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What does it take to coordinate patient care?

Operation Iraqi FreedomAs a clinical student, I’ve been a part of dozens of outpatient clinic visits, but several days ago, I witnessed a clinic visit much unlike the others.

For one, our patient arrived not for a 20-minute appointment, but for a three-hour one. As a hemophiliac, this patient came to Stanford once a year, for a comprehensive, coordinated patient care visit, where she saw not only her hematologist, but also her social worker, dietitian, nurse coordinator, physical therapist and others. I had the privilege of sitting in on this patient’s entire visit, witnessing the full spectrum of care coordination, and I found myself wondering why every clinic visit isn’t similar to this one.

For instance, I visited my own primary care physician a few weeks ago, for my annual physical exam. I had forgotten to fast that day, so had to come into the clinic a separate day for a fasting lab draw (I didn’t get around to it until 10 days later). I also wasn’t sure if my insurance covered one of the shots my doctor recommended I receive, so I had to call my insurance company, check on my policy, then make – this was now the third visit – a separate appointment. And this was just a routine physical.

In the inpatient setting, we often discharge patients with a list of follow-up appointments we’ve made for them, often on different dates, with different providers, in different clinic locations. At times, we don’t have a date finalized for these referrals or outpatient imaging studies, and we tell patients that they will get a call from the clinic. I wonder how often our discharged patients make it to all the appointments we expect them to? And even if they do, have they gotten the right imaging and labs beforehand? Or is it just so confusing that patients end up in the wrong place at the wrong time?

The hemophilia annuals clinic made it so easy for its patients by combining multiple provider visits in one location and a single time frame. This was particularly helpful for the patients who drove several hours to make it to their clinic visit, preventing them from having to return on multiple days. The patients came to the lab before each visit, came directly to the clinic afterwards (by which time their labs were often back), stayed in one room as specialists rotated through, and left promptly at noon, with their appointment date for next year – a seamless coordination of patient care.

Though I’m leaning towards practicing inpatient vs. outpatient medicine, this clinic experience was a fresh reminder of how important it is to streamline care provision in the outpatient setting to keep it simple for patients. At the end of the day, I don’t think any individual provider spent any more time than they would have in a normal clinic appointment. So this process represented what every clinic aims to be: highly efficient for both patient and provider.

Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category

Hamsika Chandrasekar is a fourth-year student at Stanford’s medical school. She has an interest in medical education and pediatrics.

Photo by U.S. Navy Photographer's Mate 1st Class Shane T. McCoy

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