I thought I’d try something different this week. Instead of me just going blah, blah, blah to the cyber world, I thought I’d ask for help compiling a list.
It has always annoyed me when well-meaning special interest groups ask family physicians to give away their professional time and expertise. A typical demand might sound like, “primary care physicians should screen all their patients for depression at each visit using my favorite instrument. It only takes a minute or two.” Of course family physicians know it never just takes a minute or two, because we have to explain why we’re doing it to patients who are fine, and we have to deal with abnormal screening results by asking more questions or ordering further tests. The economic impact of these demands are at least twofold: we aren’t allowed to bill for the screening test in the first place and after we’ve dealt with the issues the patient originally came to clinic for, we aren’t paid for the extra time to deal with the new issues that arose from the screening thingee.
When confronted with these economic realities, the typical special interest group response is “your nurse or MA can administer the screening questions.” No, they are actually very busy already trying to keep keep open a business with very thin margins. They don’t have time to give away their services either.
Other examples of these demands for screening off the top of my head include domestic violence, anxiety disorders, and alcohol abuse.
I’m asking for your help compiling a list of all the special interests and disease advocates who want us to give away our time. This is not an issue of efficacy or cost-effectiveness. I’m not saying it’s right or wrong to ask some screening questions, and I’m not asking for only interventions proven to work (short list I’m sure). The issue is about outsiders who expect family physicians to do work for free.
Think of other examples and let me know what you come up with. Respond by replying to this post or if you prefer, email me at American@healthscareonline.com. In a week or two I’ll post the list we came up with.
Thanks for your time and thoughts.
OK
Functional screening like can you take a bath
Fiaancial screening can you balance your check book or write a check
Risk for falls : can you stand up with out help are you dizzy have you fallen in the last two months
COPD screen do you smoke do you cough etc
I do at least 10 screens daily and what about the foot exam on diabetes: I just do it on everyone and that way I know I did the diabetes.
I stopped asking about the guns in the house.
I am not good about the alchol screen, domestic violence and the do you have CO monitors in your house do you wear you seat belt and do you drink and drive; by he time I have done all the screens my patients have forgotten why they came in
I was asked in a form the other day if a patient could: Can patient attend to the needs of nature?
My reply was: He cant even wipe himself much less plant a garden.