“Patients didn’t like the long wait times, delays in responding to calls, and they felt I wasn’t listening to their concerns. This was not the caring and engaged doctor I thought I saw in the mirror every day,” he wrote in an article on KevinMD.com. “As physicians we can all crank it up another 25 percent, but eventually it catches up to you.”
In that article, Kinsella shared how he was able to turn things around for himself and his patients. We met up with him at the most recent meeting of the American Academy of Neurology where he spoke about his turnaround, with an emphasis on how his use of electronic medical records (EMR) has changed.
“People like to bash the electronic medical record, but in fact it’s made me more efficient,” he told Neurology Insights in a follow-up conversation. “I’m more productive. I can see 20, 22 patients in a day and walk out the door, and I don’t have to open that note again.”
By doing this he has eliminated after-hour note writing and made his patients happier – significantly improved Press Ganey scores back that up. How does he achieve this? Through clever use of medical assistants.
In his St. Louis practice, SSM Health Neuroscience Institute, the ratio of neurologists to MAs is 1:1.4. This works out to one dedicated MA per physician and a shared MA who helps patients at checkout.
“Normally the medical assistant’s role is merely to room the patients, reconcile the meds, take the vitals — basically set up the interviews and set up the expectations,” Kinsella says. “But I’ve extended that by training my MA to function a little bit more as a scribe.”
To start, he has the MA ask the patient to list three top priorities for the visit. This helps prime for good communication and ensures the patient gets what they want from the appointment.
He has the MA put this information and any other history into the after-visit summary or patient instruction portion of the note. For follow-up patients, he has the MA copy and paste the prior impression and plan into that section as well. This makes his chart review quick and easy and helps him pre-fill his note template.
“The whole idea on the follow-up note is to set up what happened in the past, talk about what’s happened since, and then where are we going,” he says. “There is a flow to the entire follow-up note that maintains the narrative. And it does it in such a way that at least two parts of it are done by the MA.”
This preparation allows him to spend more time on his exam, listening to the patient and making eye contact. Once his exam is complete, he then asks for a moment to compose his impression and plan and lets the patient know he will be giving them a copy to take home.
This, he says, “sets up the expectation that even though you’re waiting and I’m being quiet here, this is going to be for you.”
Using copy and paste, Kinsella uses his note as a teaching tool for his patient, as an update for the referring physician, and a template for the next visit with that patient.
“The EMR is not going to go away anytime soon,” he says. “We should just learn to focus on its strengths and minimize its weaknesses.”
His goal in sharing his story is to help physicians stop documenting after hours and in their spare time.
“The closer we get to that goal, the less the temptation to do work when they’re supposed to be resting, when they’re supposed to be recreating, restoring themselves, and refining their sense of purpose,” Kinsella adds.