Culture Change

As usual, the big news comes last. No reading ahead!

Last month, I mentioned that we were going to send another letter to referring physicians regarding sending us "pooled referrals". We've found this practice has been very helpful in distributing demand and reducing wait times. Our first letter increased the pooled referral rate from 11% to 34%. We'd like to boost that rate further.

I presented our latest Advanced Access results to my partners and reported our plans to send out the second request. One of the docs trumped that.

"Why not make pooled referrals the default condition?" he asked.

Any new referral, regardless of which urologist it's addressed to, could be considered a pooled referral. Patients and their family doctors can still choose to see a specific urologist by indicating "No Substitutes" (or words to that effect) on the referral letter. As before, we will look after directing patients with specific problems to whichever urologist has a specialty interest in that area. Also, continuity of care is important, so we'll try to have continuing care provided by the same urologist. If patients do choose to see a particular urologist, we'll indicate that they may have to wait longer than if they choose the earliest available appointment.

Reformation

I've had this clipping on the fridge for over a month...

Followup MD visits need more thought
Marilyn Pachal, Special to the StarPhoenix
Published Friday, February 15, 2008
Following is the viewpoint of the writer, a senior from Yorkton

My husband had a recent appointment with a medical specialist in Regina. Although we were grateful to see the specialist for advice on my husband's condition, the trip involved winter driving that we dread because a storm can come up anytime on the prairies.

We were also concerned that a prolonged wait in the doctor's office – a common occurrence – would mean returning home in the dark. Both of us are older than 75 and aren't safe on the road when our vision is compromised.

However, the 3 p.m. appointment not only was on time, but lasted all of one minute. My husband was told to go to the lab for urinalysis and blood work – both of which I believe could have been done in Yorkton – with the results returned to the doctor. We were also told to return in a month.

I've come to learn this is a common experience for many rural residents, who must travel long distances to see a specialist. I had a similar experience following a medical treatment. On the return visit I was told that I am fine and require no further treatment. It's good news that I would have preferred to learn by phone or mail.

Taxpayers pay for all these visits out of a stretched health-care budget. Patients personally pay for transportation, food, wear and tear on our vehicles and our emotions. There is also the wear and tear on the environment and the highways from all this travel.

I understand specialists are now charging a fee to patients who don't cancel or keep appointments. I agree such patients are inconsiderate, especially when there is a waiting list to see these doctors. But the list would not be as long if unnecessary appointments aren't made. There's little consideration for those who must travel long distances for short, no-hands-on visit.

There's endless talk about making the health system more efficient and cost-effective. The initiative should come from the medical establishment itself, but the current practice is financially beneficial, so I guess it's hard to give up.

The shortage of qualified physicians in Saskatchewan and fear of losing them makes us hesitant to criticize their actions. But surely there is ample work for them all and they don't need to add this unnecessary strain and expense on the health-care system.

I’ve been holding onto this letter because it’s hard to know where to start dissecting it. In fewer than 400 words, she politely skewers so many problems with contemporary medical office practice.

The strongest message I take from this letter is this:  As physicians, we need to change the perspective we have about delivery of care.

Brainstorm

Last week, we had a celebratory lunch meeting with our office staff. It turned out to be a goldmine of ideas.

Karen presented our latest 3rd NAA stats. Still looking good:

Now we need to take the waits down to our 14 day target. Time for some small tests of change.

Contagious

I’m leading with the stats (as of February 27) this week, because they are sweet!

Two weeks ago, I met with one of the university-based surgery groups to discuss Advanced Access. It felt like I was in that TV commercial where a man travels into the past to give advice to his younger self. Their group looked just like our group did one year ago when we first considered starting this process.

The division head was interested in Advanced Access because he (and his colleagues) realized that their patients were waiting too long for consultation appointments. Perhaps he'll be the clinical champion.

Other surgeons appeared skeptical. Again, this had a familiar air to it. Several openly expressed their skepticism. They began listing the reasons why Advanced Access wouldn't work for them: I’m too busy. I have research and teaching commitments. I can't increase my clinical load to work down backlog. We're already working as hard as we can.