More time to generate quality conversations with patients?

Anna Sant

The fight of the click in the consultation

Two studies published last year in the Annals of Internal Medicine and Health Affairs compared the time that doctors spend with the patient in consultation with the time they spend with the computer. Jordi Varela analyzed these results in his post dedicated to Danielle Ofri, a Bellevue Hospital doctor and professor at the NYU School of Medicine, who said, referring to the electronic medical record (EHR), that "The beast is insatiable and every time it needs more and more food. It ends up claiming all the time I dedicate to human interaction and, given that I ought to, I have to stay late, just to satisfy its cravings.” Both studies concluded that the time spent on the screen is longer than that dedicated to the patient.

As we increase the need to control health data, we spend more time documenting medical information on the computer and less time in quality conversation with our patients.

This produces a illogical situation since the patient feels little listened to and the professional feels frustrated by not dedicating himself to what really determined him initially to exercise his profession. The Mayo Clinic and the American Medical Association conducted a study comparing the evolution of the burnout syndrome in 2011 and 2014 and the data were worrisome: in just three years, the percentage of doctors evaluated who had detected any symptom was more than 44 to 54%.

Competence distribution to improve the experience of patients and professionals

Jordi Varela, in a recent post, told us about the APEX (Awesome Patient Experience) program, implemented in the Department of Family Medicine at the University of Colorado, which encourages team work in the clinics based on increasing the skills of attendees doctors (management of the agendas, triage of the visits with previously protocolized criteria, introduction of data in the clinical record, reconciliation of medication, forms or coding of diagnoses).

Primary care has long since started, necessarily due to the growing demand, the way for an improvement of the organization, for example, with excellent results in demand management. It has also done so with the transfer of tasks from the family doctor to the nursing, social work, pharmacy or clinical therapist, but much remains to be done to match the needs of all the agents involved in the consultation process.

There is a propensity to ask for more family doctors, more nurses and more assistants, but this may not be the solution. Answering to such demand is not so easy. In addition, if we analyze in detail the operational flowchart of primary care, we can see that some of the tasks currently performed don’t necessarily require their expertise and, instead, generate much dissatisfaction in the professional, who feels that he is not only working below their capabilities, but also can not concentrate on suitably attending the most entitled to attendance: the patient.

The incorporation of assistants or medical assistants more trained and prepared to assume tasks currently carried out by doctors or nurses has many benefits: efficiency and productivity, improvement of the patient's experience, reduction of the burnout syndrome and, surely, an improvement in communication and adherence to treatment.

Some health managers reject this possibility because they believe that doctors want "personal assistants to free them from hard work". We must leave behind that old concept and embrace the concept of teamwork, where each one maximizes their abilities and aptitudes. The medical assistant that is proposed here is not a professional who spends his time with the doctor wherever he goes to assist him in everything he needs, but we could almost better call him a patient assistant given that he is with the patient during all the time the visit lasts and his main objective is to give support to the patient, dedicating time and resources to turn him into an active agent of his own health.

In short, the idea that the doctor has more time to devote to the patient and that the patient may have, apart from the doctor, another reference person to consult questions and perform more bureaucratic medical tasks (request for tests, prescriptions, etc.) is definitely a good move. And all this in a collaborative interview format in the same consultation that allows us to get rid of the "Excuse me, can I ask you a question?" As we walk through the corridors to the counter.

The medical assistant checklist

The American Medical Association offers a checklist of the functions performed by this profile halfway between the administrative and clinical tasks:

Before the visit

• Review the EHR and the patient's planned questionnaire (if any).
• Collect the results of the tests that have been performed on the patient and, where appropriate, print copies to share with the patient.
• Compile relevant data for the visit: emergency information, hospitalization, consultations, etc.

During the visit

• Go look for the patient in the waiting room to welcome him.
• Identify the reason for the visit and help the patient to define priorities.
• Reconcile the medication.
• Review allergies.
• Update needs of screenings and immunizations according to protocol.
• Monitor the status of chronic symptoms.
• Give information of the anticipated wills according to protocol, if applicable.
• Give self-care and prevention guidelines (stop smoking, weight loss, etc.).
• Perform symptom tests.
• Prepare the patient for the medical examination.
• Introduce the patient in the operation of the consultation if it’s a new patient.
• Briefing the doctor with the basic information treated in consultation.

During the consultation with the doctor

• He stays in the consultation for the introduction of data in the HCE (the patient is never left alone in the consultation).

At the end of the visit

• Print and review the summary of the visit with the patient (medication, next steps).
• Delivery of support materials (if applicable).
• Direct the patient to the health portal (if applicable).
• Schedule the next visit or tests according to what the protocol establishes or has specified the doctor.
• Schedule referrals to other specialists.
• Communicate the contact information in case the patient has doubts or concerns once he has left the centre.

It’s difficult to foresee the final results of a transformation of this type. It requires a significant investment in time (training, development of new protocols, reinforcement of teamwork, testing and evaluation of indicators) and resources (hiring more staff) before we get really close and productive.

The US Department of Labour has already predicted a growth of 29% in the figure of the medical assistant until the year 2022, a figure much higher than the average growth expected for other profiles.

Be that as it may, the medical assistants are being paramount to ensure that the patient feels accompanied and clothed during the entire visit, as well as to maintain more quality conversations with the people with whom they must be jointly responsible for their health.