Hijacked for Public Health Purposes: Previsit Planning and Morning Huddles

Mr. Adams is coming in to follow up on his MRI, but did he have it done? Mrs. Jones is supposed to bring all the medications she is actually taking, but will she remember to do that? And did Billy’s mom get his teachers to complete the teacher version of the ADHD symptom checklists she and his dad were supposed to each do before his appointment?

When doctors ran their medical offices and saw 30 or more patients per day, questions like this were part of how we planned the flow of our clinic days. Many of us called it CHART PREP. Our medical assistants would actually read our last office note the day before a patient’s appointment and try to make sure we would be ready for each visit. Then, first thing in the morning, we often had a quick HUDDLE to talk about what was supposed to happen during the day. The chart prep and huddle were very patient centered; they were about what the patients expected from their visit at least as much as what the doctor expected.

Now, with non-physicians managing medical practices and Medicare and other insurers redefining the purpose of primary care, previsit planning and morning huddles have been hijacked for public health purposes. The nation’s public health agenda is inefficiently squeezed through the bottleneck of a couple of brief in-person visits per year for unsuspecting patients who because of that don’t always then get their own concerns addressed.

Imagine driving up to an ATM for what you think will be a simple fast-cash withdrawal and having the machine start blurting out financial advice and offers of new services instead of giving you the cash you came for. On and on, until you give up and drive off empty handed. Of course, that doesn’t happen. Banks have figured out other, better ways to communicate with their customers.

Why is it so hard to imagine a health care system that lets doctors be doctors? Public health doesn’t require a medical degree or a medical license. Have other staff categories handle that with our general blessing and support.

I mean, seriously, now there are efforts to have pharmacists treat hypertension – while doctors perform routine screenings for depression, alcohol use and domestic violence and give canned one-on-one pep talks about weight loss, exercise and immunizations. Is that a reasonable division of labor???

So, in clinics around the country, and now even with grant money to support this, previsit planning has become the word for identifying gaps in preventive care and morning huddles are promoted as a way to plan how to surprise patients with alternate agendas for their doctor visit.

Mr Adams had his MRI only a few hours ago and the report isn’t available yet. But he will get his depression screen and pneumonia shot. Mrs Jones didn’t bring her pill bottles, but this time she said she’ll consider having that colonoscopy. And Billy’s visit does not clarify his diagnosis but he did get his flu shot.

Is this an efficient way to work? Is it a good use of physician time? Or is it something a non-physician could have, should have, handled?


Upselling in Medicine: Would You Like a Pap Smear with that Ankle Brace, Ma’am?

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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