Some people seized on my words in my last post:

A doctor’s office is always on the brink of chaos - with an incredible amount of information coming in and going out, a large number of phone calls, insurance company headaches, and personnel situations that can throw the best system flat on its face.  People forget that there are hundreds of other patients with thousands of test results the office is dealing with.  We do what we can to tell patients test results (and with our computerized records, we do a better job than most), and I see that as our responsibility.

Their assumption made by some commenters was that our office must be unique in our problems.  We must be disorganized.  People who manage other businesses assume that with proper organization skills, a medical office could become fully organized.

Our office is unique, but not in our disorganization but in our obsession with organizing our system. We have been on computerized medical records for 12 years and have been nationally recognized for our efforts in this arena.  We are regularly having physicians come through our office to observe our system and how well we run our office.  We are increasing our revenue in a time when others are falling - and we are doing so with improved quality and satisfaction.


So how can I say "a doctor's office is always on the brink of chaos"?  Because it is.  There are dynamics in a medical office (at least a PCP's office) that are constantly disrupting the best of plans.  There are a number of reasons for this, including:

  • Interfacing with other disorganized systems - specialists, hospitals, labs, radiologists, and old records are sending information to us in a myriad of forms.
  • Unpredictability - Some days are smooth, and go as planned.  Other days are sabotaged by a barrage of phone calls, complicated patients, and staff calling in sick.
  • Insurance companies - Insurers do nothing to help efficiency, in fact they do what they can to make you not want to deal with them.  They make staff wait eternally on the phone and mysteriously don't pay for things that were paid for in the past.

But the real reason things are hard to improve in most offices is that there is no financial incentive to do so.  With a primary care physician shortage, there are no shortages of patients.  Customer service won't determine how busy physicians are.  It is unusual for a PCP in our area to have any problem filling their practice.

But wouldn't organization allow you to see more patients?  Sometimes it would.  Sometimes having a better system will make you more efficient; but the time it takes to build a better system is huge - time that could be spent generating revenue.  Many PCP's are running with tight margins.  Reengineering the office will cause a drop in revenue that they cannot afford.  This is one of the reasons computerized record adoption has taken so long; medical offices can't afford the drop in income needed to adapt to a new system.

So what is my motivation to make a system that would track labs to make sure all my patients get their results?  Doing a good job.  I do it because I think it is the right thing to do and because I want to take care of my patients.  But the problem is that all of the time spent doing this is unpaid time.  There is not only no financial motivation to do a good job, there is a disincentive to do so. You earn less when you do right by your patients because you spend more of your time doing things you aren't paid to do.  Either that, or you spend less time with your family.

rewardThe system won't get better until there is some way of rewarding better work with more pay. Right now the system rewards the doctors who spend the least time with their patients with the most money.  We have to live in the tug-of-war between what is best medically and what is best from a business standpoint.

Until this changes, the brink of chaos will be a familiar place.