EPtalk by Dr. Jayne 11/16/23

As a frontline physician who has dealt with my share of angry patients, I’m always worried that one of them will follow me home from work or show up at my house. I’m vigilant about my personal information and make sure that it’s difficult to find me through real estate or other public records.

Recently Doximity announced a free service called DocDefender that can help physicians remove their personal information from public websites. I decided to give it a whirl. I initially tried to find it through my Doximity account, but wasn’t successful. A web search took me to the right site, but I had to go through an email authentication process to get started. From there, the system started scanning and found my information on 17 out of 35 targeted websites.

The removal process is supposed to begin automatically with results in two to 60 days. I should be receiving regular updates on the removal process, so I’ll provide updates in the coming weeks. It’s also supposed to provide periodic checks to identify new listings, so we’ll see how that goes.

While I was digging around my Doximity account, I stumbled upon Doximity GPT, which is described as “A medical writing assistant that can compose patient education, recommendation letters, grant proposals, ortho poetry – basically any writing task you can think of.” I found the idea of ortho poetry to be intriguing but not compelling, so I asked it to write a haiku about clinical informatics instead. It did not disappoint:

Data flows like streams,
In clinical realms it gleams,
Healing in light beams.

Telehealth organizations across the US are jumping into the weight loss business, making it easier for patients to obtain prescriptions for costly injectable medications, although their ability to jump through the hoops imposed by payers is highly variable. Employers are starting to try to control costs, and Mayo Clinic’s employee health plan has announced that it will cap weight loss medication expenditures at $20,000 per patient as a lifetime maximum. Since some of the medications run up to $900 per month, for patients who are already in treatment, we’re going to see what is essentially an unregulated, uncontrolled clinical trial where time and financial means will be influencing outcomes. The caps don’t go into effect for patients using the drugs for diabetes, which creates a strange “chicken or the egg” situation where prevention or risk reduction isn’t covered but treatment of disease is.

This is largely the result of our payment system, where everyone is trying to control costs for their attributed patients, but doesn’t have the means to take advantage of long-term savings. For example, let’s look at an obese 55-year-old patient with pre-diabetes. If they can achieve weight loss, they likely reduce their chances of developing diabetes, which saves money down the line. When you look at the costs of diabetes care or the complications of diabetes, those expenses would likely occur in 10 to 15 years, when Medicare might be paying them as opposed to commercial insurers.

There’s no incentive for a commercial payer to absorb the cost today in order to realize the savings down the road, because the patient won’t be on their books then, and might not even be on the books in a year or a month, if they work for a healthcare IT company that includes them in a reduction in force as we’ve seen plenty of recently. The math just doesn’t work, but inability to get treatments that could improve quality of life and reduce disease burden is a reality for so many patients today.

Mayo Clinic is just following the example of other healthcare employers that have dropped coverage, including Hennepin Healthcare, Ascension, and the University of Texas System in Austin. All of those popped up in a web search as being in the same situation. My crystal ball predicts that many more organizations will be changing coverage over the coming months unless the prices of the drug come down or there’s evidence of a way they could save money by covering it.

This week included my regularly scheduled annual visit to Big Medical Center for follow-up imaging and a consultation with my care team. I received the email reminder of my visit and confirmed it by completing the electronic check-in process the same day the reminder came out. The next day, I received a phone call, right in the middle of typical dinner hours, asking me to again confirm the appointment. However, I had to listen to a minute and a half of recordings about parking and arrival times before I could confirm. They should have told us to allow an extra 20 minutes to deal with the parking and construction situation, because it was rough and I barely made it to my appointment on time. Good thing they didn’t check my blood pressure because I’m sure it was up there.

I was seeing a new provider at this visit, since they’ve changed how the department runs. I wasn’t impressed by the fact that she had a bunch of handwritten paper notes about me, or that she didn’t use the EHR at all during our visit. It would have been one thing if her notes were accurate, but they weren’t, as I discovered when she tried to offer me genetic testing that I’ve already had.

We discussed the existing results, which I wonder if she missed because they’re scanned into the EHR as opposed to being discrete data, and she relied on my memory to tell her what testing I had completed. From there it was off to the imaging department, only to be told that they’re not doing real-time results anymore, which is one of the reasons I use this facility. Results will come to me via the patient portal in a few days, which I suppose is adequate, but the availability of real-time results was one of the reasons I tolerated the long drive and the general hassle of using this facility.

As a last bit of frustration, they used to schedule your follow up at the checkout desk, and they don’t do that any more. The new process is a bit bumpy and I had to wait for the clerk to write the appropriate phone number on a sticky note so I can call back and self-schedule. At a minimum, someone needs to make a half-sheet handout they can give patients that includes all the pertinent information. In the time it took her to write it down, she could have scheduled the appointment since it’s for a year out and my calendar is wide open. I wonder how many patients will be lost to follow up this way, as those sticky notes disappear into purses and tote bags.

As a final insult, when I returned to the parking garage, the car next to me had parked over the line to the point where I couldn’t get into my car. Fortunately, I’m spry enough to do the gymnastics needed to climb in the passenger side and crawl over the console, but I’m betting a good portion of those visiting a world-renowned cancer center might not have the ability to do so. Still, I’m glad it happened to me and not someone who just finished a treatment or who just received life-altering news, so I’ll view it as my good turn for the day.

After I got home and decompressed from the experience, I walked to the mailbox and found a fundraising solicitation from the organization. I’m no stranger to the concept of so-called “grateful patient” fundraising, but the timing on the solicitation gave me an idea. What if I challenged them to fix their messed up processes in exchange for a sizable donation? I’m sure I could solicit patients and family members to participate, as well as physician colleagues who don’t want their patients to be frustrated by the care delivery experience. I’d even throw in some complimentary consulting services to sweeten the deal.

What are the simple things that facilities could do to improve the patient experience? Leave a comment or email me.

Email Dr. Jayne.