A Country Doctor Writes:

I don’t regularly make any New Year’s resolutions, but this year I am tossing around a couple of ideas. One reason is that I have so many things going on that I need to be clever about how I use my time.

I work four days a week at my regular clinic and I also work two long days at a clinic in far northern Maine. In addition, there are many farm chores, this blog and three book projects I am working on, or at least pondering.

So here is a first draft of A Country Doctor’s New Year’s Resolutions:

1) I will more systematically listen to Audio Digest and other Continuing Medical Education talks while I drive up North and back. Halfway through the Family Medicine Review, I am noticing how I have adjusted my practice in many small ways to newer information.

2) I will be more diligent about scanning The New England Journal of Medicine on my iPad every Wednesday night. I’m usually on call that night, so it will be easy to remember this resolution.

3) In my Northern clinic, where routine prescriptions are filled by the providers, I will save myself up to an hour a week by refilling routine, non-controlled medications for a whole year and relying on the other existing systems for making sure patients don’t get “lost to followup”. I learned this from Christine Sinsky’s work many years ago, but because my Southern clinic has standing orders for routine prescription renewals, I haven’t had to worry about it so much.

4) In both clinics I will invest a little more time polishing my EMR templates in order to speed up and beef up my documentation. I will also continue to ponder how I can insert a visit snapshot near the top of each progress note so I can get the gist of it without scrolling down to the bottom when rereading it at the next, follow up visit.

5) I will more consistently insert a comment for myself with each lab test I order that requires some action on my part when it comes back, like “calculate ten year cardiovascular risk” after a lipid profile, or “increase lisinopril to 20 mg if labs ok” for a creatinine or chemistry profile.

6) I will work with the EMR coordinators on making the “lab letter” work better in both clinics, and I will make more consistent use of the web portal and smartphone messaging functionality down South in order to communicate results better to patients and also free up my medical assistants’ time (now calling many patients back with normal results) as well as my own.

7) I will firm up my morning huddle up North, where it is designed to do so many things, like catching unsuspecting patients for overdue immunizations, that the basic purpose of the visit could get lost, like “do we have the MRI and consultant report yet?”

8) I will more consistently do all action items with the patient in the room, even if some aspect of the documentation needs to happen later because of time constraints. I’m already at 90% here, but if I tell a patient, “let’s get an MRI of your shoulder”, I will always order it right then and there, so the care can keep moving along, even if I need to polish my note that night or the next day.

9) I need to think more about how I can change the insane EMR convention of making me the first one to lay eyes on incoming results and reports. In every other type of organization, information is sorted, prioritized and sometimes even condensed before it gets to the decision makers. But in medicine, providers see patients all day long without hardly even a bathroom break, while all kinds of important information piles up in their electronic inboxes. Then, when everybody else has gone home, we finally get to the abnormal results that would have taken thirty seconds to handle if someone had interrupted us with them, but often now can turn into a logistical nightmare.

10) This may not sound like a resolution to work smarter, but I will be more cognizant of the influence I have over the people I work with. As my wife once pointed out to me (see my New Year’s post 2012), I sometimes treat family and coworkers less well than I treat my patients. I can and should spread good will and consolation outside the exam room, too.