Hey Doc, How About Some More Things To Be Responsible For?

This just came via email from the AAFP:

The EveryONE Project screening tools and resources help physicians recognize and respond to social factors that impact patient health. Screening questions have been tested, validated and designed to reveal the specific hurdles patients face. Achieve healthier outcomes — for everyone.

Uh….what?  Who has time for this?  As a Direct Primary Care doc even I would be overwhelmed.  Here is some more:

Social Needs Screening Tools and Resources

Family physicians understand that it is important to identify and address social determinants of health (SDOH) for individuals and families to achieve optimal health outcomes and whole-person care.

The AAFP is committed to helping you and your patients with a series of tools to use at the point of care by the practice team to quickly and efficiently screen your patients, act when needed, and link to community resources.

The AAFP is providing resources that you can customize to your individual practice, population, and community needs, and to help get you started. These tools are intended to be useful to you and your practice team.

Guide to Social Needs Screening Tool and Resources

This toolkit includes a screening tool that can be adapted for your practice. While there are many social determinants that affect health, the needs addressed in this tool can often be addressed by community services, and are not routinely addressed by health care workers.

Feel free to click the full PDF survey HERE.

Yes, we doctors care about our patients but now we have to be RESPONSIBLE for our patient’s social welfare as well? We have now taken the place of social workers.  Who has room on their plate to do this?  I guess the people who created this SDOH have their hearts in a good place but you have to be kidding me.  And what if something is listed on the patient’s survey and you missed it or didn’t act on it? Are you responsible?  Can you get sued?

Yes. Yes, you can.

Am I wrong on this? What do you think?

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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] 

  9 comments for “Hey Doc, How About Some More Things To Be Responsible For?

  1. Bridget Reidy
    March 30, 2018 at 6:44 pm

    This is a big issue in Canada, with the much celebrated U of T docs advocating it. They promote how they discovered lots of poor patients who don’t file taxes qualify for a small tax credit if they do, and refer to social workers in the clinic. Don’t know why they don’t care if the person doesn’t happen to need medical care this year, as there’s often quite a delay between horrible life and disease, or that the well patient who finds out about it probably needs a government paid doctor visit to access it. I wouldn’t mind if it takes no time and there’s a convenient remedy, though there’s probably another stupid form to complete. The problem is they’re looking for other ways to make us the social workers for “free”, just as they try to make us PTs for “free” (not a govt benefit) instead of prescribing opiates. Not a bad strategy, as every other govt paid professional and the administrators trying to get us to do more gets bennies including paid days off, overhead paid, extended health benefits, and even pensions. And if there’s not enough of us cause we’re too busy doing all that, so much the better for the bottom line! Just tell them if they want it done right, pay a professional.

    That being said, this concept the powers that be are just discovering has enormous consequences. Maybe someday they’ll decide they actually do want to pay to make people’s lives healthier instead of high cost medical care after it’s made them sick. Maybe then a lot of the money spent on health care will be used to get people what they need to have healthy lives, but we’d have to start using the R word, ration. Seriously, when you first found out how much is spent on the last year of life, didn’t you think you could use that money better now or anytime before that? (I know we don’t always know when that last year is, but mostly we have a pretty good idea. We could still have ICU care for trauma and aggressive chemo for childhood and young people’s cancers and such if we could only be sensible about it.) Maybe instead of scoffing at the concept, we should embrace it and take it to it’s logical conclusion.

  2. Kurt
    March 28, 2018 at 5:23 pm

    I say if still a member, drop the AAFP membership fee and apply it to more meaningful
    CME. Oh yeah, I coulda’ spent mine on another review course to pass the stupid MOC
    exam. At least I passed it as it’s the last one I am going to take. Will be gone within ten
    years and hopefully leave much sooner than that. I hope all those “newly matched” residents
    that the AAFP is tooting its horn about in FP have nice careers once they get out 3 or 4 years from now. Poor b******s.

  3. March 28, 2018 at 2:00 pm

    With 80% of health due to “social determinants” like income, education and lifestyle, there is no way for docs to move the “population health” needle without addressing them. And yet – ACOs and alternative practice models will base part of payment no population health measures. Since AAFP is fully on board with population health, ACOs, PCMH and government directed quality measurement/payment, etc – of course they are going to push this.

    • Doug Farrago
      March 28, 2018 at 2:44 pm

      So you are saying doctors should spend time on social determinants?

  4. JRDO
    March 27, 2018 at 10:39 am

    I am an internist. I treat adult patients. I treat my patients as adults- not as children.
    In the U.S. adults have the legal right to refuse treatment. So..if I order a cardiac stress test which the patient doesn’t do (declined) why am I somehow on the liability hook for the patient exercising their legal right to decline? Same shit happens with screening tests, referrals, labs, imaging etc. If the adult patient declines to tell me they have a problem then I shouldn’t be liable to screen or deal with it. Also, many EMR’s now will notify a physician’s office after a certain time if the ordered test or referral has not been done- this is well down the slippery slope of transferring liability for just about everything onto physicians (particularly PCPs). This is a huge liability crisis for physicians and imo is where our professional “leaders” have sold out our profession the most.

    I do some expert witness work (all for physician defense) and the clamoring of plaintiffs (via their attorneys) for physicians to be liable for everything is insane. Recently a lawyer representing a chronic smoker who developed lung cancer told a jury the the PCP was liable because there were a few notes in the chart where smoking cessation counseling was not documented. The case was dismissed but the trend is there.

    • Pat
      March 27, 2018 at 12:07 pm

      Amen! This continues to make enemies of doctors and patients.

  5. R Stuart
    March 27, 2018 at 9:08 am

    Watch how this works: the insurers will jump on this and they’ll become “quality measures.” If you don’t address them (i.e., check the right boxes), you’ll get a nice financial hit.

    Thanks, AAFP!

  6. Pat
    March 27, 2018 at 8:29 am

    Their hearts in a “good place”? Color me skeptical. Years ago during residency, we were assigned shifts with our program social worker to go and hand out cheese sandwiches to homeless people in the area. Without studying any of their individual social determinants, we all found the exercise to be asinine. Doctors thinking it is their place to cure societal ills is the height of arrogance, and fertile ground for do-gooders paid to come up with work for other people. Which explains why the AAFP is pushing it.

  7. Mary Carney, MD
    March 27, 2018 at 8:00 am

    Are you kidding me??

Comments are closed.