Let’s Have Fun Again


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


Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  7 comments for “Let’s Have Fun Again

  1. Pat
    June 19, 2013 at 7:22 pm

    It’s pretty obvious Mr. O’Reilly never actually had to do any of this to make his living. I actually got into primary care because I thought it would be fun – I was wrong.

  2. June 19, 2013 at 2:27 pm

    How bout sending all the doctors, nurses and health professionals home and let all the administrators provide the care.

  3. Mark OBrien
    June 19, 2013 at 2:13 pm

    Hence my moniker “Sir Allyagottadois” fill out FMLA form, DME form, VNA form, get blessed by preauthorizers to perform testing I was trained for, return to work forms, Comp forms, auto insurance forms. WOW. Now I am really depressed.

    June 19, 2013 at 11:39 am

    We were doing ALL of those suggestions 20 years ago… and they do not make things more ‘fun.’

    How about we just shoot everyone in the hospital wearing a suit?

  5. DrHockey
    June 19, 2013 at 11:11 am

    Doug, your list is not only more fun for the doctor, but also way better for the health of the patients. Truly a win-win scenario. Hence, it has no chance.
    (Sorry, I’m feeling very pessimistic today)

  6. June 19, 2013 at 10:26 am

    designate some poor masochist in the community to be the only narc dispenser for the town
    Many naughty patients can be funnelled thru them
    When they are found to be unable to follow the rules, then let the medical community know this
    HIPPA can go back to the politicians, I say that the lawmakers should have some of their skin in this game
    Not all docs are bad, not all patients are honest

  7. Luke
    June 19, 2013 at 7:46 am

    How about we just let MAs see all the patients and call the doc (who is at home) if they have any questions

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