New Patient Policies Take Time to Work

November 17, 2014

In theory, prioritizing patients was great. In practice, however, it ran into three obstacles, namely patients, my staff, and referring physicians.

A couple of months ago, I decided that we needed a way to better triage new patients. As such, the plan was to accept only patients that were being referred by a physician and only after we have received the necessary information to appropriately schedule the patient. I ran the idea past a few primary-care colleagues and they said it seemed reasonable.

We've run into a few glitches along the way. First, patients weren't thrilled. They want to be able to call and make an appointment without getting their physician's OK. I know we are not the only practice who requires a request for consultation. I routinely have to send one to the local nephrology practices and surgeon offices. I know my mother needed to gather all her information and send it to a cardiologist in Philadelphia before they would schedule her. So we are not exactly breaking new ground here.

The next issue was that, in an effort to be helpful for the patients, my staff members actually defeated the purpose of the request for consultation. Instead of asking the patient to call their doctor, they were volunteering to call the doc for the information. Well, what happened was that physicians who were not really referring their patients were sending in the requested info. When I reviewed the records and found no reason for an endocrine evaluation, I would call the physician and ask what the referral was for, and they would say, "Well, I'm not really referring her to you. My staff just sent the labs you wanted." No, no. I don't want it. Well, I do, but only if the physician is truly referring the patient for a legitimate reason.

The biggest issue is that I am not getting full cooperation from the referring physicians. Patients who just want to be seen by an endocrinologist because "something isn't right" are still being referred because primary-care doctors aren't saying, "Look, your Hba1c is at goal, the endocrinologist is going to tell you the same thing." Or maybe they are, but they aren't willing to argue with the patient over it. Worse, and most frustrating for me, are the physicians who order tests that have no clinical significance (thyroid antibodies most commonly) and since they don't know how to interpret them, refer them here.

I recently called a physician and told him that the patient's thyroid function was normal and that the antibodies meant nothing. He said, "Fine, you tell the family you don't want to see her." She's 19. So I did. I called the mom, reassured her (as apparently the pediatric endocrinologist already did a year ago) that her thyroid was OK, that the antibodies meant nothing, and that from now on they should tell her doctor to check only the TSH and not the antibodies. She was very appreciative and was glad that her daughter didn't have to come home from college for an appointment and they didn't have to waste a copay.

Now maybe you're thinking I just did all that work for no compensation, that I could have seen her once for 10 minutes, and gotten paid for a consultation. And you'd be right. And she would have taken a potential appointment spot away from someone with a blood sugar of 375 and an Hba1c of 12 who just had a heart attack. Instead, I am able to schedule patients within 2 weeks to 4 weeks if necessary, or 10 weeks to 12 weeks if waiting is reasonable, instead of having everyone wait for 3 months to 4 months.

This is still a work in progress. But it is very satisfying when I can tell my staff to call Mrs. Smith and tell her there's an opening next week.