Change Your Primary Care Mindset--the Physician

“There you go again, Curmudge, trying to discuss a subject about which you don’t know diddly.”

“Now, Jaded Julie, you’ve known for a long time that I compensate for my lack of expertise by quoting material from reliable sources—literature that most people don’t have time to find and read. So may I have your permission to examine the duties and mindset of a primary care physician in his/her traditional role and then after he joins a medical home?”

“Have at it, Curmudge. I’ll follow along to keep you honest.”

“Okay, let’s consider a traditional office visit for episodic care (1). The patient arrives and is checked in by the receptionist who verifies contact and insurance information and collects the co-pay. After the patient sits in the waiting room for awhile, the nurse takes her back to the exam room and checks her vital signs. Ultimately, the physician arrives and he/she does most or all of these things: medication reconciliation, history and physical, data gathering and entry, decision making, prescription writing, documentation and paperwork, behavior modification, results reporting and order entry.”

“But Curmudge, several of those things could have been done by someone other than the physician.”

“That’s it, Julie. As we’ll learn later, having someone else do some of these things is the key to a solution. But first, let’s more fully examine the present situation. Here are some shocking numbers regarding the primary care physician in his traditional role (2): ‘It would take 18 hours per day to provide all evidence-based chronic care and preventive care to the average 2,500-patient panel. This doesn’t include acute care.’ Other sources estimate the total, including acute care, to be 19-25 hours per day.”

“Twenty-five hours per day! Someone once told me that if 24 hours a day were not enough, there’s always nights.”

“Get serious, Julie. ‘Many primary care physicians are stressed, some are exhausted physically and emotionally, and almost all are overwhelmed with crammed schedules…and unrewarding administrative tasks (3).’ ‘…they feel like hamsters on a treadmill.’”

“Wow, Curmudge! I feel badly for those physicians, and I would not want to be a patient of such a frenetic practice. The last thing Jaded Julie needs is a jaded primary care physician.”

“And that’s why physicians in recent years have developed ways to make their practices more efficient; these improvements evolved into the Patient-Centered Medical Home.”

“So the doc’s mindset has changed from frantic to relaxed?”

“Not entirely, Julie. In the traditional clinic, the people working for the physician were his/her subordinates. In the medical home, the physician is the leader of a team of quasi-peers.”

“Curmudge, I’d understand you a lot better if you called them almost-peers. But go on…”

“It’s not always easy for a physician to make the transition from absolute chief to leader of a team. In fact, consideration of that will be the second half of our exploration of the changing mindset of the primary care physician.”

“We can’t explore someone’s mindset, Old Guy. You’re not a psychologist.”

“Not a problem, Julie. All we do is read and write.”

“If you say so, Curmudge, but that can be done by any second-grader.”

Affinity’s Kaizen Curmudgeon

(1) Sinsky, C.A. Improving office practice: Working smarter, not harder.
http://www.aafp.org/fpm/20061100/28impr.html
(2) Framing the medical home model of care: blueprint from early adaptors. (book)
http://store.hin.com/Framing-the-Medical-Home-Model-of-Care-Blueprint-from-Early-Adopters_p_3791.html
(3) Primary Care at the Crossroads: Preconference Papers
http://www.familymedicine.medschool.ucsf.edu/pdf/cepc/0406_pres/preConfPapers.pdf