The new rule that sets the agenda for a doctor-patient meeting is ONE VISIT, ONE PROBLEM.
The ONE VISIT, ONE PROBLEM rule seems to work for the new doctors going into practice and for the walk in clinics that employ them.
However, using this rule is akin to a stockbroker churning his/her client’s accounts.
What happens if the patient has 6 or 8 active problems?
The agenda for the meeting should be determined by the patient’s problem set. The solutions to the problems should be integrated. There has to be continuity. There can’t be a conflict between solutions.
Here’s a CASE STUDY:
A 79 year old female was assertive and quick witted. However, she was frustrated with the process of seeking medical care.
She had 8 health problems ranging from a new mitral valve to colon cancer. She had six specialists. She described them as “excellent”.
When she went to see her family doctor who worked part time and focused on aesthetics, she was told ONE VISIT, ONE PROBLEM. That didn’t work for her.
She would have had to book 8 appointments to get the advice that she needed. And what a waste of resources that would have been.
RCM was retained to solve the problem.
Here’s What We Did:
We found a dedicated full time GP who worked within a collaborative group and who did not adhere to the ONE VISIT, ONE PROBLEM rule.
Our client also interviewed and got to know the admin assistants at the office because they control access to the doctors.
We also found a geriatrician who would see her once or twice per year to review all of her problems. The geriatrician is an excellent resource. The geriatrician is a generalist who can keep 8 problems in his/her head at the same time and generate treatment plans that are consistent, accurate and evidence based.
This astute patient kept a copy of her medical records and took them with her in a binder each time that she saw a doctor. This worked well to keep each of her specialists and her GP, literally, on the same page.
So what do you think of the ONE VISIT, ONE PROBLEM rule?
We don’t like it, because it works against complex patients with many active problems.