Re: PRACTICE TRANSFORMATION by ACTIVATING patients

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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@... > > > > > > > > >