Read on Twitter
Brief shoulder dislocation update thread: the follow-up appointment
The absurdity of my orthopedics appt today is why I work on studying specialty care and improving the delivery system. I think I experienced more or less the status quo, but jeez, what a flaming waste of time.
The absurdity of my orthopedics appt today is why I work on studying specialty care and improving the delivery system. I think I experienced more or less the status quo, but jeez, what a flaming waste of time.
I go to the check in and I'm handed a doubled sided sheet of paper that asks for all of my medical problems, my medications, my review of symptoms blah blah blah.
All of my data in the EHR - why ask me? Also ... it went into a pile at the front desk, not given to the MD. lol
All of my data in the EHR - why ask me? Also ... it went into a pile at the front desk, not given to the MD. lol
A poorly kept secret in health care is that I have NEVER seen those ridiculous information sheets used for more than a quick glance by a nurse or doctor sometimes. Their use baffles me.
Random screenshot of what I'm talking about here.
Random screenshot of what I'm talking about here.
OK, so then I wait 25 minutes for an 8:30 appointment when it is quite clear there were no patients before me. Of course this happens all the time in my clinic. But depending on what happens in the exam room, you will either understand why you were waiting or feel frustrated.
The medical assistant takes me into the room. They don't take any vital signs and I'm surprised to see that there isn't even a blood pressure cuff in the room actually. 
I don't need it clinically but still it's weird to see structurally they don't even try.
I don't need it clinically but still it's weird to see structurally they don't even try.
The doctor comes in shortly. He asks how I'm doing: "OK, getting better I think." "Good to hear." I kid you not that was the whole HPI.
Next comes the physical exam. I came to this appointment mostly expecting him to see how well my rotator cuff was doing after the dislocation.
Next comes the physical exam. I came to this appointment mostly expecting him to see how well my rotator cuff was doing after the dislocation.
The physical exam: he asks me to squeeze his hand (squeezed). He rubs my deltoid and asks if I can feel it (yes). He asks me to externally rotate my shoulder a tiny bit (OK). He also pulled back a couple of my fingers because I told him I landed on them too.
That's it!
That's it!
He tells me that I need to be in my splint for 2-3 more weeks (how does he know with almost no exam??). He recommends physical therapy (reasonable). He says he'll be right back.
10 minutes later he comes back with a sheet of >20 PT offices and a PT prescription.
10 minutes later he comes back with a sheet of >20 PT offices and a PT prescription.
I ask him what I care about, what activity restrictions I should have. He says avoid heavy lifting and avoid overhead work. OK. But I also need a splint for 2-3 weeks? In the ED he said I had to wear it "religiously." Confused.
But the appt is done. ~7 minutes of his time tops.
But the appt is done. ~7 minutes of his time tops.
Combining the drive, parking, check in, the wait, the 7 minutes of MD time, check out etc took about 75 minutes. And honestly I left the appointment knowing nothing more than I did leaving the ED.
Why am I complaining about all of this. I wasn't really surprised to be honest.
Why am I complaining about all of this. I wasn't really surprised to be honest.
I saw specialty appointments like this all the time shadowing as a medical student and resident.
But the pointlessness of the interaction, the lack of regard for patients' time never ceases to amaze me. It's the status quo. This appointment could EASILY have been telemedicine.
But the pointlessness of the interaction, the lack of regard for patients' time never ceases to amaze me. It's the status quo. This appointment could EASILY have been telemedicine.
It's no wonder that as a PCP, sometimes I can spend a whole appointment just reading a patient's recent specialist notes and telling them what happened because they are so lost. And I think that is time well spent! Because they won't get that anywhere else.
I'll be fine of course because my shoulder is healing pretty well I think (not that my appointment informed that at all). And I know how to reach out if I have problem.
But of course, as always, there's no way so many patients go through this system and have any idea what to do
But of course, as always, there's no way so many patients go through this system and have any idea what to do
And in any of the following elements and these follow up appointments can be worse than useless: non-english speaking, cognitive difficulties, psychiatric disorder, low health literacy, or someone who is just plain shy and intimidated.
/fin
/fin
Oh and I forgot the funniest part!!
On my PT prescription he scribbled - "follow up with me in 4 weeks." SERIOUSLY? No way unless I am feeling worse.
On my PT prescription he scribbled - "follow up with me in 4 weeks." SERIOUSLY? No way unless I am feeling worse.
One other thing this is that my experience is not specific to orthopedic surgery by any stretch. I've seen visits like this with nephrology, rheumatology, ENT, primary care, you name it.
