This week there was a hilarious video If Air Travel Worked Like Healthcare that parodied the inefficiencies and frustrations many of us experience with the healthcare system. The video reminded me of a recent visit to my dentist, he was commenting on having to wait at our local emergency room for hours with his son who had potentially broken his arm. He commented “if I ran my office like they run that emergency room, I’d be out of business in a month”.
It made me wonder, what would it be like if my family doctor worked like my dentist.
Every six months my dentist calls me to book a preventative care appointment for cleaning and check-up. My dentist offers evening and weekend appointments that make routine cleanings easy and convenient to book. Every few years my dentist ensures I have x-rays updated; his office keeps track of that screening schedule and calls me to book the appointment. During my appointment I spend most of my time with the hygienist who does all the cleaning and routine exam before calling in the dentist for a 5 minute consultation and chat. If I require urgent care from my dentist his office will makes sure I am seen right away (usually the same day). The continuity of my dental care is maintained by my dentist.
My family doctor (like most GPs) doesn’t believe in annual well visits so there are no preventative care appointments. It is my responsibility to track my own periodic screening schedule (such as pap tests) based on government approved clinical guidelines and schedules that seem to change quite frequently. When I remember to call for my screening appointment it will take six months to book a ‘non-urgent’ appointment and I will have to mark it in all my calendars because no one from my doctor’s office will call to remind me. My work/family schedule will have to accommodate the appointment when it comes due because rescheduling will mean 6 more months of waiting. When I visit my doctor, she takes care of 100% of the visit. If I require urgent care I usually find myself in a walk-in clinic or emergency room. The continuity of my medical care is scattered among many providers.
In my ideal, imaginary healthcare system my doctor would run her office like my dentist. All my preventative appointments would be monitored by her office, they would call me when I was due and it wouldn’t be my doctor who took care of these appointments, but an RN or even LPN. My doctor’s office would also track and schedule my screening appointments and book me in within a reasonable timeframe that would include evening and weekend appointments. Again, my doctor doesn’t need to perform these routine screenings, a nurse or nurse practitioner can with my doctor providing a brief consultation following the screening. If I require urgent care that is not acute, I would be able to visit my family doctor within a day or two and the continuity of my medical care would be maintained in one office.
Last week I wrote about Prognostications and Health Policy citing the OMAs decision to not provide annual physicals. This week the Washington Post ran an article Don't Open Wide, Annual Check-Ups Are Pretty Much Useless. We could find all kinds of holes in both the OMAs decision and the research cited by the Post, but it is infinitely more enlightening to look the Mayo Clinic’s recently published a study Why Patients Visit Their Doctors: Assessing the Most Prevalent Conditions in a Defined American Population
Here are the top 10 reasons people visit their family doctor
- Skin disorders
- Osteoarthritis/joint disorders
- Back problems
- Cholesterol problems
- Upper respiratory conditions (not including asthma)
- Anxiety, depression and bipolar disorder
- Chronic neurologic disorders (such as Parkinson’s and Alzheimer’s diseases)
- High blood pressure
- Headaches/migraine
- Diabetes
It seems strange to me that while family doctors don’t see a need for preventative care, they do spend the majority of their time responding to patients dealing with chronic conditions that could be prevented.
I believe it's time to have a chat about the future of preventative care. Who is responsible for monitoring it, what is the best way to manage it, how do we position government policies to incent it, how can healthcare consumers and practitioners work together and where does new technology fit in to keep everyone living to their optimal health.
It’s your health. It’s your health information. Manage it well.
Hi, I like your post, and not just because I am a dentist ;-) . You make many valid points about the differences between dental and medical practice, and I would like to add a few. Yes, dentistry is very prevention-oriented partially because of its culture. But, let's face it, dentists also do it because the six-month or yearly checkup is a reimbursable service. Another thing your comments highlight is that for the dentist, the interaction with (and satisfaction of) patients is connected a lot more to the bottom line and success of their business than in hospitals. It is more personal for us. Yes, many physicians are also paid on the basis of volume and scope of services. But a hospital usually doesn't go out of business just because a few physicians don't fill their appointments. In fact, there is too much demand (and too little reimbursement) for most primary physicians’ services. So, they tend to be busy and you can't get an appointment easily.
ReplyDeleteAs the experience in other countries and some settings in the US has shown, prevention-oriented medicine works and is cost-effective. The movement toward Accountable Care Organizations, which places a lot more responsibility (and autonomy) in the hands of the healthcare setting may drive us in that direction.
I sure hope things improve from where we are now ;-)
Thanks
Titus Schleyer, DMD, PhD
http://about.me/titusschleyer