I like the American Medical News. I know they are associated with the AMA but they do a great job and that is why I reference their stuff a lot. I have two connections over there that I know and have helped with stories in the past. One of them is Kevin O’Reilly who is one of their best writers. That is why it pains me to rip on him for his article Serious work put into making primary care fun again. Let’s just say he missed the boat on this one. Why? Well, he uses the work of researchers instead of grunts in the field. “Twenty-three of these clinics are profiled in a report in the May/June Annals of Family Medicine that describes practice innovations that can ease the chaos, administrative overload, miscommunication and computerized busy work that too often characterize primary care.” How fun are these innovations? Well, here is the list of recommendations:
- Plan ahead for patient visits in such ways as having patients get lab tests done before the appointment so results can be discussed in the office.
- Expand nurse or medical assistant rooming protocols to help cover elements such as administering vaccines or scheduling preventive screenings.
- Use standing orders to let nurses treat simple problems.
- Extend responsibility for health coaching, care coordination and integrated behavioral health to nonphysician members of the team.
- Have the entire team take responsibility for panel management through such actions as sending reminder letters to patients about overdue preventive services.
- Use a medical assistant or other team member as a “scribe” to help complete electronic documentation.
- Standardize and synchronize 12-month prescription renewals for patients with stable chronic conditions.
- Use a nurse or medical assistant to help manage the physician’s email inbox by filtering out normal lab results, regular prescription renewals and other things for which the doctor is not needed.
- Talk to other team members face-to-face to get questions answered more efficiently than through email.
- Sit close to team members to facilitate communication.
- Use daily huddles to help anticipate problems.
- Hold regular team meetings to review quality and other performance data.
- Map the flow of work in the office to spot where effort is wasted and devise more efficient ways of operating.
Sounds like a blast, doesn’t it? Who is ready to jump out of bed and get to the office to start the above with a bang? I am sure Kevin will hear about this and probably will ask me what I would recommend to make primary care fun again. Here are some of my thoughts:
- Remove all administrators from making patient care decisions
- Hell, remove all administrators while you are at it
- See less patients in a day and get paid more
- Fire those patients that destroy your day
- Remove all wasted clerical work that means nothing to the care of the patient
- Remove all coding that means nothing to the care of the patient
- Get paid for call
- Eliminate quality indicators which are unproven and take away from the care of the patient
- Only document information that will help you in the care of the patient or protect you from lawsuits
- Eliminate frivolous lawsuits
- Only fill out paperwork that you decide is worth filling out (minimal or none) and not because some state agency, nursing home or job thinks it “has” to be filled out
- Cut your staff down to a manageable size because you have removed all of the above
PLEASE SEND ME MORE RECOMMENDATIONS. MAKE THEM REAL OR FUNNY. MAKE THEM HELPFUL OR SARCASTIC. LET US HAVE FUN WITH THIS.