We’re headed into hurricane season here in southeast Virginia. The southeast is famous for them. While we are familiar with the devastating effects of hurricanes, few of us ever think about the cause.
What Causes a Hurricane?
I could get very technical here, but simply stated hurricanes occur when the moist, warm air from the surface of the ocean rises and meets the cooler air.
Amazing that such deadly storms can occur from such a simple, essential combination of natural elements.
So what does this have to do with Primary Care? Everything. A storm has been brewing for decades in American Healthcare. And just as hurricanes begin slowly and pick up pace as they progress, so, too, is the hurricane in Primary Care. And the cause? I believe it is something as simple as two essential elements of Primary Care converging: The Lone Ranger Physician meets the fifteen minute office visit.
Essential Element One: The PCP (aka The Lone Ranger)
In a recent blog post (see Hi-Yo Dysfunction! Away!), I referenced “The Myth of the Lone Physician: Toward a Collaborative Alternative,” the myth “the lone physician: a competent professional who is esteemed…for his or her willingness to sacrifice self, accept complete responsibility for care, maintain continuity and accessibility, and assume the role of lone decision maker in clinical care” is failing. The article states that, “the myth fundamentally fails them as they strive to be super-doc —- one person to attend to the biomedical, individual, and interpersonal needs of patients and families in 15 minute increments. The “tyranny of the urgent ”creates a work life in which autonomy gives way to isolation, continuity to fragmentation, and compassion to burnout” [i]
Essential Element Two: The Fifteen Minute Exam
The fifteen minute office visit is indeed the elephant in the room! Just think of all that a PCP is required to do in 15 minutes – engage personal non-medical, but relevant conversation, deal with several chronic diseases, address any new symptoms, update a medication list that may be 10-15 meds, follow up on previous unfinished issues, investigate other medical events that have occurred since you last saw the patient, deal with preventative issues, develop diagnoses and a treatment plan, document the entire visit and then fulfill administrative tasks including formularies, prior-authorizations, and proper coding. One is expected to do all this in 15 minutes — just to go to the next room and repeat the process again. Overwhelming? Absolutely!
The Perfect Storm
So when the Lone Ranger PCP meets the intense demands of the fifteen minute office visit a storm begins to brew. This storm, Hurricane Primary Care, has been brewing for decades and is currently wreaking havoc in American healthcare today.
So, what is to be done? No one can stop a hurricane. It will run its course, destroying everything in its path. Many medical professionals and the general public alike fear the same is true for healthcare in the United States. I disagree.
Calming the Storm
I believe the answer lies in teamwork. Primary care teams come in all shapes, sizes and missions. A team starts with a PCP and can include RNs, NPs, PAs, case managers, community health workers, pharmacists, social workers and the list goes on. Each PCP must determine what team configuration would best meet the needs of the patients and staff, not to mention his or her own needs, while fulfilling the mission at hand. Having the right team suited for the specific challenge is critical.
How does a team calm the raging hurricane that is Primary Care? It takes the just the right amount of pressure off of the PCP, sharing the responsibility of the office visit with trained, capable team members. And by the way, 15 minutes won’t cut it for today’s primary care patient, especially one with multiple chronic illnesses. The total time required is more like 30 minutes. But that work can be accomplished by a team. Teamwork makes the patient visit viable again, increasing quality, patient satisfaction, staff satisfaction, provider satisfaction, specialty coordination, access and financial performance.
The team approach to Primary Care is not some sort of magical potion. It is simply alters the hurricane-making chemistry of the lone PCP and the fifteen minute office visit and transforms it into a team and the office visit, averting the perfect storm.
How are you battling Hurricane Primary Care? Are you hunkered down in the storm cellar waiting it out, growing wearier by the day? Or will you fight back, embrace team work and help bring American healthcare back into the sunlight?
[i] Annals of Family Medicine; Vol 10, No.2 ; Mar/April 2012;p169-173