Amidst the uncertainty of healthcare’s future under the new presidential administration, there are certain attributes of good care which hold true, regardless of what policies are in place. I’ve written about these attributes before, and we’re continuing to refine how they translate at the ground level in our work with practices and systems across the country.
Primary care is struggling to keep up with the needs of consumers, but I believe there are practical steps we can take to move us in the right direction, even if progress is slow. So in the spirit of changing seasons and how Spring symbolizes growth, here are three ways for providers to change the way they think about care delivery in 2017:
Redefine the purpose of the exam room
What many providers don’t realize is that time is essentially the product we offer. We’re equipped as physicians with education and training, but we exercise that expertise in segments of time. So it’s not accurate to think about our medical training as the service we deliver—it’s the time we spend with patients in the exam room.
But it’s also not right to operate under the assumption that the more time we spend with patients, the better the quality of care we provide. The provider/patient connection is vital, but it requires boundaries. Many providers are losing time—their most valuable resource—through burdensome ancillary work, inappropriate focus on socializing with patients and too much leeway for unreasonable patient expectations. No business can survive if it gives away unlimited product, and the same principle holds true in medicine. Unlimited time for one patient destroys access for another, and it’s this lack of appropriate, timely access for our patient panels that has marginalized the discipline of primary care.
Health achieved for every patient under our care—whether seen on a particular day or not—should always be the goal of the exam room. The quality of care for our panel is what determines its success—not the amount of time the provider spends in it.
Rethink priorities inside the exam room
It’s fair to say that time management begins with priority management. And that’s very applicable to the context of the exam room. Primary care providers must prioritize their time in order to deliver the quality of care their panels need and create or maintain patient health.
So what does this priority management look like? It means the provider is personally involved in the health of each of his/her patients and responsible for ensuring they receive the care they need. It means creating appropriate access for the entire panel and communicating with patients in a timely manner. And all of this is accomplished by facilitating a team approach to care so non-physician work is accomplished by clinical staff, freeing the provider to do what only he/she can.
Recognize the high cost of independence in the exam room
I know all too well how difficult it can be to change habits in the exam room. My practice was on the verge of failure before I was able to change its course by altering my care delivery model.
I and many other primary care providers are independent by nature and training. Medicine as a discipline has been historically and culturally organized around the individual. But our fierce independence has come at a high cost: to providers, consumers, the sustainability of practices and the discipline of primary care itself. It has impeded our ability to offer appropriate access for our panel, adapt to new challenges and mobilize a team approach to elevate our delivery process. And without recognizing how this independence inhibits good care, we’ll continue to fall short of the goal of improving health outcomes.
There’s much that could be said regarding these different areas, and I’ll be sharing more about them in the future. As we look for new and better ways to help primary care achieve its full potential—improving medical outcomes, consumer satisfaction, and financial viability along the way—primary care providers must embrace new ways of delivering their product. The health of our patients is too important for the comfort of old habits or fear of change to prevent us from doing everything we can to provide accessible, comprehensive care in the context of a long-term provider/patient relationship.