letters

No time for practice management resolutions

I would like to respond to some of the resolutions described by Dr. Mitchell Cohen in his essay "Auld Lang Syne: Practice Management Resolutions for the New Year" [The Last Word, January 2007].

1. "See one more patient BID." That translates to one more chart and potentially multiple phone calls and follow-ups to attend to after hours. Dr. Cohen suggests squeezing in an additional patient before lunch. What lunch? The additional $15,000 would be nice but not at the expense of my family and my physical and mental health.

2. "Attend a local AAFP meeting." When? I certainly cannot go during office hours or in the evening because squeezing in extra patients on an already full or overbooked schedule makes my days even longer. Should I give up a weekend to go? Dr. Cohen, I believe you mean well, but it is good to be a part of the non-doctor world - as a doctor and as a person.

3. "Take a vacation, or two." When? I am paid for my clinical work based on my productivity, and each vacation costs me income. Why not just forgo vacations altogether and add another several thousand dollars in income?

I know there will be many who read this and think that I am lazy. I am not. I am a hard-working doctor in a busy clinic who is finding that my work is invading all aspects of my life, and I am looking for methods that can help me improve my efficiency while allowing me to continue to provide medical care of the highest quality. I have learned billing and coding and use our electronic health record quickly and efficiently. I don't know what else to do other than set some limits.

It is important for us as physicians to be able to say "no" without the stigma of being a lazy physician. It is also important that physicians not be forced to replace their family time and personal lives with more work. Patient care comes first, but does it have to come at the physician's expense?

Natascha Lautenschlaeger, MD
Park City, Utah

Starting the year off right

Articles on patient satisfaction, new codes and practice management resolutions for the new year, all in one issue [January 2007]. Nice work.

Gregory Bentz, MD, PhD, FAAFP
Leesburg, Va.

No more coding!

Why are you bothering us with coding? Studies show that doctors are unhappy and burned out in part because of overwork, mostly due to paperwork hassles.1

The overwork issue could be significantly helped by leaving the coding to one of the myriad administrators who seem to have proliferated over the years. I know the excuse for encumbering highly and expensively trained medical doctors with this clerical chore is that administrators think these numbers are the diagnosis. From a doctor's point of view, codes are not diagnoses. They are a translation of the accurate verbal diagnosis into a numerical language. Most of us do not understand this numerical language any better than we understand ancient Sanskrit. You seem to think we should put our already overburdened time into learning this language. I think we should put this time into face-to-face patient care and to keeping up with the medical literature, which has a half-life of two years.

If something isn't done about the paperwork burdens that doctors now bear, there won't be any more of us. And because prospective medical students are smart enough to see the situation we are in, they will find something else to do for a living. They will, therefore, not be replacing the growing numbers of retirees and escapees from medicine.

Ann Ewalt Hamilton, MD
Riverside, Calif.

1. Steiger B. Survey results: doctors say morale is hurting. The Physician Executive. 2006; 32(6):6-15.

Editor's response:

The coding articles that appear in FPM continue to be rated by our readers as our most useful content. As long as they're highly valued, we'll keep publishing them.

Radiating courtesy and professionalism

While a good deal has been written about the importance of effective communication in health care, I am not sure we pay enough attention to the nonverbal aspects of communication. The mood and foundation for the rest of the visit is established in the first 30 seconds, and if we cannot communicate professionalism, kindness, trustworthiness and compassion quickly, we're not likely to repair the lapse.

Our appearance does a lot to frame expectations. Wear a newly laundered and pressed white coat, and you will both meet OSHA standards and reassure the patient that professionalism is important in all aspects of your practice. Wear tennis shoes, jeans and a casual shirt, on the other hand, and you'll suggest that the patient may be interfering with your recreational pursuits. You earned a medical degree, not a license to ignore common courtesy or professionalism. Should physicians not look at least as professional as lawyers, accountants, chiropractors or store managers?

Honing and using good interpersonal skills, of course, is crucial to effective communication. We need to be able to explain complex treatment plans in simple messages delivered in ways the patient will accept. But here, too, nonverbal aspects of communication may tend to be slighted. Cordiality in particular may be underrated as a communication "skill." Napoleon Hill, the great 20th century lecturer on communication and success, suggested that professionals treat everyone as if he were a rich uncle who might be leaving them something in his will. A warmhearted professional is most pleasing to patients and gives added value to their office experiences. Remember that our patients hire and fire us at every visit and high quality "customer service" is required from all for all.

Wm. Jackson Epperson, MD, MBA
Murrells Inlet, S.C.

Family medicine and innovation

I would like to comment on the "Tis better to disrupt than be disrupted" editorial ["Can Family Medicine Still Catalyze Social Change?" From the Editor, February 2007]. Be aware that MinuteClinic was started by a family physician - me. I believe that family physicians are in the best position to observe patient frustrations and to develop new avenues of patient-centered care delivery. I still believe that family physicians understand that medicine is for the patient - not for insurers, employers, hospitals or even physicians. As long as we focus on our patients, we can continue to develop ideas and businesses that can ease their frustrations.

Douglas Smith, MD
Long Lake, Minn.