• 21st Century Issues •
Bruce Bagley, M.D.:
'Patients will expect better
customer service from us'
AAFP President Bruce Bagley, M.D., of Albany, N.Y., has adopted quality issues as the focus of his term. He believes that family physicians will be expected to provide more and better services in the future. To prepare for that, Bagley would like to see the AAFP and its members look at the efficiency of their systems and how to improve them, including the implementation of electronic medical records. He discusses quality in this Q&A.
What are the important quality issues facing family physicians?
Quality of care means not only practicing consistent evidence-based medicine, but also being able to document that care and monitor outcomes of care.
Family physicians are well trained to provide quality care, but most of us need to work on monitoring and improving outcomes of care. In the future, we will need systems such as electronic medical records to help manage and document patient care, yet we will still provide the quality of care patients have come to expect from their family physicians.
Probably the biggest quality issue facing all of medicine is customer service. We must do something about poor telephone service, office waiting times, messages and call backs. People have begun to expect great service in all other things they do. Why not at the doctor's office?
How can FPs tackle these issues?
One way will be to move toward full implementation of electronic medical records to help resolve both quality-of-care and customer service issues.
Implementing office systems that are paperless, efficient and capable of "e-medicine" is essential. For instance, with current electronic medical systems, patients can contact their family physicians for personalized health advice 24 hours a day, seven days a week, 365 days a year and can expect a reply within 24 hours. Also, patients can provide their family physicians with information regarding their chronic diseases such as diabetes or hypertension by entering data directly into their own medical records. And family physicians can share patient data and test results among physicians who are treating the same patient to reduce duplication and waste.
Another way to improve customer service is to instill a culture of continuous quality improvement into office functions and routines. CQI has a proven track record for effecting organizational change.
How do office design and layout affect quality?
Our current office systems are designed to bring the patient to the doctor, face to face, for the purpose of diagnosing and treating disease. With managed care, family physicians are expected to take on the responsibility of caring for a population of people whether they need to come to the office or not. New systems of ongoing care and the ability to communicate personalized health advice will be essential.
Electronic medical records can help with this. For example, implementing electronic medical records would allow a patient to get lab results and health tips online. Patients could make appointments through the computer as well.
How can FPs improve teamwork in the office to facilitate patient care?
Teamwork results from an office culture of empowerment. All office staff -- from front desk receptionists to back office nursing staff -- must be given responsibility for the product of not only their own work but also the work of the team. Having a common mission and core values developed by your team of workers helps define the work environment. Rewards and constant positive feedback for a job well done will foster a sense of teamwork. And teamwork is required to have a consistent quality product and excellent customer service. No one can do it all alone.
How will electronic medical records affect family medicine in the future?
The explosion of information technology will leave no part of our society untouched. The business of medicine will have to leap into the information age soon. Electronic medical records will be the platform for the care of patients in the future. Web medicine and shared medical records among all who treat the patient will be the norm. It's important for family physicians to be part of this revolution, and electronic records will provide better support for the increasingly complex task of management we are expected to do.
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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