How come patients can be on time and docs can't?

[Guest guest]

Actual question from CNN Medical Correspondent:

" but how come you can be so on time and they can't?

you face the same challenges they do, don't you? "

Go for it guys. I am opening this up to the group.

Time sensitive. Please respond in sound bites.

Pamela

[Guest guest]

Who is the “they “ that run on time? Because they run on a clock. Someone else takes the vitals, someone else takes the history, often someone else writes the prescriptions. The doctor spends 6 minutes with you and is out the door. If you have extra problems, see someone else about it or schedule an extra appointment. The only way to run “on time” all the time is to have a clock and escort the patient out of the room 5 minutes before the end of their appt so you can be on time with the next one. Patient’s can start to charge me for their time waiting in my office the day I get paid by the minute for every service I do for the patient. Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of roxywibleSent: Monday, June 27, 2011 3:57 PMTo: Subject: How come patients can be on time and docs can't? Actual question from CNN Medical Correspondent: " but how come you can be so on time and they can't? you face the same challenges they do, don't you? " Go for it guys. I am opening this up to the group.Time sensitive. Please respond in sound bites.Pamela

[Guest guest]

NO, we don't face ALL the same challenges. We see half the people per day that most doctors do, and because we know our patients better after spending more time with them, can schedule accurately for the most part. The big hamster groups, are told how many they will see a day, 30-45, is the norm around Seattle, and if you can't you get negative reviews, lower pay or just let go. They also have no input in scheuling, every pt with X should take the same amt of time, because some accountant or actuary said no, and said person has never practiced real live medicine, and never will. People are not cogs in a machine to be treated exactly the same, in 10 min slots, and spit out as fast as you can go. They have a greater challenge than IMP doctors in this regard.

CCOTE

To: Sent: Monday, June 27, 2011 12:57:20 PMSubject: How come patients can be on time and docs can't?

Actual question from CNN Medical Correspondent:"but how come you can be so on time and they can't? you face the same challenges they do, don't you?"Go for it guys. I am opening this up to the group.Time sensitive. Please respond in sound bites.Pamela

[Guest guest]

In our office:

We see fewer patients per day (about 12 per day, on average, compared to 25 in other offices)

We don't do hospital work - for the most part (hospitalists take care of our inpatients).

We schedule the appropriate amount of time for each patient (no double-booking, no cramming 4-6 patients in per hour even though the MD can only see 2-3/hour max, and most of all, we KNOW our patients and schedule extended amounts of time if we know those patients need more time).

 

Actual question from CNN Medical Correspondent: " but how come you can be so on time and they can't? you face the same challenges they do, don't you? " Go for it guys. I am opening this up to the group.

Time sensitive. Please respond in sound bites.Pamela

--

Pratt

Oak Tree Internal Medicine, PC

2301 Camino Ramon, Suite 290

San Ramon, CA 94583

p.

f.

c.

www.prattmd.info

 

[Guest guest]

I schedule a 30 min. appt for a 15-20 min visit, so I DO have have time

for that " oh by the way " question. Docs on the hampsteer wheels can't do

that.

> Actual question from CNN Medical Correspondent:

>

>

> " but how come you can be so on time and they can't?

> you face the same challenges they do, don't you? "

>

> Go for it guys. I am opening this up to the group.

> Time sensitive. Please respond in sound bites.

>

>

> Pamela

>

>

>

>

[Guest guest]

I run on time to the best of my ability. But patients come in early sometimes 1/2 hour early and that's disruptive to those who are in their scheduled appointment which in turn can make me late. I get others who see I'm 10 minutes behind and run back home. My nurse tells them to come back in 15 minutes they come back in 45 and fire me because now I can't see them for their pre-op physical.

But most of the time I am on time because I see patients every 1/2 hour instead of every 15-20 but I earn considerably less than other doctors by doing this. The appropriate time slots must be given to indivicual patients. I have a list of those I always give 45 minutes because they have a long list of health issues and/or are hard of hearing etc. But if they run over I never get paid the extended visit code and just have to settle for the 45 minutes if I get that.

Patients want every minute of their visit with me and have no clue how much behind the scenes work is done from reading the mail, prior auths, scripts clarifications, co-ordinating with a consultant, finishing the note, sending copies to referals, billing, etc.

To: Sent: Mon, June 27, 2011 4:02:23 PMSubject: RE: How come patients can be on time and docs can't?

Who is the “they “ that run on time?

Because they run on a clock. Someone else takes the vitals, someone else takes the history, often someone else writes the prescriptions. The doctor spends 6 minutes with you and is out the door. If you have extra problems, see someone else about it or schedule an extra appointment.

The only way to run “on time†all the time is to have a clock and escort the patient out of the room 5 minutes before the end of their appt so you can be on time with the next one.

Patient’s can start to charge me for their time waiting in my office the day I get paid by the minute for every service I do for the patient.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From: [mailto: ] On Behalf Of roxywibleSent: Monday, June 27, 2011 3:57 PMTo: Subject: How come patients can be on time and docs can't?

Actual question from CNN Medical Correspondent:"but how come you can be so on time and they can't? you face the same challenges they do, don't you?"Go for it guys. I am opening this up to the group.Time sensitive. Please respond in sound bites.Pamela

[Guest guest]

agree with belowI have always been on time WHen people call I know who they are. I give them an appointmetn  time suitable for their needs ...Talkers are scheduled at the end of sessions or for longer... I know  who they are

IF it is nearing the end of the time I ask anything else or i say we need  to  endEach visit begins with the patietn s  agenda Agenda is  discussed priotized and  then we do what they want first and whentime is  up " we need to  end " NExt vist times are negotiatied- what i think/what they think

Everything a patietn needs is done  at the visit- all the refill etc.Other than that my patietns  can   yak an d yak and yak about nonmedical stuff and not leave,  my visits are long enough to do the work we need to do

This negative impacts my income as I give them the  time they need Thi s  positively impacts to reduce   er use and hospital useit positively impacts their confiednce  and complaince.Patietns  agenda is first, appointments set up to match what they need.

JEan

 

I schedule a 30 min. appt for a 15-20 min visit, so I DO have have time

for that " oh by the way " question. Docs on the hampsteer wheels can't do

that.

> Actual question from CNN Medical Correspondent:

>

>

> " but how come you can be so on time and they can't?

> you face the same challenges they do, don't you? "

>

> Go for it guys. I am opening this up to the group.

> Time sensitive. Please respond in sound bites.

>

>

> Pamela

>

>

>

>

--      MD          ph    fax

[Guest guest]

I can see patients on time (most of the time) because I schedule 30-60 minutes per patient. I can schedule more time per patient because I care about the quality of care I deliver.I can do this because I voluntarily sacrifice income that I could make by seeing more patients, and because of the quality of life I want for myself and my family. Yet I know most primary care doctors wouldn't be able to maintain the kind of practice I have because of the lower income. When I used to work at Kaiser, I routinely ran 30-60 minutes late seeing 24+ patients a day. I knew some doctors at Kaiser who always ran on time. They used to amaze me as to how they could do this, until I saw their notes and heard from their patients. Any time they run overtime, they tell the patient to schedule another visit. They were not very compassionate. Their notes were brief and lacking detail. But they were on time. They were not whom I would choose to be my doctor. There'e the famous saying, "Quality, Time, Price. Pick two."http://www.marketing.fm/2009/06/16/price-quality-time-choose-two/Current healthcare system = Quality + Price (but no Time) or Time + Price (but poor Quality).Concierge medicine = Quality + Time (but high Price)IMP is the closest to providing all 3 = Quality + Time + Price but most IMP physicians make less (some much less) than their non-IMP counterparts. If primary care physicians could get paid more for the services we provide, we could give patients 3 out of 3. Good luck in getting a positive message across to CNN. SetoSouth Pasadena, CA

Actual question from CNN Medical Correspondent:

"but how come you can be so on time and they can't?

you face the same challenges they do, don't you?"

Go for it guys. I am opening this up to the group.

Time sensitive. Please respond in sound bites.

Pamela

[Guest guest]

RE running on time.

1) I do schedule pts for 1/2 hour appts, but am willing to put in acutes at 1/4 and 3/4 hour points. Usually I avoid more than 3 pts per hour.

2) New pts and sick pts usually take more than allocated times, and sometimes I run over.

3) What goes around, comes around. If a pt really doesn't realize that the next time it may be them, we have a bigger problem.

I see between 10-15 pts a day.

I do my best. I give the time needed. I try NOT to have them return for straightforward issues.

My thoughts, yours?

Matt L in Western PA

Residency completed 1988

Solo since 2004

Re: How come patients can be on time and docs can't?

I can see patients on time (most of the time) because I schedule 30-60 minutes per patient.

I can schedule more time per patient because I care about the quality of care I deliver.

I can do this because I voluntarily sacrifice income that I could make by seeing more patients, and because of the quality of life I want for myself and my family. Yet I know most primary care doctors wouldn't be able to maintain the kind of practice I have because of the lower income.

When I used to work at Kaiser, I routinely ran 30-60 minutes late seeing 24+ patients a day. I knew some doctors at Kaiser who always ran on time. They used to amaze me as to how they could do this, until I saw their notes and heard from their patients. Any time they run overtime, they tell the patient to schedule another visit. They were not very compassionate. Their notes were brief and lacking detail. But they were on time. They were not whom I would choose to be my doctor.

There'e the famous saying, "Quality, Time, Price. Pick two."

http://www.marketing.fm/2009/06/16/price-quality-time-choose-two/

Current healthcare system = Quality + Price (but no Time) or Time + Price (but poor Quality).

Concierge medicine = Quality + Time (but high Price)

IMP is the closest to providing all 3 = Quality + Time + Price but most IMP physicians make less (some much less) than their non-IMP counterparts. If primary care physicians could get paid more for the services we provide, we could give patients 3 out of 3.

Good luck in getting a positive message across to CNN.

Seto

South Pasadena, CA

Actual question from CNN Medical Correspondent:"but how come you can be so on time and they can't? you face the same challenges they do, don't you?"Go for it guys. I am opening this up to the group.Time sensitive. Please respond in sound bites.Pamela

[Guest guest]

Thanks for

gathering ‘the collective wisdom’ of the group, Pamela! And

thank you for getting out into the media world and sharing our thoughts, experiences,

etc.

My two cents:

I’m on

time because

1. I know

my pts and don’t have to spend time trying to learn who they are each

appt by scrounging through their chart.

2. I

control my schedule, and have long appts (30 – 60 mins usually, longer if

needed)

3. I

value my sanity and personal satisfaction in taking excellent care of my pts

over a high income

4. I work

to be on time and have breathing room in my schedule

In my former

group practice, I was always running behind with 15 minute appts (30 mins for a

physical). I would try to watch the clock, but always got engrossed with

listening to and taking care of the pt that I ran behind. I even bought a

watch that had a swivel timer on it to try to stay on time, but I learned that

I was incapable of cutting people off on the group’s time schedule for

the most part. I was miserable when I ran on time - I felt like I was

working without any compassion for my pts and not doctoring to their needs.

Eads, MD

Pinnacle Family Medicine

Colorado Springs, CO

www.PinnacleFamilyMedicine.com

From:

[mailto: ] On Behalf Of roxywible

Sent: Monday, June 27, 2011 1:57 PM

To:

Subject: How come patients can be on time and

docs can't?

Actual question from CNN Medical Correspondent:

" but how come you can be so on time and they can't?

you face the same challenges they do, don't you? "

Go for it guys. I am opening this up to the group.

Time sensitive. Please respond in sound bites.

Pamela

[Guest guest]

Providers run late because they are trying to meet their patients' needs, plain and simple. Too often, these needs cannot be predicted by either the patient or the provider before a visit occurs. Many of the providers who don't run late, make a sacrifice in income in order to assure the luxury of adequate time to meet their patients' needs without falling behind in their schedule. The travesty is that the units of work performed by both types of providers is probably the same while, not so surprisingly, the lower paid provider typically achieves the better outcome.In my practice, allowing the patient to determine how much time to allot to the appointment has been the key to running on time. Carla Gibson FNPTo: Sent: Mon, June 27, 2011 1:42:50 PMSubject: How come patients can be on time and docs can't?

You guys will tear into this question from reporter. Before I respond

I will open it up to the group.

Here's your chance to let it all out:

" but how come you can be so on time and they can't?

you face the same challenges they do, don't you?"

Time sensitive. Please respond ASAP.

~ Pamela

[Guest guest]

Hi Pam -

One of our first patients six years ago told us "wow, you treat patients as if we were people".

In our current automated, delegated, alienated, overmedicated and undersatiated medical system, both patients and doctors feel dehumanized and commodified. IMP doctors have made a deliberate decision to use our energy, creativity, passion, and love of medicine to doggedly carve out medical sanctuaries for our patients. Generally, we give up financial income, professional stability, and 9 to 5 schedules to deliver high-quality, personalized, old-fashioned medical care. We stubbornly hold on to our ideals, refusing to abandon endangered, virtually obsolete beliefs about medical altruism and professionalism.

We all face similar challenges as doctors - I think the common themes among IMPs are thinking outside the box, taking risks, practicing common-sense medicine instead of maximizing third-party payment schemes, leveraging technology to lower our overhead, and most of all - restoring the human patient-doctor relationship.

In my practice we give presents to our patients all the time - flowers in the hospital, free pre-op guided imagery CD's to people undergoing surgery, donations to walkathons and fundraisers, graduation gifts, original art pieces that they fall in love with in our office, homemade tamales at Christmas time, hand-written birthday cards, just to name a few. We get to know our patients on a personal level, and they get to know us personally as well.

Patients are people too.

Palm Desert, CA

Subject: How come patients can be on time and docs can't?To: Date: Monday, June 27, 2011, 12:57 PM

Actual question from CNN Medical Correspondent:"but how come you can be so on time and they can't? you face the same challenges they do, don't you?"Go for it guys. I am opening this up to the group.Time sensitive. Please respond in sound bites.Pamela

[Guest guest]

What I love about this thread is that numerous people have weighed in proudly expressing how they have enhanced the relationship with their patients by valuing their patient’s time, and then they have given practical examples of how they have done it. This gets to the core strength of what IMP is—the realization that by meeting the needs of the patient, we meet our own needs as providers. I would venture to guess that any other medical list serve would be full of docs whining about patient expectations and, even worse, full of practice management gurus telling the same docs how to fit in that one extra patient a day. Yet here we are offering solutions as to how to always run on time (with the expectation that we will). You guys rock!P.S. In 8 years of IMP practice, I have gotten 30 minutes behind once. Due to the breathing room in the schedule, I was back on time within 60 minutes. If my schedule is full (10 plus patients/half day), I might get 10 minutes behind, but more often than not, I am waiting on patients more than they wait on me. From: [mailto: ] On Behalf Of flores chrisSent: Tuesday, June 28, 2011 1:21 AMTo: Subject: Re: How come patients can be on time and docs can't? Hi Pam - One of our first patients six years ago told us " wow, you treat patients as if we were people " . In our current automated, delegated, alienated, overmedicated and undersatiated medical system, both patients and doctors feel dehumanized and commodified. IMP doctors have made a deliberate decision to use our energy, creativity, passion, and love of medicine to doggedly carve out medical sanctuaries for our patients. Generally, we give up financial income, professional stability, and 9 to 5 schedules to deliver high-quality, personalized, old-fashioned medical care. We stubbornly hold on to our ideals, refusing to abandon endangered, virtually obsolete beliefs about medical altruism and professionalism. We all face similar challenges as doctors - I think the common themes among IMPs are thinking outside the box, taking risks, practicing common-sense medicine instead of maximizing third-party payment schemes, leveraging technology to lower our overhead, and most of all - restoring the human patient-doctor relationship. In my practice we give presents to our patients all the time - flowers in the hospital, free pre-op guided imagery CD's to people undergoing surgery, donations to walkathons and fundraisers, graduation gifts, original art pieces that they fall in love with in our office, homemade tamales at Christmas time, hand-written birthday cards, just to name a few. We get to know our patients on a personal level, and they get to know us personally as well. Patients are people too. Palm Desert, CASubject: How come patients can be on time and docs can't?To: Date: Monday, June 27, 2011, 12:57 PM Actual question from CNN Medical Correspondent: " but how come you can be so on time and they can't? you face the same challenges they do, don't you? " Go for it guys. I am opening this up to the group.Time sensitive. Please respond in sound bites.Pamela

[Guest guest]

RE running on time.

Maybe I'm too hard on myself as all you are better than me...

I must say as I've started to "trust" my patients more by using a 6 month recheck for my chronic stable pts (2+ more problems), I've been able to encourage pts to see me also for acute issues, and that fits in the schedule nicely.

2 Factors I've discovered:

1) Copays for visits to me are more cost effective for pts vs urgicare, but you need to point this out to pts. Also, for urgicares, pts get more tests hitting their deductibles, where I don't usually test (especially as I know them and will follow them more closely if needed instead of doing a "test."

2) Seeing pts every 6 months no matter how many chronic problems is hard but not too hard -- many pts I've seen for 10+ years using EMR at point of care (yep, started with EMR in 1997 in hospital owned practice, now almost every pt encounter since 2004 -- except camp forms and the like).

3) I know that EMR upgrade can make some of my processes more efficient -- I encourage ALL of you that have "low volume" practices (for sake of argument, 50 or less pts a week, this is a break point for me for a 4 day work week -- 2 mornings out of office for hourly "moonlighting") to use your EMR to best effect.

I find demand is going to about 60 pts a week in my area, esp for chronic adults. I still don't do hospital work or NH.

Will continue with my 2 FTE...starting IRA this year! One of "small" benefits of staff.

Am I still an IMP? I hope so...will be in Silver Spring in Fall!

Matt L in Western PA

FP since 1988

Solo since 2004

EMR Soapware since 1997

MU version hosted SW 2011 in process

Re: How come patients can be on time and docs can't?

I can see patients on time (most of the time) because I schedule 30-60 minutes per patient.

I can schedule more time per patient because I care about the quality of care I deliver.

I can do this because I voluntarily sacrifice income that I could make by seeing more patients, and because of the quality of life I want for myself and my family. Yet I know most primary care doctors wouldn't be able to maintain the kind of practice I have because of the lower income.

When I used to work at Kaiser, I routinely ran 30-60 minutes late seeing 24+ patients a day. I knew some doctors at Kaiser who always ran on time. They used to amaze me as to how they could do this, until I saw their notes and heard from their patients. Any time they run overtime, they tell the patient to schedule another visit. They were not very compassionate. Their notes were brief and lacking detail. But they were on time. They were not whom I would choose to be my doctor.

There'e the famous saying, "Quality, Time, Price. Pick two."

http://www.marketing.fm/2009/06/16/price-quality-time-choose-two/

Current healthcare system = Quality + Price (but no Time) or Time + Price (but poor Quality).

Concierge medicine = Quality + Time (but high Price)

IMP is the closest to providing all 3 = Quality + Time + Price but most IMP physicians make less (some much less) than their non-IMP counterparts. If primary care physicians could get paid more for the services we provide, we could give patients 3 out of 3.

Good luck in getting a positive message across to CNN.

Seto

South Pasadena, CA

Actual question from CNN Medical Correspondent:"but how come you can be so on time and they can't? you face the same challenges they do, don't you?"Go for it guys. I am opening this up to the group.Time sensitive. Please respond in sound bites.Pamela

[Guest guest]

pamela,

grassroots level yes... however your topic WILL get lost in translation and will

just be 'patients need to be compensated for waiting'

i dont know how you can achieve going beyond the patients' possibility of

getting paid for their time , for them to look beyond what they see into the

difficulties in how we operate. money means money.

you have picked a difficult topic to handle and as someone admonished here you

need to be careful, i think pandora's box has a lot more in store for you.

the problem is the middle men, the insurance companies, and the AMA for their so

called strict regulations of coding --- we all know that... i will back who will

handle that.. but so far, i dont have time, i have payroll to cut and preauths

to do.

grace

>

>

>

> Actual question from CNN Medical Correspondent:

>

> " but how come you can be so on time and they can't?

> you face the same challenges they do, don't you? "

>

> Go for it guys. I am opening this up to the group.

> Time sensitive. Please respond in sound bites.

>

> Pamela

>

[Guest guest]

I've been working in hospital outpatients for the last 6 months here

in New Zealand.

I have 30 min apts for follow ups and 45 mins for news.

I spend most of my time waiting for patients to arrive!

The main reason patients have to wait is if someone comes late and

puts those after them late.

If they don't ring to confirm the appt we are supposed to consider

those as cancelled though sometimes these patients still turn up.

My letters to the referring GPs go out in 5 mins of the patient being

seen, either by fax or electronically.

Imps aren't the only ones who can organise things!

> pamela,

>

> grassroots level yes... however your topic WILL get lost in translation and

will just be 'patients need to be compensated for waiting'

>

> i dont know how you can achieve going beyond the patients' possibility of

getting paid for their time , for them to look beyond what they see into the

difficulties in how we operate. money means money.

>

> you have picked a difficult topic to handle and as someone admonished here you

need to be careful, i think pandora's box has a lot more in store for you.

>

> the problem is the middle men, the insurance companies, and the AMA for their

so called strict regulations of coding --- we all know that... i will back who

will handle that.. but so far, i dont have time, i have payroll to cut and

preauths to do.

>

> grace

>

>

>

>

>>

>>

>>

>>       Actual question from CNN Medical Correspondent:

>>

>>       " but how come you can be so on time and they can't?

>>       you face the same challenges they do, don't you? "

>>

>>       Go for it guys. I am opening this up to the group.

>>       Time sensitive. Please respond in sound bites.

>>

>>       Pamela

>>

>

>

>

>

> ------------------------------------

>

>

[Guest guest]

Ya know what folks, He's RIGHT!!!!

Good Call ...

To: Sent: Tuesday, June 28, 2011 6:55 AMSubject: RE: How come patients can be on time and docs can't?

What I love about this thread is that numerous people have weighed in proudly expressing how they have enhanced the relationship with their patients by valuing their patient’s time, and then they have given practical examples of how they have done it. This gets to the core strength of what IMP is—the realization that by meeting the needs of the patient, we meet our own needs as providers. I would venture to guess that any other medical list serve would be full of docs whining about patient expectations and, even worse, full of practice management gurus telling the same docs how to fit in that one extra patient a day. Yet here we are offering solutions as to how to always run on time (with the expectation that we will). You guys rock!

P.S. In 8 years of IMP practice, I have gotten 30 minutes behind once. Due to the breathing room in the schedule, I was back on time within 60 minutes. If my schedule is full (10 plus patients/half day), I might get 10 minutes behind, but more often than not, I am waiting on patients more than they wait on me.

From: [mailto: ] On Behalf Of flores chrisSent: Tuesday, June 28, 2011 1:21 AMTo: Subject: Re: How come patients can be on time and docs can't?

Hi Pam -

One of our first patients six years ago told us "wow, you treat patients as if we were people".

In our current automated, delegated, alienated, overmedicated and undersatiated medical system, both patients and doctors feel dehumanized and commodified. IMP doctors have made a deliberate decision to use our energy, creativity, passion, and love of medicine to doggedly carve out medical sanctuaries for our patients. Generally, we give up financial income, professional stability, and 9 to 5 schedules to deliver high-quality, personalized, old-fashioned medical care. We stubbornly hold on to our ideals, refusing to abandon endangered, virtually obsolete beliefs about medical altruism and professionalism.

We all face similar challenges as doctors - I think the common themes among IMPs are thinking outside the box, taking risks, practicing common-sense medicine instead of maximizing third-party payment schemes, leveraging technology to lower our overhead, and most of all - restoring the human patient-doctor relationship.

In my practice we give presents to our patients all the time - flowers in the hospital, free pre-op guided imagery CD's to people undergoing surgery, donations to walkathons and fundraisers, graduation gifts, original art pieces that they fall in love with in our office, homemade tamales at Christmas time, hand-written birthday cards, just to name a few. We get to know our patients on a personal level, and they get to know us personally as well.

Patients are people too.

Palm Desert, CA

Subject: How come patients can be on time and docs can't?To: Date: Monday, June 27, 2011, 12:57 PM

Actual question from CNN Medical Correspondent:"but how come you can be so on time and they can't? you face the same challenges they do, don't you?"Go for it guys. I am opening this up to the group.Time sensitive. Please respond in sound bites.Pamela

[Guest guest]

I can't say that I'm ALWAYS on time, but I would say that I am on time 95%. This is why many patients stay in the practice and many patients come to the practice.

In our appointment reminders (both on the phone as well as e-mail reminders), we ask that patients arrive 15 minutes ahead of time for any administrative issues. If there are any insurance glitches, we try our best to take care of these things before the appointment begins.

If patients are more than 15 minutes late as new patients, they will not be seen. If patients are more than 10 minutes late as existing patients, they will li not be seen (I am usually a little more lenient on existing patients, since I already know them).

If there are more than 3 new shows, the patient is dismissed from the practice. There is a late fee charge which we state is donated to a charity in India supporting children's health and education.

I am on time everyday, unless there are major train delays, etc... But I make it a point to respect my patients time. This is something that was instilled in me from a very early age. If my own doctor is very very late consistently, I have usually fired them and see someone else that can respect my time. Same philosophy works very very well in my practice.

Soma

[Guest guest]

My wife and I are in the planning stages for a trip to New Zealand.Perhaps we

should stay a while and work!!(she is a Neurologist)

Lou Spikol

> >>

> >>

> >>

> >>       Actual question from CNN Medical Correspondent:

> >>

> >>       " but how come you can be so on time and they can't?

> >>       you face the same challenges they do, don't you? "

> >>

> >>       Go for it guys. I am opening this up to the group.

> >>       Time sensitive. Please respond in sound bites.

> >>

> >>       Pamela

> >>

> >

> >

> >

> >

> > ------------------------------------

> >

> >

[Guest guest]

I am able to be on time because I am now back in control of my schedule. I am building a solo practice and learning how to implement the IMP model. I have worked for group practices in the past. I was frequently behind schedule for a variety of reasons. I know that many of those have been acknowledged by others. However, I would like to offer the following. I'm sure that others in the group can see themselves in these as well:

I've gone many days without a lunch break. There are times I've had to recall if I had taken time to use the bathroom during the course of a day. I remember eating microwave popcorn in the care for lunch on my way to the hospital, eating it again on my way back to the hospital after 6 PM and again by the time I get home after midnight. My sister said she couldn't understand how I gained weight when all I ever ate was popcorn. I responded, we corn-feed beef don't we. Eat enough of anything or too little (starvation) and your body will store it as fat.

Like others, I've apologized for being late and explained to patients that I never know what's behind the door until I walk through it. Sometimes, patients don't want to tell the scheduler the real reason they are there (for whatever reason). Sometimes, the patients are there for one reason. However, during the course of the visit, I find that they have a more pressing medical issue/problem that needs to be addressed. When repairing lacerations there would not likely be cosmetic do overs. I knew that WIDWWTG (what I did was what they got). So, I would take the time necessary for the best cosmetic result.

I've asked previous front desk staff to please acknowledge when someone is waiting for a prolonged time. No one wants to feel that have been forgotten. Most, if they know they have not been forgotten are willing to wait when necessary. I've had to remind a few that this is not Mc's. The extra time I've spent with others will be given to them when needed. If they want Mc's care (fast food medicine), I would recommend they find another physician. I would also remind them that I respect their time because whenever I'm running late, it means I can't go home (to take of my family) at a reasonable time.

But some of the more important reasons for running late are:

Because, I refuse to walk out of the room when a patient has broken down in grief.

Because, I refuse to walk away from an elderly patient in a wheelchair who is at the nurses' station screaming incoherently.

Because, a worried father brings in his crying 2 yo son who speaks Spanish. His fingernail is almost completely avulsed. It takes time to complete the removal, debride it, suture it back in the nail bed to improve his chances of normal nail regrowth.

Because, I refuse to walk out of the room with a desperate grandmother who is raising 2 teenagers. She has brought in her 13 yo granddaughter who has mild intellectual, social and learning disabilities and is very sexually promiscuous. She brings her for evaluation, guidance and any assistance she can get to help stop this behavior.

Because, my malignant hypertensive patient with acute anasarca is falling asleep between the words in his sentences while attempting to give me the phone number of a friend to take him to the hospital after he adamantly refuses ambulance transport.

Because...I CARE!

Cheryl S , MD, MAc

15 W Milwaukee Street, Suite 205

Janesville, WI 53548

Phone:

Fax:

[Guest guest]

Cheryl,Nice post. Congrats on getting back your schedule. I am somewhat confused though. Have you been working until midnight and living off popcorn since taking control or prior to that? If you are currently working until midnight, something is wrong. No one reading this post would argue that you do not care, but don’t confuse caring with running behind. You do not run behind because you care, you run behind because you are being asked to do too much. Too many people, too many places, too little time for food and water and, subsequently, bodily functions. You do not have the breathing room you need. If this is indeed the case, run stuff by this list serve to get more suggestions about how to meet the needs of your patients without sacrificing yourself in the process. I have never met a more caring and insightful group of people. From: [mailto: ] On Behalf Of Cheryl Sent: Thursday, June 30, 2011 2:22 AMTo: Subject: Re: How come patients can be on time and docs can't? I am able to be on time because I am now back in control of my schedule. I am building a solo practice and learning how to implement the IMP model. I have worked for group practices in the past. I was frequently behind schedule for a variety of reasons. I know that many of those have been acknowledged by others. However, I would like to offer the following. I'm sure that others in the group can see themselves in these as well: I've gone many days without a lunch break. There are times I've had to recall if I had taken time to use the bathroom during the course of a day. I remember eating microwave popcorn in the care for lunch on my way to the hospital, eating it again on my way back to the hospital after 6 PM and again by the time I get home after midnight. My sister said she couldn't understand how I gained weight when all I ever ate was popcorn. I responded, we corn-feed beef don't we. Eat enough of anything or too little (starvation) and your body will store it as fat. Like others, I've apologized for being late and explained to patients that I never know what's behind the door until I walk through it. Sometimes, patients don't want to tell the scheduler the real reason they are there (for whatever reason). Sometimes, the patients are there for one reason. However, during the course of the visit, I find that they have a more pressing medical issue/problem that needs to be addressed. When repairing lacerations there would not likely be cosmetic do overs. I knew that WIDWWTG (what I did was what they got). So, I would take the time necessary for the best cosmetic result. I've asked previous front desk staff to please acknowledge when someone is waiting for a prolonged time. No one wants to feel that have been forgotten. Most, if they know they have not been forgotten are willing to wait when necessary. I've had to remind a few that this is not Mc's. The extra time I've spent with others will be given to them when needed. If they want Mc's care (fast food medicine), I would recommend they find another physician. I would also remind them that I respect their time because whenever I'm running late, it means I can't go home (to take of my family) at a reasonable time. But some of the more important reasons for running late are: Because, I refuse to walk out of the room when a patient has broken down in grief. Because, I refuse to walk away from an elderly patient in a wheelchair who is at the nurses' station screaming incoherently. Because, a worried father brings in his crying 2 yo son who speaks Spanish. His fingernail is almost completely avulsed. It takes time to complete the removal, debride it, suture it back in the nail bed to improve his chances of normal nail regrowth.Because, I refuse to walk out of the room with a desperate grandmother who is raising 2 teenagers. She has brought in her 13 yo granddaughter who has mild intellectual, social and learning disabilities and is very sexually promiscuous. She brings her for evaluation, guidance and any assistance she can get to help stop this behavior.Because, my malignant hypertensive patient with acute anasarca is falling asleep between the words in his sentences while attempting to give me the phone number of a friend to take him to the hospital after he adamantly refuses ambulance transport. Because...I CARE! Cheryl S , MD, MAc15 W Milwaukee Street, Suite 205Janesville, WI 53548Phone: Fax:

[Guest guest]

Suggestion # 1: This is a very personal and two sided discussion here and I respect both sides and in a perfect world with normal "Worldy" constraints I gather we could all do the one perfect unrealistic expectation.... and that is:

To use hospitalists if possible for your patients that need the higher level of care that being in hospital does provide. It saves doctors TONS of time and energy between travel time back and forth at least twice a day, rest in being able to sleep a bit later in the morning because you do NOT have to round on your patients personally, and allows you to at least start your day of office visits almost always on time, which is in and of itself a HUGE blessing and organizing assistant.

In a perfect, beyond Perfect, Magic Wish kind of world I'm sure my wife would love to be able to not only round on her own patients but to do more OB with her GYN and care for patients all the way thru the pregnancy and then be there to be the doc who delivers the baby with that Mom and be there to share in that most wonderful of moments, the start of or the addition to a young family.... Everytime one of our newest brand new patients comes thru the door with his or her parents we end up "wasting" way too much time, fawning over and playing with the wonderful new additions to our practice... As I love to say this is just about one of the best parts of our jobs... Getting to do toothless smiles and tickles and finger grips with these brand new little people... It sometimes changes the feel of the entire day.... And darn it if having three or four generations of one family in the same practice is not part

of practicing Better Medicine as now we can watch for issues in this brand new patient that we have been tracking and working with in the parents and grandparents too....

Anyway, rounding and traveling to and from hospitals and delivering babies is an awesome thing to do for the patients that need it, but many times it burns out the doc and messes up their schedule pretty darn badly too.... Ya can't schedule in a delivery from 2 to 3 pm this coming Thursday... These little stinkers come out if and only when they are good and ready and on their own schedule, never ours it seems.... What are you supposed to do with half a dozen other patients that also need their doc the following morning while you are still at the hospital waiting to play catcher or trying to catch a few winks yourself to catch-up on all the lost sleep??? Docs who do deliveries really earn their keep and their daily bread as far as I'm concerns.... Bless 'em all. Not for me and not for most people for some twenty, thirty year straight kind of lifestyle....

I have no idea whether you delivery babies or not but they are one of the most wonderfu but under appreciated kinds of doctor's work around. Just to show the problem with "The System".... Every since I was 16 years old until my early 30's I have worked most summers as a Moving Man, most of those in NYC and the surrounding Burbs where moving work is Hot, Sticky, hard work with terrible traffic, many buildings are five story walk-ups (under 6 flights and elevators are not required) udering many ozone alert days at 90 plus degrees. Not for the faint of heart for sure.... But guess what this industry gets to do as REAL private contractors and members in a Real Free Market???? They get to bill and collect "Travel Time" charged at the rate that the men are charged at per hour, times the number of men on your crew... So a short local move of like 20 blocks still in the same part of town might we say, is a half

hour of travel time. And if we had to travel from one side of Mannhatten to the other or from one side of the city to the other like Queens to the Bronx, or Mannhatten to the Burbs in Westchester or Long Island, then at least an hour or whatever the actual time it took was because Traffic SUCKS...

But we in medicine get NO SUCH THING for house calls or hospital work. As a matter of fact we get paid a lower fee many times on the "Facilities" set of Fee Schedules instead of Non-Facilities... To pretend that there is not lost office hours and other personal and productive time, even if such things are done scheduled around, before or after regular office hours, is such BS it makes my blood boil. Like my Wife and our Jeep are not at increased risk of a personal accident each and everytime she hops in the Jeep to go to some bed ridden patients home.... and are we not saving the system tons of money not having such a patient go without extra care or having to be "put" somewhere be it assisted living or a nursing home... So why are docs not allowed to charge real and honest, their hourly rate or some sort of honest and open $50 travel charge at the very least???? We save the patient and the system tons

of money and probably help them feel better and heal better or at least are more stable because they are in their own home with their own loved ones which is very important to their frame of mind and therefore their outcome.... But instead we get some additional extra $10-20 bucks and are supposed to be happy and OK with that, smile and say, "Thank you Sir, May I have another.."

So cut back on uncompensated travel and underpaid work after normal hours if you can afford to do so to allow yourself the chance to rest and re-charge your own batteries... does limited housecalls based upon her understanding of the needs and condition of the patient's health and needs. And many times we schedule those for mid Friday afternoon when we close at about 2 or sometime on Wedn when were are usually closed for "Paperwork".... And there is another Broken System scheduling compromise to my Doc's Burn-Out and the system's demands for paperwork and the like, Closed almost every Wedn except for the odd housecall or business meeting now and again.... So there is an entire day "sacrificed" to the gods of Corporate Errected Barriers to Care and the God's of only in American healthcare paperwork....

And perhaps that's another idea for you and others too. could see and take care of patients themselves all day long just fine, it is usually one of the more rewarding and stimulating parts of your jobs, as I'm sure is the same for all of you.... But turn your attentions to the Crap Paperwork and suddenly her heart and efforts sink like a lead ballon and honestly who could blame her or any of you for that.... So perhaps scheduling in an extra hour off in the middle of a part of the day, like blocking 2-3 once or twice a week (the patients have no idea it's your schedule, I'm sorry that slot is not available) of only seeing patients for half a day or restricted hours one or two days a week.... It frees up mental rest time, bathroom breaks, meal time and just sit and veg time which is just as important as anything else.... takes a few minutes now and again to do puzzles or close her eyes now and

again... "Heal thy self doctor"..... It's that important and why we IMP's are different. Lastly I do believe when we stake a claim to a certain amount of time free to catch up and we let our patients know why we do this too BTW, it shows that we respect ourselves and the doctor especially, and we let them know that the time is not Free Time spent on the Golf Course or at the Day Spa... even when not at the office we are almost always working "Tele-communting" or attending meetings or working on something, or even God Forbid Catching up on our own life needs or seeing our OWN Doctors, like OMG what a concept... It claims the space in a healthy self respect kind of fashion as well as let's them know that we are Loosing productive office visit time, doing all the other Crap that the System demands with care management. And again does much of the Prior Auth stuff on the phone with the patients in the room as taught to us by our wonderful Mentors here

(thanks guys and gals) and let's them see what a PIA it all is and what a freakin nightmarish joke it all is.... Again, changing the terms of the discussion because we include them in their insurances headaches and let them see what we have to deal with all too regularly....

To: Sent: Thursday, June 30, 2011 7:39 AMSubject: RE: Re: How come patients can be on time and docs can't?

Cheryl,

Nice post. Congrats on getting back your schedule. I am somewhat confused though. Have you been working until midnight and living off popcorn since taking control or prior to that? If you are currently working until midnight, something is wrong. No one reading this post would argue that you do not care, but don’t confuse caring with running behind. You do not run behind because you care, you run behind because you are being asked to do too much. Too many people, too many places, too little time for food and water and, subsequently, bodily functions. You do not have the breathing room you need. If this is indeed the case, run stuff by this list serve to get more suggestions about how to meet the needs of your patients without sacrificing yourself in the process. I have never met a more caring and insightful group of people.

From: [mailto: ] On Behalf Of Cheryl Sent: Thursday, June 30, 2011 2:22 AMTo: Subject: Re: How come patients can be on time and docs can't?

I am able to be on time because I am now back in control of my schedule. I am building a solo practice and learning how to implement the IMP model. I have worked for group practices in the past. I was frequently behind schedule for a variety of reasons. I know that many of those have been acknowledged by others. However, I would like to offer the following. I'm sure that others in the group can see themselves in these as well:

I've gone many days without a lunch break. There are times I've had to recall if I had taken time to use the bathroom during the course of a day. I remember eating microwave popcorn in the care for lunch on my way to the hospital, eating it again on my way back to the hospital after 6 PM and again by the time I get home after midnight. My sister said she couldn't understand how I gained weight when all I ever ate was popcorn. I responded, we corn-feed beef don't we. Eat enough of anything or too little (starvation) and your body will store it as fat.

Like others, I've apologized for being late and explained to patients that I never know what's behind the door until I walk through it. Sometimes, patients don't want to tell the scheduler the real reason they are there (for whatever reason). Sometimes, the patients are there for one reason. However, during the course of the visit, I find that they have a more pressing medical issue/problem that needs to be addressed. When repairing lacerations there would not likely be cosmetic do overs. I knew that WIDWWTG (what I did was what they got). So, I would take the time necessary for the best cosmetic result.

I've asked previous front desk staff to please acknowledge when someone is waiting for a prolonged time. No one wants to feel that have been forgotten. Most, if they know they have not been forgotten are willing to wait when necessary. I've had to remind a few that this is not Mc's. The extra time I've spent with others will be given to them when needed. If they want Mc's care (fast food medicine), I would recommend they find another physician. I would also remind them that I respect their time because whenever I'm running late, it means I can't go home (to take of my family) at a reasonable time.

But some of the more important reasons for running late are:

Because, I refuse to walk out of the room when a patient has broken down in grief.

Because, I refuse to walk away from an elderly patient in a wheelchair who is at the nurses' station screaming incoherently.

Because, a worried father brings in his crying 2 yo son who speaks Spanish. His fingernail is almost completely avulsed. It takes time to complete the removal, debride it, suture it back in the nail bed to improve his chances of normal nail regrowth.

Because, I refuse to walk out of the room with a desperate grandmother who is raising 2 teenagers. She has brought in her 13 yo granddaughter who has mild intellectual, social and learning disabilities and is very sexually promiscuous. She brings her for evaluation, guidance and any assistance she can get to help stop this behavior.

Because, my malignant hypertensive patient with acute anasarca is falling asleep between the words in his sentences while attempting to give me the phone number of a friend to take him to the hospital after he adamantly refuses ambulance transport.

Because...I CARE!

Cheryl S , MD, MAc

15 W Milwaukee Street, Suite 205

Janesville, WI 53548

Phone:

Fax:

[Guest guest]

,

Thanks for letting me know I wasn't clear...

This was prior to setting up a solo practice. I agree with you, this is a very caring, insightful group.

Cheryl S , MD, MAc

Elements of Health

15 W Milwaukee Street, Suite 205

Janesville, WI 53548

Phone:

Fax: