Buffet patients

One of the issues that we have to constantly deal with are buffet patients. When a patient is referred to us it is for a particular reason. The referring doctor sends the related studies and labs and our staff also sends for anything else that may be needed. Time is then alloted in the schedule for that problem. It is like someone ordering a cheeseburger over the phone. You know what you need to make it and about how long it will take to cook. Then comes in the buffet patient. They not only want to discuss and be seen for what they were referred for but also ten other things. They also ask questions like Aunt Bessie has a bump on her head, what is that. You try to be understanding but also know that there are now other patients who are mad because you are running late. The office staff is mad because they are having to call all around to track down stuff that I'd unrelated to why the patient is scheduled. One of our docs starters telling buffet patients that he would address the reason they were referred and that their other concerns are just as important and would schedule another visit for those. Ofcourse he got called uncaring and inconsiderate all over the internet and patients told the referring docs not to send people to him.

DE-access

We are six months into our wonderful electronic records system. It was touted to help increase our efficiency and to allow ease of patient care. The government even touted it as something that increases access to healthy care as it became so much more efficient.

Here is what we have found so far. It has decreased the numbers patients that can be see in a clinic by 30%. Even with that reduction, the clinic runs an extra hour and half longer. The actual time of patient contact, defined as listening, examining, and answering questions has been decreased by 50%.. We have had to hire 2 new assistants for every three doctors. We are told that it would improve our coding and because of this it would be cost neutral. As of today, it has decreased productivity and only added to overhead for a cost to the practice of 112k per physician.

9% of our staff have quit. Our practice is between 9 and 14% indigent care and 20% Medicaid. We are the only ones in the area that will see Medicaid patients. We have had to cut back so much we just don't have the time to see the amount of patients we did before, much less the ability to provide for those like Medicaid that cost more than we are paid.

On the good side, we are fairing far better than most of the other practices in the area. The biggest primary care group with over 500 docs is on their third system and having more problems than we are. The bad side, if you were counting on Obama-Care you are.. You are de-accessed to the healthcare system.

The TEMPLEt OF DOOM

I hate making people wait and I know they hate waiting for the doctor and no matter what we do we always run late. We have looked at every possible appointment template and no matter what it always seems to fail. It is especially worse this time of year when everyone has to update their insurance and or Medicare info. The first appointment is at 830, we try to make that a follow up, but of course they come to the office at 830, have to update all the information which takes 20 minutes and then it has to be entered into the computer so they dont even go back until after 900. You then go to see them for what was scheduled as a brief check up of the problem that you were consulted to take care of only to have them want you to check and look at something unrelated. Meanwhile the other patients are arriving and by some type of space-time wormhole, all arrive about the same time regardless of their actual appointment time. Now the waiting room is full, everybody is mad and doesnt want to wait. In comes someone who has an appointment tomorrow and wants to see if they can be worked in. Whne you finally get to see the patients, after you see them for what the appointment was for, they say " oh, by the way, I have this stange pain down my left arm now and then, but its worse when I go up stairs!"

Comes with the Job

There are many jobs where you can avoid certain circumstances or push the hard part off onto someone else. Many days, I wish I had one of those jobs. Instead, I have to be the one who walks into the waiting room and bring the parents into the consultation room to tell them that the frozen section shows the worst tumor possible and that it is rapidly fatal. You go into surgery for what seems like a routine thing, only to find out it is anything but. They were not expecting this kind of news, neither was I. You want to save them the grief, hide from the information, hope someone else has to bring the bad news, but you cant. It comes with the Job.

Coal in the Stocking

I really, really wish insurance deductibles ran on the fiscal year instead of the calendar year! It seems all too often people put off things until the holidays hoping to meet their deductible or just give up on meeting it and wanting to get things done before it starts all over again. Soon after thanksgiving, people flock to the office to get that CT or MRI or endoscopy that they have been putting off, or to have that funny pain when they eat checked. They absolutely want it done before Christmas. Sure enough, we then get to spend the holidays being BAD SANTA telling them and their family that they have some horrible ghastly cancer. Cant we just make deductibles end on April 15th so all the bad news is at the same time?

The Otis Effect

We had to cancel our study of the Otis effect early because the data reached such a statistical preponderance so early. We found the following things to be true. The elevator that is the farthest from you will always be the one to open the doors. the time that the doors are open is exactly 2 seconds less than the time it takes to get to the elevator. This is especially true in the middle of the night when there is not anyone else on the elevators. When you get in the elevator and have to be somewhere in a hurry, all the floor buttons between you and your destination will be pressed. This effect is enhanced when your destination is the parking lot to go home. If your arms are full, however, the only button not pressed will be the one that you need pressed. Further, when you ask for help, someone will press the wrong button. Flatulence is immune to the ventilation effect of any elevator fan. Lastly, the person who wants to get off first will always be the one farthest back.

Bobcat

My back is killing me. Sometimes it doesnt matter how many people you have to move a patient, especially when they have all their monitors and drips. Just trying to push a wieghted down ICU bed is a struggle. I was at the local lumber yard and saw someone moving a bunch of heavy duty carts. He pulled them along with a bobcat, put them where he needed them and then filled them with the bucket. It was awesome. I wonder if you can get a Bobcat into the hospital. I was thinking about a fork lift as well but with a Bobcat you load and move all that other stuff. Better yet, what if hospital beds where made by Bobcat? Each bed would be like an industrial hover-round with a winch, scoop bucket and a hydrolic lift system that you turn around real quick and easily. Press a lever and you could load and unload. When the pateints are alert they could drive themselves around.