What Should a Medical Office Visit Be Like?
Centering Care on the Patient
Background
Patients are often anxious or fearful about coming to the medical office. When considering medical office visits focused on patient care, it is essential that the primary objective is to achieve the best possible health outcome for the patient. An ideal office visit should incorporate more advanced technology than is typically found in medical clinics. However, technology should be utilized to augment care rather than create a barrier between the patient and the doctor. At every stage of the process, technology must enhance patient benefits. Let's explore how a proven system can enable doctors to concentrate on the patient rather than the computer screen, increase office efficiency, improve patient outcomes, and increase patient satisfaction.
The videos presented were recorded in 2010, well before the advent of large-language-model artificial intelligence but illustrate the use of expert system artificial intelligence. This software continues to be the gold standard for patient screening today, and it is constantly being improved by thousands of doctors and over a million patients daily.
Patient Arrives
In What Happens When a Patient Calls the Office the process of computer-assisted patient interviewing offers three pathways for patients entering the office visit process. This video demonstrates a computer used for patient self-check-in. It first asks whether the patient has completed their interview online prior to the visit. If the patient responds affirmatively, the next screen directs them to proceed through the door to their left. Patients who have not registered online in advance are asked to have a seat while the receptionist assists them. Patients unable to use self-check-in receive help from the staff, similar to the support provided in home improvement stores and retail outlets.
Vital Signs Taken by Nurse
Vital signs are recorded seamlessly by connection to the electronic health record speeding the patient through the office to the exam room. The result makes the office quieter and more efficient by reducing rework by staff. The ambience reduces stress of the visit for patients and staff.
Patient Answers Questions on a Computer
For demonstration purposes of this essay, the video demonstrates the nurse teaching the elderly patient how to interact with the computer software. As patients experience the process repeatedly, they become more familiar with it. Over 80% of established patients have internet access or a smart phone and will complete the interview at home before arrival.
By allowing the patient to enter the information, the data gathering is at the patient’s own pace. No information is skipped. Free text allows the patient to add additional details about their problem as well as indicating multiple problems to be addressed. The next essay will show how health systems do not want the patient to drive the agenda.
Doctor Greets Patient and Reviews Information
Notice how the doctor greets the patient cordially and explains his respect for the time the patient dedicated to entering information into the computer system. This acknowledgment could take place before the doctor enters the room, but it is important that the doctor recognizes the benefits this information provides to the patient. Otherwise, the patient may be less inclined to complete the information accurately.
With the information organized in a medical record format that the doctor can easily understand, he quickly scans it, confirming some of the important positive responses with the patient to verify the accuracy of the interview.
Finally, the doctor stops reading, looks at the patient, and asks open-ended questions about how the condition is affecting them. During the remaining portion of the exam the doctor is looking directly at the patient – not the computer screen. This recommended interview style for patient evaluation often resonates most with the patient during the first two questions. By asking the patient to explain how the illness is impacting their daily function, the doctor gains an immediate understanding of the outcome the patient hopes to achieve from the visit.
Doctor Examines Patient
After the patient explains his reason for the visit and his expectations, the doctor instructs him to undress and get on the exam table. The doctor wisely uses this time to edit the health record that the software has initiated. The doctor can add or modify any information entered by the patient during the face-to-face interview. This ensures the accuracy of the record, with the initial information provided by the patient being supplemented by the doctor in near real-time. Without this process, the doctor would either have to type throughout the entire visit or take notes and complete the medical record sometime after the visit.
Doctor Inputs Data
As the patient dresses, the doctor explains how he completes the medical record for the visit. He documents the physical examination by noting exceptions, makes the diagnosis, and shows the patient how he writes the prescription while confirming any allergies and the patient's preferred pharmacy. The doctor concludes the visit by asking, "Is there anything else?"
Patient Leaves the Office
The doctor accompanies the patient out of the office, having completed the medical record along with customized patient instructions and education, which he hands to the patient upon departure.1 He shakes the patient's hand and ensures all their needs have been met.
Note the physician hands the patient a paper print-out of the prescription which today would have been sent directly to the pharmacy.