I will be entering my last week of family medicine rotation this week. I'e been able to see a wide range of patients and gather a plethora of new knowledge about medicine and the politics that go with operating a clinic that is primarily for low-income populations.
One of the things that plagues these types of clinic is the forced inefficiency. With every patient with medicare, especially with children, there are a certain amount of boxes that you must check in order to "complete" the visit. In theory, this would be beneficial to make sure that nothing gets looked over, however, it takes away from focusing on a chief complaint if there is one. The same concept can be applied to review of systems in general. If every system was reviewed in detail for every patient then it would be nearly impossible to have a visit and note completed under thirty minutes, especially if the patient has complaints. This takes away time from the other patients being seen on time or at all, as patients are having to wait longer and longer to get an appointment. Furthermore, going through a review of systems, especially in an elderly patient, would lead to a wide range of problems to then be addressed. So for most patients, the technique I've seen utilized the most for doctors, and seemingly the most effective, is to address one problem then speak quickly about the treatment plan and leave before the patient has a chance to ask follow up questions. This unfortunately, seems to be the best way of having a quick visit without leaving too many patients in the waiting room when you have a busy clinic.
The various inefficiencies I have noticed include patients coming back for lab results, having patients come in for prescription refills. prescription writing, filling out check boxes on CDHP (well child visits). Sometimes, it seems like medicine is always lagging in innovation when it comes to the medical/medicare patients. In an ideal setting, I imagine their being more telemedcine follow-ups for situations such as common medication refills or discussing lab results. Or simply emailing all prescriptions to a given pharmacy (Faxing seems so outdated). Or even finally having a central database for all patients where all visits, prescriptions, and previous notes from all providers can be seen. Eliminating the whole going back and forth from one clinic to another with this paper and that paper and needing certain documents signed.
Maybe I can implement some of this if I start a clinic. Or maybe I'll find that I was just a naive medical student and conform to the notion that these inefficiencies will always just be a part of medicine.
