It's National Primary Care Week, an annual event to highlight the indispensible role of primary care in our health care system. At PCP, we celebrate NPCW all month long. During this time, we're looking to the future of primary care. We think teamwork and advocacy are crucial elements of that future. We'll talk teams later this month in the webinar "Transforming to Team" with Christine Sinsky and Margaret Flinter. Today on the blog, in a Q&A with
Progress Notes editor Sonya Collins, Dr. Sinsky discusses the value of teamwork in primary care.
SC: As part of your research, you've traveled around the country observing innovative models of primary care. When you're out on the road visiting practices, what have you seen that's made you the most excited?
CS: First, my heart breaks when I see bright, well trained physicians spending most of their day on non-physician-level work. Many physicians spend a significant portion of their day doing work that in an ideal clinic would be re-engineered out of the practice or delegated to a more appropriate person on the team. When a doctor doesn’t have enough support staff, he tends to do a lot more on his own: getting supplies, keyboarding orders, typing the visit note, retyping portions of the note into the after-visit summary, then running down the hall, grabbing the note from a printer and taking it back to the patient.
Our time with patients could be more patient-centered as well. Many of us walk into the exam room, look at a computer screen, glance at the patient, and then as we ask questions, we start typing. We are furiously multi-tasking, trying to record the information, while periodically looking over at the patient. Some things get lost.
As I observe other physicians, oftentimes the patient is communicating something really important but the physician misses it, perhaps the depression or the depth of worry, because at that moment his attention is on the computer screen.
But that didn’t happen at a family practice residency program in Quincy, Illinois, where they are piloting “The Office of the Future. ” In this model there are two medical assistants always working with the same doctor, and they have developed an effective model of collaborative care, including collaborative documentation.
One medical assistant (MA) records the initial patient history during the pre-visit rooming process, comes out and tells the physician what she has learned, then they go back into the room together. The physician is able to attend directly and completely to the patient, while in the background the MA records the notes. While the doctor examines the patient, he verbalizes the findings, which the MA also records.
The physician tells the patient and MA the assessment and plan, which the MA records, along with the meds, upcoming labs, appointments and whatever else is required. When the doctor leaves, the MA stays with the patient, prints up all the instructions and reinforces the plan while the doctor goes on to the next patient who is already in an exam room with the second MA. This system allows the doctor to bond with each patient. He has a relaxed visit and a calm clinic day.