Mea Culpa

Did you ever have the experience of having an idea that was vivid and compelling when you saw it in your mind’s eye, only to have it fall flat when you gave it voice? Maybe, when you tried to express yourself, you were tired. Or in a rush. Or not quite as clever as you thought you were. That’s what happened with my last post, Wasted. (Heavy on the 3rd excuse.)

After the post went up, someone emailed me another meeting invitation, with the comment I see you like to have plenty of notice for these invitations! A similar remark about how upset I seemed, received a few days later, along with some of the comments on the blog, made me realize I need to clarify my intentions about that posting.

Okay. That whole angry rant about how nobody shows consideration for my busy, surgeon’s schedule... Acting! Can you believe that some readers were actually convinced that I’m pompous and self-absorbed? (Note: Readers snort in disbelief.)

I don’t expect everyone else to bend over backward to accommodate me. The point I wanted to make was that physicians’ inflexible schedules are largely a result of the long wait lists that jam our calendars for months ahead. If we accept that fact, then we can take action to give us more control over scheduling. Trimming wait lists would give us more latitude to schedule other activities on short notice (department meeting or golf game, your choice). Yet another potential benefit of Advanced Access.

Misunderstandings aside, Wasted brought in some great comments. Jill acknowledged the importance of physician input in decision-making, but was frustrated by physician no-shows at meetings. I’m not going to make excuses for anyone who doesn’t make a reasonable attempt to honor commitments to attend meetings. However, maybe there’s an opportunity here to get a better understanding about what motivates physicians to participate with administration.

IHI’s Engaging Physicians in a Shared Quality Agenda (you need to log in to download it, but it’s free) gives a framework on how to engage physicians in quality and safety initiatives. I appreciate the general ideas that the paper puts forward, but I’d like more concrete strategies. Perhaps individual health regions need to do surveys or focus groups to find out what local docs say is keeping them from participating fully. Then we can PDSA various incentives that will improve attendance at Jill’s meetings.

Sheribiah had some great suggestions on using communication technology to facilitate meetings. Eliminating travel time could indeed let me fit in a 30 minute meeting in the middle of an office day.

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I made a New Year’s resolution to pursue some projects that have been gathering dust. One down! I made a very brief medical history questionnaire for patients coming for new consultation. You can see it on our office website under “General Information - Medical history questionnaire” (or try downloading it at this link). It’s not meant to be exhaustive, just to cover the main questions a urologist would ask about someone’s medical history.

Last week, as a small trial, we sent out the questionnaire to new consultation patients scheduled to see me on Feb. 18. Out of 6 new patients, 4 brought in the completed questionnaire. My staff scanned it into the computer as the patients arrived, making it handy for me to review before I greet my patient. I asked the other 2 patients if they had received a questionnaire in the mail and they said they had not. That may have been a result of the short interval between sending the letters out and the appointment date. I found the completed forms very helpful. Now we’re going to send the questionnaire out to all the urologists’ new patients, along with their appointment letter.

Note that we’ve specifically asked that patients not go to their family physician to have these forms completed. When I blogged about this questionnaire project previously, I received a comment from a family physician that patients were likely to take them in to his office to be completed, thus increasing his workload. That would definitely be an undesirable consequence.

The information is essentially the same as patients would give us in the office, but it speeds up the exchange, and it lets patients reflect unhurriedly at home about their medical history, so significant details aren’t forgotten. Also, medication lists will be more complete given their access to all their pill bottles at home.

Maybe you think I’m exaggerating the fact that we often receive referral letters devoid of patients’ past medical history. I did a quick review of the new patients I’ll be seeing in my office over the next 2 weeks. Out of 20 patients, only 5 referral letters had any mention of the patient’s past medical history, that is, other than the reason for referral.

I hadn’t considered another benefit of these questionnaires until this week. In our large specialist group, we often provide care to each other’s patients during evenings, weekends or holidays. If I’m going to call a patient to discuss a problem he’s having, I find it useful to review his past medical history on our electronic medical record before speaking with him. However, because of different practice styles, some of our group may occasionally be less scrupulous about recording patients’ past medical history, medications, etc. on our shared EMR. Now, if we have the patient medical questionnaire scanned into the EMR, that problem is solved.

All week, I had been looking forward to finding out whether it would work. It was very satisfying to see it was successful. My final “a-ha” for this little project was this: Clinical Practice Redesign is fun!