Re: PRACTICE TRANSFORMATION by ACTIVATING patients

[Guest guest]

These things are all EXCELLENT advice! These points are all critical to

reducing administrative burdens of running a practice. I feel almost as

though I could have been the one that wrote that response, rather than Dr.

Wible. I agree with all of those things. Do all of those things & it will

help make your life/practice much more enjoyable & " doable " .

PRACTICE TRANSFORMATION by ACTIVATING

patients

In thinking about Greg's dilemma I just wanted to put out to the group the

idea that

creating ACTIVE rather than PASSIVE patients could help with our pracices.

They could

reduce administrative burden substantially and other " extra work " that gets

shifted to the

clinic (meaning directly on the laps of solo docs if we are ultralight). I

try to be very clear

with my expectations for patients which works 99% of the time. Of course

there are a few

mentally ill or demented who would find this challenging but overall it is

possible for the

majority of patients to do the following:

1) Come prepared on time to visits with their " lists " to prevent stray phone

calls later

2) Get refills at the time of visit only ( I rarley fill between visits

unless I clearly tell

a patient to call with an update and I will refill by phone)

3) Understand their insurnace and come with co-pay in hand at start of

visit, exact change

4) Not call my emergency cell phone unless on the way to ER/UC

5) Call office primarily to schedule visits (majority of office calls are

scheduling if all is

handled at the office visit and pt understands that they should schedule

for any

significant discussion)

I do the following to limit admin burden

1) Discuss any significant abnormal results in person/OV (otherwise I mail a

copy to pt)

2) Schedule FU visits with specialists during pt visit. Then, they call the

specialist office

later and complete demographics, etc..

3) Give patient 1,3,6 or12 months of refills so I can recheck at interval

visits.

(no refill phone calls)

4) Send Billing out same day as pt was seen

5) Deal almost exclusively with hassle-free insurers

6) Limit services that create burden (vaccines at public health dept, for

example)

In summary, an ACTIVE patient can sometimes be better than an employee as

they can

take the laed in their health, do much of their on footwork (billing,

contacting their

insurer, scheduling with FUs, calling office appropriately, understanding

their ailments and

when to treat at home, when to call....) and ultimately lift the burden off

the backs of the

docs. For the few repeat offenders who do things that are counterproductive

to office flow

or who create unecessary burden in my life I give them a handout called " How

to make the

most of your office visit " which is essentially a list of acceptable

behaviors. I may highlight

the one they still have not incorporated in their life and...voila ... no

longer an issue. I do

exempt my homeless, mentally ill,and demented wher appropriate.

I sometimes feel a certain amount of our burden is self inflicted by not

changing

counterproductive behaviors in ourselves and in our patients.... and by

behaving

codependently in dealing with unfair organization and insurers ( " even though

the insurer

or medical organization is soo dysfunctional, I'll just keep taking their

crap " )

Anyone else on the list with comments on this??

Pamela

Pamela Wible, MD

Family & Community Medicine, LLC

3575 st. #220

Eugene, OR 97405

roxywible@...

[Guest guest]

These things are all EXCELLENT advice! These points are all critical to

reducing administrative burdens of running a practice. I feel almost as

though I could have been the one that wrote that response, rather than Dr.

Wible. I agree with all of those things. Do all of those things & it will

help make your life/practice much more enjoyable & " doable " .

PRACTICE TRANSFORMATION by ACTIVATING

patients

In thinking about Greg's dilemma I just wanted to put out to the group the

idea that

creating ACTIVE rather than PASSIVE patients could help with our pracices.

They could

reduce administrative burden substantially and other " extra work " that gets

shifted to the

clinic (meaning directly on the laps of solo docs if we are ultralight). I

try to be very clear

with my expectations for patients which works 99% of the time. Of course

there are a few

mentally ill or demented who would find this challenging but overall it is

possible for the

majority of patients to do the following:

1) Come prepared on time to visits with their " lists " to prevent stray phone

calls later

2) Get refills at the time of visit only ( I rarley fill between visits

unless I clearly tell

a patient to call with an update and I will refill by phone)

3) Understand their insurnace and come with co-pay in hand at start of

visit, exact change

4) Not call my emergency cell phone unless on the way to ER/UC

5) Call office primarily to schedule visits (majority of office calls are

scheduling if all is

handled at the office visit and pt understands that they should schedule

for any

significant discussion)

I do the following to limit admin burden

1) Discuss any significant abnormal results in person/OV (otherwise I mail a

copy to pt)

2) Schedule FU visits with specialists during pt visit. Then, they call the

specialist office

later and complete demographics, etc..

3) Give patient 1,3,6 or12 months of refills so I can recheck at interval

visits.

(no refill phone calls)

4) Send Billing out same day as pt was seen

5) Deal almost exclusively with hassle-free insurers

6) Limit services that create burden (vaccines at public health dept, for

example)

In summary, an ACTIVE patient can sometimes be better than an employee as

they can

take the laed in their health, do much of their on footwork (billing,

contacting their

insurer, scheduling with FUs, calling office appropriately, understanding

their ailments and

when to treat at home, when to call....) and ultimately lift the burden off

the backs of the

docs. For the few repeat offenders who do things that are counterproductive

to office flow

or who create unecessary burden in my life I give them a handout called " How

to make the

most of your office visit " which is essentially a list of acceptable

behaviors. I may highlight

the one they still have not incorporated in their life and...voila ... no

longer an issue. I do

exempt my homeless, mentally ill,and demented wher appropriate.

I sometimes feel a certain amount of our burden is self inflicted by not

changing

counterproductive behaviors in ourselves and in our patients.... and by

behaving

codependently in dealing with unfair organization and insurers ( " even though

the insurer

or medical organization is soo dysfunctional, I'll just keep taking their

crap " )

Anyone else on the list with comments on this??

Pamela

Pamela Wible, MD

Family & Community Medicine, LLC

3575 st. #220

Eugene, OR 97405

roxywible@...

[Guest guest]

Kathy,  I will attach the handout below.  Regarding your specific issues I would like to make a few comments.1) If you start giving free advice (telephone medicine) you will never get off the phone and your income will plummet. You will also start to get irritated. You are a professional and you should charge for your services as all professionals do.  A simple answer on the phone will be tempting in cases but folks always seem to have follow up questions and you will set the stage to be doing all your 99212 & 99213s by phone. Your patients will learn that they can call and not come in.--> a counterproductive behavior  (female codependence?)2) Activated patients come to visits prepared and do not need to make stray phone calls between appointments.  We give them our attention for as long as they need during the office visit and they should be prepared to discuss refills, FU intervals, disease management at that time.  Enforce this.3) Patients should never ever bother you on your cell phone unless they are on their way to the ED/UC.  If they are worried enough that they will consider disrupting THEIR plans to get in the car and be seen urgently/emergently then I want to know.  Otherwise, if they are not so concerned that they plan NOT to interrupt their plans but can still interrupt YOUR PLANS with an unnecessary phone call then something is wrong with the picture.  ---> Do not train your patients to abuse you. My phone message on my machine says you may notify Dr. Wible on her cell phone at 968-8510 if you are ON YOUR WAY TO THE ED/UC.  Very clear and it is upheld by all patients even my traumatic brain injury patients in the middle of the night when they call in a total panic/frenzy about not being able to find their car keys or their boyfriend walked out on them.  Even with their brain injury and impulse control issues they understand what my cell phone is for. Uphold the sanctity of your personal space.4) A practice with well trained activated patients will have an office phone that primarily rings for scheduling office visits.5) Dysfunctional behavior attracts others with dysfunctional behavior.  Clean up your act and set firm boundaries and the patients will be respectful or...they leave and find another kindred dysfunctional soul at ANOTHER office.You can make your office life whatever you want. You can be supportive, empathetic and firm!Keep a running list of ANYTHING or ANYONE that gets under your skin and problem solve your list weekly. Soon you will have nothing to put on your list!

PamelaPamela Wible, MDFamily & Community Medicine, LLC3575 st. #220 Eugene, OR 97405roxywible@...On Mar 1, 2006, at 8:05 PM, Kathy Broman wrote: Pamela, Do you have a copy of your handout on How to get the most out of your visit, that you could send as an attachment? I am guessing that I am often my own worst enemy as I tend to do a lot of phone medicine.  So many problems are often so simple that when I answer the phone regarding scheduling the problem then I can often give simple suggestions and then there is no need to come in.  Also, the ease with which patients can get ahold of me, makes it easy for them to call for advice.  I had to go to a voice mail system so that I could finish something and not always be answering the phone.  But then I need to return most of those calls, so I am not sure how much it is helping me other than allowing me to finish one project at a time before getting interrupted again.  We have an an office manager who is doing some of the scheduling now, so that is helpful. I find that dysfunctional patients that need more time or can fill up more time, tend to migrate to my practice.  I am becoming better at not getting too abused, but some lessons are hard in coming.  These patients definitely need care, but it is hard to decide when one is using way too much energy on one patient and getting nowhere.  I am much more hard nosed than when I first started, but I still need to become more firm. Kathy Broman MD Mason City, IA 50401 kmlb2@... On Wednesday, March 1, 2006, at 11:10 AM, Brock DO wrote: > These things are all EXCELLENT advice!  These points are all critical > to > reducing administrative burdens of running a practice.  I feel almost > as > though I could have been the one that wrote that response, rather than > Dr. > Wible.  I agree with all of those things.  Do all of those things & it > will > help make your life/practice much more enjoyable & "doable". > > > > PRACTICE TRANSFORMATION by ACTIVATING > patients > > In thinking about Greg's dilemma I just wanted to put out to the group > the > idea that > creating ACTIVE rather than PASSIVE patients could help with our > pracices. > They could > reduce administrative burden substantially and other "extra work" that > gets > shifted to the > clinic (meaning directly on the laps of solo docs if we are > ultralight).  I > try to be very clear > with my expectations for patients which works 99% of the time. Of > course > there are a few > mentally ill or demented who would find this challenging but overall > it is > possible for the > majority of patients to do the  following: > > 1) Come prepared on time to visits with their "lists" to prevent stray > phone > calls later > 2) Get refills at the time of visit only ( I rarley fill between visits > unless I clearly tell >       a patient to call with an update and I will refill by phone) > 3) Understand their insurnace and come with co-pay in hand at start of > visit, exact change > 4) Not call my emergency cell phone unless on the way to ER/UC > 5) Call office primarily to schedule visits (majority of office calls > are > scheduling if all is >   handled at the office visit and pt understands that they should > schedule > for any >    significant discussion) > > I do the following to limit admin burden > > 1) Discuss any significant abnormal results in person/OV (otherwise I > mail a > copy to pt) > 2) Schedule FU visits with specialists during pt visit. Then, they > call the > specialist office > later  and complete demographics, etc.. > 3) Give patient 1,3,6 or12 months of refills so I can recheck at > interval > visits. >   (no refill phone calls) > 4) Send Billing out same day as pt was seen > 5) Deal almost exclusively with hassle-free insurers > 6) Limit services that create burden (vaccines at public health dept, > for > example) > > In summary, an ACTIVE patient can sometimes be better than an employee > as > they can > take the laed in their health, do much of their on footwork (billing, > contacting their > insurer, scheduling with FUs, calling office appropriately, > understanding > their ailments and > when to treat at home, when to call....) and ultimately lift the > burden off > the backs of the > docs.  For the few repeat offenders who do things that are > counterproductive > to office flow > or who create unecessary burden in my life I give them a handout > called "How > to make the > most of your office visit" which is essentially a list of acceptable > behaviors. I may highlight > the one they still have not incorporated in their life and...voila ... > no > longer an issue.   I do > exempt my homeless, mentally ill,and demented wher appropriate. > > I sometimes feel a certain amount of our burden is self inflicted by > not > changing > counterproductive behaviors in ourselves and in our patients.... and by > behaving > codependently in dealing with unfair organization and insurers ("even > though > the insurer > or medical organization is soo dysfunctional, I'll just keep taking > their > crap") > > Anyone else on the list with comments on this?? > > > Pamela > > Pamela Wible, MD > Family & Community Medicine, LLC > 3575 st. #220 > Eugene, OR 97405 > > roxywible@... > > > > > > > > >

[Guest guest]

Hi n!  Here is my handout.  I recommend a similar one to anyone with irks about patient behavior.  It acts as a teaching tool and also formalizes some of the behind the scenes rules that evolve in a new practice. People learn by repetition and like children they want to know where the boundaries are. It creates safety and better rapport with trust over time. I mail these to frequent rule breakers or hand them to them at their office visit - often with segments highlighted.  I do this from a space of compassion.  It has worked BEAUTIFULLY!Pamela Wible, MDFamily & Community Medicine, LLC3575 st. #220  Eugene, OR 97405(541)345-2437  roxywible@...How to make the most of your office visit....Office VisitsMedical issues need to be discussed in person rather than "telephone medicine" so please call when you will need an appointment and as early in the day as possible.It is very likely that you will be able to be seen the same day or within 24 hours.When calling make sure you let Dr. Wible know ALL THE THINGS you are coming in for so she can give you an adequate appointment slot.Please BRING YOUR LIST to the appointment.  Keep a list of questions that come up between office visits so you will be less likely to forget to discuss important issues.Ask for the REFILLS you will need DURING your office visit to prevent running out of your medications between visits. In the rare instance that you misjudge and do call for a refill you must call during the week and allow 24 hours for the refill to be processed. Maintain a regular pharmacy at one location.  Make sure you schedule your follow up visits and/or lab tests BEFORE you run out of your medication.Please plan to get your lab tests and other specialty exams as soon as possible. Please let Dr. Wible know if you will be unable to get those tests within a few weeks of your visit.Understand the frequency of follow up visits that you will require. If stable on your medications with no real medical issues you may be seen yearly. If you have chronic issues you may need to be seen every 3 months.  If you have uncontrolled chronic issues you may need to be seen monthly or even more frequently until things are stabilized.Be prepared with your co-pay at the time of visit.  If you do not understand your insurance please make an effort to do so by reviewing the booklet or calling your insurer.  This allows Dr. Wible to focus on providing medical care rather than calling insurance companies and reminding patients about missed co-pays later.CommunicationThe cell phone is reserved for emergencies so please do not use the cell line unless you are on your way to the emergency room or urgent care.Dr. Wible checks her messages frequently so you should hear back the same day. Please return phone calls and correspondence as soon as you are able.  Patients who are unable to return communication risk being discharged from the practice.Please let Dr. Wible know about any change in you essential information including address, phone number, or insurance carrier.Email is currently available for administrative (scheduling, billing) questions. All sensitive medical issues should be discussed at your next office visit. Behind in my e-mail readings and just catching up.  Two months into practice and growing SLOWLY. I would love to get a copy of your "How to make the most of an office visit."  Would you post it? I like what you have to say regarding making patients accountable and "encouraging" certain behaviours from the onset. Thanks, n Bobb-McKoy, MD Ideal Family Health, P.C 291 South Van Brunt Englewood, NJ 07631 roxywible wrote: In thinking about Greg's dilemma I just wanted to put out to the group the idea that creating ACTIVE rather than PASSIVE patients could help with our pracices. They could reduce administrative burden substantially and other "extra work" that gets shifted to the clinic (meaning directly on the laps of solo docs if we are ultralight).  I try to be very clear with my expectations for patients which works 99% of the time. Of course there are a few mentally ill or demented who would find this challenging but overall it is possible for the majority of patients to do the  following:1) Come prepared on time to visits with their "lists" to prevent stray phone calls later2) Get refills at the time of visit only ( I rarley fill between visits unless I clearly tell      a patient to call with an update and I will refill by phone)3) Understand their insurnace and come with co-pay in hand at start of visit, exact change4) Not call my emergency cell phone unless on the way to ER/UC5) Call office primarily to schedule visits (majority of office calls are scheduling if all is   handled at the office visit and pt understands that they should schedule for any   significant discussion)I do the following to limit admin burden1) Discuss any significant abnormal results in person/OV (otherwise I mail a copy to pt)2) Schedule FU visits with specialists during pt visit. Then, they call the specialist office later  and complete demographics, etc..3) Give patient 1,3,6 or12 months of refills so I can recheck at interval visits.  (no refill phone calls)4) Send Billing out same day as pt was seen5) Deal almost exclusively with hassle-free insurers 6) Limit services that create burden (vaccines at public health dept, for example)In summary, an ACTIVE patient can sometimes be better than an employee as they can take the laed in their health, do much of their on footwork (billing, contacting their insurer, scheduling with FUs, calling office appropriately, understanding their ailments and when to treat at home, when to call....) and ultimately lift the burden off the backs of the docs.  For the few repeat offenders who do things that are counterproductive to office flow or who create unecessary burden in my life I give them a handout called "How to make the most of your office visit" which is essentially a list of acceptable behaviors. I may highlight the one they still have not incorporated in their life and...voila ... no longer an issue.   I do exempt my homeless, mentally ill,and demented wher appropriate.I sometimes feel a certain amount of our burden is self inflicted by not changing counterproductive behaviors in ourselves and in our patients.... and by behaving codependently in dealing with unfair organization and insurers ("even though the insurer or medical organization is soo dysfunctional, I'll just keep taking their crap")Anyone else on the list with comments on this??PamelaPamela Wible, MDFamily & Community Medicine, LLC3575 st. #220 Eugene, OR 97405roxywible@... Relax. Yahoo! Mail virus scanning helps detect nasty viruses!

[Guest guest]

The handout is great. I noticed

though that you say that “If stable on your medications with no real

medical issues you may be seen yearly.” That made me start to

wonder if I’m bringing people back too often. What would be an

example of a diagnosis/medication combo that you would feel comfortable giving

to someone & then telling them on the way out “I’ll see you in 1year.”

I can’t think of anything I prescribe that I would do that with, other

than maybe Fosamax for bones. To me, if a med requires an Rx then the

patient usually needs seen at least every 3 mos, no more than 6 mos.

Re:

PRACTICE TRANSFORMATION by ACTIVATING patients

Hi n! Here is my handout. I recommend

a similar one to anyone with irks about patient behavior. It acts as a

teaching tool and also formalizes some of the behind the scenes rules that

evolve in a new practice. People learn by repetition and like children they

want to know where the boundaries are. It creates safety and better rapport

with trust over time. I mail these to frequent rule breakers or hand them to

them at their office visit - often with segments highlighted. I do this

from a space of compassion. It has worked BEAUTIFULLY!

Pamela Wible, MD

Family & Community Medicine, LLC

3575 st. #220 Eugene, OR 97405

(541)345-2437 roxywible@...

How to make the most of your office

visit....

Office

Visits

Medical

issues need to be discussed in person rather than

" telephone medicine " so please call when you will need an appointment

and as early in the day as possible.

It is very likely

that you will be able to be seen the same day or within 24 hours.

When calling make

sure you let Dr. Wible know ALL THE THINGS

you are coming in for so she can give you an adequate appointment slot.

Please BRING YOUR LIST to the appointment.

Keep a list of questions that come up between office visits so you will be less

likely to forget to discuss important issues.

Ask for the REFILLS you will need DURING your office visit to prevent

running out of your medications between visits. In the rare instance that you

misjudge and do call for a refill you must call during the week and allow 24

hours for the refill to be processed. Maintain a regular pharmacy at one location. Make sure you schedule

your follow up visits and/or lab tests BEFORE you run out of your medication.

Please plan to get

your lab tests and other specialty exams

as soon as possible. Please let Dr. Wible know if you will be unable to get

those tests within a few weeks of your visit.

Understand the

frequency of follow up visits that you will require. If stable on your medications with no real

medical issues you may be seen yearly. If you have chronic issues you may need to be seen every 3 months.

If you have uncontrolled chronic issues

you may need to be seen monthly or even more frequently until things are

stabilized.

Be prepared with

your co-pay at the time of visit.

If you do not understand your insurance please make an effort to do so by

reviewing the booklet or calling your insurer. This allows Dr. Wible to

focus on providing medical care rather than calling insurance companies and

reminding patients about missed co-pays later.

Communication

The cell phone is reserved for emergencies so

please do not use the cell line unless you are on your way to the emergency

room or urgent care.

Dr. Wible checks

her messages frequently so you should hear back the same day. Please return

phone calls and correspondence as soon as you are able. Patients who are

unable to return communication risk being discharged from the practice.

Please let Dr.

Wible know about any change in you essential information including address,

phone number, or insurance carrier.

Email is currently

available for administrative (scheduling, billing) questions. All sensitive

medical issues should be discussed at your next office visit.

Behind in my e-mail readings and just catching

up. Two months into practice and growing SLOWLY. I would love

to get a copy of your " How to make the most of an office

visit. " Would you post it?

I like what you have to say regarding making patients

accountable and " encouraging " certain behaviours from the onset.

Thanks,

n Bobb-McKoy, MD

Ideal Family Health, P.C

291 South Van Brunt

Englewood, NJ 07631

roxywible

wrote:

In

thinking about Greg's dilemma I just wanted to put out to the group the idea

that

creating ACTIVE rather than PASSIVE patients could

help with our pracices. They could

reduce administrative burden substantially and

other " extra work " that gets shifted to the

clinic (meaning directly on the laps of solo docs

if we are ultralight). I try to be very clear

with my expectations for patients which works 99%

of the time. Of course there are a few

mentally ill or demented who would find this

challenging but overall it is possible for the

majority of patients to do the following:

1) Come prepared on time to visits with their

" lists " to prevent stray phone calls later

2) Get refills at the time of visit only ( I

rarley fill between visits unless I clearly tell

a patient to call

with an update and I will refill by phone)

3) Understand their insurnace and come with co-pay

in hand at start of visit, exact change

4) Not call my emergency cell phone unless on the

way to ER/UC

5) Call office primarily to schedule visits

(majority of office calls are scheduling if all is

handled at the office visit and pt

understands that they should schedule for any

significant discussion)

I do the following to limit admin burden

1) Discuss any significant abnormal results in

person/OV (otherwise I mail a copy to pt)

2) Schedule FU visits with specialists during pt

visit. Then, they call the specialist office

later and complete demographics, etc..

3) Give patient 1,3,6 or12 months of refills so I

can recheck at interval visits.

(no refill phone calls)

4) Send Billing out same day as pt was seen

5) Deal almost exclusively with hassle-free

insurers

6) Limit services that create burden (vaccines at

public health dept, for example)

In summary, an ACTIVE patient can sometimes be

better than an employee as they can

take the laed in their health, do much of their on

footwork (billing, contacting their

insurer, scheduling with FUs, calling office

appropriately, understanding their ailments and

when to treat at home, when to call....) and

ultimately lift the burden off the backs of the

docs. For the few repeat offenders who do

things that are counterproductive to office flow

or who create unecessary burden in my life I give

them a handout called " How to make the

most of your office visit " which is

essentially a list of acceptable behaviors. I may highlight

the one they still have not incorporated in their

life and...voila ... no longer an issue. I do

exempt my homeless, mentally ill,and demented wher

appropriate.

I sometimes feel a certain amount of our burden is

self inflicted by not changing

counterproductive behaviors in ourselves and in

our patients.... and by behaving

codependently in dealing with unfair organization

and insurers ( " even though the insurer

or medical organization is soo dysfunctional, I'll

just keep taking their crap " )

Anyone else on the list with comments on this??

Pamela

Pamela Wible, MD

Family & Community Medicine, LLC

3575 st. #220

Eugene, OR 97405

roxywible@...

Relax.

Yahoo! Mail virus

scanning helps detect nasty viruses!

[Guest guest]

Yearly FU would be  hypothyroid stable on Rx NL TSH, Depression meds (same dose 5 years stable like low dose prozac), 10 years on same low dose antiHTN Rx like maxzide with good ABPM).  It has to do with risk of adverse side effects of the drugs and stability of the medical condition AND the trust I have for the patient. That is the art.... It is and individual call.Pamela The handout is great.  I noticed though that you say that “If stable on your medications with no real medical issues you may be seen yearly.”  That made me start to wonder if I’m bringing people back too often.  What would be an example of a diagnosis/medication combo that you would feel comfortable giving to someone & then telling them on the way out “I’ll see you in 1year.”  I can’t think of anything I prescribe that I would do that with, other than maybe Fosamax for bones.  To me, if a med requires an Rx then the patient usually needs seen at least every 3 mos, no more than 6 mos.   Re: PRACTICE TRANSFORMATION by ACTIVATING patients  Hi n!  Here is my handout.  I recommend a similar one to anyone with irks about patient behavior.  It acts as a teaching tool and also formalizes some of the behind the scenes rules that evolve in a new practice. People learn by repetition and like children they want to know where the boundaries are. It creates safety and better rapport with trust over time. I mail these to frequent rule breakers or hand them to them at their office visit - often with segments highlighted.  I do this from a space of compassion.  It has worked BEAUTIFULLY!     Pamela Wible, MDFamily & Community Medicine, LLC3575 st. #220  Eugene, OR 97405(541)345-2437  roxywible@... How to make the most of your office visit....   Office Visits   Medical issues need to be discussed in person rather than "telephone medicine" so please call when you will need an appointment and as early in the day as possible.   It is very likely that you will be able to be seen the same day or within 24 hours.   When calling make sure you let Dr. Wible know ALL THE THINGS you are coming in for so she can give you an adequate appointment slot.   Please BRING YOUR LIST to the appointment.  Keep a list of questions that come up between office visits so you will be less likely to forget to discuss important issues.   Ask for the REFILLS you will need DURING your office visit to prevent running out of your medications between visits. In the rare instance that you misjudge and do call for a refill you must call during the week and allow 24 hours for the refill to be processed. Maintain a regular pharmacy at one location.  Make sure you schedule your follow up visits and/or lab tests BEFORE you run out of your medication.   Please plan to get your lab tests and other specialty exams as soon as possible. Please let Dr. Wible know if you will be unable to get those tests within a few weeks of your visit.   Understand the frequency of follow up visits that you will require. If stable on your medications with no real medical issues you may be seen yearly. If you have chronic issues you may need to be seen every 3 months.  If you have uncontrolled chronic issues you may need to be seen monthly or even more frequently until things are stabilized.   Be prepared with your co-pay at the time of visit.  If you do not understand your insurance please make an effort to do so by reviewing the booklet or calling your insurer.  This allows Dr. Wible to focus on providing medical care rather than calling insurance companies and reminding patients about missed co-pays later.   Communication   The cell phone is reserved for emergencies so please do not use the cell line unless you are on your way to the emergency room or urgent care.   Dr. Wible checks her messages frequently so you should hear back the same day. Please return phone calls and correspondence as soon as you are able.  Patients who are unable to return communication risk being discharged from the practice.   Please let Dr. Wible know about any change in you essential information including address, phone number, or insurance carrier.   Email is currently available for administrative (scheduling, billing) questions. All sensitive medical issues should be discussed at your next office visit.                         Behind in my e-mail readings and just catching up.  Two months into practice and growing SLOWLY. I would love to get a copy of your "How to make the most of an office visit."  Would you post it? I like what you have to say regarding making patients accountable and "encouraging" certain behaviours from the onset. Thanks, n Bobb-McKoy, MD Ideal Family Health, P.C 291 South Van Brunt Englewood, NJ 07631 roxywible wrote: In thinking about Greg's dilemma I just wanted to put out to the group the idea that creating ACTIVE rather than PASSIVE patients could help with our pracices. They could reduce administrative burden substantially and other "extra work" that gets shifted to the clinic (meaning directly on the laps of solo docs if we are ultralight).  I try to be very clear with my expectations for patients which works 99% of the time. Of course there are a few mentally ill or demented who would find this challenging but overall it is possible for the majority of patients to do the  following: 1) Come prepared on time to visits with their "lists" to prevent stray phone calls later 2) Get refills at the time of visit only ( I rarley fill between visits unless I clearly tell       a patient to call with an update and I will refill by phone) 3) Understand their insurnace and come with co-pay in hand at start of visit, exact change 4) Not call my emergency cell phone unless on the way to ER/UC 5) Call office primarily to schedule visits (majority of office calls are scheduling if all is   handled at the office visit and pt understands that they should schedule for any    significant discussion) I do the following to limit admin burden 1) Discuss any significant abnormal results in person/OV (otherwise I mail a copy to pt) 2) Schedule FU visits with specialists during pt visit. Then, they call the specialist office later  and complete demographics, etc.. 3) Give patient 1,3,6 or12 months of refills so I can recheck at interval visits.   (no refill phone calls) 4) Send Billing out same day as pt was seen 5) Deal almost exclusively with hassle-free insurers 6) Limit services that create burden (vaccines at public health dept, for example) In summary, an ACTIVE patient can sometimes be better than an employee as they can take the laed in their health, do much of their on footwork (billing, contacting their insurer, scheduling with FUs, calling office appropriately, understanding their ailments and when to treat at home, when to call....) and ultimately lift the burden off the backs of the docs.  For the few repeat offenders who do things that are counterproductive to office flow or who create unecessary burden in my life I give them a handout called "How to make the most of your office visit" which is essentially a list of acceptable behaviors. I may highlight the one they still have not incorporated in their life and...voila ... no longer an issue.   I do exempt my homeless, mentally ill,and demented wher appropriate. I sometimes feel a certain amount of our burden is self inflicted by not changing counterproductive behaviors in ourselves and in our patients.... and by behaving codependently in dealing with unfair organization and insurers ("even though the insurer or medical organization is soo dysfunctional, I'll just keep taking their crap") Anyone else on the list with comments on this?? Pamela Pamela Wible, MD Family & Community Medicine, LLC 3575 st. #220 Eugene, OR 97405 roxywible@...     Relax. Yahoo! Mail virus scanning helps detect nasty viruses!

[Guest guest]

Yeah, I would never let a person on

depression meds go an entire year with no follow up, same with HTN. Stable thyroid

maybe. Like you said though, different styles for each of us.

Re:

PRACTICE TRANSFORMATION by ACTIVATING patients

Hi n! Here is my handout. I recommend

a similar one to anyone with irks about patient behavior. It acts as a

teaching tool and also formalizes some of the behind the scenes rules that

evolve in a new practice. People learn by repetition and like children they

want to know where the boundaries are. It creates safety and better rapport

with trust over time. I mail these to frequent rule breakers or hand them to

them at their office visit - often with segments highlighted. I do this

from a space of compassion. It has worked BEAUTIFULLY!

Pamela Wible, MD

Family & Community Medicine, LLC

3575 st. #220 Eugene, OR 97405

(541)345-2437 roxywible@...

How to make the most of your office

visit....

Office

Visits

Medical

issues need to be discussed in person rather than

" telephone medicine " so please call when you will need an appointment

and as early in the day as possible.

It is very likely

that you will be able to be seen the same day or within 24 hours.

When calling make

sure you let Dr. Wible know ALL THE THINGS

you are coming in for so she can give you an adequate appointment slot.

Please BRING YOUR LIST to the appointment.

Keep a list of questions that come up between office visits so you will be less

likely to forget to discuss important issues.

Ask for the REFILLS you will need DURING your office visit to prevent

running out of your medications between visits. In the rare instance that you

misjudge and do call for a refill you must call during the week and allow 24

hours for the refill to be processed. Maintain a regular pharmacy at one location. Make sure you schedule

your follow up visits and/or lab tests BEFORE you run out of your medication.

Please plan to get

your lab tests and other specialty exams

as soon as possible. Please let Dr. Wible know if you will be unable to get

those tests within a few weeks of your visit.

Understand the

frequency of follow up visits that you will require. If stable on your medications with no real

medical issues you may be seen yearly. If you have chronic issues you may need to be seen every 3 months.

If you have uncontrolled chronic issues

you may need to be seen monthly or even more frequently until things are

stabilized.

Be prepared with

your co-pay at the time of visit.

If you do not understand your insurance please make an effort to do so by

reviewing the booklet or calling your insurer. This allows Dr. Wible to

focus on providing medical care rather than calling insurance companies and

reminding patients about missed co-pays later.

Communication

The cell phone is reserved for emergencies so

please do not use the cell line unless you are on your way to the emergency

room or urgent care.

Dr. Wible checks

her messages frequently so you should hear back the same day. Please return

phone calls and correspondence as soon as you are able. Patients who are

unable to return communication risk being discharged from the practice.

Please let Dr.

Wible know about any change in you essential information including address,

phone number, or insurance carrier.

Email is currently

available for administrative (scheduling, billing) questions. All sensitive

medical issues should be discussed at your next office visit.

Behind in my e-mail readings and just catching

up. Two months into practice and growing SLOWLY. I would love

to get a copy of your " How to make the most of an office

visit. " Would you post it?

I like what you have to say regarding making patients

accountable and " encouraging " certain behaviours from the onset.

Thanks,

n Bobb-McKoy, MD

Ideal Family Health, P.C

291 South Van Brunt

Englewood, NJ 07631

roxywible

wrote:

In thinking about

Greg's dilemma I just wanted to put out to the group the idea that

creating ACTIVE rather than PASSIVE patients could

help with our pracices. They could

reduce administrative burden substantially and

other " extra work " that gets shifted to the

clinic (meaning directly on the laps of solo docs

if we are ultralight). I try to be very clear

with my expectations for patients which works 99%

of the time. Of course there are a few

mentally ill or demented who would find this

challenging but overall it is possible for the

majority of patients to do the following:

1) Come prepared on time to visits with their

" lists " to prevent stray phone calls later

2) Get refills at the time of visit only ( I

rarley fill between visits unless I clearly tell

a patient to call

with an update and I will refill by phone)

3) Understand their insurnace and come with co-pay

in hand at start of visit, exact change

4) Not call my emergency cell phone unless on the

way to ER/UC

5) Call office primarily to schedule visits

(majority of office calls are scheduling if all is

handled at the office visit and pt

understands that they should schedule for any

significant discussion)

I do the following to limit admin burden

1) Discuss any significant abnormal results in

person/OV (otherwise I mail a copy to pt)

2) Schedule FU visits with specialists during pt

visit. Then, they call the specialist office

later and complete demographics, etc..

3) Give patient 1,3,6 or12 months of refills so I

can recheck at interval visits.

(no refill phone calls)

4) Send Billing out same day as pt was seen

5) Deal almost exclusively with hassle-free

insurers

6) Limit services that create burden (vaccines at

public health dept, for example)

In summary, an ACTIVE patient can sometimes be

better than an employee as they can

take the laed in their health, do much of their on

footwork (billing, contacting their

insurer, scheduling with FUs, calling office

appropriately, understanding their ailments and

when to treat at home, when to call....) and

ultimately lift the burden off the backs of the

docs. For the few repeat offenders who do

things that are counterproductive to office flow

or who create unecessary burden in my life I give

them a handout called " How to make the

most of your office visit " which is

essentially a list of acceptable behaviors. I may highlight

the one they still have not incorporated in their

life and...voila ... no longer an issue. I do

exempt my homeless, mentally ill,and demented wher

appropriate.

I sometimes feel a certain amount of our burden is

self inflicted by not changing

counterproductive behaviors in ourselves and in

our patients.... and by behaving

codependently in dealing with unfair organization

and insurers ( " even though the insurer

or medical organization is soo dysfunctional, I'll

just keep taking their crap " )

Anyone else on the list with comments on this??

Pamela

Pamela Wible, MD

Family & Community Medicine, LLC

3575 st. #220

Eugene, OR 97405

roxywible@...

Relax. Yahoo! Mail virus

scanning helps detect nasty viruses!