Physician Centered;
Patient Focused
Patient Focused
By designing the practice around the
physician’s needs, you can
focus on the patient.
focus on the patient.
The idea of a physician-centered practice
is stirring a lot of controversy. Many physicians are embracing
this practice development method that places physicians
squarely at the center of the medical practice. However others,
mostly non-physicians, see this as flying in the face of
so-called “patient-centered” care. After all, the
sales pitch from managed care plans and health systems is
rooted in their “patient-centric” focus. The
problem is, without physicians, who is going to
“focus” on the patients?
The concept of the
physician-centered practice is actually pretty simple. Without
a physician you don’t have a medical practice. Therefore,
first defining the basic work style and needs of the physician
is elemental to making the practice work and being able to
serve your patients well. It’s putting the concept into
operation that can be a challenge.
An analogy to this
situation would be a factory that relied heavily on one very
expensive piece of machinery to produce its products. The
factory workers would probably take very good care of that
machine and they would learn to use it well. And although they
know they need to produce quality products, they realize that
without the machine, they can’t. They understand the
importance of keeping the machine running well.
Once physician work
styles and needs are defined (the machine is understood), the
practice, from staff responsibilities and work processes to
managing the patient interaction, is built around those defined
needs. Simple, right?
Well, if you’re a
physician, you may be asking, what needs? I’d like a cup
of coffee on my desk when I walk in, is that a need? You know
better. Needs are hardwired behaviors that often can be
accurately determined only with deep introspection,
professional assistance, or an objective assessment. We have
assessed more than 400 physicians to precisely determine their
work needs and how to make those needs fundamental to the
operation of their practices.
Some of us can get an
idea of our “needs” if we take a giant step back
and look at those work patterns that we’ve exhibited most
of our lives. For example, is there “a place for
everything and everything is in its place?” Are you most
comfortable making snap decisions or do you prefer to ponder
and research an issue first? Do you shoulder all
responsibilities or do you see system issues as the source of
problems? Answers to those questions can reveal some of your
needs, but ‘yes’ and ‘no’ responses are
too simplistic to be valid.
If you’re a
physician, snap decisions probably aren’t an option, but
a necessity, and although you like orderliness, there just
aren’t enough hours in the day to devote to a tidy desk.
That’s the complexity of defining your needs. You may
want to respond or act a certain way, but circumstances may not
allow it. Daily routines become habits, and it’s
difficult to separate habit from need.
However, assume you have
defined a list of your most important needs through
introspection, outside counsel, or a work-assessment like the Birkman Method®.
You know your needs; what do you do with them?
You turn them into the
business and operational plan for your practice.
Let’s use the
example that is not uncommon among physicians we’ve
assessed: You need a high degree of order or structure. A
look at many physicians’ desks or ink-stained shirt
pockets may not seem to support that notion, but again,
it’s the difference between usual behaviors, habits, or
circumstance, and needs behaviors.
If the staff sees the
cluttered desk and other indicators that this is a pretty loose
ship, they’ll likely respond in kind. A lax attitude
towards scheduling, record keeping, financial reporting or
performance is likely if staff believes structure isn’t
important to the physician.
Inserting order and
structure into business and operational plans is sometimes most
easily achieved by following the money. The money starts at the
front desk when patients are scheduled or registered. What
system or process does the physician need to create the
required level of order and structure? It’s defined
individually, but it is defined.
In an office-based
practice, the money, via a superbill, then accompanies the
patient to the exam room. Who is responsible for this? How are
patients roomed? How is the physician informed of the roomed
patients? What has occurred prior to the physician’s
arrival? As you can see, it’s an exercise of mapping both
operational processes and individual staff responsibilities. If
you pursue this exercise, you’ll find it isn’t
always a straight-line process; it will have offshoots and
parallel lines. But in creating this map, order will follow.
Staff duties and responsibilities will become better defined
and more logical, and policies and procedures will emerge as
effective and intuitive to the needs of the practice.
The usual result of
this process is staff members with better understanding of
their responsibilities, less ambiguity towards procedures, and
greater flexibility in dealing with situational changes. They
understand how to use and interact with the
“machine” more effectively.
How does this attitude
affect patients? Patients benefit from a better running office,
as well as a more satisfied and effective physician.
Keeping with the
example of order and structure, patients will likely perceive a
higher level of focus on themselves and their needs when the
physician has her needs met. Patients know when offices are out
of synch. They’ll make comments about hoping their
records aren’t lost or express concerns that the doctor
seems unhappy or is not attuned to them.
Considering other
elemental needs that are usually measured and incorporated into
physician-centered practice development, patient communications
may be improved and staff may find structure helps them be more
responsive to patient needs.
Patient advocates need not
worry. The physician-centered practice doesn’t turn
patients into second-class citizens. It allows and encourages
physicians and their staffs to better focus on patient needs
because their own needs are being met. In the machine analogy
we used earlier, if the machine isn’t handled properly
and maintained appropriately, as hard as it may run, it
won’t produce quality products. For a physician practice
to operate like a well-oiled machine, the physician’s
needs must be known and met. g
Robert F. Priddy is the executive director of Physicians
Career Practice, LLC, a
physician career management consulting firm based in
Westminster, Colorado. T. Robert Mestas, MD is the
company’s medical director.
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