Merigian Studios


Pareto Optimality

Pareto Optimality

New Year's Day seems to inspire wondrous thoughts about the year ahead. I think this year will be a dilly-whopper. There is so much uncertainty in politics, healthcare, the Federal Reserve, the weather and education. Not to mention the rematch of last year's college championship game Alabama - Clemson on 9 January 2017.

Many people make a New Year's resolution and break it within a week or so. Making New Year's resolutions is an age old tradition that usually requires discipline. But discipline without joy is mere suffering. As I look forward into the New Year, I see changes occurring at the Stone Institute. But what kind of change?

The first thing to keep in mind, the patient population has grown to over seven thousand active patients. In 2016, we added over two hundred new patients to that number. These are not patients with sore throats and ear aches, our patients have complex serious medical conditions that no physician wishes to treat. Sure, there are a number of medical specialists that are usually involved in each new patient's illness, but they seldom communicate with one another, and their pharmacologic therapies many times interact with each other. It is an honor caring for each and every patient at the Stone Institute, but there comes a time when a solo practitioner cannot continue to expand his/her practice. We have tried to provide care to every patient who wants to walk through our threshold, but over the years, the growth in my practice has created massive congestion.

This past year, I had physicians and nurse practitioners shadow me in an effort to find another physician or physician extender who might help take the load off of me. Not to replace me, but to provide care to our patients who are stable and require very little attention now that they are healing or healed. However, each practitioner stated in one way or another, "I get forty-percent of what you do, but sixty-percent is beyond me. I'm not fit to practice with you." Of all of the healthcare providers we had visit our office, none of them were excited about learning something new, looking at patients with a different vision, using a different evaluation approach, listening to the patient's history, learning about emergent systems and fractal physiologic patterns. I'm out. That's it.

Over the past few months, I have been leaving the office at about 7:30 pm to 8:00 pm each patient care day. The staff rotates their late night, but I stay each night. It does not allow me to maintain my healthy rituals, nor does it not allow me to address the concerns of all of our patients that have been coming to the Stone for sixteen years or more. In truth, some of my patients have been in my practice since 1997. Twenty years has gone by quickly.

The new office schedule will reduce the new patient visits to two per week. This will be put into place immediately. This scheduling change will impact new patients as far out on our schedule as March 2017. However, many of our previous seven thousand patients who want to be seen, cannot get on the schedule because we are spending our care time seeing new patients. In addition, we will not schedule more than eight patients per day, on the two days we do not evaluate new patients. On the days we see new patients, we will see no more than five follow-up patients. In order to see those who need acute care for any new onset illness or acute exacerbation of their chronic illness, the staff will make available more 10 minute visits. We could see probably four or five per day. These slots will be reserved for patients that need a quick evaluation to see if new medications are indicated or if their old medications need to be adjusted.

There are other changes that will be put in place. Most of them are related to our internal processing. These are needed to avoid any problems with communicating laboratory and imaging results to our patients. I prefer our office communicate through email. Phone calls are difficult to manage. Emails are much simpler to fit into the workday and answer properly. We also make both inquiry emails and our answers into each patient's chart capturing clinical changes in chronological order. We do not have electronic records and will never have them. I do not want to type on a computer during our actual patient visit. Those physicians who prefer electronic records to paper charts are more often concerned with reimbursement issues than patient care. Technology can put a wedge between the patient and the doctor.

Video and telemedicine is the next step in caring for patients. Video recordings have the advantage of being able to be placed into charts and subsequent patient care can be visualized directly by reviewing the video. This technology will not be embraced by me anytime soon.

I need to make modifications in the schedule to enhance the likelihood that these alterations will enhance my longevity in the healthcare profession and afford me the time I require to stay well. My ultimate goal is to stay focused on helping each and every one of you.

It's going to be a great new year. 2017 has many different mysteries ahead. Let's all look forward to the unknown and ready ourselves for the challenges and changes that might come about. I'm getting ready to be more responsive to everyone in the practice and at the same time, finding a way to enhance my own personal health. That's Pareto Optimality for me.

What about you?


Posted by Amanda Sanders at 12:09 PM
Share |