Thanks to everyone who wrote me back on some of the “simple” screening tests that “just take a few minutes” that well-meaning special interest groups want family physicians to give away their time to administer. And remember, the family physicians’ nurses are busy also, so if a special interest expects only nurses to deal with the screenings, their time must be paid (and more globally, the family physician will probably need enough overall increased payment to hire a new nurse, which still won’t increase family physician income, but it will create more work for the physician.)
I’m sure this isn’t exhaustive, but here is what we came up with:
Post Traumatic Stress Disorder
Exercise type and amount
COPD (in smokers mostly, but maybe secondhand smoke exposure)
Peripheral neuropathy (mostly in diabetics)
Autonomic neuropathy (in diabetics)
Peripheral artery disease
Carotid artery disease
Asking about other smokers in the house
Readiness to quit if the patient does smoke
Guns in the house
Intimate partner violence
Dementia/Alzheimer’s disease/cognitive impairment
Gait and balance
Independent functional activities such as balancing a check book
Seat belt use
Water heater temperature setting
CO monitor in the house
Other substance abuse
“Cardiac” screening for young athletes
Notice I left off the list components of well child exams mandated under state and federal law that are kind of paid for by being bundled in the overall fee. Examples include lead levels and developmental assessments.
This next section includes the comments of a reader that isn’t as much about screenings as it is other work family physicians are asked to do so others can be paid. This is what he wrote:
We tend to call the small trivial tasks that other want us to perform “Death by minnow bites”
I won’t give you all of them due to time sake but just some of my favorites:
1) Primary care docs in Ohio have to complete the form for diabetic shoes when the podiatrist orders them for a patient.
2) Our medical record system “Epic” requires you to state whether the medication is a cap or tab.
3) To get OTC meds paid for by your flexible spending account you need a script. I had to write a script for alcohol swabs and band-aids the other day.
I’ll add to this list filling out forms so radiologists can be paid.
So in the end, we came up with over 30 different diseases or conditions some group or another expects family physicians to screen for without being paid for the time and effort it takes to not only ask the questions, but then deal with the patients with abnormal results (which doesn’t mean they necessarily have the disease. Screening tests are often constructed to over diagnose disease to minimize the number of missed cases.) Some of these screening steps are targeted to specific populations — diabetics for example — but most aren’t.
For the non-family physicians out there: If you were a family physician, would you ask all these questions without payment 25 times a day?