Curbside Consult with Dr. Jayne 8/17/20

Sunday was National Rum Day. Alas, I spent it treating patients rather than enjoying fuzzy drinks in the sun somewhere.

Today was a case study on how broken the healthcare industry is. Given the economy, over the last few weeks we’ve seen a surge in people questioning their deductibles and trying to figure out what the cost of care might be prior to checking in to be seen. Of course we haven’t done anything remotely close to installing real-time eligibility checking and usually don’t have a clue what their benefits might be due to convoluted payer contracts, so they stand at the front desk and debate whether they want to be seen or not. I feel for them because most of them need care, but are feeling like they’re stuck between a rock and a hard place in deciding what to do.

We’re seeing a mix of patients who are terrified that they might have COVID, those who are likely to actually have COVID but don’t think it could possibly happen to them, and the usual things that come into an urgent care, such as lacerations, chest pain, and traumatic injuries. We’re also seeing patients at the urgent care who are terrified of going to the ED since the state is in a surge situation, so they stay at home too long with complicated problems. Tonight ended with an elderly patient who fell and whose family kept them at home due to those fears rather than seeking care. Ultimately, they did little more than prolong the patient’s pain and delay definitive care for her broken femur.

We’re also seeing a total breakdown in the primary care infrastructure. Patients can’t get in touch with their providers to determine the best place to seek care. We’re seeing more and more patients relying on us for basics and necessities such as medication refills and quarterly labs.

Despite everything that is supposed to be going on in the realm of value-based care and management of costs, it feels like things are upside down and we’re just lighting money on fire rather than delivering coordinated care. If we as a society can’t manage something as straightforward as medication refills, I’m not sure how we think we’re going to motivate patients to make major health-related changes or meet their growing psychosocial needs as the pandemic rages on.

I struggle to figure out the answer. I’m certain technology isn’t the full answer, although I’m eternally grateful that Epic has essentially taken over the market in our area. Nearly every patient has a phone and can access MyChart, so those of us in the urgent care trenches can figure out what’s going on. Except for those patients who flit around the urgent care market between CVS Health Hub, the Walgreens clinic, and the handful of urgent cares in town, in which case all bets are off. Most patients don’t know that they can coordinate their MyChart accounts though and pull in data from the different health systems, so it feels like I do a fair amount of technology teaching some days as we try to see an integrated picture of patients who seek care across the different systems.

I have noticed an improvement in the medication history information we can receive back through Surescripts, which helps quite a bit when you’re trying to figure out how compliant your patients are. Our prescription drug monitoring program database also continues to perform like a champ, which helps bridge the gaps. Still, the bottom line is that I’m usually in at least three or four different systems trying to do my job, which doesn’t seem right in the middle of a public health crisis that should be driving us towards greater sharing and improved patient care.

I’ve also noticed an increase in patients who want to discuss politics during their visits. It always gives me a little chuckle when they ask me whether I think COVID is as bad as the media make it out to be. My double mask and the face shield should be an indicator. Still, it doesn’t seem like there’s much realization that healthcare workers are desperate to not take the virus home to their family members, or that we are stressed to the max and both physically and mentally exhausted, given the complaints that we get when anyone has to wait more than 30 minutes for their visit.

We’re squandering resources right and left as colleges and universities mandate COVID testing, but on a clinically inappropriate timeline. A negative test 10 days before move-in day is meaningless unless the students have been quarantining. We’re also still seeing employers that demand patients who have negative tests get a second negative test to return to work despite the CDC updates that occurred more than three weeks ago that say this is unnecessary. I’m sure the local school district’s HR department is far wiser than infectious disease experts, so we do what has to be done regardless of whether it makes sense or is a good use of resources or not.

I had an interesting conversation with my scribe today, I didn’t realize he is a COVID survivor. He was pretty sick and spent a couple of weeks in the hospital, receiving convalescent plasma and not requiring intubation. He’s glad to be recovered, but worries about the long-term consequences of the disease, especially since he’s under 30 and hopefully has many years ahead of him. He’s focused on making it to medical school in a year or so and I can’t help but think that his experience will make a difference in the kind of physician he grows into.

He had never heard of clinical informatics, so I was able to do some education there. It’s good for those who aspire to join the healthcare team to know the underpinnings that try to hold it all together. We talked about some of the work I’ve done in the past, which had me hankering for a good lab interface build or maybe some kind of a legacy EHR conversion. It’s funny how the things we thought were arduous at the time take on a whole new look when we’re faced with something that has changed our perspective as radically as COVID has.

Regardless of how tedious our days seem or how frustrating some of the interactions might be, the reality is that we’re dealing with someone’s mom, dad, grandmother, daughter, sister, and more. It’s a unique privilege to care for people. I’m hoping we will eventually be able to elevate our game and find a better path forward.

What is your employer doing to change the big picture of healthcare or drive innovation forward? Leave a comment or email me.

Email Dr. Jayne.