By Rob Lamberts, MD

Finally.

I can finally see progress in what I am doing.  Above is a photo of the front page of my new practice website (visit http://doctorlamberts.org).

There still is a little “Lorem ipsum” here and there – like having labels you missed on a shirt you are wearing – but I am very happy with the look.  The pictures of the sepia photos with the iPad making it color were the genius of my web developer (with some suggestions from me), giving a perfect image of the use of technology to accomplish “old-fashioned care made new.”

I’ve spent good portion of the past few days writing the content (replacing most of the “Lorem ipsum”).  Of what I’ve written, the strongest was in the section “Why It’s Different,” where I compare life in a traditional practice to what I intend to do.  Here are a few examples:

“I Need an Appointment”

Traditional Practice

· Call the office, hear a message about calling 911, get placed on hold or leave voice message (after navigating automated attendant).
· Get called back to find out the reason for your appointment.
· Appointment is made around what is open for the doctor.
· Take time away from your schedule to meet doctor’s schedule.

Our Practice:

· Log on to portal and directly make your own appointment to fit your schedule.
Or
· Call the office and tell a human being that you need an appointment.

Minor Problem (“My Foot Hurts” or “My Baby is Sick”)

Traditional Practice

· Look it up online (hoping your choice of advice is right) and follow advice of someone you do not know if you should trust.
Or:
· Call the office, listen again to the message about calling 911, get placed on hold or leave voice message (after navigating automated attendant).
· Get called back by nurse who either tells you to come in for an appointment, or takes a message and sends your symptoms to the doctor.
· Doctor sends message back to the nurse (usually at the end of the day), either telling you what to do, or tells you to come in to the office.
· If told to come to the office, you then complete steps in “a typical appointment” below.

My Practice

· Log on to advice section offered by my practice, which offers you 3 options.
· Something written by me about what I recommend.
· A video of my advice about the symptom/problem.
· A list of trusted websites that help answer your question.

Or:
· Call the office and talk to a human being (maybe even the doctor) about what to do, who will only bring you in to the office for the parts of the encounter that can’t be done over the phone.
Or:
· Log on to portal and send a message to your doctor asking a question about your foot.  The doctor will respond via electronic message (or call you) and will only bring you to the office for a brief exam (if needed).

A Referral to the Specialist

Traditional practice

Primary care doctor decides you need a referral and tells staff to set up the referral.

· Referral information is sent to specialist, which includes mainly the diagnosis and insurance information.
· Specialist’s office calls to set-up appointment.

Either at the specialist office or before the visit, you must fill in your detailed past medical history for the specialist (from your own memory), including
· medications
· problems
· surgeries
· family history
· past procedures

1. Since the specialist may or may not know the reason for the visit (depending on the referring physician’s office), they will usually takes a detailed history of problems, making a recommendation on what they think you need.

2. Since the specialist often does not have all of the labs or test results done at your PCP’s office, they will often repeat recent tests if they are not immediately available.

3. After the visit, the specialist sends a detailed report with recommendations to the PCP (although this may or may not happen, depending on the specialist, and often is significantly delayed if it is sent).

4. The specialist gives you recommendations about testing, medication changes, and follow-up.  You must reconcile this with your previous medications, deciding if they conflict with recommendations given by your PCP.  If they do conflict, you either call your PCP (listen to 911 message, etc.), or set up an appointment to discuss.

5. At your next visit to your PCP, you give your updated medication list and tell of any procedures done and their results (if you know them), in case they were not sent to your PCP.  If you don’t do so, your medication list will be inaccurate.

If you end up regularly seeing the specialist, you must do your best to balance their recommendations, those of other specialists you see, and your PCP, serving as the intermediary between each of your doctors.  You must inform each doctor about any changes the other doctors make.  Not doing so could lead to confusion or harm.

My practice:

1. I decide you need a referral and send an email to the specialist, telling them why I need their help.  I send any pertinent labs, tests, or other history to the specialist that I think would help them.  I can take the time to do this since I don’t have to keep a full office to get paid.

2. When the appointment is made, you give a detailed medical history by printing out your patient health record.  This assures that medication lists, dates of surgeries, and problem lists are accurate.  It also greatly cuts down on your time filling it out.

3. If the specialist is the geeky type, I get an email back with their recommendations; otherwise, they send their detailed recommendation and I update your record accordingly.

4. When I sent the referral, I set a reminder to check and see if I got information on the referral.  If I did not, I contact the physician to get their update.

5. If the specialist orders tests or changes medications, you can update your personal health record or log on to the patient portal and tell me.  If I have questions, I can contact the specialist and ask directly.

6. Since I will be communicating with all specialists this way (in a perfect world), I will be notified of any changes to the problems, medications, or of any tests done under others’ supervision.  This will allow me to help patients keep an accurate and updated personal record.  It will also let me catch any conflicting recommendations between specialists.

I think it’s pretty convincing.  Almost as good as “Lorem Ipsum.”

Rob Lamberts, MD, is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at More Musings (of a Distractible Kind) where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player. He is a primary care physician.