Easy Access for Patients

Much has been written of late on the subject of access to healthcare. But, what about patients’ ease of access to physicians? I’m not talking about the uninsured or being unable to find a physician that accepts Medicare, but patients who have established relationships with their physicians and are unable to get their doctor’s attention.

I hear all about it in the exam room:

“I couldn’t get my doctor on call.”
“Waited two hours and I was the first patient scheduled for the day.”
“I just had a quick question and the doctor never returned my call.”

Over the years doctors have sequestered themselves in exam rooms; scurrying quickly between them, so as not to be exposed to lingering patients in the hallway. They’ve systematically secured their e-mail addresses, insulated themselves during office hours with circular phone-menu systems, and instituted incompetent answering services after hours. Just take a trip to your average primary-care physician’s office, where patients endure mind-numbing waits in the waiting room to spend an average of six minutes with a hurried, oftentimes standing doctor.

Seven years ago I set out to change this paradigm by removing all barriers to access, and then, for those still skeptical of an easily-accessible doctor, by branding our practice after this anomaly: Access Healthcare.

Want to be where everybody knows your name? Our patients are greeted by name by a friendly greeter across a slate desktop. Your time’s valuable too? We have only four chairs in our no-waiting room. Like to be heard? We schedule 30 minute slots for even acute care visits. Have more than one medical issue? We ask, “Is there anything else?” and mean it. Uncomfortable assuming that no news is good news? We e-mail all labs and study results along with commentary directly to our patients.

We also work hard to facilitate patient/physician communication. When you call the practice during office hours, only one of two people with direct access to your chart might answer the phone. When you call after hours, you get the physician directly. Tend to get hurt or sick after hours? We’re on call 24/7. Forgot the e-mail or cell phone number of your doctor? We print it on a key chain and give it to you.

Seven years later the results are in. The benefits of access are well known and well publicized:

• Earlier prevention;
  

• Earlier identification and treatment of disease;
  

• Less utilization of more expensive emergency rooms; and
  

• Efficiencies of continuity of care.

But what about the downside? Is it possible that too much access breeds inefficiency as well? There is an expression that goes, “Give a person an inch and they’ll take a mile.” I fear this truism does apply at times to my practice, probably because of Americans’ insatiable demand for healthcare. I still get many calls over the weekend requesting refills of routine meds. And yes, there is often “one more thing.” And, I still struggle to be on time.

So, is there a healthy middle ground? I think so. Consider the following points and don’t be afraid to “just say no.”

• Choose your ports of access with work flow in mind. Does an online instant chat with your receptionist really save anyone time from the traditional telephone call?

• Create and maintain clear boundaries. In the end, patients will respect you more for it.

David Albenberg, MD,

a board-certified family medicine specialist, opened South Carolina's first retail medicine primary-care practice, Access Healthcare, in 2003. He focuses on disease prevention and wellness maintenance. He can be reached at accesshealthcare@letssimplify.com.