Managing a primary care practice requires physicians to master a formidable range of skills and perform them quickly and efficiently. With the typical initial office visit for a new patient lasting from 45 minutes to an hour, and subsequent visits lasting approximately 15 minutes, time management and clear communication are essential to providing quality diagnostic and treatment services.
In this episode of Kentucky Health, Dr. Wayne Tuckson speaks with a primary care physician and an attorney who shadowed her on a typical workday about the best practices for managing a primary care clinic, how primary care has changed in recent years, and how the system can be improved.
Dr. Mary Barry is employed by Norton Community Medical Associates and received her medical degree from the University of Louisville’s School of Medicine, with a residency in internal medicine at Emory University in Atlanta. Sarah Spurlock is an attorney with Stites & Harbison, PLLC, in Louisville and is a member of the firm’s Health Care Service Group.
Spurlock recently shadowed Dr. Barry at her Norton office on Barret Avenue in Louisville for one day as part of the “Wear the White Coat” program conducted by the Greater Louisville Medical Society. Clips from Spurlock’s visit are included in this episode.
Managing Data and Relationships
Reflecting on her experience shadowing Dr. Barry during a busy workday, Spurlock says that she was impressed by how Barry was able to work within time constraints and still provide thorough, professional medical care with a personal touch. Barry says that she’s had to work to achieve such a balance, and that it is far easier with repeat patients than with new ones since she is already familiar with her regular patients’ medical history.
During Spurlock’s day with Dr. Barry, the pair met with a variety of patients. One woman in her 60s visited for a follow-up appointment after surgery, and Dr. Barry trained Spurlock how to check for the patient’s pulse and blood pressure. Another patient, a man in his early 60s, had a hoarse voice, weight loss, and mild depression. Barry learned that the man had become a full-time caretaker for his infant grandson, and she advised him to fill the prescription for anti-depression medication that she had previously ordered and he had declined.
Another patient, a woman in her late 40s, told Dr. Barry that she was considering getting her knee replaced on the advice of an orthopedic surgeon. Dr. Barry consulted with the patient on pain medication options, and said that she, not the surgeon, will be responsible for prescribing it and following up on the patient’s usage.
Barry spends part of each patient’s appointment sitting in front of a computer and keystroking in medical information, giving credence to a quote from Louisville Greater Medical Society CEO Bert Guinn that “doctors are the most expensive medical data entry clerks in the world.” Still, Barry never disappears into the screen; rather, she keeps in constant communication with her patients and makes thoughtful, evidence-based decisions on the best ways to treat their specific conditions.
“What I do is process information and make a decision – over and over and over,” she says.
Primary Care in a Technology-Driven Age
Processing information has become both easier and more challenging in the age of electronic medical recordkeeping, Dr. Barry says. She feels that electronic medical records are of great benefit to patients as they can travel with a patient from the primary care physician, to the specialist, to the surgeon, and on to any other medical office needed. But “there’s a vast potential for error here,” Barry concedes. “That’s the scary part.”
As a health care attorney, Spurlock has seen a lot of changes in how primary care is administered due to technological innovation. “I think that one of the things that is difficult, not just for physicians but for the health care industry in general,” she says, “is to keep up with this adoption of new technology and physicians’ potentially being able to answer email after hours for patient needs instead of seeing someone in person, and some of the complexities that come along with that.
“That’s probably the biggest thing that I’ve seen change in the time that I’ve been practicing, that increased use of technology and how that impacts the physician-patient experience and also how it can impact things like the security of information,” Spurlock adds. “I think that there’s a lot of good that can come out of that, but I think that it’s important, as Dr. Barry said, to have that balance with interaction with the patient as well.”
Barry makes herself available for emergency calls when she’s done holding office hours, but forbids patients to email her. She has done FaceTime visits with patients, but is not a fan of those either. “I want to be able to touch the person, and look at them, and determine how sick they are,” she says. “Because, you know, in my line of business, people get really sick, or they’re not sick at all. So I have to be able to see them to make that decision.”
After shadowing Dr. Barry, Spurlock says that she has expanded her own knowledge base about the primary care sector of the health care industry. She also says that she has learned how important a patient’s responsibility is when visiting the doctor. Spurlock says that she already has productive relationships with her own primary care physician and her children’s pediatrician, but now has a better understanding of how she can communicate more effectively with her doctors in the future.
Effective communication is crucial to a good doctor-patient relationship, Barry explains – especially in an era of technology and limited time. She advises patients to bring in a list of their medications and an immunization record, but more importantly, to have compiled a detailed description of what exactly is causing them to see a doctor at this particular time.
“You should really think about what’s wrong and what you’re worried about and what your questions are, and if you have those written down or organized, you’ll do great,” Barry says. This will allow the physician to ask more probing questions about the patient’s health, make an accurate diagnosis, and set a course for successful treatment.
“That’s why I believe in the annual physical,” she says. “Because you get to ask your questions, and go over what you’re worried about. And it might not be much, or it might mean something important. … The reward of the relationship is getting to know people, you know, to have the mutual trust. And it’s such a privilege to be so intimately involved in what happens to other people, and to be able to help them.”