Nov 20, 2020

TRANSCRIPT

So you went to the doctor for a problem, doctor made a plan, and you may have followed the plan or maybe you didn't, but you never told the doctor that it didn't get better. This is why follow-up is so important.

So it turns out that often people come to their physician, and in this case, for me, it's a gynecologist, and they have a problem. Let's just pick hot flashes. They come in, they have hot flashes, I talk about hot flashes, and I say, "I think you're a good candidate for some estrogen." And I write them a prescription, and I send them home. And I think I'm the best, smartest doctor that ever was because I didn't see them again. Now, what possibly happened?

Statistically, 50% of those patients, they get a prescription for hormones, and this is just this particular kind of problem, but get a prescription for hormones, don't ever fill it. Do I know that? No, I don't know. My system doesn't tell me with a little alert on their electronic health record that she didn't ever fill it. So I don't know she didn't fill it. What happened if she filled it and took it and it didn't help, but she thinks I'm a bad doctor because I gave her something and she didn't come back? I have lots of other tools in my toolkit, but if I don't know from her that she isn't better, then I can't do anything.

So follow-up is a difficult thing, because it has to do with failure. It has to do with communication. So in the case of the thing that I know best, which is hot flashes, I may have not really gotten to the bottom of what this patient's primary concern is. Maybe her primary concern is that she's not a woman anymore, or maybe her primary concern is that these hot flashes make her cranky and she's angry at her family, and this is really not about hot flashes, but that's what brought her in. I heard hot flashes. She's a woman of the right age. I prescribed a medication that usually works, and I sent her home happily according to me, but she's not happy. And this is where follow-up is important.

Now, the question is, whose responsibility is it to follow up? I personally think it's my electronic health record, because the electronic health record should give me a ping if my patient didn't follow up the prescription. I think my electronic health record should send out a little reminder to my patient, "Dr. Jones gave you a prescription three days ago for the problem that you saw her for. Did you get better? If you got better, keep taking it. If you didn't get better, please call. If you got better but you're having side effects, make a follow-up appointment so we can talk about alternatives." This is something that would be so easy for an electronic health record to do, and we get all these telephone calls anyway about what we thought about our doctor and what we thought about the clinic. So why not have a little reminder, "Your doctor gave you a prescription. Did you fill it? If you filled it and it didn't work, push 1. If you filled it and it did work, push 2. If you filled it and you had side effects, push 3, which it will get you right to my nurse."

So if your electronic health record doesn't do this, and the vast majority don't, what should you do if it doesn't work? You should let us know. So if you didn't fill it but you're still symptomatic because you had questions that weren't answered, call my nurse, ask those questions on our private email, or come back and see me. If you took it and did fill it and it worked, well, just keep taking it, and I'll see you in a year. If you took it and you had a side effect, I want to hear about that, because it turns out I have a whole bunch of other things in my tool case that we could try.

So I used the paradigm for hot flashes. I could have used it for any one of a number of common problems. But follow-up is important on my part, and follow-up is important on your part. And don't just give up because you tried once, because we have a lot of Plan B's. So keep thinking about it, learn more, come back and see me, and thanks for joining us on The Scope.

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