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Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences,
St, Pomona, CA |
As an employee of a university, I don't have much say as to the overall construction of my clinical practice. This, of course, is one of the downsides to being an employee. When I was a resident, most of my attendings were part of individual practices, each with their own flavor and personality. As time goes on, this seems to be disappearing. More and more doctors are employees of large health care delivery organizations such as Kaiser or the Veteran's Affairs hospitals. Of course, there are strengths to delivering medicine via economies of size, and the Affordable Care Act is likely to push this type of thing even further.
 I currently practice in a building Western University of Health Sciences calls the Patient Care Center, which is a three floor structure that houses a pharmacy, optometric practice, medicine (several subspecialities), podiatry, and a dental clinic. The various colleges educate their respective students at each of these clinics, with the occasional overlap and communication. The collegiality of the building makes it a fun place for me to work, but as I mentioned before, I have no control over any management decisions or development of the podiatry clinic. The building itself is nice with spacious rooms and a generally comfortable feel. However, it lacks personality. There's an institutional feel to the place that misses the personal touch of the individual medical office. Since I was originally taught through the private practice model, I occasionally get the itch to speculate about what I would want my podiatric practice to be under "dream" conditions. So, just for fun, let's speculate about how a dream podiatry practice would appear and function.
Now, I close my eyes and dream about my fantasy practice...
The Dream
First, before the patient arrives to the practice, my incredibly friendly office staff would contact them. The staff gathers their information, completing most of the intake paperwork right then. Alternatively our slick website allows the patient to input their information, which would, of course, sync directly into the electronic medical record (EMR) system. All of the patient's information is then available to me when they arrive. My amazing staff determines the patient's complaint, and, according to an algorithm, obtains insurance approval for radiographs, orthoses, or other treatment options that might be necessary. This prevents delays from occurring when the patient arrives at the office.
After all of the preliminaries are complete, the patient is emailed (or paper mailed at their choice) a practice brochure discussing the practice, location, appointment time and giving instructions on what to bring to the first visit.
 Upon arrival to the office, the patient enters the small but comfortable waiting area. This is small because little space is necessary for patient waiting, since the office doesn't run behind. A smoothly run office that runs on time does not need a large waiting area. The waiting area is impeccably designed with hardwood floors and a comfortable ambiance. The patient is offered coffee or juice and a sugar free cookie. (Take it easy, people, this is my dream!) For those patients that did not register online, they are given an iPad to complete their registration, all the information from which would again go directly to the EMR. My staff is ready to assist anyone who is not media savvy.
When it's time to room the patient, they first obtain pertinent imaging such as radiographs by one of my staff. The images are sent from the digital radiography system directly to the patient's room, where it is available for me to review on a large screen with my patient. Those images would also be imported automatically into the EMR, as would clinical images taken by my staff prior to actually being roomed.
 The exam rooms themselves are set up for patient comfort as well as efficiency. Important supplies such as medications, instruments and dressing supplies are in the room, tucked away in drawers. Rather than sitting on a hard podiatric exam chair, my patient revels in the comfort of a plush recliner (automated, of course). The room is comfortably lit without fluorescent lighting. Warm yellow lighting and walls painted a warm beige relax a previously nervous patient. Nothing in the room looks "medical."
When a procedure is necessary, the patient is given a tablet computer and earphones with variable options for games, videos, or other activities to distract them from the medical side of things. The same tablet computers may be used to assist in the education process when discussing various medical topics. Additionally, as the exam rooms are set up as independent "minipractices", I do not have to leave the room more than one time, making it highly efficient.
Patients requiring surgery have an additionally positive experience. In my dream world, I have a full-blown certified surgical suite for outpatient procedures. An anesthesiologist keeps the patient comfortable during their surgery, just as is common in a plastic surgeon's office. Postoperatively, patients would recover in recliners similar to those in the exam rooms in a semi-private PACU. They would leave with an embroidered pair of practice scrubs (easy to don with dressings plus good advertising), a disposable cast shower cover, and a get-well card signed by the staff.
Patients leave their appointment with written information about their diagnosis as well as instructions such as postoperative care or orthosis break-in methods. Their time at the office is as stress-free as possible. Additionally, it is highly effective and efficient.
...and I wake back up to reality.
Interestingly, each part of this dream is actually possible and exists in many medical practices to some extent or another. In some cases, medical practices, especially those concierge types, are more elaborate than what I have described. In fact, individually some of the ideas presented herein are not particularly difficult (minus the certified OR suite!), and may be implemented to some extent in the average practice.
Ah, so much for my dream. I'll go back to work and continue to provide the best care possible within what's currently available at my facility. Hopefully, the direction of medicine in this country will not lead to the end of sole providers where this type of thing is most commonly seen.
Best wishes,
Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]
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