Ninety seconds to take care of one medical problem. Hours of paperwork at night. Angry patients waiting to be seen. The working conditions of the primary care provider can be unpleasant. There is just too much to do in the time available.
Medical students know this. That’s why, after doing rotations through all the specialties, they are unlikely to choose primary care. They see what it’s like, and choose something else.
Why is primary care like this? Well, every year there is more and more that medicine can do. There are more diagnoses, more monitoring requirements for each diagnosis, and more treatment options. There are more elements of preventive medicine to be performed every year. So more and more work is being pushed onto primary care, while resources have not been increased. (The Alliance of Community Health Plans says we should double primary care spending – to make us in line with other industrialized nations.) And we know that strong primary care improves outcomes.
So how do we decompress primary care? We take away work from the primary provider wherever we can. We extract work from that 20 minutes. We prepare, prepare, and over-prepare. And most of that preparation involves data flow.
Let’s focus on the data flow from the patient to the care team. Each chronic disease involves a set of questions that the team needs to ask the patient. For example, the questions for diabetes might be:
The person who asks these questions doesn’t have to be the provider. It doesn’t even have to be a person. An artificial intelligence or chatbot would do just fine. If a person has six chronic diseases (and that’s not unusual for a primary care patient), just having these questions prepped for the provider, before they enter the room, can save much time.
Likewise, when a patient has an issue they want to ask the provider about, there are frequently a set of questions that must be asked. So if someone says they are “dizzy,” the questions might include:
Getting these answers before the visit does not substitute for the thinking and assessment of a provider, but it gives them a head start.
Theoretically, a library of such questions could be created to gather information about each issue the patient might be worried about. Having those questions answered beforehand would save time and decompress the provider’s workload. And it could also increase patient satisfaction by allowing more issues to be addressed during the visit.
Again, an artificial intelligence or chatbot would be perfect for this work. It wouldn’t even have to be done in the office. It could be done in the home a day or two before the appointment.
Finding a way to make primary care tolerable for providers is possible inside the current system if we are intelligent about the way we deploy resources, including tech. The pathway forward is clear, if we merely use technology and knowledge we have now in the correct way.
on November 5, 2021.
Mike is the Chief Medical Officer at Brook. Formerly CMO of United Memorial Medical Center at Rochester Regional Health, Medical Director for Innovation and Science at Independent Health, and a partner in Endion Hospitalists. He has degrees from Dartmouth College, Columbia University, the University of Liverpool, and SUNY Buffalo, where he is currently Associate Clinical Professor of Medicine.