When January rolled around this year, I decided to take care of all of my health care needs. I hadn’t had a check up in more than a year and I had a few issues that I wanted to discuss with my primary care doctor. So, I went to my insurer’s online patient portal and tried to make an appointment with her. She didn’t have anything that week, so I was prompted, by the system, to contact her directly. I sent her a secure email, via the system, explaining what I wanted. Voila, the next day, I was on the phone with her nurse setting up an appointment, at a time of my choosing, or about a week later.
My doc sent requisitions to the lab so that I could show up a few days before my appointment to get my blood drawn. The results were in my electronic health record, and accessible to me via the portal, later that evening. I could compare them to my prior labs, opting to see the comparison in either graph or chart form.
I showed up at my doc’s office a few minutes before my scheduled time, paid my $15 co-pay, and sat down to review my preventive health reminders which printed out on my co-pay receipt:
Hey, I have been a pretty good patient.
I no sooner sat down in the waiting room than I was called by the nurse who put me in one my doc’s exam rooms. She gave me that little flimsy paper gown to put on and then proceeded to take my vital signs, including weight and pulse ox. She entered everything into the electronic medical record. Then she left to get the doctor.
Enter my PCP
I was trying to decide which of the very old magazines I was going to read while waiting when my doctor came in. She has been my doctor for a number of years so we are now health buddies. She is also one of the finest internists in the San Francisco Bay Area. It does not matter what topic I bring up, she has read and thoughtfully analyzed medical literature on the topic. She seems to be in love with medicine the way we all were when we started out. But, she is mid-career and still seems to have a thirst for knowledge and a desire to do the absolute best for her patient – me. Could I do any better?
She asks me why I am here and if I have any issues. I do – a trigger thumb developed a few months ago and I want to get an injection. I also want to talk about a change in my medications and a minor foot problem that I have had for about a year. [You may have determined by now that I am a pretty routine and somewhat boring patient].
My doctor does a complete physical examination and then pulls the electronic medical record (computer mounted on wheels) over to where I am seated. We proceed to review every medical problem I have ever had to update the status. She also reviews my compliance with evidence-based prevention guidelines and notes that I am up-to-date. (yeah!)
We talk about my new lab results and she notes that my potassium is on the low side (I take high blood pressure medications). Together, we decide to make a change in my regime. One of the drugs I want to switch to – and she agrees – was previously listed in the adverse drug reaction section of my electronic record (I got a cough and thought it was from the ARB even though that drug doesn’t usually cause a cough). She made the change and electronically sent the new prescriptions to the pharmacy to be mailed to me at home. She then injected my thumb and ordered an x-ray for my foot as well as a referral to podiatry.
The visit was productive but leisurely. Joan and I talked about the terrible ending to my last job, my family, the medical literature and a bunch of other stuff. I forgot to look at how long the visit took, It wasn’t relevant. I got what I wanted/needed and I felt “cared for.”
So I left the office and went down a floor to get my foot x-rayed. Again, old magazines, but no wait. While I was in line to register for the x-ray, my cell phone rang. It was the podiatry department offering me an appointment the following Monday. I am thinking, are you kidding me? Now, this is service. In fact, this is the way outpatient primary care ought to be – for everyone.
Now you probably have two questions? “First, are you in a VIP or concierge practice that you paid a bunch of money out of pocket for so you could get this type of service?” The answer: No sireee! I get my care at Kaiser Permanente in San Rafael, California. That’s right, I belong to a HMO…and I wouldn’t have it any other way.
Your other question probably is: “So, why do you call this an almost perfect outpatient experience?” The answer: The magazines were really really old. And I didn’t have any waiting room time to read them. [Hahahahaha.]