I had been training for my first full marathon for months. I was on the proverbial home stretch. My race was in four weeks. And then I got a stomach virus that I couldn’t shake. I took nap after nap, chalking it up to the routine for weekly 4:45 a.m. training runs, but I was fatigued in a way that I had never known.
My mind was foggy, and emotionally, I felt like a different person. I stopped into my PCP to get her expert opinion. One CBC later and the answer to my fatigue was obvious. A referral to a local hematologist was an experience in and of itself -- one that left me anxious while I listened to my inner dialogue between hysteria and reason.
I knew the workup would include an at-home fecal occult blood test, or FOBT, to help rule out a GI bleed. No big deal. Really. How many stools have I glopped, poured, and otherwise collected? Countless! How many patients have I personally educated about completing FOBT at home? Too many to even know! Collecting my own stool for three days? Puh-lease. I got this. I attentively listened to my nurse’s instructions, though, and left with the supplies.
And then I got the FOBT card and collection hat home and quickly realized that I had to collect my own stool... three times. (Gulp!) I seriously had to psych myself up to collect the stool, and then I had to figure out a place to hide the cards from my husband. We've been married for almost 14 years, but still... an FOBT card out and about is not my idea of sexy. Looking back, it’s comical. It was a distress-laden three days at the time, though. Over an FOBT card!
Thankfully, I completed the FOBT series with no evidence of a GI bleed, but this experience changed my perceptions of internal barriers to FOBT, which is an inexpensive and evidence-based annual screening method for colorectal cancer (among other uses). "If I'm feeling this and I am fully educated and quite comfortable handling body fluids, then how in the world must my patients feel?" I wondered. Collecting stool is a barrier we can easily gloss over, affecting FOBT completion rates.
How do you assess and intervene with this potential barrier?