This is a digest of an article originally published in the April 7, 2006 edition of Medical Economics and written by Michael J. Schlesser, MD.
Which patients really want regular preventive care and which ones don't? That is a critical question for medical practitioners and you need to know the difference!
Recent medical malpractice claims by one insurer included two cases of primary care doctors who had "missed" cancers. In both cases, however, the patients had not scheduled an annual physical.
Dr. Schlesser's strategy to sort out patients who truly want primary care from those who don't may provide you some ideas for your own practice.
1. Do an annual review on all primary care patients. Although a "required" annual physical can be controversial, Dr. Schlesser uses it to make sure patients are up to date on mammograms, Pap, DEXA, PSA, urinalysis, guaiac smear test, colonoscopy, etc.
2. Identify patients who don't want a review, or are not "your patients". It is ok if patients opt not to have an annual review; however Dr. Schlesser documents that it was their choice.
3. List patients over the age of 40. The list should include all patients who have been seen in the last two years and have not been billed for a comprehensive preventive exam or a routine health checkup รข€“ and that all necessary diagnostics are normally included in such visits.
4. Send a letter. All patients from that list, representing risk exposure for failure to diagnose, are sent a letter inviting them to come in for an annual review.
5. Include a postage-paid return postcard with the letter, asking them to signify a) whether Dr. Schlesser is their chosen Primary Care Physician who they want to guide them in a proactive plan for maintaining good health, b) Whether Dr. Schlesser is their PCP for Internal Medicine, but they see another doctor for GYN, and c) Whether Dr. Schlesser is not their PCP, but they have seen him in the past.
The letter explains that Dr. Schlesser is available for future appointments for all patients, regardless of the box they checked off on the postcard. However, he further explains that he has a higher level of expectation for patients who consider him their PCP to take the initiative to come in for an annual exam. (If they don't make an appointment, he continues to send them regular and documented reminders.
Surprisingly, he has experienced a postcard response rate in excess of 50% and those that check off box #3 are deemed to have opted out of preventive care. As a result, Dr. Schlesser can better focus on patients who want preventive medicine, while documenting against potential future claims of negligence.
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