People Exist Outside of the Office

This is a shock to many physicians.  They think that the minute a person leaves the office they go into a time-space vortex only to exist when they return.  OK, they dont really think that way, but they certainly seem to act that way.  The problem is that, because of a payment system that only covers face-to-face encounters, the doctor is only motivated to interact with people when they are sitting in the office.

This would probably still be an OK thing if not for several important details:

  1. It's a hassle to get in to the doctor's office.
  2. Doctors are usually hurried and stressed when they finally see the patient.
  3. People don't remember everything since their last visit, and so important details may be left out.

In reality, health care has been held hostage to the exam room setting.  People who simply want questions answered so they can take care of themselves are unable to get the answers unless they pay for visits.  As a physician, I found that these visits were usually a big waste of time for both me and my patient.  I believe that much of the reason for people not taking care of themselves is because of this.  

The Alternative to Office Visits

So why not just answer questions via email or on the phone?  Unfortunately, unless a doctor wants to give away care for free, this doesn't happen in our health care system.  In my office, however, I don't care where the care gets done because I am not rewarded for holding information hostage.  I answer questions on the phone, via electronic message, and give an online resource to give answers to my patients' questions.  I also use online tools for people to easily let me know how they are doing:

  • Online spreadsheets with blood pressure, diabets numbers, and other information.
  • Online forms where people can submit information and give me details of how they are doing.

If I am monitoring your blood pressure from home, then why do I need to bring you in for an office visit just to check your blood pressure?  In truth, the readings from home are more accurate.  The same is true for monitoring other conditions, such as diabetes, depression, anxiety, and weight management.

The Response From Patients

My initial fear was that increased access to me and my staff would lead to increased dependency.  They would run everything by me before making decisions.  I have found the opposite.  Patients are more confident when they know I am by their side.  They know they can reach me if they want, and that lets them take a bigger role in their own care without the feeling of being on their own.

From my standpoint, I'd rather have patients who are independent and confident of their own care.  The time it takes me to view a blood pressure log on a daily basis is very brief, and the reward is huge.  

So when are Office Visits Needed?

Obviously, I don't think office visits are altogether unnecessary.  Like everything else, the face-to-face encounter is a tool that is quite useful when used properly.  Here are the circumstances where an office visit makes a difference:

  • When there is an important physical finding that will affect my treatment decision.  Are the ears infected?  Is there wheezing in the chest?  
  • When there are lab tests needed to be done.  Is there strep throat?  Is the urine infected?
  • To monitor physical findings on a regular basis.  Some things need to be checked on a regular basis, such as the foot exam of a diabetic, a child's height and weight, and a regular physical exam for people as they get older (listening for heart murmurs and other problems that may sneak up).
  • When people need the reassurance of a face-to-face encounter.  Sometimes it just feels better to see someone in person.

Even in these cases, however, the time needed to do these things is significantly less because of the other resources available to the patient (and because the office is not kept full to pay the bills).

It's really better, easier, more convenient, less hassle, and higher quality care.