 Oct. 18, 2002 |
| ASSEMBLY EDITION • SAN DIEGO |
Practice redesign
It's all about giving
patients what they want
Lecturer W. Gordon Moore, M.D., knew he had to change his practice when he began every patient encounter with the same refrain: "Sorry for being late."
The problem, he decided, was that he was seeing too many patients in order to meet costs. Although it may be the norm for patients to wait at the doctor's office, it was not how he wanted to practice medicine, he told attendees yesterday at the lecture "Practice Redesign: Transforming Office-based Care."
"This is a very noble enterprise we're in, because it's centered on the patient," said Moore, clinical senior instructor in family medicine and community and preventive medicine at the University of Rochester (New York) School of Medicine and Dentistry. "But patient-centeredness gets short shrift when you have to see more and more patients to meet overhead."
He observed that most doctors' offices have set up barriers to keep patients from physicians. Such barriers -- receptionists, appointment desks, waiting rooms and answering services -- cost money and are inefficient, Moore said.
His solution may seem drastic: He started a solo practice in which he was the sole staff member. A patient calls up; Moore answers the phone. Same day appointment? No problem. Pager? He doesn't carry one. There's no need to. His patients have his cell phone number.
These changes allowed him to cut expenses, improve efficiency and spend more time with patients, Moore said. The whole point is to look at what is of value to the patient, he said. "Get rid of everything else."
Some in attendance seemed skeptical of his ideas, starting with same-day appointments. Moore said he found that the time and energy spent on the patient calling in for an impromptu appointment was taxing on everyone. The patient would explain the problem to a receptionist, who would pass it on to a triage nurse, who would make the patient recount the reason for the call, and ultimately the triage nurse would interrupt the doctor, who often was in the middle of another visit. Better to just tell the patient, "Come on in," said Moore.
He uses an answering machine to take calls while he's seeing patients and gives his cell phone number for use in emergencies. He estimates that phone calls to his office last an average of 23 seconds.
He likened open access scheduling to moviegoers queuing for a movie. At any given moment, 25 persons are in line. Some people step out of line, some move to the front and go on in, but the fact that people are in line doesn't change. The key is to match capacity to demand, he said.
Other participants questioned the notion of a physician giving a phone number to patients.
"If I get more than one call a month after 10 p.m., it's a surprise," said Moore. He forgoes the cost of an answering service, plus there's the unexpected benefit: He gets to know his patients better, sometimes recognizing their voices when he answers the phone. "I know these people so well; we have deep and meaningful relationships," he said.
The use of electronic medical records makes the efficiency of his practice possible, Moore said. What's more, he's better able to manage patients whose conditions require special needs, such as diabetes and hypertension. "Even Jiffy Lube sends out reminders to customers when it's time for an oil change. We can at least be as good as Jiffy Lube," he said. For physicians not ready to purchase such a system, something as simple as index cards can be used to maintain a patient directory, he said.
The end result is that he's able to customize care according to patient needs. Granted, he's no longer seeing 30 to 40 patients a day, but a much saner 10 or 12. "I was trying to be Mr. Productivity and do the right thing," he said. But doing the right thing meant change. "I no longer feel the pressure of feeling wound up like a mainspring," he said.
The AAFP has devoted a site to practice redesign: http://www.aafp.org/x3847.xml.
FP Report is published by the
AAFP News Department.
Copyright © 2002 by
American Academy of Family Physicians.