Shoot for the Moon. And Bacon.

I posted the following status update on Facebook today and had an overwhelming 180-plus responses, and dozens of “likes” endorsing individual answers. It was amazing. Although not very scientific, the exercise turned out to be a good marketing survey!

Facebook Focus Group time–Other than a doctor that knows what he or she is doing, what do you want in a doctor’s office? Shoot for the moon. Do you want free lollipops? Evening hours? Humans answering the phones? Reply with one or three things you think you would want from your doctor?

(Please comment here whether or not you have been a patient of mine in the past, or whether you want to be in the future. This is for anyone who has ever been a patient. Forget what is conventionally available. Ask for anything you want!)

My purpose is obvious. I am hoping to start a new practice on Nantucket, and need to decide on what I want that practice to look like. What better way to plan it than to ask the people it might matter to the most?

In asking everyone to “shoot for the moon,” I wanted honest opinions about how an office should run, about what would make a new practice stand out, and be the best one out there.

Here are the results. I grouped the responses into categories and summed their mentions and “likes.” In order:

40       Online access to medical records
35       Decreased wait times
31       Dual waiting rooms—sick and well
31       Undivided attention/good listening
27       Evening hours
27       Weekend hours
25       Attention to diet/nutrition/exercise, overall wellness
24       Email access
21       Help to avoid unnecessary ER visits
18       Questions to prompt for reasons for visit (during visit or before)
18       Courtesy call if running late
18       Courtesy from receptionist
18       Avoid triage or gatekeeper role of receptionist
17       Alternative/integrative treatment options
16       Online self-scheduling tool
15       Waiting room comfort (seating, temperature, good magazines, privacy)
15       Decreased wait for appointments
12       No automated answering machines
10       Bacon
10       Followup with test results
9          Comfortable exam room environment (seating, lighting, good magazines)
9          Seeing doctor, not NP or PA
8          Walk-in slots
8          Enhanced check-in technologies
8          Respect my opinions on illness
7          Donuts
7          Alerts/reminders from doctor
6          Telephone access for after-hours emergencies
5          Coffee
4          Teleconference (Skypelike) or other alternative visit options
4          Nutella
4          Wifi
3          No lollipops
2          Lollipops
2          Home-cooked meals
1          Same day appointments
1          Cookies
1          Snacks
1          Drinks
1          “Fancy” chocolates
1          Massages

Pretty interesting results, don’t you think? First of all, it would seem that it is more important for me to provide complimentary bacon to my patients than a comfortable exam room environment or walk-in slots for appointments. Why didn’t I think of that? Bacon is always the key to excellent customer service!

You can tell the thread had a little humor in it, and that is always a good thing. But, ignoring the requests for Nutella and home-cooked meals, I was happy to see that online access to medical records was the most “liked” topic. This shouldn’t be a surprise. Today’s patients, raised on WebMD and the University of Google want to be involved in their care, or at least feel well-informed about their visits.

In October, a study was published in the Annals of Internal Medicine that looked at the interaction between clinician and patients (as well as the satisfaction each party feels and its affect on healthcare) when visit notes were made available after every doctor’s visit. It was summarized as follows in an article on the study in Forbes magazine:

“Patients accessed visit notes frequently, a large majority reported clinically relevant benefits and minimal concerns, and virtually all (99%) patients wanted the practice to continue.  With doctors experiencing no more than a modest effect on their work lives, open notes seem worthy of widespread adoption.”

So now, in my own little study, my Facebook friends have put online access to medical records as their number one request in an “ideal medical practice.” In the study, this meant actually delivering copies of the notes. But there are different ways to interpret this informal request from Facebook, especially since I did not specify what this would entail. Other than in the study environment described above, not many electronic medical records are programmed to share visit notes online, as this is something that, prior to this study, is so foreign to ambulatory medicine that it has likely never been requested of the health IT companies. Today, online access to medical records is more likely to be represented in a patient portal, written by the software companies, to which a patient can securely log in and see some portion of their records. This should, in the least, include appointment requests, problem lists, allergies, medicine list, visit summaries, lab results, and secure messaging.

“Decreased wait times” is not a surprise at number two, given our severe doctor shortage and the pressures from our third-party payer system that makes a doctor see more and more patients each day to maintain a steady income. If I were to recreate the practice that I left, the mill that grinded me up and spit me out in a bag of grits, I would have the same situation all over again. In opening a new practice, I will need to find a way to limit the overall patient load to better match the advanced level of service I am talking about trying to provide, which includes minimal wait times. I think at least part of the solution, in addition to limiting patient load, is found farther down the list. If I try to mostly stick to same day scheduling, allowing patients to schedule their own appointments online, and offer alternative visit options like Skype or telephone visits, then I should be able to limit the time spent waiting for me to see you.

Coincidentally, this will also help me take care of the issue that surprised me by coming in third, having a dual waiting room, separating the sick from the well. Going forward, I do not want a practice with more than one person waiting!

So what is next? I need to take this list, as grandiose as it may seem, and see if I can come up with a practice model that can make it happen. I am going to try!

3 Responses to “Shoot for the Moon. And Bacon.”

  1. Brian Pierce Says:

    Greg,

    What do they (or you) mean by ‘online access to medical records’? Do you simply
    mean a portal with much of the data viewable or do they want to see the office notes as well?

  2. Greg Says:

    In the thread, this showed up as various responses like “log in to see my results,” “see my records online,” and a couple of people referred to it in relationship to the MGH product “Patient Gateway,” which is a traditional, fairly limited online portal. As I discussed, I think this is because, outside of the context of the Open Notes study, patients don’t even realize that would be an option. I’m sure most would opt for a setup like the Open Notes study, were it available. The problem with this is, I don’t know of an EMR, with on exception, that can even make the notes available. HelloHealth.com does. Otherwise?

  3. ackdoc » Blog Archive » Do Over. Part Two. Says:

    [...] A couple of weeks ago, I posted a “Shoot for the Moon” Facebook question asking my friends and contacts what they would like from their physician’s practice. I posted the not so surprising results here: Shoot for the Moon. [...]

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