Medicine, the old way: doctor usually available, makes house calls, accepts farm goods in payment. Medicine, the new way: long wait for appointment, high-tech digital imaging, computerized patient records, 24/7 Internet access to information.
What would be the best of both worlds? It would probably look something like Birmingham's Seale Harris Clinic, which is creating new ways to use technology that work on behalf of the patient, and not just of the system.
"In today's world, health care is more than ever about management," says Jay Crenshaw, MD, whose father James was the clinic's founder. "People need to have access to a doctor without waiting weeks or months for an appointment, and all the various medical professionals a patient will see need to be on the same page, where information is concerned. So we're kind of a full-service clinic."
During his own 22 years of practicing internal medicine, Crenshaw says, "In a lot of ways, medicine got turned upside down, from the original concept of the patient being the hub. With all the new technology and equipment, patients tended to get bounced around from office to office. Not only was it inefficient and time-consuming, but the costs became exorbitant.
"Nowadays, fortunately, there are more clinics like ours who actively manage patients in real time. We can manage maybe four times as many of them as an average busy internist because they're referred appropriately rather just bumped from specialist to specialist, and in the process we can eliminate a lot of extra visits and costs."
For starters, the clinic's staff are accessible 24/7 and 365 by phone and e-mail. After regular hours, two nurses are on duty to take initial calls and either forward them to a physician or, in the case of pharmacies, find the patient record in question and immediately e-mail it.
"The most common complaint I hear from new patients," Crenshaw says, "is, 'I like my doctor, but he or she doesn't return my phone calls.' All too often, patients end up going to the emergency room where they might, say, get a scan for just a headache and run up thousands of dollars in costs. Self-insured companies love what we offer, because it reduces costs by keeping people out of the ER."
Ideally, he says, Seale Harris's system works as it did for one young patient recently who saw a physician in the morning complaining of abdominal pain, got lab results back quickly, had gall bladder surgery the same day, and was headed home by four p.m.
In many cases, results of blood work are finished while a patient is still in the examining room. According to Crenshaw, "It's a huge improvement over the old way of chasing somebody down by phone to let them know they have diabetes, for instance, or dealing with patients who are from out of town and letting them and their pharmacist know what they need to do next."
Another major breakthrough since the old days is the growth of digital imaging technology. Crenshaw says: "Rather than looking at traditional X-ray film against a light box, we can manipulate the digital images to enlarge and enhance them and then send them anywhere across the world, if need be.
"The bottom line is that we've worked hard to build people's trust, and it's gratifying to see that they're less nervous and upset because they know what's going on. Basically it's just good medicine, but it translates across the board to patients being happier, as well."