PRACTICE PEARLS

The patient portal is a blessing and a curse. It allows patients more access to solicit medical advice, but because most primary care physicians are fully engaged during business hours, they often have to respond to messages during “pajama time.”

Developing a standard operating procedure (SOP) is one way to lessen physicians' workload while ensuring a timely response to patient portal requests. An SOP gives staff direction and authority to respond to common requests without direct physician input. Requests that can easily be delegated to staff include standard medication refills (those that aren't subject to other restrictions, e.g., controlled substances), referral renewals, and annual lab orders. If delegating lab orders, be sure to identify the corresponding ICD-10 codes staff should use to order them. Spell out in the SOP that staff should direct patients to a face-to-face visit when the message requests that the practice prescribe new medications, address new health problems, order imaging, place a first-time referral, or complete paperwork.

Start developing an SOP by convening a workgroup of key administrators, medical assistants, nurses, and clinicians. Arrange frequent patient requests into themes and create a standard workflow for each. Then put it in writing and review it with staff frequently — until it becomes part of the clinic's culture.

We often hesitate to give constructive feedback because we underestimate how much others want it, or overestimate the potential discomfort in both giving and receiving it.¹ One common tactic is the feedback sandwich — start with a positive, then the negative, and then finish with a positive to lessen the blow. However, this tactic is falling out of favor across many industries because it can dilute the constructive feedback or make the positive comments feel like a “setup.”² Instead, consider these principles: