Should Physicians Take On Some Of The Patient Check-In Burdens?

Sustainable For The Long Term Or Not; Some Physicians Take The Patient Check-In Responsibility On Empathetic Grounds

Initially published by Illumination Curated on Medium!


Photo by Benyamin Bohlouli on Unsplash

Not very long ago, I published a short article titled "Digital Patient Clinic check-in for the modern Medical Practice." The idea was to shed some light on today's continually shifting medical practice landscape by focusing on the "stat poll" conducted by the Medical Group Management Association (MGMA) on May 3rd, 2022.

The survey pointed out that most medical practices from which the MGMA probed believe, Digital check-in can be a great asset to ensuring seamless and more accurate patient flow.

Yesterday, when I was trying to catch up with my daily readings on the most recent topics in healthcare, I could not overlook an interesting article from Rebekah Bernard, MD, with the title "Revitalize your practice with this innovative patient flow." One can find the abovementioned piece in the April 22nd edition of Medical Economics Journal, Volume 99, Issue 4.

Dr. Bernard points to a fundamental medical practice doctrine within her nicely written article: "the value of the doctor-patient relationship."

The author in the Medical economics journal clearly outlines the traditional medical practice workflow norms and how such means have been molded by a prevalent contemporary project management methodology, "The Toyota Lean" process.

Dr. Bernard, just like many other physicians, has had her fair share of bureaucracy, as she describes. For 15 years, she had to follow organizational patient flow benchmarks and cliches. Throughout her entire career, she had to follow the routine of what she represents:

“The patient arrives at the check-in window to register and sits down to wait. A medical assistant (MA) shows up holding a chart, calls the patient’s name, and walks them into the clinical area. First stop: the dreaded scale for a weight. Next, into the exam room for vital signs: blood pressure, pulse and temperature. Now, the MA barrages the patient with questions, typing furiously into an electronic system for the next five to 10 minutes or more, depending on the historian. Many of these questions will turn out to be completely irrelevant, already in the chart, or repeated by the physician. Finally, the MA leaves the patient alone in the exam room to wait — and sometimes wait, and wait — until the doctor finally rushes in.”

The author highlights a scenario that is today "almost universal" to a practicing physician. At least, that is the case for those physicians in the United States. As you may take from the abovementioned scenario, many variables exist in the check-in process. In contrast, every variable and step must run almost perfectly if we intend to build and preserve that vital-winning instrument of every patient visit, the doctor-patient rapport. Otherwise, a crack in the patient flow and check-in system will result in dissatisfaction, physician burden, and operational delinquency.

“I had been “flow mapped” and “cycle time measured” by a team of managers with Toyota-lean precision, so I assumed this must be the most efficient way to run a practice.” — says Dr. Rebekah Bernard

Traditionally, physicians have been the culture of leaders, but that almost ended with the overtake of medical practices by the corporate culture of insurance companies and their novel reimbursement practices. Then there came the project management tools like Toyota's lean methodology. The standardized tools primarily focus on cost control and business model without considering the doctor-patient relationship aspect of the clinic operation. The Toyota car manufacturing organization initially developed the project management tool and was later adopted by other industries.

Dr. Bernard also points out the redundancies of patient check-in; hence, the inefficiency of the tasks performed from the minute patients check in to the reception and are first seen by the physician. These are the real issues with today's healthcare system driving up the healthcare costs and placing an additional burden on physician productivity.

Author continues:

“If this orchestrated ballet works perfectly, the patient is out of the office in about an hour, perhaps 15 minutes of which was spent with the physician.”

The latter statement is the epitome of why physicians burn out, and healthcare is one of the most inefficient systems in the world.

Administrators and workflow experts assure doctors that this type of streamlining leads to the most efficient visit and “patient experience.” After all, it takes a team to care for patients these days! Or does it?”

Is It Ideal For Physicians To Take On The Tasks That Are Typically The Medical staff's Responsibility?

That is what the author of the April 22nd edition of Medical Economics Journal did. Meaning, that once the patient arrives at her office, checks in, and takes a seat, the doctor comes to the waiting room entrance, beckons the patient into the office, walks the patient into the exam room, and both enter the exam room. While on the way, she establishes a rapport with the patient and continues to chat for a few moments facilitating empathy and trust. Then the doctor obtains the patient's history and personally brings vital signs. If necessary, Dr. Bernard draws the patient's blood as well.

As a medical professional, I can concede that nothing can replace more hands-on medical care, as it builds a solid doctor-patient relationship.

But, is that realistic given today's overly monopolized system of reimbursement?!

Of course, maintaining such a hands-on approach solely by the treating physician would have been practical if the cost, quality, and service delivery time could have been well balanced. Since third-party payers of our span control how much physicians should or should not be paid for a service, any additional hands-on uptake of any medical practice by physicians will subject them to burden, inefficiency, and ultimately burnout.

That is, precisely, what 3rd party payers want: extra physician work at no cost to them.

Patient welfare and satisfaction are of utmost importance for any physician. Although cutting the intermediaries like medical assistants, technicians and phlebotomists may be a way to reach that goal, nevertheless can serve as a double-edged sword.

Indeed, a more hands-on approach to patient check-in, registration, and workflow may yield happier and compliant patients and fewer errors, but at what cost?!- and sustainability? — As Dr. Bernard proposes, even if a medical practice drops, subsidizing C-suite managers, reducing staff members, and adding a scribe to take notes.

The Real Solution

You can run from the bureaucracy and bypass the obstacle of medical practice, but you can never hide!

As a medical practitioner, I take from Dr. Bernard's point of view; she sees the bureaucracy and corporate culture distorting the essence of a genuine doctor