We need to empower docs to rethink everything about how they practice
As I read Sanaz Majd’s “Why is my doctor always late?” I cycled through many emotions: frustration as a patient, rage as a software designer, and ultimately pity: I am fortunate to be a member of a healthcare technology team that constantly critiques and reevaluates its own processes and tools to work smarter, faster, and more reliably — and I see too many doctors throw their hands up in despair, resigned merely to accept software products, team structures, and business models that are wholly unfit for modern medical practice.
As much as we, outside the medical field, need to see more “days in the life” of our doctors, they too need to see how we in technology (and other industries) embrace change on a daily/weekly/monthly basis. With the right mindset of questioning everything, I can imagine a far more customer-centric, and less expensive, system of primary care that reserves a physician’s expertise for the issues that truly require it.
“The first patient…is brand new… he needs to arrive at least 15 minutes prior to his appointment to complete paperwork and processing.”
This should be done electronically at home, or on the phone with a low-cost assistant.
“A progress note for the patient visit cannot be opened until the patient is actually processed and roomed”
Find a new EHR, or complain like holy hell to your EHR provider or IT department. For a business to be successful, you can’t be held hostage by crappy technology companies and their design mistakes.
“One of the nurses seeks her out to show her an abnormal EKG… The doctor has never met this patient, who belongs to the patient panel of another doctor who is out on vacation. Dr. Tardy needs to search the patient in the electronic medical records, study the medical history… This is an urgent issue; she cannot simply ignore this EKG.”
If the doctor does not know the patient from Adam, and needs to study the history, why is she involved at all? Farm the question out to a Harvard-educated tele-health doc in Bangalore.
“The next patient is also healthy. She has some urinary symptoms and it’s pretty straightforward.”
Again, does this require a doctor? Is all applicable routine care being diverted to lower-cost nursing staff?
“The patient requires referrals for multiple specialists… The family is frustrated because they cannot care for her at home… The patient is also diabetic and her blood sugar levels are out of control…”
This burden should not all fall on the primary care physician. The patient requires team-based care, spread across multiple (professional & family) care providers, including a (yes, lower-cost) care coordinator to manage the time-consuming referral process.
(Note: ACT.md was built for precisely this challenge!)
“The next patient is a 45-year-old who complains that she needs all 4 of her medical issues addressed today because she has a $60 copay and it’s a financial hardship for her to come for more frequent visits.”
Don’t penalize a patient for doing her job, just because the business model is archaic! She should have your kudos for coming prepared. She sounds pretty capable, why not use electronic (and non-real-time) means to manage all the things that don’t require an in-person office visit?
“Mom brings in her two kids — they have been struck with the same bug and are coughing and sniffling every which way.”
Again, this doesn’t sound like something that a highly-trained physician needs to spend her time on. A MinuteClinic, for example, would be far more convenient, and cost far less.
“A 58-year-old woman with diabetes… comes to Dr. Tardy for her 3-month follow up… At the end of the 20-minutes… she admits that she’s been experiencing chest pain for the last 3 weeks…”
The 20 minutes of routine management for diabetes could be done by a nurse in a group setting. Save the physician’s time, expertise, and cost for the acute issues like chest pain.
“The next patient is 15 minutes late — he is brand new and got lost attempting to locate the clinic.”
Some things are unexpected and unavoidable… But has your clinic ever evaluated how hard it is for people to find your office for the first time? Are your website’s directions correct? Is there proper signage?
“Thankfully, the last patients scheduled for the morning are understanding and wait for Dr. Tardy. She sincerely apologizes to each one, as she does to every single appointment she is late for.”
Uber can tell me super-accurately how long I’ll have to wait for my taxi. The clinic’s scheduling system knows you’re running late — the data is there. Why not automatically text-message (or robo-call) your last patients to let them know they don’t need to show up at the pre-scheduled time?
Again, stop settling for broken, outdated systems. These are solved problems in other industries — let’s learn from them.
If necessary, get loud, and fight for change.