Physicians must innovate to meet the needs of patients

I can’t stop thinking about a drive-thru. Not the one for burgers and shakes but the one for ear checks, sports forms, quick med refill visits or a lingering rash. For those things you just want to know fast or need done now, but don’t want to spend 2 hours resolving. For those things that really make you worry as a parent. Instead of the millisecond-mall-type clinic, we all want our doctors, our clinics, and our child’s team to provide health care. In my opinion, parents and pediatricians both believe in the medical home.

McClinic?

Imagine if you knew your doctor did the drive-thru on Tuesday afternoons. Would you swing by to ask about that rash you’re worried about or to check in on your child’s ears? Follow up on a new seizure medication? What if it didn’t even require a call ahead of time? What if tight time restraints were agreed upon (say 7 minute visits or so) in advance so the patient/physician agenda was aligned? Swing by on your way to daycare?

We want quality, trust, and mobility when it comes to health care. We want easy access, too. Of course we must fight for improved electronic visits and online advice. We want comprehensive, compassionate preventative care. We will need in-office visits, yes. And sometimes we need hands-on more urgent care, too. Now the “kwik-clinic” idea isn’t new, I know. Even hospitals are opening urgent-care clinics throughout the country. But your pediatrician often isn’t involved.  So what about that drive-thru:

This all started for me when a pediatrician friend spilled her dream list for a new pediatric clinic. In it she mentioned the “ear-check drive thru.” She said, “Sometimes parents just want to know if they can let their child cry at night–or if it’s an ear [infection] keeping them up.” The drive-thru concept became a reality when her clinic  recently had to evacuate for a mechanical issue in the building. They cancelled all the afternoon visits but she was on-call and spent the afternoon seeing patients out of a station wagon. She said it was phenomenal. It was efficient, centered around the patient, and more directed than usual. Less waiting, less exposure to illness for children in the waiting room, and easy for parents. Imagine being able to pull up in line, chat with the doctor and have an evaluation without unbuckling the car seat.

Would adolescents feel more comfortable asking questions from their car? Would they swing through for a medication check or to chat about a new embarrassing problem? Does the environment of the car improve the ease for asking questions for some?

Mobile health in an entirely different way.

I recognize the complexities, limitations, and difficulties with providing medical care in a parking lot of course. Some patients would need to be triaged inside to the clinic. But I also sense great opportunity for service and patient-centeredness, cost reduction and partnership.

I’ll write next about the other kind of mobile health and exciting new data that compels us not only to build the drive-thru, but also to use mobile apps to promote patient’s health (there’s already an app for ear checks). We live in a time where no longer is it the patient’s responsibility to conform to the system; I believe we live in the time where physicians must innovate to meet the needs of patients.

Wendy Sue Swanson is a pediatrician who blogs at Seattle Mama Doc.

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  • MarylandMD

    We are starting to see our health care system strain from the increasing gap between what the patients want (increased access/convenience) and what many physicians want (9-5 five days/week or even part time such as 10-4 four days/week, great work life balance, etc.). Patients are willing to give up the benefits of continuity of care for convenience. Doctors don’t want to give up a cushy schedule. If we want to serve our patients, we will have to think more broadly about how we can best serve them, and think outside the “box” of the four walled exam room and banker’s hours (which bankers don’t even work any more!). This issue came up in an earlier thread on 11/21 (“When pharmacies administer vaccines, physicians lose an opportunity”).

  • Blake McKinney, MD

    I agree that physicians MUST innovate. Your friend spent an afternoon seeing
    patients in the parking lot and realized, “I can actually do this”… and then
    she realized that she cut out several barriers between herself and the patient
    and the work was much easier, it was refreshing for the patient and ultimately,
    more rewarding. Watch out – she may have just disrupted the healthcare marketplace. Problem: how to get paid to see patients in a walk-up fashion, on the front porch of your office without all the paperwork and tedium of the usual surroundings?

    What patients want is access to their physician. What physicians want is to provide efficient care that satisfies the patient’s needs and is tied to a decent compensation model. As you observe, the urgent care industry has crept up between patients and their primary physicians by providing what the patient wants: access, now. Most primary practices aren’t able to accommodate walk-in visits and even if they are, the usual custom of making an appointment dampens the spontaneity required for patients to “drive thru” your office. They’re much more likely to put that burning feeling off until after work and then go pay $100+ cash to see the urgent care provider for the same UTI you could have treated.

    So what’s a primary physician, a pediatrician, to do? Innovation must occur in the way we
    look at compensation, our work day, the necessity of an in-person visit. Are we ready to accept new workflows if it means we will be able to reach more people and to sustain or even improve
    our financial situation in these tumultuous times? With change comes opportunity. Many physicians will miss out because they are resistant to change.

    No matter what anyone says, physicians are going to have to “fix” healthcare. No one else can. We can start by reverse-engineering our delivery model off of what the patient wants. This is what any successful business does. You brought up the teenager who is more likely to mention an embarrassing problem from inside a car at a drive-thru than in an exam room (after waiting in the lobby where they saw their friend’s mom before being asked to get into a ridiculous gown…) Take it a step further, to the teenager’s most comfortable place: her phone. In your example, what that teenager wants, or what the modern parent wants for that matter, is to be able to text a clinical question to their own physician or to have a video chat with their doctor on their iPad rather than schlepping into the office.

    Doctors willing to embrace this type of communication will be providing what patients want, and from what patients want, we can derive the business model that will propel medical practice into the digital health era. Stay tuned…

    Blake McKinney, MD
    Co-Founder, CirrusMD

    • Belinda Rose

      Dr McKinney, how do we capture the compensation for those “out of the box” encounters? As a practice administrator, I am aware of and extremely interested in ways to provide better access and quality care to our patients, but also realize the need for survival of the practice. Any suggestions as to where I may find those answers or are they even out there yet?

      • Blake McKinney, MD

        Dear Ms Rose,

        Thank you for your reply. You are right when you observe that any new service line must be monetized or it will be unsustainable for practices. There’s a reason why doctors don’t give out their personal smartphone numbers to patients as a general rule and its not that they don’t want to be reachable: its because the only way for a group of doctors to make money, presently, is by seeing patients in the office and
        generating charts (never mind the unsecure ancillary medical record it creates when doctors text their patients using personal tech). Patients would love to interact remotely for most routine matters but practices can’t afford to dispense more uncompensated care than they already do. As a physician, it pains me to hear when one of my patients has a recurrence of sinusitis or a UTI, has a simple question, or needs a refill or referral and knowing how simple it is for me to help them,
        that they MUST come in. This is why my practice has several built-in barriers (receptionist, advice nurse, answering service) between doctors and patients. If I acquiesce to over-the-phone requests day after day in our current financial situation
        my group practice will eventually go under.

        As an administrator, you will have opportunity in the new digital and mHealth era we’re entering to influence the modernization of healthcare delivery and physician compensation. Patients AND doctors are looking for answers to access and mobile connectivity questions right now. The telecom industry has given us the tools to communicate in our “civilian” lives in ways that can significantly improve health
        outcomes. But there will be several challenges to implementing these solutions in medicine. Many practices have recently invested in costly (and limited) first-generation EHR systems that will preclude use of newer, more agile interfaces. More and more physicians affiliate with a large health systems that are less nimble when it comes to process improvement. And most importantly, as providers experience change fatigue they will offer up resistance to new workflows, which is why a meaningful revenue stream must be linked to any enhanced access service offering. As a practicing physician I am well aware of this effect. My partners and I can give 10 quick reasons why the answer to any new electronic workflow is “no”, until you propose a hockey-stick revenue projection along with it, and all of the sudden we can responsibly agree, “this will be good for our patients”.

        Strictly speaking, the answers you’re looking for aren’t out there yet. But they will be in about 8 weeks. With respects to this forum I won’t get any more sales-y, but would be glad to chat with you, or anyone else offline: mckinney@cirrusmd.com.

        Blake McKinney, MD

    • southerndoc1

      “I agree that physicians MUST innovate”

      I have a list of patients waiting 6-9- months to get in to my practice. They want to see me, not my partner. What innovation MUST I effect?

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