The future family medicine clinic?

We may have seen the future family medicine clinic.

aafad 98/365 every mouse droid's dream ...: the future family medicine clinic lamont_cranston via Compfight

At the October OntarioMD EMR conference, one group presented last, or almost last. Exhaustion was palpable. Slumping replaced sitting. But this group was enthused. These young people, recent grads, had developed their own software additions to use in concert with Oscar, the open source EMR: a unique scheduling system, and a system that kept exam rooms full.


In this new clinic, patients know the score as they sign on. Minimal support staff. No telephone lines, but an online, internet based phone system. Telephone callers can leave a message, to which they will receive an email response. All appointments are booked online by the patient through a snappy website.


Patients appear, slide an OHIP card through a machine to register, and are greeted by an automated response. They are instructed to either wait, or to access a certain room, by a computer generated voice. No face, no escort, just a direction.


Large TV screens in the lunchroom show clearly if there are empty rooms, and if the room is occupied. Doctors do their own appointments. No nurses. That’s vitals, pap, well babies, driver physicals, heights and weights, visual acuities. Dressings, sutures, and suture removals. Doctors use templates and standard forms to construct their own consult notes. No booking clerk.


Naturally this setup attracts a certain demographic, and is not something that can fly solo in a rural area with non digitally native patients. In an urban area, highly populated with traditional clinics, patients not able to negotiate the clinic access will be able to go elsewhere.


Is this the future family medicine clinic? Patients, greeted on the phone by an in the flesh receptionist at our clinic, are quick to point out if the tone of voice isn’t perfect, and swear and curse at simple voice mail. With a large, mature practice, I quite enjoy passing a referral off to a referrals clerk. And, after almost thirty years in practice, I often find I need help with a superficial hemorrhoid, if only for a pair of hands. To have those hands experienced, and professional, is to me worth it.


It’s becoming difficult financially. Well. This has to be put into perspective. This automated, digital, new clinic, to save money on staff, has spent a great deal of money on software, its development, and hardware, which will all need upkeep, and which they can afford. Doctors are paid well. BUT, cuts are cuts. In a recent email from the OMA (president’s update, vol 20, # 36), our profession will take a relative 30% net pay cut by 2017 from a combination hit from inflation, fee cuts and overhead cost increase. In our own clinic, we will be paying over $25000 next year merely for software licensing for EMR, with the collapse of the computer support program. All clinics will be looking at any option possible to save money.


Where’s the major expense? Salaries.


But we’re still paid well. Even with that hit. We’re not pushing brooms, or slinging coffee at Horton’s. Even with a 30% wage cut, still well paid.


What are we going to do? What are you going to do?


We could become faceless. Save salaries and move to an electronic greeter. Cut phone lines, and use only email generated response. Struggle with dressings after learning how to actually do that.


I just bought a loaded truck after a couple of years of teeth gnashing over a vehicle that I had to squeeze my 6’ 4” frame into. There was zero percent financing. We looked at lower models, but frankly I liked the navigation system. And to be completely silly, the sports package. So, we picked the loaded truck, and we’ll pay for it over six years.


Isn’t it part of our social responsibility to support some kind of staff? Isn’t medicine a human art, as well as a science? Can a robot replace a receptionist? Don’t we accept that nurses help us practise medicine, better?


Pirsig, in his exploration of the metaphysics of quality (Zen and the Art of Motorcycle Maintenance, 1974) argued that quality is balanced on the dual horns of function and beauty. That new clinic is beautiful. Art on the walls, crisp, bright, cement floors, a designer’s dream. A bit stark for me, but that’s taste.


Medicine is a human art. Visual art may play a part. The meat of it, however, is human interaction. Nurses, and support staff help concretely, and substantively with function. And beauty. Quality is job one. I think this new, young, enthusiastic, innovative group of physicians can teach us some new things, perhaps some new ways to survive financially in this province…


Maybe I’m getting old. But I think I’ll pay for the loaded truck. Or at least the sports package…


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