21 May 2020

Restricting medical care to traditional in-clinic consultation is so 20th century!

Know Cents Practice Management

Like most rheumatologists, the doctors at BJC Health in western Sydney have fixed session times at various clinics where we consult. We typically start at 0800 and end around 1700. We take appointment bookings, ordered one after the other, and mostly work on weekdays.

It’s how our mentors worked, how hospital outpatient clinics are typically set up, and just the way things were.

It might not be so convenient for the people who seek our help. Those who work 9-to-5 jobs will need time off work, many have to battle heavy traffic times, parents have to juggle the consultation around the needs of their kids.

Typically, disease flares and worry about possible side effects also tend to occur at inconvenient times, almost always out of clinics and perhaps even after hours or on weekends.

We know this, but for our own convenience and the convenience of the various medical organisations we work for and within, there has been a lot of resistance to change.

At BJC Health, we introduced our emails on all our business and appointment cards about a decade ago. Patients have access to us.

We’ve also had an open door policy, encouraging people to email or to ring us. And we actually call back! In between consultations, during our lunch break or after the work day.

Some of my patients have my mobile phone number and some involved in our multidisciplinary RESTORE program are on a WhatsApp chat with me and many of our allied health team.

This is high level access. But it does come at a cost.

Nothing more to the patient. Much more to the provider.

It’s tiring and while the overwhelming majority of people do not abuse this out-of-consultation help and communication, the sheer volume and the difficult-to-restrict access does wear you down. Like all of you, we do need some protected time and headspace away from medical issues and trying to sort out the variety of problems patients contact us about.

Additionally, the lack of reimbursement for this additional time and imposition on our out-of-clinic lives does sometimes lead to a degree of resentment, usually after a difficult week or a difficult patient encounter.

So why bring this up now?

The high volumes of telehealth consultation brought on by the Covid-19 pandemic will show people how much more convenient routine medical consultation can be. It should also lead to doctors being more open to expanding models of care.

Rather than just telehealth, which in the narrow current definition tends to focus on video consultations, let’s consider a more complete, virtual care scenario.

One-click video consultation, supplemented with phone calls and email.

How about SMS, FaceTime, WhatsApp?

What about patient self-monitoring on a variety of apps, generating a message to a treating doctor based on some pre-defined trigger?

Can we actually automate parts of this? A chat-bot to help handle questions about missed pills or possible side effects. A managed email/SMS communication strategy with reminders for monitoring blood tests or vaccinations. A patient-centred app linking directly to the clinic’s electronic medical record so that patients have access to their test results and receive e-copies of investigation request forms & prescriptions (meaning I might not need to ever recreate/reprint lost forms of prescriptions. Yay!).

Don’t stop there. How about consultations at different times? Maybe after you’ve fed the kids and put them to bed. How about on Sunday morning before that lazy, long family lunch?

The technology already exists. And I can see all this happening.

However, it does lead to a few headaches and issues to solve.

How to pay and who pays for this?

Can the provider, eg me, avoid becoming a jaded, middle-aged rheumatologist, due to excessive access and an overload of patient contact?

How do we make all the components actually integrate, more seamlessly?

It’s not fun having to run 10+ different types of software and apps just so that I can schedule appointments, document findings, order investigations, communicate by video and voice, order tests and bill for the time.

Mmm. More thinking to do. Do you have any ideas?

Dr Irwin Lim is a rheumatologist at BJC Health and the editor of Rheumatology Republic. This blog was originally posted on the BJC Health website.