The practice of Internal Medicine is rapidly changing. General Internists are by the nature of things having to chose between a hospital-based practice i.e. - A HOSPITALIST- who treats serious acute problems in the hospital -OR- an office-based physician who treats minor acute problems and chronic problems such as hypertension, diabetes, asthma, heart disease, lung disease, and risk factors in general. The office-based physician tries to keep his patients out of the hospital. The hospitalists try their best to get the patients back to the office physician. There is little time and intellect to do both jobs at once, and do both well.
I HAVE CHOSEN TO BE AN OFFICE-BASED PHYSICIAN, AND I TRY TO PREVENT OR MINIMIZE MEDICAL PROBLEMS.
Quality Care and Prevention
There is a new movement in the delivery of medical care that is rapidly gaining momentum, and I am all for it. But it requires a lot more work, and a lot of cooperation between the physician and the patient.
Insurers and Medicare/Medicaid are going to study the top chronic problems in terms of the proper care, at the proper time, and the proper response.
These chronic conditions include Diabetes Mellitus, Ischemic Heart Disease, Congestive Heart Failure, Hypertension, Asthma, Tobacco use, Immunizations, Women's Health (PAP, Pelvic, Mammogram, Bone Density) and Colonoscopy.
Physicians will actually get graded on the percentage of proper care over the total number of patients.
This is hard stuff, but it is good stuff, and it is the right stuff.
To follow the guidelines, patients will notice that they will be prodded and pushed and constantly reminded about the various elements. You will also be asked to refuse in writing that which you have every right not to do.
The various elements include lab tests at various intervals for various diseases, medications for various diseases, and combinations of diseases and examinations.
I hope you will participate and enjoy better care and prevention. The payers are actually behind this and support it financially. They are already checking, by what they pay for, who is doing what, to whom, and when.
You have one or more of several chronic problems. To be honest, there is not enough time in a typical acute visit to acquire all of the tests that are recommended, ask all the appropriate questions, and deliver the latest information that would provide the quality care as described by several national organizations as well as your insurance companies and medicare. I am participating in several quality care programs that measure these goals, and I believe in their purpose to deliver the best available care and to document that care. The end result would be to use all the current knowledge to prevent problems or complications. I am therefore asking you to schedule a WAIT-FREE mini exam solely to accomplish these goals whenever you can schedule a time. We, therefore, can concentrate on providing quality long-term care, when we are not facing an acute problem. Suggested times are 1:30 and 4:00 PM lasting approximately 20 minutes.
Please Schedule a Physical Exam
You have one or more chronic problems and you have not had a physical exam in over a year. I think that a periodic exam is very important. I also think your time is very important. To encourage you, I would like to promise not to keep you waiting. Times for physical exams will be 8:30 and 11:30 am and 1:30 and 4:00 pm. For those of you who prefer afternoon exams, I suggest coming in earlier one morning, get your blood drawn fasting and leave. This would also be nice for morning exams because the results would be available at the time of the exam. However, morning exams can come fasting and get their bloodwork at the time of the exam. Bring any prescriptions with you so that we may record them accurately and also find the most economical way for you to get the same quality medicine.