What if ssomeone were to call you patient prior to arriving at the office and do the entire HPI for all of their complaints and then send this to you so that you had it before seeing the patient?
Lowell Kleinman, MD www.drkleinman.com www.old-fashionedhousecalls.com
DrK: What if ssomeone were to call you patient prior to arriving at the office and do the entire HPI for all of their complaints and then send this to you so that you had it before seeing the patient?
Wow, I think the history is the most important part of the patient visit. Having someone else do it over the phone seems awfully odd to me, even if it was another doctor...
I think the patient would be annoyed.
They are busy as well, chatting on the phone before seeing the doctors, going to the doctor, waiting, then being seen by a nurse, then the doctor .... probably will burn them out.
I am an HPI purist and so is my colleague - we both feel that the subtleties of the patient's story in their own words provides the best clues as to how to handle it.
There are many things that can be done over the phone mind you.
My sentiments exactly. There was an article this month about having a doc with 2 RN's. The first RN takes the HPI and presents it to the doc in fron of the patient. The doc does his/her stuff with the RN present. The doc leaves and the RN re-explains the treatment. This increased revenues.
I agree there are ways to increase revenues but having someone else do the HPI seems ...very un-family medicine and a rx to ruin the enjoyment of practice.
Was this doctor a primary care doctor, or a specialist with a ratehr limited focus (like an ophthanologist doing mostly RK or soemsuch)? I think a full H&P is probably best in all situations, but for a very limited focus, maybe focused RN history would make for a somewhat passable standard of care. As a primary care doctor, the breadth of issues I deal with are just too broad for a phone interview with an RN. In my case, this would probably just give the patient more time to raise more issues...
He is an fp...it's in this month's family practice management journal.
In the craze to be more efficient (due to lousy reimbursement) we are starting to erode what we do. People come to us for lots of reasons the least of which is not the relationships we have.
Someone explain to me how one picks up non-verbal cues in a telephone interview....
Graham http://www.synapsedirect.com/ Synapse - the EMR for smart users
You can't...maybe by video. I can forsee the virtual office now...go to your drugstore and get an exam by a doc offshore by video. Would work for uri's I suppose.
There are so many things being done around "efficiency". We need more reimbursement.
DrK: We need more reimbursement.
We need more reimbursement.
Obviously that is unlikely.
Change is the only way forward. Your suggestion is a lateral move.
Healthcare in most Western Countries is appearing unaffordable/unsustainable, exemplified by the US. of A.
DrK: You can't...maybe by video. I can forsee the virtual office now...go to your drugstore and get an exam by a doc offshore by video. Would work for uri's I suppose. There are so many things being done around "efficiency". We need more reimbursement.
Hmm...interesting. HPI via YouTube. How urbane.
You could put your HPI out there on youtube and docs could bid on your illness :)
DrK: You could put your HPI out there on youtube and docs could bid on your illness :)
That sounds like a good idea for a science fiction story!
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As a resident, I had this idea that every patient that books an appointment with the receptionist would be directed to a special voicemailbox where they would be given 45 seconds to explain why they are coming. This audio file would be saved with the patient's booked medical appointment so I could click on my schedule and listen, in the patient's own words, why they booked the appointment. I always felt that the typed reason why people are coming to an appointment never reflected how the visit went.
Forinstance, a visit booked as "Blood pressure problem" was actually the patient was stressed out because their pressure was 141/86 and they thought they were going to have a stroke. The patient would always say ... "I told the receptionist!" about my problem ... but the Flavour of why the patient wanted to be seen seemed to be missing.
Anyone like this idea ? It would be something that a keen doctor could listen to as the appointments are booked, or what you might do just before you see a patient. Likely not for every patient. I guess one problem would be that patients would expect you to listen to them.
Maybe 30 seconds !
:)
How about virtual physical exams. The Mass General Hospital has relationships with several hospitals where a stroke patient at anopther hopsital ER is brought into a room and placed in front of a webcam and examined by the ER nurse as the neurologist gives instructions and zooms in on the patients eyes etc sitting at his desk in Boston. The MGH neuro then gives the ER doc instructions on treatment.
This in conjunction with a whole lot of other stuff is being introduced to streamline the process of capture of data for the EMR. Ironically, th cost for transcription was high, but this was never a issue in the original non-digital charting world.
The doctor comes in, talks with the patient, makes his notes on a progress note or transcribes between patients, often while eating his lunch or some potato chips while dictating.
It was very efficient. It amazes me how much technology is becoming required to help the physician to get through the painstaking process of EMR documentation.
I know it works great for some, but many find it way to much work for the practice.
Oh well, it is what all of us trying to accomplish, including my company. Right or wrong, we all will get r done.
Off to breakfast with my birthday son before school. Have a good day guys.
Brendon