutical Pricing and Reimbursement project for the European He alth Commission.
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