D epartment
of
M edicine
Con ne c ti ng T e c h n o lo g y , Ed uca t i o n a n d D i s cove ry w ith H um anis m in Me dicine
Resident Clinic Update
Vol. 7 Issue 2 Apr 2018
Dr. Juli Williams, Clinic Director (R), pictured with Internal Medicine Residents Drs. Sneha Thakur, Tyler McLaurine, and Blair Reynolds (L-R)
The resident clinic is undergoing many new and exciting changes! Over the last year, there has been a collaborative effort focusing on overhauling the “as needed” or “PRN” visits, launching the patient portal, and increasing the number of physical and wellness exams. In May, the PRN schedule was revamped to allow for more flexibility. Previously, patients with acute issues who needed to be seen within one to two days were added to openings in individual residents’ schedules. Now, each morning or afternoon clinic session has three to six 15-minute blocks reserved for PRNs. At the beginning of each clinic, residents divide the PRNs based on cancellations and acuity of the patient’s illness. PRN visits can vary from a mild viral gastroenteritis to a COPD exacerbation needing hospital admission. The resident clinic chief-elect, Dr. Henry Shiflett, views the new system as “a great success. It is a wonderful service to patients and reduces the number of urgent care and ER visits.” Dr. Juli Williams also echoes his sentiments, “The new system was a true collaboration amongst attendings, residents, office staff, and nurses. It has been warmly received.”
Points of View The increasing costs of prescription medications has once again become a matter for public concern. In my clinic, patients’ inability to pay for the high cost of their medications is becoming increasingly frequent. Many of my patients, especially those on fixed retirement incomes, must make difficult choices about affording their medications, often preferring to use only those medicines that are essential for life Rajiv Dhand, MD, Chair while omitting others needed to improve their quality of life. Public awareness about the high cost of prescription medicines has been heightened by the increase in prices of some previously marketed drugs and the extraordinary costs of some newly introduced 1
Our resident clinic director, Kay Rangnekar, doubles as our technology guru. Since her arrival, she made many improvements to the electronic medical record. Her most recent coup d’état was tweaking office note templates for annual physicals and wellness exams. The goal is to increase the number of physicals and wellness exams, in order to increase preventative screening measures. Ms. Rangnekar identified 180 patients who qualify for exams and are being contacted to schedule their clinic visits. Lastly, the patient portal is now up and running. This portal is a service provided to both Internal Medicine and OB/GYN patients and provides patients with the opportunity to view and download lab and diagnostic results. Ultimately, it allows for more accessibility between patients and physicians in between office visits. Nearly 3,570 patients have access to the patient portal, and approximately 245 patients frequently access the secure messaging service. In the last year, there have been many improvements in resident clinic. Thankfully, changes will continue to evolve as Dr. Shiflett is constantly reassessing needs in clinic. therapies (in excess of $100K/year). In the U.S., the government allows drug companies to set their own prices, often to a level that the public demand and market will bear. As a result, the public spends more on prescription drugs than any other high-income country. Pharmaceutical companies justify the cost of medications based on the high expenditure involved in research and development and the limited duration of patent protection afforded to a new product. There is no doubt that pharmaceutical companies have developed many life-saving therapies for chronic, serious illnesses. However, we must balance the cost of these life-saving treatments against the public’s ability to afford such therapies. The increasing cost of prescription drugs limits physician’s ability to treat their patients effectively, even those with adequate health insurance, because of the high out-of-pocket costs paid by consumers. The inability to afford medications becomes even more critical in patients who lack health insurance. continued on page 2