TerryJ2
Well-Known Member
Psychiatric Times
[h=1]Doctoring to the No-Shows[/h]
October 08, 2013 | Couch in Crisis, Cultural PsychiatryBy Erik Vanderlip, MD
A patient no-shows. Gut reaction? Relief. A chance to catch a break from the stress, from the responsibility, from the weight of others problems. From being constantly behind by 5 minutes 10 minutes 20 minutes. To get back on track with clinic. To reward those who showed up on time by being on time for them. To even get ahead, catch up on some labs and prescription refills and prior notes to help get out earlier to be home to care for the kids so the wife can make it to her meetings, appointments.
Its one less note at the end of the day. One less worry about what to do when this patient is not feeling better, not fixed, and looking to me to make it right. Paying me to make it right. Its not my fault if they dont care to come into clinic for their appointments. How can I help someone I dont even see?
Meanwhile, at home sits Mr M. Or, there's Mrs P, out on the streets or in her car or at work. And we all revel in the relief of foregone responsibility. The medical assistants even seem to take a certain pride in announcing a no-show, putting NS next to the name in red ink, the clinic version of the scarlet letter(s). Concerned comments bubble up: We havent seen her for a while or I think this is his third no-show . . . The genuine sentiments are instantly awash in the chaos of walk-ins and vitals. In fact, weve planned it this way. Like an overbooked plane flight, each clinic counts on no-showsanticipates themand then scrambles on the rare occasion that people do show up at the proper time, with their proper ticket. Its a wonder people show up at all.
In response to a constant tide of no-shows, one of the administrators from clinic drew up a list of patients who hadnt been seen for over 6 months. The list was not short. Is the clinic still responsible for them? Should we discharge them? The knee-jerk thoughts: Were still sending out those appointment reminders, right?
How many of them had an ER visit between when they were last seen in the clinic and now? How many were dead? Looking over the list, Im sure there are some whom Ive had deep encounters withsharing fiercely intimate feelings and insecurities in quick snapshots of time that then are lost. Did I miss a chance to engage them better? To listen more? Or, perhaps its not me (us) the clinic . . . Maybe it was the patients transportation. Maybe theyre embarrassed. Maybe they had something else more pressing. Maybe they completely forgot. Maybe they were in the ER.
Either way, Mr M is a walking time-bomb of medical calamity. Its the patients we dont see, who dont return, that have the high blood pressures and the untreated cholesterol values and the high A1Cs. These are the ones who are depressed, who are stressed, and who comprise our deplorable health outcomes as a country. Their use of the healthcare system is fragmented, inconsistent and expensive. They have little support. They dont like doctors. Or, they cant afford it.
One of my attractions to family medicine was the notion of "caring for a community" that is embedded within the identity (and name) of many family medicine departments. Somehow, family physicians were responsible for the health and well-being of a community, not just its individuals. More than other medical specialties, these physicians recognized that societal structures were equal to LDL levels and antihypertensives as important determinants of health.
But where was the community in my practice today? Four of them werent in my clinic.
Ive discovered that perhaps the best measure of how well were caring for a population of patientshow effective our system is, and I am, at delivering community medicineis the answer to one simple gut-wrenching question: How relieved am I with a no-show? Note: This article was originally posted on the primary care website, ConsultantLive, on October 3, 2013. For the link, please click here.
- See more at: http://www.psychiatrictimes.com/blo...ette's Syndrome=12102013#sthash.VQhvvnl5.dpuf
[h=1]Doctoring to the No-Shows[/h]
October 08, 2013 | Couch in Crisis, Cultural PsychiatryBy Erik Vanderlip, MD
A patient no-shows. Gut reaction? Relief. A chance to catch a break from the stress, from the responsibility, from the weight of others problems. From being constantly behind by 5 minutes 10 minutes 20 minutes. To get back on track with clinic. To reward those who showed up on time by being on time for them. To even get ahead, catch up on some labs and prescription refills and prior notes to help get out earlier to be home to care for the kids so the wife can make it to her meetings, appointments.
Its one less note at the end of the day. One less worry about what to do when this patient is not feeling better, not fixed, and looking to me to make it right. Paying me to make it right. Its not my fault if they dont care to come into clinic for their appointments. How can I help someone I dont even see?
Meanwhile, at home sits Mr M. Or, there's Mrs P, out on the streets or in her car or at work. And we all revel in the relief of foregone responsibility. The medical assistants even seem to take a certain pride in announcing a no-show, putting NS next to the name in red ink, the clinic version of the scarlet letter(s). Concerned comments bubble up: We havent seen her for a while or I think this is his third no-show . . . The genuine sentiments are instantly awash in the chaos of walk-ins and vitals. In fact, weve planned it this way. Like an overbooked plane flight, each clinic counts on no-showsanticipates themand then scrambles on the rare occasion that people do show up at the proper time, with their proper ticket. Its a wonder people show up at all.
In response to a constant tide of no-shows, one of the administrators from clinic drew up a list of patients who hadnt been seen for over 6 months. The list was not short. Is the clinic still responsible for them? Should we discharge them? The knee-jerk thoughts: Were still sending out those appointment reminders, right?
How many of them had an ER visit between when they were last seen in the clinic and now? How many were dead? Looking over the list, Im sure there are some whom Ive had deep encounters withsharing fiercely intimate feelings and insecurities in quick snapshots of time that then are lost. Did I miss a chance to engage them better? To listen more? Or, perhaps its not me (us) the clinic . . . Maybe it was the patients transportation. Maybe theyre embarrassed. Maybe they had something else more pressing. Maybe they completely forgot. Maybe they were in the ER.
Either way, Mr M is a walking time-bomb of medical calamity. Its the patients we dont see, who dont return, that have the high blood pressures and the untreated cholesterol values and the high A1Cs. These are the ones who are depressed, who are stressed, and who comprise our deplorable health outcomes as a country. Their use of the healthcare system is fragmented, inconsistent and expensive. They have little support. They dont like doctors. Or, they cant afford it.
One of my attractions to family medicine was the notion of "caring for a community" that is embedded within the identity (and name) of many family medicine departments. Somehow, family physicians were responsible for the health and well-being of a community, not just its individuals. More than other medical specialties, these physicians recognized that societal structures were equal to LDL levels and antihypertensives as important determinants of health.
But where was the community in my practice today? Four of them werent in my clinic.
Ive discovered that perhaps the best measure of how well were caring for a population of patientshow effective our system is, and I am, at delivering community medicineis the answer to one simple gut-wrenching question: How relieved am I with a no-show? Note: This article was originally posted on the primary care website, ConsultantLive, on October 3, 2013. For the link, please click here.
- See more at: http://www.psychiatrictimes.com/blo...ette's Syndrome=12102013#sthash.VQhvvnl5.dpuf
