Stories from the Stethoscope: March 2021

One of the changes that has developed with most primary care practices is the utilization of the huddle. It is a time when the primary care provider and team members look at the patient list for the day, anticipate issues and discuss what outstanding items need to be addressed before or during the visit. It lasts no more than 10 minutes but helps to set the tone for the day. Early in my career, the only time our office had a huddle was when the heat did not work.

My original private practice had two floors. On many busy days, I would run up and down the stairs obtaining a physical workout as much as a mental one. One day early in my career while I was navigating both floors, I ran up the stairs grabbed the chart, and noticed one of the local surgeons had an appointment with me. In the next 10 seconds, I reviewed the chart and noticed a hospital form. One of the requirements to have privileges at many hospitals is to have a provider
sign off that there are no medical or psychiatric limitations to provide care. It is a quick form that requires a few questions and a signature. I opened the door, sat down and we started to chat. After a few bad jokes, I asked some questions signed the form, and wished him well. On to the next patient.

Two weeks later, I saw that he was back in the office with one of the other doctors getting a complete physical exam. I thought it was odd that I just saw him last week, checked his vitals, did a quick exam, and signed his form. With an uneasy feeling, I looked back to the original schedule and noted that he came to see me for a complete physical exam two weeks ago. I could not believe what I did or more importantly did not do. That day I rushed to get inside the room, grab the form sign it, and hand it back. I never asked, “How can I help you today?” The patient wanted my best and I did not give it to him. The form was only part of the visit and not the reason for the visit. In addition, I never asked, “Is there anything else I can do today?” If a well-respected surgeon did not interrupt me and tell me that they are not satisfied, how many others would? I am glad I discovered early in my career that my patient left without being satisfied. It was a jolt of reality that I needed. Quantity does not replace quality and patient safety. I am excited to see providers are now being held to outcome-driven standards. It will ensure more health care equity and balance. Health care providers need to embrace their new roles in creating quality touches. This means providers will create warm hand-offs to other staff members to ensure recommendations and orders are completed. A team-based workflow is paramount to effective care. I have been rushed many times since then. Yet, I often think about that moment. I do not often have all the answers for my patients but, I have learned that we must make sure we do not miss out on hearing the questions. Once the questions have been shared, the team can work together to raise the tide for all patients so that they can benefit from our experiences.