R. came in for a physical last week. I've cared for him and his family for years. They are the the type of family FPs love - nice, funny, engaging, cute kids. R is in his early 30s and drives a truck. Pretty healthy guy for the most part, except for one problem. He weighs 325 pounds.
After a few minutes of chit chat, I asked him if there was anything on his list he wanted to address. He said he was tired of being overweight, and he was looking for some guidance on how to begin losing weight. You could sense that his weight has begun to bother him, not physically, but emotionally. He seemed genuinely ready to lose weight, so we began our discussion in the usual place, talking about his diet.
I usually begin these kind of discussions asking about the typical "empty calories" that people take in, so I asked R about his soda intake. R admitted that he drinks 2 Cokes per day. "2 Cokes per day" can mean anything, so I questioned him further, and it turns out he drinks 2 large Cokes per day, bought from one of the major fast food chains, the one that has $1 sodas, any size. He said he does this every day. Even weekends.
I went online to try to find out how many ounces were in a large Coke from the above chain. It turns out that a large Coke is about 24 ounces (2 cans), if one adds ice. So, he was drinking the equivalent of 4 cans of Coke daily.
A can of Coke has 140 calories. So, R takes in 550 (rounded) empty calories every day. When I told him this, he didn't look at all concerned. We then talked about the number of calories men should consume per day. Usually, men should consume 2000-2200 calories per day. He still didn't seem to get it. That is, until I did the math.
550 empty calories, every day, is 16,500 extra calories per month. He is taking in 8 extra days of calories each month just in Coke. Let's just say that this got his attention. His jaw literally fell open.
I guaranteed him that if he could transition from regular Coke to something like Coke Zero, he would lose 10-15 pounds, without making one other change to his diet or exercise regimen (which was non-existent). In 3 weeks, I'm going to go through starch reductions, increasing his protein intake, and how to eat healthy (speed of eating, water intake, snacking, etc.). We should be able to get him under 300 pounds by Halloween.
Small changes seem just that, small. But if you add up those changes over time, they will make a big impact. So, if you are looking to make changes in your diet (or any behavior for that matter), start with something small and be consistent. It will definitely make a difference.
Sunday, August 28, 2011
Monday, August 15, 2011
Free advice to Big Box practices
We see about 40 new patients a month in our practice. We've done this for years, without advertising. We rely on the word of mouth of our patients and referring specialists to build our practice. It's been a successful approach so far.
When I first meet a new patient, I ask them about how they heard about our practice. The majority are referred by either friends or family. Once I've established some repoire, I'll explain my practice philosophy, some of the history of the practice, and how the hierarchy of my practice is designed. I make a point to tell patients that I am their physician, and that by coming to a small group, they will always either see me or my physician assistant Karla.
It never gets old to see how new patients respond to this. They almost seem relieved. I had one patient say to me, "Finally! I'm sick and tired of seeing every other doctor or assistant than the one that's supposed to be my doctor". You hear this enough times from enough patients, and sooner or later, you come to the conclusion that the paying public is looking for something more than what they are getting.
The majority of our new patients are former customers of the Big Box Practice (BBP going forward) which has locations throughout the western suburbs of Chicago. I have some fairly strong opinions about the way BBP does business, but in this post, I want to focus on the patient, specifically the patients who have left BBP as unhappy customers.
The number one complaint I hear from our new patients is that they "felt like a number" at the Big Box. This criticism is a reflection on the business model that large medical practices have adopted. Physicians simply want to dilute their duties among as many "partners" as possible, even if it means alienating the most important piece of the equation, the patient.
Primary care medicine should always be built on the long-term relationship of a physician and patient. If you notice, the word "physician" in the last sentence is singular. There is no feasible way to provide insightful care without getting to know your patient, and the only way to get to know your patient is for the physician to see and care for them, not their seven partners. Patients shouldn't tell their friends and family, "I'm a patient of Big Box Practice". They should say, "I'm Dr. (insert name here)'s patient".
So, as a small practice physician, I'm going to give BBP a free consultation.
First of all, it's OK to have a large group of physicians. What you need to do is make that large group feel intimate, and that starts by having your physicians take ownership of their patients. As important as it is for patients to identify with a specific physician, it's equally important for the physician to identify with their patient. To do this, you need to break the large group into smaller parts.
It's not that hard. If you have 8 physicians, split into four 2-physician groups. When one physician is on vacation, the other physician can cover, and vice-a-versa. When you shrink your practice down into manageable parcels like this, call becomes easy. Trust me - I've done it for years. We take care of 6000+ patients, and I'm lucky to get one call a night during the week. On the weekends, divvy up the hospital call amongst the 8 of you. Patients completely understand your need for some down time.
What this will do will be amazing. Your patient attrition will slow down, patient satisfaction will soar, and you will start to like medicine again. I'm not say all physicians are unhappy working for BBP, but I can tell you that how they practice medicine isn't what they imagined when they went to medical school. I take great pride that my patients are my patients. I am protective of them. I work harder for them. I am accountable.
BBP docs, don't hide inside the big groups you have built. Re-design the way you deliver care. I understand if you do this, I may see less new patients coming my way. That is completely fine with me. It will mean that your patients are happier, and getting the care they deserve. It will mean that your patients no longer feel like they are just a number.
Like I said, this consult is a freebie. I'd be happy to talk about my going rate if you need any other advice.
When I first meet a new patient, I ask them about how they heard about our practice. The majority are referred by either friends or family. Once I've established some repoire, I'll explain my practice philosophy, some of the history of the practice, and how the hierarchy of my practice is designed. I make a point to tell patients that I am their physician, and that by coming to a small group, they will always either see me or my physician assistant Karla.
It never gets old to see how new patients respond to this. They almost seem relieved. I had one patient say to me, "Finally! I'm sick and tired of seeing every other doctor or assistant than the one that's supposed to be my doctor". You hear this enough times from enough patients, and sooner or later, you come to the conclusion that the paying public is looking for something more than what they are getting.
The majority of our new patients are former customers of the Big Box Practice (BBP going forward) which has locations throughout the western suburbs of Chicago. I have some fairly strong opinions about the way BBP does business, but in this post, I want to focus on the patient, specifically the patients who have left BBP as unhappy customers.
The number one complaint I hear from our new patients is that they "felt like a number" at the Big Box. This criticism is a reflection on the business model that large medical practices have adopted. Physicians simply want to dilute their duties among as many "partners" as possible, even if it means alienating the most important piece of the equation, the patient.
Primary care medicine should always be built on the long-term relationship of a physician and patient. If you notice, the word "physician" in the last sentence is singular. There is no feasible way to provide insightful care without getting to know your patient, and the only way to get to know your patient is for the physician to see and care for them, not their seven partners. Patients shouldn't tell their friends and family, "I'm a patient of Big Box Practice". They should say, "I'm Dr. (insert name here)'s patient".
So, as a small practice physician, I'm going to give BBP a free consultation.
First of all, it's OK to have a large group of physicians. What you need to do is make that large group feel intimate, and that starts by having your physicians take ownership of their patients. As important as it is for patients to identify with a specific physician, it's equally important for the physician to identify with their patient. To do this, you need to break the large group into smaller parts.
It's not that hard. If you have 8 physicians, split into four 2-physician groups. When one physician is on vacation, the other physician can cover, and vice-a-versa. When you shrink your practice down into manageable parcels like this, call becomes easy. Trust me - I've done it for years. We take care of 6000+ patients, and I'm lucky to get one call a night during the week. On the weekends, divvy up the hospital call amongst the 8 of you. Patients completely understand your need for some down time.
What this will do will be amazing. Your patient attrition will slow down, patient satisfaction will soar, and you will start to like medicine again. I'm not say all physicians are unhappy working for BBP, but I can tell you that how they practice medicine isn't what they imagined when they went to medical school. I take great pride that my patients are my patients. I am protective of them. I work harder for them. I am accountable.
BBP docs, don't hide inside the big groups you have built. Re-design the way you deliver care. I understand if you do this, I may see less new patients coming my way. That is completely fine with me. It will mean that your patients are happier, and getting the care they deserve. It will mean that your patients no longer feel like they are just a number.
Like I said, this consult is a freebie. I'd be happy to talk about my going rate if you need any other advice.
Subscribe to:
Posts (Atom)
