I rememder some slogan from my 1970's elementary school experience that went "Safety First" or something like it. My impressionable young mind retained this slogan till the present day. I look both ways when I cross a street, I wash my hands a zillion times a day, I'm hyper-aware of all the stimuli around me. It gets exhausting.
But now, to maintain my board certification (that's right, for those of us unlucky enough to be born in the 1960's and afterwards, we have time-limited board certification) I must take a "Patient Safety" online course. No matter that doctors practice in a myriad of ways, from concierge to hospital-only; the course is the same. What's worse, it's the same course for every kind of doctor, whether a psychiatrist, pathologist, or a trauma surgeon.
Now, the thing is, what this is TRULY about, is paying $25 (it's helpful that they take credit cards online) to an unheard-of entity to take a mind-numbing online course extolling to virtues of root cause analysis for medical errors.
Into this bag of responsibility also falls the fact that I am responsible for reminding or notifying a patient that he/she has a follow up appointment.
When was my career as a physician saddled with the task of appointment manager?
When you hurt, and you have a doctor's appointment, you keep the appointment in the thing known as a CALENDAR and now they even have them in smartphones and they go **ping** when you have an appointment....and I think it's fair to say that if you aren't even sufficiently invested to keep your appointment, how are you a good risk for me to take? How are you a compliat patient? How are you a patient that deserves my time and effort?
The simple fact is, you're none of the above. You're a flake that NEEDS to be discharged.
I'm not talking about people who are overscheduled, forget, and call us the next day full of apologies and excuses. I'm not talking about the people who had other crises erupt, or who had a death in the family, etc. and missed their appointment only to realize it days later. I'm willing to give those the benefit of the doubt. I am more than happy to reschedule anybody who apologizes and who WANTS to come in.
I'm referring to those who never call, never show up, and just fade off the planet. We've gotten onto the merry-go-round of phone calls to disconnected phone numbers, not-in-service cell phones, and I've just given up the excessive waste of time and energy that it takes to be an appointment babysitter.
Yet, in this Safety Course, it was harped on again and again. Why? I don't know. I understand that medication errors occur, chart errors occur, etc. but since when does a missed appointment fall under the purview of a physicians' duties as a safe practice?
Because it's an easy clerical task that can be called upon in a court of law. Nothing to do with actual medical delivery and medical duty.That's what I believe.
The Foundations in Patient Safety course was entirely geared towards hospital based medicine. That's where the big money, risk, and federal oversight is the heaviest.
My dentist informed me that they get annual recommendations from the ADA to discharge the bottom 10% of patients that are, in his words, dead weight. I always marvel at how dentists have managed to avoid being called health care (we all know that periodontal disease and abcesses are quite lethal) but they are completely outside of this system. Fascinating.
