Guest guest Posted May 3, 2006 Report Share Posted May 3, 2006 I've come to think the biggest challenge for me is actually the breaking of old habits and the building of new habits and personal systems. For so many years, if a patient needed something (form, referral, insurance clarification, etc) we'd get the info, send the patient home and then catch up with the work later with either myself or the nurses/staff fitting it in (or perhaps staying late). Now however, as I've designed more time for appts and I have no staff, the easiest thing is to do it NOW... right away... immediately... pronto... you get the story! But still, I feel my brain pause before I do it as if it wants to say, " I'll get back to you about that " . But then it feels so good when I get the job out of the way and the patient is happy. The feeling of scanning a completed form and handing the original back to the patient is simply great. But also, to call for a referral is very satisfying too. I use a speaker phone so the patient hears the whole conversation. And while on hold, we are either discussing plans or I'm writting my advise or the specialist's address, etc -- things I need to do anyway, so I'm not really losing time on hold. Yesterday was yet another example -- 44 year old woman in for severe seasonal allergies - first visit in new office though I've known her four years prior ... as I'm looking at old records and setting her up in my EMR, I clarify her last mammo was more than 3 years ago ... I ask if I can help her set that up, she says yes, I pick up the phone and booked it for her then and there. As she left with a plan for her allergies, she turns and said thanks, " I'd never have scheduled that if you didn't call just now. " Is that good use of a doctor's time? Perhaps from a financial perspective, no. But from the humanistic perspective, absolutely! It's like a Mastercard commercial -- " Doctor's pay per minute... $2.50. Time to book a mammo... 6 minutes. Value of helping patient get timely mammo and strengthening our relationship... PRICELESS! " I know this story is redundant for many others which have been told on the list. But this is my personal, freshest perspective so I figured I'd share it. I do hope it helps someone in some way, some day. Tim Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2006 Report Share Posted May 6, 2006 RE Doing today's work today. This is once again an extension of open access type method. Don't forget, though, that you can help a pt get scheduled at some hospitals by the following: 1) Print out copy of order, say, a mammogram. 2) See if you can fax it directly to the facility and have THEM contact pt. Be sure to put the pt's contact number on the order. 3) I put in the note after each test: A) If the hospital doesn't contact you to schedule your test within 1 week, please call the doctor's office for assistance. If our office does not contact you within 1 week with the result, please call us. 4) Hospital usually faxes back a confirmation for testing such as sonogram, CT scans, MRIs and I track them. Service doesn't have to be completed at the immediate time of service, but best to get the fax out the door! And don't forget the pesky things like the preMRI screening questionaires, and BUN/creatinine orders to be completed prior to dye testing. Dr Matt Levin FP, solo since Dec 2004. Worked for others from July 1988-Dec 2004. Pittsburgh, PA SOAPware user since 1997 new habits... > I've come to think the biggest challenge for me is actually the breaking > of old habits and the building of new habits and personal systems. > > For so many years, if a patient needed something (form, referral, > insurance clarification, etc) we'd get the info, send the patient home and > then catch up with the work later with either myself or the nurses/staff > fitting it in (or perhaps staying late). > > Now however, as I've designed more time for appts and I have no staff, the > easiest thing is to do it NOW... right away... immediately... pronto... > you get the story! But still, I feel my brain pause before I do it as if > it wants to say, " I'll get back to you about that " . But then it feels so > good when I get the job out of the way and the patient is happy. The > feeling of scanning a completed form and handing the original back to the > patient is simply great. > > But also, to call for a referral is very satisfying too. I use a speaker > phone so the patient hears the whole conversation. And while on hold, we > are either discussing plans or I'm writting my advise or the specialist's > address, etc -- things I need to do anyway, so I'm not really losing time > on hold. > > Yesterday was yet another example -- 44 year old woman in for severe > seasonal allergies - first visit in new office though I've known her four > years prior ... as I'm looking at old records and setting her up in my > EMR, I clarify her last mammo was more than 3 years ago ... I ask if I can > help her set that up, she says yes, I pick up the phone and booked it for > her then and there. As she left with a plan for her allergies, she turns > and said thanks, " I'd never have scheduled that if you didn't call just > now. " > > Is that good use of a doctor's time? Perhaps from a financial perspective, > no. But from the humanistic perspective, absolutely! It's like a > Mastercard commercial -- > > " Doctor's pay per minute... $2.50. > Time to book a mammo... 6 minutes. > Value of helping patient get timely mammo and strengthening our > relationship... PRICELESS! " > > I know this story is redundant for many others which have been told on the > list. But this is my personal, freshest perspective so I figured I'd share > it. I do hope it helps someone in some way, some day. > > Tim > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2006 Report Share Posted May 6, 2006 RE Doing today's work today. This is once again an extension of open access type method. Don't forget, though, that you can help a pt get scheduled at some hospitals by the following: 1) Print out copy of order, say, a mammogram. 2) See if you can fax it directly to the facility and have THEM contact pt. Be sure to put the pt's contact number on the order. 3) I put in the note after each test: A) If the hospital doesn't contact you to schedule your test within 1 week, please call the doctor's office for assistance. If our office does not contact you within 1 week with the result, please call us. 4) Hospital usually faxes back a confirmation for testing such as sonogram, CT scans, MRIs and I track them. Service doesn't have to be completed at the immediate time of service, but best to get the fax out the door! And don't forget the pesky things like the preMRI screening questionaires, and BUN/creatinine orders to be completed prior to dye testing. Dr Matt Levin FP, solo since Dec 2004. Worked for others from July 1988-Dec 2004. Pittsburgh, PA SOAPware user since 1997 new habits... > I've come to think the biggest challenge for me is actually the breaking > of old habits and the building of new habits and personal systems. > > For so many years, if a patient needed something (form, referral, > insurance clarification, etc) we'd get the info, send the patient home and > then catch up with the work later with either myself or the nurses/staff > fitting it in (or perhaps staying late). > > Now however, as I've designed more time for appts and I have no staff, the > easiest thing is to do it NOW... right away... immediately... pronto... > you get the story! But still, I feel my brain pause before I do it as if > it wants to say, " I'll get back to you about that " . But then it feels so > good when I get the job out of the way and the patient is happy. The > feeling of scanning a completed form and handing the original back to the > patient is simply great. > > But also, to call for a referral is very satisfying too. I use a speaker > phone so the patient hears the whole conversation. And while on hold, we > are either discussing plans or I'm writting my advise or the specialist's > address, etc -- things I need to do anyway, so I'm not really losing time > on hold. > > Yesterday was yet another example -- 44 year old woman in for severe > seasonal allergies - first visit in new office though I've known her four > years prior ... as I'm looking at old records and setting her up in my > EMR, I clarify her last mammo was more than 3 years ago ... I ask if I can > help her set that up, she says yes, I pick up the phone and booked it for > her then and there. As she left with a plan for her allergies, she turns > and said thanks, " I'd never have scheduled that if you didn't call just > now. " > > Is that good use of a doctor's time? Perhaps from a financial perspective, > no. But from the humanistic perspective, absolutely! It's like a > Mastercard commercial -- > > " Doctor's pay per minute... $2.50. > Time to book a mammo... 6 minutes. > Value of helping patient get timely mammo and strengthening our > relationship... PRICELESS! " > > I know this story is redundant for many others which have been told on the > list. But this is my personal, freshest perspective so I figured I'd share > it. I do hope it helps someone in some way, some day. > > Tim > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2006 Report Share Posted May 6, 2006 Regarding scheduling patients for tests: to me it seems more efficient to create the order/consult letter and fax it to the facility/ print it out and give to the patient in one fell swoop; and then have the patient call for the appointment. I almost never call for appointments for patients, unless for example, it's an urgent LE US to r/o a DVT that I want then and there, or an urgent consult that I have to speak directly to the specialist about. Lynn > >Reply-To: >To: < > >Subject: Re: new habits... >Date: Fri, 5 May 2006 20:36:28 -0400 > >RE Doing today's work today. > >This is once again an extension of open access type method. >Don't forget, though, that you can help a pt get scheduled at some >hospitals >by the following: > >1) Print out copy of order, say, a mammogram. > >2) See if you can fax it directly to the facility and have THEM contact pt. >Be sure to put the pt's contact number on the order. > >3) I put in the note after each test: > A) If the hospital doesn't contact you to schedule your test >within >1 week, please call the doctor's office for assistance. > If our office does not contact you within 1 week with the >result, >please call us. > >4) Hospital usually faxes back a confirmation for testing such as sonogram, >CT scans, MRIs and I track them. > >Service doesn't have to be completed at the immediate time of service, but >best to get the fax out the door! > >And don't forget the pesky things like the preMRI screening questionaires, >and BUN/creatinine orders to be completed prior to dye testing. > >Dr Matt Levin >FP, solo since Dec 2004. >Worked for others from July 1988-Dec 2004. >Pittsburgh, PA >SOAPware user since 1997 > > new habits... > > > > I've come to think the biggest challenge for me is actually the breaking > > of old habits and the building of new habits and personal systems. > > > > For so many years, if a patient needed something (form, referral, > > insurance clarification, etc) we'd get the info, send the patient home >and > > then catch up with the work later with either myself or the nurses/staff > > fitting it in (or perhaps staying late). > > > > Now however, as I've designed more time for appts and I have no staff, >the > > easiest thing is to do it NOW... right away... immediately... pronto... > > you get the story! But still, I feel my brain pause before I do it as >if > > it wants to say, " I'll get back to you about that " . But then it feels so > > good when I get the job out of the way and the patient is happy. The > > feeling of scanning a completed form and handing the original back to >the > > patient is simply great. > > > > But also, to call for a referral is very satisfying too. I use a >speaker > > phone so the patient hears the whole conversation. And while on hold, we > > are either discussing plans or I'm writting my advise or the >specialist's > > address, etc -- things I need to do anyway, so I'm not really losing >time > > on hold. > > > > Yesterday was yet another example -- 44 year old woman in for severe > > seasonal allergies - first visit in new office though I've known her >four > > years prior ... as I'm looking at old records and setting her up in my > > EMR, I clarify her last mammo was more than 3 years ago ... I ask if I >can > > help her set that up, she says yes, I pick up the phone and booked it >for > > her then and there. As she left with a plan for her allergies, she >turns > > and said thanks, " I'd never have scheduled that if you didn't call just > > now. " > > > > Is that good use of a doctor's time? Perhaps from a financial >perspective, > > no. But from the humanistic perspective, absolutely! It's like a > > Mastercard commercial -- > > > > " Doctor's pay per minute... $2.50. > > Time to book a mammo... 6 minutes. > > Value of helping patient get timely mammo and strengthening our > > relationship... PRICELESS! " > > > > I know this story is redundant for many others which have been told on >the > > list. But this is my personal, freshest perspective so I figured I'd >share > > it. I do hope it helps someone in some way, some day. > > > > Tim > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2006 Report Share Posted May 6, 2006 RE Print out and fax for pt to call, or facility to schedule Yep, me too. I just was outlining how to do just that. Dr Matt Levin new habits... > > > > I've come to think the biggest challenge for me is actually the breaking > > of old habits and the building of new habits and personal systems. > > > > For so many years, if a patient needed something (form, referral, > > insurance clarification, etc) we'd get the info, send the patient home >and > > then catch up with the work later with either myself or the nurses/staff > > fitting it in (or perhaps staying late). > > > > Now however, as I've designed more time for appts and I have no staff, >the > > easiest thing is to do it NOW... right away... immediately... pronto... > > you get the story! But still, I feel my brain pause before I do it as >if > > it wants to say, " I'll get back to you about that " . But then it feels so > > good when I get the job out of the way and the patient is happy. The > > feeling of scanning a completed form and handing the original back to >the > > patient is simply great. > > > > But also, to call for a referral is very satisfying too. I use a >speaker > > phone so the patient hears the whole conversation. And while on hold, we > > are either discussing plans or I'm writting my advise or the >specialist's > > address, etc -- things I need to do anyway, so I'm not really losing >time > > on hold. > > > > Yesterday was yet another example -- 44 year old woman in for severe > > seasonal allergies - first visit in new office though I've known her >four > > years prior ... as I'm looking at old records and setting her up in my > > EMR, I clarify her last mammo was more than 3 years ago ... I ask if I >can > > help her set that up, she says yes, I pick up the phone and booked it >for > > her then and there. As she left with a plan for her allergies, she >turns > > and said thanks, " I'd never have scheduled that if you didn't call just > > now. " > > > > Is that good use of a doctor's time? Perhaps from a financial >perspective, > > no. But from the humanistic perspective, absolutely! It's like a > > Mastercard commercial -- > > > > " Doctor's pay per minute... $2.50. > > Time to book a mammo... 6 minutes. > > Value of helping patient get timely mammo and strengthening our > > relationship... PRICELESS! " > > > > I know this story is redundant for many others which have been told on >the > > list. But this is my personal, freshest perspective so I figured I'd >share > > it. I do hope it helps someone in some way, some day. > > > > Tim > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2006 Report Share Posted May 6, 2006 Right, I agree that normally I will simply give the patient the order and phone number and ask them to book it on their own time with their schedule in front of them. But the anecdote I offered was specifically someone who was behind in standard screening. I didn't mention it, but when I asked she gave the common sheepish look and said something like, " yeah, I know, I gotta plan for that soon. " A reply that made me guess she's contemplative and not in the action phase of mammo planning. Thus, I was able to adjust the appt on the fly, and get her booked. Something I would not have felt able to do in the standard office. But the structure of the office (phone two feet from me, no need to leave room or move anywhere else) and schedule (can " steal " an extra five minutes if needed for quality of care and not fall further behind) offers me that ability to spontaneously give a service I believe is beneficial. If she was only 4 months late on the mammo rather than 3 years (actual, though she initially said 6 years) I would not have taken the extra step. It was an anecdote to demonstrate an inate quality I believe this model possesses. The details of how we get the job done will vary beyond that. If I faxed the form as suggested, the model would still allow me to do it while the patient is sitting there -- thus demonstrating to her my commitment to help her get the right care, and perhaps add to her own motivation. Structure and design can improve function. Tim > Regarding scheduling patients for tests: to me it seems more efficient > to create the order/consult letter and fax it to the facility/ print it > out and give to the patient in one fell swoop; and then have the > patient call for the appointment. I almost never call for appointments > for patients, unless for example, it's an urgent LE US to r/o a DVT > that I want then and there, or an urgent consult that I have to speak > directly to the specialist about. > > Lynn > >> >>Reply-To: >>To: < > >>Subject: Re: new habits... >>Date: Fri, 5 May 2006 20:36:28 -0400 >> >>RE Doing today's work today. >> >>This is once again an extension of open access type method. >>Don't forget, though, that you can help a pt get scheduled at some >> hospitals >>by the following: >> >>1) Print out copy of order, say, a mammogram. >> >>2) See if you can fax it directly to the facility and have THEM contact >> pt. Be sure to put the pt's contact number on the order. >> >>3) I put in the note after each test: >> A) If the hospital doesn't contact you to schedule your test >>within >>1 week, please call the doctor's office for assistance. >> If our office does not contact you within 1 week with the >>result, >>please call us. >> >>4) Hospital usually faxes back a confirmation for testing such as >> sonogram, CT scans, MRIs and I track them. >> >>Service doesn't have to be completed at the immediate time of service, >> but best to get the fax out the door! >> >>And don't forget the pesky things like the preMRI screening >> questionaires, and BUN/creatinine orders to be completed prior to dye >> testing. >> >>Dr Matt Levin >>FP, solo since Dec 2004. >>Worked for others from July 1988-Dec 2004. >>Pittsburgh, PA >>SOAPware user since 1997 >> >> new habits... >> >> >> > I've come to think the biggest challenge for me is actually the >> breaking of old habits and the building of new habits and personal >> systems. >> > >> > For so many years, if a patient needed something (form, referral, >> insurance clarification, etc) we'd get the info, send the patient >> home >>and >> > then catch up with the work later with either myself or the >> nurses/staff fitting it in (or perhaps staying late). >> > >> > Now however, as I've designed more time for appts and I have no >> staff, >>the >> > easiest thing is to do it NOW... right away... immediately... >> pronto... you get the story! But still, I feel my brain pause >> before I do it as >>if >> > it wants to say, " I'll get back to you about that " . But then it >> feels so good when I get the job out of the way and the patient is >> happy. The feeling of scanning a completed form and handing the >> original back to >>the >> > patient is simply great. >> > >> > But also, to call for a referral is very satisfying too. I use a >>speaker >> > phone so the patient hears the whole conversation. And while on >> hold, we are either discussing plans or I'm writting my advise or >> the >>specialist's >> > address, etc -- things I need to do anyway, so I'm not really losing >> >>time >> > on hold. >> > >> > Yesterday was yet another example -- 44 year old woman in for severe >> seasonal allergies - first visit in new office though I've known her >> >>four >> > years prior ... as I'm looking at old records and setting her up in >> my EMR, I clarify her last mammo was more than 3 years ago ... I ask >> if I >>can >> > help her set that up, she says yes, I pick up the phone and booked >> it >>for >> > her then and there. As she left with a plan for her allergies, she >>turns >> > and said thanks, " I'd never have scheduled that if you didn't call >> just now. " >> > >> > Is that good use of a doctor's time? Perhaps from a financial >>perspective, >> > no. But from the humanistic perspective, absolutely! It's like a >> Mastercard commercial -- >> > >> > " Doctor's pay per minute... $2.50. >> > Time to book a mammo... 6 minutes. >> > Value of helping patient get timely mammo and strengthening our >> relationship... PRICELESS! " >> > >> > I know this story is redundant for many others which have been told >> on >>the >> > list. But this is my personal, freshest perspective so I figured I'd >> >>share >> > it. I do hope it helps someone in some way, some day. >> > >> > Tim >> > >> > >> > >> > >> > >> > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2006 Report Share Posted May 6, 2006 Right, I agree that normally I will simply give the patient the order and phone number and ask them to book it on their own time with their schedule in front of them. But the anecdote I offered was specifically someone who was behind in standard screening. I didn't mention it, but when I asked she gave the common sheepish look and said something like, " yeah, I know, I gotta plan for that soon. " A reply that made me guess she's contemplative and not in the action phase of mammo planning. Thus, I was able to adjust the appt on the fly, and get her booked. Something I would not have felt able to do in the standard office. But the structure of the office (phone two feet from me, no need to leave room or move anywhere else) and schedule (can " steal " an extra five minutes if needed for quality of care and not fall further behind) offers me that ability to spontaneously give a service I believe is beneficial. If she was only 4 months late on the mammo rather than 3 years (actual, though she initially said 6 years) I would not have taken the extra step. It was an anecdote to demonstrate an inate quality I believe this model possesses. The details of how we get the job done will vary beyond that. If I faxed the form as suggested, the model would still allow me to do it while the patient is sitting there -- thus demonstrating to her my commitment to help her get the right care, and perhaps add to her own motivation. Structure and design can improve function. Tim > Regarding scheduling patients for tests: to me it seems more efficient > to create the order/consult letter and fax it to the facility/ print it > out and give to the patient in one fell swoop; and then have the > patient call for the appointment. I almost never call for appointments > for patients, unless for example, it's an urgent LE US to r/o a DVT > that I want then and there, or an urgent consult that I have to speak > directly to the specialist about. > > Lynn > >> >>Reply-To: >>To: < > >>Subject: Re: new habits... >>Date: Fri, 5 May 2006 20:36:28 -0400 >> >>RE Doing today's work today. >> >>This is once again an extension of open access type method. >>Don't forget, though, that you can help a pt get scheduled at some >> hospitals >>by the following: >> >>1) Print out copy of order, say, a mammogram. >> >>2) See if you can fax it directly to the facility and have THEM contact >> pt. Be sure to put the pt's contact number on the order. >> >>3) I put in the note after each test: >> A) If the hospital doesn't contact you to schedule your test >>within >>1 week, please call the doctor's office for assistance. >> If our office does not contact you within 1 week with the >>result, >>please call us. >> >>4) Hospital usually faxes back a confirmation for testing such as >> sonogram, CT scans, MRIs and I track them. >> >>Service doesn't have to be completed at the immediate time of service, >> but best to get the fax out the door! >> >>And don't forget the pesky things like the preMRI screening >> questionaires, and BUN/creatinine orders to be completed prior to dye >> testing. >> >>Dr Matt Levin >>FP, solo since Dec 2004. >>Worked for others from July 1988-Dec 2004. >>Pittsburgh, PA >>SOAPware user since 1997 >> >> new habits... >> >> >> > I've come to think the biggest challenge for me is actually the >> breaking of old habits and the building of new habits and personal >> systems. >> > >> > For so many years, if a patient needed something (form, referral, >> insurance clarification, etc) we'd get the info, send the patient >> home >>and >> > then catch up with the work later with either myself or the >> nurses/staff fitting it in (or perhaps staying late). >> > >> > Now however, as I've designed more time for appts and I have no >> staff, >>the >> > easiest thing is to do it NOW... right away... immediately... >> pronto... you get the story! But still, I feel my brain pause >> before I do it as >>if >> > it wants to say, " I'll get back to you about that " . But then it >> feels so good when I get the job out of the way and the patient is >> happy. The feeling of scanning a completed form and handing the >> original back to >>the >> > patient is simply great. >> > >> > But also, to call for a referral is very satisfying too. I use a >>speaker >> > phone so the patient hears the whole conversation. And while on >> hold, we are either discussing plans or I'm writting my advise or >> the >>specialist's >> > address, etc -- things I need to do anyway, so I'm not really losing >> >>time >> > on hold. >> > >> > Yesterday was yet another example -- 44 year old woman in for severe >> seasonal allergies - first visit in new office though I've known her >> >>four >> > years prior ... as I'm looking at old records and setting her up in >> my EMR, I clarify her last mammo was more than 3 years ago ... I ask >> if I >>can >> > help her set that up, she says yes, I pick up the phone and booked >> it >>for >> > her then and there. As she left with a plan for her allergies, she >>turns >> > and said thanks, " I'd never have scheduled that if you didn't call >> just now. " >> > >> > Is that good use of a doctor's time? Perhaps from a financial >>perspective, >> > no. But from the humanistic perspective, absolutely! It's like a >> Mastercard commercial -- >> > >> > " Doctor's pay per minute... $2.50. >> > Time to book a mammo... 6 minutes. >> > Value of helping patient get timely mammo and strengthening our >> relationship... PRICELESS! " >> > >> > I know this story is redundant for many others which have been told >> on >>the >> > list. But this is my personal, freshest perspective so I figured I'd >> >>share >> > it. I do hope it helps someone in some way, some day. >> > >> > Tim >> > >> > >> > >> > >> > >> > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2006 Report Share Posted May 6, 2006 Let me qualify my post prior to being flamed. I have been a lurker and infrequent poster on this list for a few months. Some of you know me from off this list and that is usually where I keep my communications. I am not an MD or a PCP but a practicing chiropractor. Nine months ago, I formed a micropractice within the ideals that have been set forth by Gorden and this group. I bounce back and forth between a larger, multi-doctor, multi-staffed office with high volume of patients to a small, one room practice with no staff depending on the day of the week. My micropractice patients have 24/7 direct access to me by cell phone and e-mail and deal with me directly to make appointments, take co-payments, etc. Certainly there are topics discussed on this list that I cannot relate to...pharmaceutical samples, certain specialized testing and procedures, etc. But the nuts and bolts of running a healthcare practice without staff, the small practice mentality, the delivery of care to patients on a highly personal level, all overlap with my own experience. I wanted to chime in on the discussion about ordering tests because I think there is a more important point than just setting up the test. When patients are sent for a radiology study or even bloodwork, they very often go home thinking, "I have cancer and I know they are going to find something terrible." Patients lose sleep for days awaiting the results of even routine tests. Many doctors don't even call their patients with negative results thinking no news is good news. For many years, my standard operation is one day after the test was scheduled (or if the patient is scheduling, I have them call me once the test is completed), I will call the radiology center or lab for a faxed copy of the results. If the results aren't ready, I will take a verbal. Almost every imaging test and many bloodwork tests can return some result within 24 hours. The patient then gets a call...positive or negative results notwithstanding. If I have referred the patient to another specialist who I know has ordered the test, I will still call for the results. Patients are amazed since they are usually told it will take "a couple of weeks" to hear about their results can know as soon as possible. Allowing your patients to sleep better at night knowing the outcome of their testing is certainly a valuable, personal service that the big practices cannot offer. Brett L. Kinsler, DC Rochester, NY Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2006 Report Share Posted May 6, 2006 Let me qualify my post prior to being flamed. I have been a lurker and infrequent poster on this list for a few months. Some of you know me from off this list and that is usually where I keep my communications. I am not an MD or a PCP but a practicing chiropractor. Nine months ago, I formed a micropractice within the ideals that have been set forth by Gorden and this group. I bounce back and forth between a larger, multi-doctor, multi-staffed office with high volume of patients to a small, one room practice with no staff depending on the day of the week. My micropractice patients have 24/7 direct access to me by cell phone and e-mail and deal with me directly to make appointments, take co-payments, etc. Certainly there are topics discussed on this list that I cannot relate to...pharmaceutical samples, certain specialized testing and procedures, etc. But the nuts and bolts of running a healthcare practice without staff, the small practice mentality, the delivery of care to patients on a highly personal level, all overlap with my own experience. I wanted to chime in on the discussion about ordering tests because I think there is a more important point than just setting up the test. When patients are sent for a radiology study or even bloodwork, they very often go home thinking, "I have cancer and I know they are going to find something terrible." Patients lose sleep for days awaiting the results of even routine tests. Many doctors don't even call their patients with negative results thinking no news is good news. For many years, my standard operation is one day after the test was scheduled (or if the patient is scheduling, I have them call me once the test is completed), I will call the radiology center or lab for a faxed copy of the results. If the results aren't ready, I will take a verbal. Almost every imaging test and many bloodwork tests can return some result within 24 hours. The patient then gets a call...positive or negative results notwithstanding. If I have referred the patient to another specialist who I know has ordered the test, I will still call for the results. Patients are amazed since they are usually told it will take "a couple of weeks" to hear about their results can know as soon as possible. Allowing your patients to sleep better at night knowing the outcome of their testing is certainly a valuable, personal service that the big practices cannot offer. Brett L. Kinsler, DC Rochester, NY Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2006 Report Share Posted May 6, 2006 right you are. Brent > > Let me qualify my post prior to being flamed. I have been a lurker and infrequent poster on this list for a few months. Some of you know me from off this list and that is usually where I keep my communications. I am not an MD or a PCP but a practicing chiropractor. Nine months ago, I formed a micropractice within the ideals that have been set forth by Gorden and this group. I bounce back and forth between a larger, multi-doctor, multi-staffed office with high volume of patients to a small, one room practice with no staff depending on the day of the week. My micropractice patients have 24/7 direct access to me by cell phone and e-mail and deal with me directly to make appointments, take co-payments, etc. Certainly there are topics discussed on this list that I cannot relate to...pharmaceutical samples, certain specialized testing and procedures, etc. But the nuts and bolts of running a healthcare practice without staff, the small practice mentality, the delivery of care to patients on a highly personal level, all overlap with my own experience. > > I wanted to chime in on the discussion about ordering tests because I think there is a more important point than just setting up the test. When patients are sent for a radiology study or even bloodwork, they very often go home thinking, " I have cancer and I know they are going to find something terrible. " > > Patients lose sleep for days awaiting the results of even routine tests. Many doctors don't even call their patients with negative results thinking no news is good news. > > For many years, my standard operation is one day after the test was scheduled (or if the patient is scheduling, I have them call me once the test is completed), I will call the radiology center or lab for a faxed copy of the results. If the results aren't ready, I will take a verbal. Almost every imaging test and many bloodwork tests can return some result within 24 hours. The patient then gets a call...positive or negative results notwithstanding. > > If I have referred the patient to another specialist who I know has ordered the test, I will still call for the results. Patients are amazed since they are usually told it will take " a couple of weeks " to hear about their results can know as soon as possible. > > Allowing your patients to sleep better at night knowing the outcome of their testing is certainly a valuable, personal service that the big practices cannot offer. > > Brett L. Kinsler, DC > Rochester, NY > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 6, 2006 Report Share Posted May 6, 2006 right you are. Brent > > Let me qualify my post prior to being flamed. I have been a lurker and infrequent poster on this list for a few months. Some of you know me from off this list and that is usually where I keep my communications. I am not an MD or a PCP but a practicing chiropractor. Nine months ago, I formed a micropractice within the ideals that have been set forth by Gorden and this group. I bounce back and forth between a larger, multi-doctor, multi-staffed office with high volume of patients to a small, one room practice with no staff depending on the day of the week. My micropractice patients have 24/7 direct access to me by cell phone and e-mail and deal with me directly to make appointments, take co-payments, etc. Certainly there are topics discussed on this list that I cannot relate to...pharmaceutical samples, certain specialized testing and procedures, etc. But the nuts and bolts of running a healthcare practice without staff, the small practice mentality, the delivery of care to patients on a highly personal level, all overlap with my own experience. > > I wanted to chime in on the discussion about ordering tests because I think there is a more important point than just setting up the test. When patients are sent for a radiology study or even bloodwork, they very often go home thinking, " I have cancer and I know they are going to find something terrible. " > > Patients lose sleep for days awaiting the results of even routine tests. Many doctors don't even call their patients with negative results thinking no news is good news. > > For many years, my standard operation is one day after the test was scheduled (or if the patient is scheduling, I have them call me once the test is completed), I will call the radiology center or lab for a faxed copy of the results. If the results aren't ready, I will take a verbal. Almost every imaging test and many bloodwork tests can return some result within 24 hours. The patient then gets a call...positive or negative results notwithstanding. > > If I have referred the patient to another specialist who I know has ordered the test, I will still call for the results. Patients are amazed since they are usually told it will take " a couple of weeks " to hear about their results can know as soon as possible. > > Allowing your patients to sleep better at night knowing the outcome of their testing is certainly a valuable, personal service that the big practices cannot offer. > > Brett L. Kinsler, DC > Rochester, NY > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 7, 2006 Report Share Posted May 7, 2006 RE helping scheduling vs paternalism Hmm.... I have learned over my 20+ years practice that there is a fine line between " follow up " and paternalism Last practice I was at was hospital owned. We had lab draw on site provided by hospital, so I decided that we'd put orders for labs in a lab file at our office-- all pt had to do was walk over to our office, get the order, and go across the lobby to go to the lab. So what happened? 1) Many pts just didn't get the labs done! 2) I at first requested that we check the lab box once a month to see if anyone was " overdue " and call pt, but check chart first to be sure they didn't already have the lab done? 3) We ended up with overlapping labs, pts who didn't want to come in for labs, staff " resistance " to checking the box, multiple labs on same pt and wrong one pulled. So, in my own office, we don't keep a lab box. 1) I give copy of lab to pt, and keep a copy in my running note in my EMR. 2) If we have a follow up lab, we mail a copy of the lab order to the pt, and keep a copy in my paper chart (yes, I have a dual system of EMR with printed notes, works for me currently, am gradually going paperless). 3) If pt didn't get lab done next time seen, I note CLEARLY in the office note " UPDATE [date] pt was instructed to have lipid profile, reminded. This also goes for mammograms, nonurgent screening. I'm an advisor, but pt has to take responsibility. We'll gladly fax the order to the scheduling area of the hospital, but I personally feel that for things like mammograms, even delayed ones, pt (if competent) has to take this one on. Of course, there's exceptions to each rule; this is the way I've chosen to do it. Dr Matt Levin new habits... >>> >>> >>> > I've come to think the biggest challenge for me is actually the >>> breaking of old habits and the building of new habits and personal >>> systems. >>> > >>> > For so many years, if a patient needed something (form, referral, >>> insurance clarification, etc) we'd get the info, send the patient >>> home >>>and >>> > then catch up with the work later with either myself or the >>> nurses/staff fitting it in (or perhaps staying late). >>> > >>> > Now however, as I've designed more time for appts and I have no >>> staff, >>>the >>> > easiest thing is to do it NOW... right away... immediately... >>> pronto... you get the story! But still, I feel my brain pause >>> before I do it as >>>if >>> > it wants to say, " I'll get back to you about that " . But then it >>> feels so good when I get the job out of the way and the patient is >>> happy. The feeling of scanning a completed form and handing the >>> original back to >>>the >>> > patient is simply great. >>> > >>> > But also, to call for a referral is very satisfying too. I use a >>>speaker >>> > phone so the patient hears the whole conversation. And while on >>> hold, we are either discussing plans or I'm writting my advise or >>> the >>>specialist's >>> > address, etc -- things I need to do anyway, so I'm not really losing >>> >>>time >>> > on hold. >>> > >>> > Yesterday was yet another example -- 44 year old woman in for severe >>> seasonal allergies - first visit in new office though I've known her >>> >>>four >>> > years prior ... as I'm looking at old records and setting her up in >>> my EMR, I clarify her last mammo was more than 3 years ago ... I ask >>> if I >>>can >>> > help her set that up, she says yes, I pick up the phone and booked >>> it >>>for >>> > her then and there. As she left with a plan for her allergies, she >>>turns >>> > and said thanks, " I'd never have scheduled that if you didn't call >>> just now. " >>> > >>> > Is that good use of a doctor's time? Perhaps from a financial >>>perspective, >>> > no. But from the humanistic perspective, absolutely! It's like a >>> Mastercard commercial -- >>> > >>> > " Doctor's pay per minute... $2.50. >>> > Time to book a mammo... 6 minutes. >>> > Value of helping patient get timely mammo and strengthening our >>> relationship... PRICELESS! " >>> > >>> > I know this story is redundant for many others which have been told >>> on >>>the >>> > list. But this is my personal, freshest perspective so I figured I'd >>> >>>share >>> > it. I do hope it helps someone in some way, some day. >>> > >>> > Tim >>> > >>> > >>> > >>> > >>> > >>> > Quote Link to comment Share on other sites More sharing options...
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