We’re fed up and we won’t take it anymore

Now I think I’m going crazy.

Over the years, this column has been a place where I have been able to report issues and challenges in the healthcare system and hopefully not only complain, but make helpful suggestions, based on common sense and wisdom. ‘experience. But it looks like we just haven’t been able to move the dial. There are more meetings, more guidelines, more bureaucracy, more clicks through the electronic health record, and providers and patients seem more frustrated, weary, and tired of not getting what we need from the system. health we have.

A reference defect

Here is an example. About 2 weeks ago a patient called our practice asking for a referral to follow up on a routine issue with a specialist. Due to what looks like an error in the way the message was routed through our system, as well as someone being connected to a mail pool they shouldn’t have (and didn’t know they was online), the post was marked as “done”, and fell off everyone’s radar.

Time passed, no referral was sent to the specialist’s office and the day the patient presented he was told he could not be seen because his primary care physician had not managed to make a referral and get it processed ahead of time with his insurance. of their visit. This led to more phone calls to our practice, more back and forth in and out of the electronic medical record, more communication issues, and before we knew it, the patient had been fired from the other doctor’s office. In the end, someone was able to step in and save the day, and we called the patient on his cell phone and he was able to go back and be seen.

How many ways can this go wrong? Let’s start with the fact that our patient being seen in a specialist’s office depended on the act of a referral placed in the EHR, processed on an insurance company’s website, and then faxed to another office. . It seems like a twisted process to try to help our patients be healthier. And in this system of messaging and accountability within the EHR, many problems ensue. We all get unexplained messages, test results we didn’t order, messages about patients we’ve never met, and documents to sign for patients whose care we’ve never been involved with. .

It’s just such a clumsy, inefficient, and not very helpful system that we’ve allowed to build around patient care, and it feels like we have to tear it all down and start from scratch. If our patient is seen by a specialist for the ongoing care of a problem that this physician is managing, why do we need to be involved? Maybe we’re shifting the job of making sure the patient has the referral they need to the insurance company, who has a vested interest in making sure the paperwork is in place so the doctor gets paid for their services.

A twisted sorting system

Let’s take another example. Last week, we participated in a team conference call about the processes we’ve put in place to transform our phone triage, the system by which people in the answering service, whenever they hear a “word trigger” such as swelling, headache, bleeding or chest pain, immediately transfer the call to a nurse for clinical evaluation. This initially seemed very logical, an opportunity for the nurse to triage the call and see if it was a chronic problem that could wait, or if this patient needed to be brought into the practice in a more more urgent for the same day or appointment the next day or if they should be referred directly to the emergency room.

What we found was that once the nurse decided the patient needed to be seen today, instead of referring the patient to the person who sent the call in the first place, she was supposed to try to contact a chain of people in our practice, one of whom was supposed to answer the call, jot down the information, and then pass it on to our local planners who would then schedule the same-day appointment with our patient. It seems much more complicated than necessary.

I told the people on the call, “Why don’t we just have the nurse redirect the call to the scheduler who sent the patient to them in the first place, telling them when the patient should be seen — i.e. later today, tomorrow, or as part of a routine follow-up at the primary care provider’s next available appointment?” The system doesn’t work that way, we they said — at the time the planner passed the call to the nurse, the “event” (the call) was technically “closed” in the planner’s system, and there was no way to go back to the original person. It feels like we’ve created a system full of opportunities for error, duplication, and delays that interfere with providing our patients with the timely care they need.

They said that’s how the system was built, and while they thought we had some great ideas, they didn’t think things would change.

Another example of this is the insistence on a pain score. Many years ago, heavy hitters in the healthcare industry decided that asking for a patient’s pain score at every office visit was the right thing to do, and recording pain in the a patient’s record has become a “cold stop” in the electronic health record. – something you couldn’t bypass to continue the tour until it was saved. Many of us on the front line thought that was overkill. Are you telling me that if I see a patient with hypertension on two consecutive visits that I have to put a pain score on both, even if I don’t treat their pain during one or the other other ?

Now, many years later, it’s clear that that little thing, that recording of a number from 1 to 10, probably had a lot to do with the deepening and entrenchment of the opioid crisis in this country. This obsession with pain and the incessant need to bring down a number seems to have done far more harm than good.

We must call for change

I’m not saying we’re always right about every suggestion we have, about every idea we have to try to change things. There are many smart people in the fields of hospital administration, health care management, and the creation of EHRs who have been and will continue to be an extremely important part of the patient care process, and they provide useful tools and information that help us every day. But we keep saying things aren’t working, our patients aren’t getting better, that our country is still spending billions of dollars on health care with little return for the dollars we spend.

I know we can’t do it alone, we need the rest of this infrastructure to support us. But the voices of those caring for patients on the front lines, in the community, in the office and in the hospital, must be heard. If we continue to respond verbally to these calls for change, we will likely continue to achieve the outcome that this health care system is so perfectly designed for — this system with horrible inequities, poor access to care, poor outcomes for so many of our patients and missed opportunities to prevent disease.

Yes, making this change is going to be messy and going to have growing pains and missteps. But if we don’t recognize that so many things just don’t work, and if we don’t listen to the voices calling for better health care, we can never get there.

As we have seen during the pandemic, the system is under strain. We are not providing the best possible care, and our providers and patients are suffering. So I just hope we can join our voices to make a clear call, for those with the power to make change and create a better place for patients and providers across the healthcare system to listen. Or we’re sure to find ourselves somewhere, in 5 or 10 years, no better off than today, trying to piss people off with a call for change.

Please tell me how crazy you are, on a scale of 1 to 10.

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