Time is a precious commodity in today’s healthcare. Visits are short and agendas can be far reaching. The concept of previsit planning has penetrated our world in recent years, but what is it, and what should it be?
Supposedly our patients are our patients every day of the year. Why then does everything have to happen the few times they show up for an appointment?
Clinics like mine actually have staff members research “care gaps“ and save them up for us providers to deal with in each patient’s glorious 15 minutes in our presence: Depression screening, colonoscopy, immunizations and on and on and on.
There was a time when previsit planning meant making sure that we were ready to deal with the clinical issues: Are the test results and consultation reports available to discuss in tomorrow’s appointment? This task is no longer prioritized. So that means I have a long list of things that could have been done by somebody else some other time while I have to scramble to do what the patient expected and deserved to have done in our visit.
How hard would it be for those people who create our work list of care gaps to also be the ones to contact the patients, leaving us to be doctors, NPs and PAs?
We are supposed to be teams, working together for the benefit of our patients. Why do we have this crazy system that funnels, absolutely bottlenecks, everything through the medical provider?
“Hello, this is so and so from X health services, calling to remind you flu shots are out, and we noticed you haven’t had a colonoscopy since 2011…”
That would be teamwork. Having a bunch of people telling me what to do does not feel like teamwork, but more like having too many bosses.
The morning huddle has been hijacked and the role of previsit planner of what the doctor should do is becoming more and more prominent. There are better ways to provide public and preventive health in primary care offices.
A Country Doctor Writes: 
When I was growing up in Brazil, the doctor would ask questions, take notes, examine and stay with the patient as long as needed. The problem with the 10 min visits these days in the USA is that a relationship with the doctor is not established. For that reason, when the doc tells the patient simple things like “ I suggest you goon statins” the patient feels no reason to believe the doctor. Unless there’s a serious complaint, like a pain or discomfort, the visits are a waste of time followed by Google searches that will convince the patient of what he wants to be convinced of. And all those unknown medical assistants and nurses tanking notes and asking questions before the consultation, doesn’t help. I go see the doctor, not them, so I fell like asking “who are you and why are you here asking me questions”. Monetizing healthcare has transformed it in a waste of everyone’s time, to the detriment of the patient. A relationship of trust is what’s needed for it to work.
I agree, but I don’t think it’s the monetization necessarily. They have the same problem in the NHS.
I take as much time as my patients need, develop relationship, and practice medicine the way I think we should. It is hurting me though. The same patients write online that they love me, but the wait time is long. They contribute to that long wait time though. It also hurts me financially as I cannot see as many patients needed to make good income in my private practice. I am embarrassed to say what I made even this last year as salary. It’s a catch 22.
Patients can’t have both, short wait times and the doctors’ attention. Many Americans, like me, don’t see private doctors: we go to the clinic our insurance covers, and there the doctors are on a leash and are forced to keep the consultations short and wait times close to zero.
I’m a retired doctor, but now as an experienced 84 yo patient getting Treycuda, I can see how young doctors in their 40’s and 50’s are confused about where to focus. Does one doctor talk with another? I wonder (which might clarify an investigation) or only with his/her computer? CPCS have vanished. Check your computer is the mantra