A Country Doctor Writes:

What do you do when you get a multi-page letter from an insurance company with care reminders about several patients? I toss it in the shred box.

This is why:

The business model in primary care is that providers are scheduled to see patients all day long. We treat one patient at a time. Anything else, like prescription refills, review of results, answering messages and so on, happens at the expense of scheduled patients’ time with us or our own free time (not-so jokingly called pajama time).

Those care reminders would require me to look up each patient’s chart, review it, consider the recommendation and then maybe create an order and a message to my nurse.

On whose dime? (This is an expression from the era of telephone booths.)

In manufacturing, at least before the recent supply chain meltdown, the concept of just-in-time has been popular. Have raw materials or parts arrive when you need them. That eliminates the need for excessive inventory and storage capacity.

In paper medical records, care reminder letters would have been placed as the first page you see when you open the chart the next time the patient comes in. There is no easy or established way to do that in an EMR. And we are far away from the utopia of having doctors sit at their desks thinking about and directing the care of any patients who are not right in front of their faces.

So, in the reality of today’s work flows, the best I could possibly do would be glance at them and put the “recommendation” in the back of my mind for the next time I see the now normoglycemic diabetic who isn’t on a statin drug. And so on.

If we are supposed to work outside the face-to-face assembly line model, we need our schedules and our tools to be redesigned for such purposes. Until that happens, care reminders and many other things, like population management, are just recipes for physician burnout.