Enter to win a Amazon gift card–list a goal for your practice this year and a plan to achieve it!

See the December 29 post and enter your practice’s goals for 2009.  Include a plan by which your will achieve the goals.  The best plan wins a $15 gift card from Amazon.

Power to the Punctual! How Physicians can be on Time!

Patients have a pet peeve: they hate waiting for the doctor.  I hate waiting for the doctor, and hate it when patients wait for me!  It’s very funny, but in my personal life I tend to run late, but at work, I’m usually on time.  Reflecting on what helps me be on time, I came up with some tips:

  1. Don’t check voice mail or email first thing.  Get to the clinic (or hospital, as is my case), and get started.  Checking emails/voice mails will likely take up more time than you have.  Remember, the beauty of email/voice mail is that you can respond when you are able.
  2. Give yourself extra time to get to the office/hospital.  Don’t fall in to the “well, I have three extra minutes so I will check my emails, start my latest article, read up on transplants…”  trap.  Get to work first!
  3. Set your clock or watch ahead by an uneven amount.  (It’s harder to subtract, although my fiendish little brain has become adept at subtracting odd numbers.)  Set different clocks ahead by different amounts.  (Take that, smart brain!)
  4. Estimate accurately how long something will take, then add 15 minutes.  When a nurse calls me and asks when will I see a patient, I estimate how long it will be, and then add the extra 15 minutes.  The patients and families love it because I am on time, and I really look good if I arrive in the room early!
  5. Don’t schedule meetings during peak times.  At one hospital I worked at, they wanted us to meet with the case managers at 9:00 am.  I am hitting my rounding stride around then, and having a meeting in the middle of the morning would really slow me down, (not to mention slowing discharges down!)  My group was able to get a different meeting time set up.
  6. Set a goal for what you want to accomplish ahead of time.  I try to break my day up when I’m rounding into segments.  I will set a goal of seeing 2/3rds of my patients by 1:00 pm for example.  I know I am much slower in the afternoon, so I try to have the bulk of my work done before lunch.
  7. Set up your day so you can use your peaks effectively.  I try to see my ICU patients first, when I am sharpest, and leave phone calls for late in the day, when I can sit down with a cup of tea and really listen to what the families say.
  8. Don’t dwaddle on the Internet.  There is so much to read and learn, but getting sucked into the Internet black hole is a guaranteed time drain.  Be strong!
  9. Cut the optimism.  We all have ideas that we can get “just one more thing” done.  Try doing less, and you will probably be able to do more, because  you are less stressed because you are on time!
  10. Lastly, why are you late?  Is it a rebelliousness toward the system?  Are we physicians late because we can get away with it? Better book some time on the shrink rap couch!

So what are my top reasons for being late:

  1. Exuberant optimism about how much I can get done.
  2. Perfectionism, for example trying to get my computerized note to look “just so.”  (I am desperately trying to break this habit!)
  3. My kid/family/dog.
  4. Reading when I should be in the car driving.
  5. Complaining.  (Seriously, the way we docs carry on!  I am working HARD on breaking this habit, and will post on my ‘no complaining’ bracelet later.)

And you?  What’s keeping you from your patients?  Make 2009 the year when physicians are on time!  Power to the punctual!!!

Resources:  See posts on Lifehack and MedicineNet.

Enter the YOUR plan to improve your practice and win an Amazon Gift Card!

See the December 29 post and enter your practice’s goals for 2009.  Include a plan by which your will achieve the goals.  The best plan wins a $15 gift card from Amazon.

Don’t Write Off E-prescribing

I may appear to be somewhat of a troglodyte, but I actually have  committed myself to learning to love technology.  I am the proud owner of a smart phone, have mastered my email, and actually use two different EMRs.  So, you see, this qualified me as an expert on EMRs and e-prescribing (wipe that smirk off your face!)

It was with interest that I read “Effect of Electronic Prescribing With Formulary decision Support On Medication Use and Cost” in the December 8/22 2008 issu3e of Archives Of Internal Medicineby Michael Fischer, MD, MS et al.  The authors describe a study in which physicians using e-prescribing with formulary decision support were compared with physicians using traditional paper prescriptions with respect to prescribing tier 1 medications.  When prescribing electronically, the physicians were more likely to choose the lower cost generic tier 1 medication.  There was a 3.3% increase in tier 1 prescribing, with a decrease in tier 2 and 3 prescriptions.  Fischer et al estimate that this would result in an $845,000 savings per 100,000 patients, based on the assumption that each patient filled one prescription per month.

I love saving money, but what was the cost of saving money?  According to the authors, “government estimates of approximate first year costs were $3000 per prescriber.”  In the study, Blue Cross Blue Shield supplied the software to the physicians, along with a free wireless device, access to a secure Web portal, licensing and wireless carrier.  So, the cost was not borne by the participating physicians.

I think as a first step toward an EMR, e-prescribing makes sense.  I do not think that every insurance company should provide physicians with it’s wireless device.  Can you imagine, five different devices for five different insurance companies?!

So what is to be done?  The federal government must mandate one SINGLE e-prescription system that we all should use, and insurance companies should bear the cost, based on percentage of patients enrolled in each plan.  Why should health insurance plans pay?  Because they are the ones that will enjoy the savings!  I think this would be an effective way to usher in the beginnings of an EMR.  Mr. Obama and Mr. Daschle, are you listening?

As physicians, we must look for ways that we can use e-prescribing efficiently and effectively.  We must commit to learning all the bells and whistles, and using it to our advantage.  So, stop hiding behind your prescription pad, and make way for what is inevitable.  Get out there and lobby for what should be done, rather than whining when we get handed the bill for something that will most benefit the health insurance industry!

Win an Amazon Gift Card: What Are Your Goals for Your Practice in 2009?

As a way to encourage goal setting and planning for medical practices, I am hosting a contest.  I will email a $15 Amazon gift card to the person who sends in the best plan for improving their medical practice in 2009.

Here are the rules:

  1. Under the comments section for this post, list the goal your practice will achieve in the year 2009.
  2. Write out the  step by step plan as to how your practice will reach this goal.
  3. Have a time line accompanying each step.
  4. Assign a person  (don’t use their name, but rather “office manager” or “me”  or “book keeper”) who will be responsible for each action.
  5. All goals/plans must be submitted by January 16, 2009 by 12:00 midnight.
  6. I will pick the best goal/plan/action list, and post it on the blog by January 23rd.
  7. I will email the winning entry a $15 Amazon gift card.

That’s it.  No  bull, just good ideas on how to improve medical practices!  I will post my goals for my company, ExtraMD,  by January 8th.

Here’s to some great ideas!

Link Fest: Updates on group visits, RVUs, Medicare and the ‘Physician Shortage’

I’ve been storing up some links and today seemed to be a good time to have at ’em!  They range from the scary (Health Policy and Market) to the fun (the Efficient MD’s slide show.)

Read The Country Doc Report for another take on the group visit.  Country Doc relates how his practice does a group diabetic visit.  He uses smaller group sizes, and describes the three phases of the visit. 

For  an RVU Review, and exactly WHAT the RUC is, and how it effects you, visit Health Care Renewal blog. Boy, did I learn a lot about how we as physicians get paid (or not, as the case may be!)

To increase your understanding of the complexities of Medicare, Medicare Advantage, and Medicare Gap, see Insure Blog.  You may want to have this posted at  your front desk as patients come in with their “red white and blue” cards.

Now there are two types of Medicare plans, Traditional Medicare (administered by the government) and Medicare Advantage Plans (administered by private insurance companies). This has led to an unbelievable amount of confusion.

I love ways to improve my efficiency, and enjoyed the  fun, short  The Efficient MD’s  slide show.  I love his blog, and wish he would post more often!

For a chilly take on the role of physicians in the future, visit The Health Policy and Market blog.  According to the blog, we have plenty of doctors, and a “federal physician workforce policy” should be in place.  Just what I want, the federal government interfering even more into the business of health care! 

Establish a federal physician workforce policythat achieves the goals of organized care. TDI research has shown that the U.S. does not need more physicians; we have enough to care for America’s needs well into the future.

Let me know YOUR favority business of health care posts and I’ll put ’em up!

Walk the Talk: the Patient Encounter

I am fascinated by how we physicians communicate (or not) with each other and with our patients.  As a medical student and resident NO ONE ever thought about how physicians communicated with patients.  We were always so focused on nailing the disease process and treatment that the patient was nearly ignored.  I don’t think I had a single attending that excelled in talking and listening to patients.  I have tried to self educate (isn’t that what most of medicine is?) and found a thoughtful curriculum for residents on line, from the University of Washington.  I will reproduce the salient points here:

  1. Have an opening introduction: “Hi, Mrs. Marlboro, I’m Dr. Pookie.”  (Hand shake, sit down, look at patient.)
  2. Allow the patient to complete their opening statement.
  3. Attempt to get the patients full agenda: “Mrs. Marlboro, what is the most important thing we need to work on today?” At this point, prioritizing the patients concerns is key.
  4. Set the ground rules: “Mrs. Marlboro, it sounds like stopping smoking is what we should focus on today.  Is that right?”
  5. Gather information, with a  mixture of open and closed ended questions.  Summarize and clarify with out interrupting.
  6. Actively listen, using non verbal cues as well as verbal cues.  (“Uh huh, ah…”)
  7. Explore their beliefs about the illness.  (Yes it’s hard to keep your mouth shut when a patient insists that smoking isn’t bad “because, Doc, I know you’ve heard it before, but I don’t inhale.”  Just heard this from a diabetic as he went on his way to the cardiac cath lab…  But try!)
  8. Acknowledge the patients feelings/values.  (“Yes, quitting smoking is really hard, even our President Elect thinks so.”)
  9. Share information in terms that patients understand.  (Save the free radical talk, two gene promotor theory of cancer for some one who cares.)
  10. Encourage questions: “what questions or concerns do you have?”
  11. Reach agreement on the treatment plan, actively encouraging patients to participate in the plan. 
  12.  IMPORTANT: TRY TO GAUGE THE PATIENTS WILLINGNESS  AND ABILITY ENGAGE IN THE TREATMENT PLAN!  The best plan in the world is worthless if the patient can’t/won’t follow it!
  13. Provide resources (hand outs, referrals etc.)
  14. Realize you can NOT cover every item at every visit. 
  15. Close the encounter by summarizing the treatment plan and setting up the follow up plan.

The patient encounter needs to be a balance between “patient centered skills” and “agenda setting skills.”  Interestingly, when a patient is dissatisfied, they underestimate by 8% how much time the physician spent with them, while if they are satisfied, they overestimate the time the physician spent with them by 20%!

Please see link from Society of General Internal Medicine below.   First author is Matthew F. Hollon, M.D., M.P.H., from the University of Washington. 

http://sgim.org/userfiles/file/AMHandouts/AM08/WC01%20Matthew%20Hollon.pdf