With focus, preparation and teamwork, you can probably improve the care you give patients who have chronic diseases, leave them healthier and more satisfied, and maybe even get paid more for your trouble. This issue’s cover story (page 43), by Kurt Elward, MD, joins a long line of articles published in FPM and elsewhere that demonstrate this truth. So what’s stopping you?

OK. I grant you that you may face any number of barriers, from high staff turnover to schedule overload, uncooperative associates, claims hassles and lack of time. You know better than I how ugly the realities of practice can be. Still, I hope you will ask yourself seriously whether any or all of the barriers you face are insuperable. They may just look that way. I’ve always found that the world changes with my state of mind: What is impossible when my energy level is low turns out to be merely hard or even easy when I have the energy to focus and to act rather than react. The trick for a practicing family physician is getting that energy level up after it has been battered by reimbursement hassles, long days, mountains of paperwork, staffing problems and all the rest.

Why make the effort?

If you feel so beaten down by practice that the idea of taking on some new project seems more than you can stand, I can’t offer much material assistance, but I can offer a few thoughts that might help:

• Well-conceived practice-improvement efforts seem to be relatively easy to maintain once they’re under way. While they may not be self-perpetuating, they’re easier to keep going once the initial start up effort is over. Thus, the energy you invest in such a project is likely to bring good returns and not to be required for the long haul.

• Practice improvement may get easier with experience. Elward says he believes that the principles outlined in his article could apply to any chronic disease. Of course, if you feel like starting with asthma, Elward’s article is a good resource, and we can offer other help. As the article mentions, a two-article series on asthma is appearing concurrently in our sister journal, American Family Physician. More, the AAFP has recently published a resource guide and various associated tools for treating asthma and allergies (see https://www.aafp.org/asthmaallergyguide.xml). In fact, Elward was the chief author of the resource guide.

• Not only can the principles Elward outlines be adapted to any chronic disease, the mind-set they come out of is central to any improvement effort you might undertake. Success in improving chronic disease care can help equip you for improving things like billing, appointment scheduling and refill management.

• Well-conceived practice-improvement efforts don’t just improve patient care; they improve everything. Elward, for instance, reports that his practice’s “Asthma Days” program has improved several markers of good asthma care, has improved documentation of that care, has left nurses in the practice feeling that “their ability to provide consistently good nursing care and education was improved,” and has brought financial rewards to the practice. While he doesn’t supply a detailed accounting, he says, “the program generated more than $5,600 … over the three-month period from charges that would have been lost and planned care that would not have been provided.”

Better than “good enough”

If you think your practice runs well and you do a good job of caring for patients with chronic diseases, you’re probably right. But if you think your practice runs as well as it reasonably can given the circumstances, or if you think you do as well for your patients with chronic diseases as any family physician reasonably can, chances are you’re wrong. Unless you have a very unusual practice, there are family physicians out there demonstrating that it’s possible to do better than you are doing now. I hope you’ll take heart from Elward’s article, though, and recognize that you have the power to make things better for your patients, your staff and yourself.