Monthly Archives: March 2013

The Fish Bowl

bigstock-Gold-fishes-in-aquarium-17062952 - CopyMy mother possessed an aquarium filled with tropical fish. I recall she obtained her fish from a small store in the lazy town I grew up in. My twin brother and I accompanied her on one of excursions. After paying for the fish I insisted on carrying the plastic bag out of the store. She reluctantly complied with this request. What I can’t remember is what happened next. I either dropped the bag or became enraged at something my brother did and slammed the bag down. You can guess what happened. By the time my mother exited the store there was a bag full of fish belly up, dead. “Do not Tap On The Glass” signs are posted on fish tanks for a reason. The stress affects the health of the fish. Shock waves can even kill these small fish.
Working in primary care I often feel like a fish trapped in an aquarium. Everyone can see me. Insurance companies, government agencies, medical boards, and patients have full access to my charts, prescriptions statistics and even how many samples a drug company supplied to me. Someone is constantly tapping on the glass. The stress is sometimes unbearable and makes the job of providing compassionate care difficult.
I whole heartedly agree that transparency in medical care is necessary. However, when it takes me 30 minutes on the phone to get an MRI of the brain approved for someone with unusual headaches, or I have to fill a prior authorization form out because the insurance company has a preferred generic ace inhibitor I feel like a small fish beating up against the side of an aquarium. When will insurance companies and government run agencies have the same transparency?

Tootsie Pops

250px-Tootsie_Pops_1At the ripe old age of four I recall visiting our family practitioner, a gentle, and kind man advanced in years. I don’t remember if I cried when I got the shots. I don’t remember if I was scared. I don’t remember much past the smell of the disinfectant. What I do remember is the Tootsie Pops. An office visit always produced that reward. Either he or his wife (who also doubled as his nurse, cleaning lady, office manager, secretary and biller) would open the cabinet at the bottom of the exam table and miraculously the bottomless box of Tootsie Pops appeared. Grabbing my favorite color purple, I ravenously removed the wrapper and walked out proudly working on another cavity to help buy my dentist’s new car.
Today we hear much about patient satisfaction. Large companies, practice consultants and speakers thrive on this. We often try to take a problem and make it complex. The consulting firms and those specializing in patient satisfaction position themselves knowing that there are those willing to throw money at the problem to solve it.
Like that simple treat mentioned above, little things can mean a lot. Eye contact, a smile, a warm greeting, kind facial expressions and sometimes just listening is what our patients want and need.
I plan on discussing some simple, inexpensive things we can do to keep patients satisfied with care , with office staff, and with primary care in general.

The Knife

Should Have Used A Pry Bar.

Should Have Used A Pry Bar.

Some 15-20 years ago while working on the siding of the mobile home I lived in at the time I needed some leverage to remove some heavy staples that were holding up cables.  Rather than go expend the energy  of rummaging through my “well organized” tool box I pulled my hunting knife from my back pocket.   I recall spending over 80 dollars on this precision instrument of carbon steel, brass and wood.  I also recall that I owned it less than one month when I broke it. Fortunately I only broke the first 1/2 inch of the blade. Grinding it down, I created a rounded tip and salvaged it.  I still have this knife.  Every time I Use it I am reminded to USE THE RIGHT TOOL FOR THE JOB. As primary care providers we face many challenges.  The Affordable Care Act and the uncertainty of payments. The need to meet every increasing demands of time and create and foster a patient centered environment. HIPPA, CMS, PPOs, HMOs, ACOs, Pay for Performance, Patient Satisfaction, Prior Authorizations, Gate Keeping, Capitation, Evidence Based and Copay: How many of the anacroyms or phrases even entered primary care providers minds 20 years ago?  I look back and wish I had used the pry bar instead of my knife.  It still works, but it has never been the same.  More vitial today, we need to use the right tools for our job of proving appropriate compassionate care to our clients today.  If you have a specific need or question that you have not found the answer to or have a tested practice that works for you in dealing with our challenges let us know.