Dr. Sarah Smith [00:00:04]:
Welcome to the sustainable clinical medicine podcast. I am your host, Sarah Smith. I am a practicing rural family physician and the charting coach. This is the podcast for physicians and advanced practice providers who are ready to step back from the busyness of their clinical day to share ideas, question everything, and redesign their clinical day. We are redesigning clinical medicine to create sustainable clinical days and create time for our lives outside of medicine. Join us for discussions with world experts who are helping design sustainable models of clinical medicine and the physicians or clinicians who have discovered or designed sustainable models of clinical medicine for themselves. Hey, everybody. Welcome back.
Dr. Sarah Smith [00:00:52]:
Did you know that this is the 1 hundredth episode of Sustainable Clinical Medicine podcast? And I am so delighted that you are here and that you've been telling me that you've been enjoying the podcast. My team of amazing helpers behind the scenes have encouraged me to tell you why I started this podcast, and I thought it was a good enough reason to have a podcast episode. So let's dive in. As you know, I have 2 amazing programs for my amazing members. We have charting champions program for physicians and the smarter charting program for our nurse practitioners, physician assistants, residents, and other allied health professionals. Both of these programs are one time by and lifetime access. And inside the programs, we have regular calls where we talk about anything to do with your clinical day that is stopping you getting home with your work done. We do clinical practice efficiency, and we give you those weekly Zoom calls so you can come inside and get that individualized help for yourself from our clinical day advisors.
Dr. Sarah Smith [00:02:10]:
When I was considering a podcast, I wanted to make sure that it was valuable to our members. These are the physicians and clinicians who are wanting to create a sustainable clinical day their way. And there are many, many aspects of our clinical day, and some amazing experts in the world working on creating sustainability for clinical medicine. We are very thankful to those experts, and you've heard many of their wisdom and ideas here on the podcast. If at any point you hear of an amazing person in the world doing great things towards sustainability in our clinical day, please make sure you reach out. Let me know by email or in the comments or reviews about someone you'd like me to interview here on the podcast. In the meantime, we've developed a listenership, which is beyond the members. So it's not just the members of the Charting Champions and Smarter Charting Program who are listening in to keep getting great ideas on how to adapt their clinical day.
Dr. Sarah Smith [00:03:28]:
It's also all of you, listeners, who are not necessarily part of the program, but you're getting value from this podcast. And I'm delighted to have you here. Some of you have left reviews, and I'd like to list a couple of those right now so that you can hear from other listeners. We have Gazzuzi in the United States left us a 5 star review. Thank you so much. Doctor Sarah does a terrific job of providing tips for practicing docs and health care professionals. She's a great interviewer. Thank you so much.
Dr. Sarah Smith [00:04:05]:
And then there's the stories. I love hearing your stories. So please remember to subscribe and jump in and leave a review for us. Tell us your story. This is from Leanne T. Thank you. I am 3 years into family medicine practice at a health network and was feeling so burnt out. It is too soon to feel this way.
Dr. Sarah Smith [00:04:29]:
I have a toddler at home and priorities outside of work. And I like medicine, the work we do at its core. Thank you for giving doctors this powerful tool. It was the reminder I needed that we can do both and that we are in control of a lot more than we realize. I feel lighter, like my job more. I love my family time even more. My loved ones have even noticed the shift. I have to work.
Dr. Sarah Smith [00:05:01]:
I have work to do, but this was an incredible start. Truly, this podcast has saved me. Thank you for this. And I thank you, Leanne, for the work you're doing in the world and all of you who are persisting despite our health care systems, EMRs, administration, and other areas that may not necessarily be out there in our favor to help us. This one from tce99jfm. In medicine, there are so many podcasts to listen to these days, which is fantastic, But this podcast offers real practical support to sustain our work we do in these very challenging times. Thank you, Sarah, for creating this space. You're most welcome.
Dr. Sarah Smith [00:05:46]:
And this one from k m 777. This is a much needed resource for physicians. Sarah expertly conveys transformative before and after stories, making complex topics digestible. Her interviews with experienced coaches provide actionable strategies and an essential listen for our forward thinking physicians. Thank you again for that review. I wanted to mention that, yes, I do have quite a number of physician coaches in the podcast as experts in their area. And I did have someone reach out and ask if the aim was for us all to become coaches. And no.
Dr. Sarah Smith [00:06:26]:
That is not what the aim is. What's fascinating about coaching is that ability to go after incredible and impossible goals and have that support and encouragement to figure out the obstacles on our way towards something that we want in our lives. That's what the coaching experience was for me at the start of my journey. And in the process of achieving big, amazing, or new things in the world, sometimes that amazing assistance from the coaches has encouraged the physicians to go and become coaches themselves. So often, we've come across coaching in the pursuit of trying to make something better. And in doing so, we've done what we do as physicians and clinicians. We wanted to learn more. We wanted to know that this wasn't just a magic wand, and it's repeatable.
Dr. Sarah Smith [00:07:25]:
And so many of us have come into certification of coaching from that way. You've heard me on the podcast talking about my story, that at the beginning of this journey, about 2017, it was me who needed help creating a sustainable clinical day. I was done with later. I did not wanna be at the office for long hours anymore. I did not wanna go home with work still left behind. I was done with working in the evenings. I was done with missing out on weekends, socialization, physical exercise, and other aspects of my personal life to complete the work of the clinical day. It took me 18 months working with a coach who was not a physician, but she was helping me know that doing something new and impossible was possible if I wanted it.
Dr. Sarah Smith [00:08:24]:
If I didn't quit, if I didn't just wish for it, if I was prepared to do new and hard things and know that I would fail and it would be okay so long as I didn't quit, I could go and make something new for myself in the world. And that's what I encourage you here to know. That if you have something about your clinical day that's frustrating you and you'd like it to look or feel different, you can do that. And it is much easier with help. It's much easier with community. And it's always hard and frustrating and difficult to do new things. So I want to encourage you, whatever that looks like for you in your journey, if you have a deep desire to create different about your life or your work, go for it. Really start to define what is it that you want, where are you going? You don't know the how yet.
Dr. Sarah Smith [00:09:28]:
You don't know the path. You don't even know the obstacles you'll come up against. But I encourage you to look and say, what is it that I'd like? What is it that I'd like to go and create in the world about my life. You don't have to give yourself a deadline. You don't have to know the way. You just need to know what you want and then work towards it. Don't quit. Go and create big, mighty, or new in the world for yourself if you want to.
Dr. Sarah Smith [00:09:57]:
I look forward to bringing in new and exciting guests for us to learn from because there are infinite challenges about our clinical day. And in good news, there's infinite options about our clinical day. There are so many ways to do this. I am so encouraged by the innovation that I hear and see about my members within the programs, we have in there some really amazing people. Most recently, one of the conversations I had was a physician assistant whose medical administration has asked her to double the number of patients that she sees in a day. Now that is a big challenge. Most of us would really struggle to hear that type of recommendation. And when she asked questions, she was informed that her in basket was not going to be within her immediate responsibility.
Dr. Sarah Smith [00:11:04]:
She was the most responsible physician clinician for that in basket. But the nursing staff would be the ones doing the work within that in basket. Isn't that fascinating? For many of us, that in basket is sacred territory. I audit it. It's my responsibility. And while the responsibility is still within her control, she has somebody else doing the work for her. Fascinating. Now what? What would that look like? Well, it looks like having to build this skill of putting someone there for you to do that work.
Dr. Sarah Smith [00:11:47]:
That onboarding, the making sure the quality, making sure we've thought about how we empty that in basket. It's not something that we're all asked to do. But in this case, she was asked to do this. So we worked on strategies for how this would look to help onboard these clinical staff members to help you. And starting to build processes and systems to help them not have exponential questions and to be able to do quality work on her behalf. It looks like how do we know there's quality? How do we watch for that? What's it gonna look like to do this work in a different way? This is just one of the many infinite possibilities, and I hope to bring some of these members in to interview them so you can hear about these challenges and frustrations and how they've managed to start to be curious about different ways of doing this work. This year, I've been asked to do some speaking engagements for some organizations, and I have absolutely loved the challenge of this. And these are now resources that we can use in the world to further teach and enhance our clinical day.
Dr. Sarah Smith [00:13:08]:
One of the examples is working with North Calgary. Sorry, West Calgary Physicians, in their their primary care network. We worked on doing a chart audit around the standard of care and medical documentation towards the physician practice improvement program for their doctors, which was super exciting to be able to help them achieve their quality assurance activity within a facilitated discussion. We talked about what it looks like with regards to the standard of practice around medical documentation, and then we looked at what it looks like to look at your own records and do that audit. It's a little bit challenging, isn't it, to be confronted by what do I actually put in the note? Is it good enough? Is it up to standard? And we looked at clinic processes. How easy is it for your patients to get appointments? How easy is it to know if they should be telehealth or by phone? What is your access like? What is the follow-up like? Our inboxes emptied quickly. All of the other parts of that practice improvement. Then we as we marked ourselves against the standard with these audits, we came together to talk about it.
Dr. Sarah Smith [00:14:36]:
To talk about not just what is the standard and am I up to the standard, where are my deficiencies, and how could I start to do things differently? How could I use the team members that exist around me to help me towards these goals? And what other great ideas are out there for helping get this work done that's not just you? I wanna know where we can find time back for you. Where else can we use team or other automations or easier workflows to get you done while staying up to standard? Part of the challenge. The next group that I loved working with this year was in North Zone Edmonton. They had their annual conference for their family doctors, and we talked about working within uncertainty. You've heard me talk about this on the podcast. I actually did a couple of an episode on it for you so you can hear all about that talk because we all work within uncertainty. We don't know when our lunch break will be. We don't know which patients will show up or which ones will show up late.
Dr. Sarah Smith [00:15:49]:
Even the things that we think we're good at, like prescribing common medications, guess what? Occasionally, it doesn't go well. Not with any intention of doing harm, but simply that some medications can have side effects and long term complications for our patients. We had the uncertainty of pay models, of how many patients we have to see in a day. So much of our day is uncertainty. And that's just a reminder that you are amazing, courageous, brave. When you're working, you're working with that risk and uncertainty, and yet you still show up and help and look after your people and do an amazing job. So thank you for your service, for looking after your patients within the model of health care that you exist. You're awesome.
Dr. Sarah Smith [00:16:43]:
Tonight, I'm working with the Nanaimo Division of Family Physicians. Hi, guys. Because I'm sure we'll talk about this podcast tonight. Tonight, we're talking about sustainable access. We're looking at access improvement. We're looking at the whole topic of access and how we can start to do things in a way that's unique to you or within the health care system or the clinic or the rules that exist for you right now. Some of you have significant autonomy when it comes to booking in patients, and others are really limited by what's given to you, especially those of you working in salaried positions in the states. I hear it.
Dr. Sarah Smith [00:17:29]:
I talk to you often, weekly, in fact, about the challenges that come from systems that don't have as much autonomy. But we're talking about the infinite possibilities around access. When we're talking about family medicine in particular, I wanna recognize how awesome you guys are. There was some, review of the studies around continuity of care. So this is relational continuity in family or primary care, where patients who are linked to a specific family doctor or to a specific clinic, which is their patient medical home, there is good evidence. 8 out of 10 studies showed improvement in preventative care for patients that had a family physician. 61 out of 64 showed positive results in lowering utilization of hospitals. 11 out of 11 studies showed reduced mortality, and this was of all age groups, not just our most severely unwell patients.
Dr. Sarah Smith [00:18:45]:
Isn't that incredible? 13 out of 16 studies showed positive results in improved health for our patients. 16 out of 17 studies demonstrated cost savings to the health care system when patients had relational continuity with their primary care physician. 6 10 out of 16 studies showed positive results in overall care quality for patients who had a family doctor. 15 out of 16 studies showed increased patient satisfaction around their health care needs being met, and 6 out of 6 studies showed improved self management and treatment adherence for patients who had a family physician. That's pretty damn incredible. Someone who acknowledge how awesome we are to be looking after our patients in such a way and to even be considering improving our access when we know that the demand well exceeds the supply of family physicians, especially in Canada right now, we're seeing a significant amount of population that don't have family doctors. So when we start to look at, consider, and change up the ways we're providing access for our patients, it's doing so within these models where there is increased demand and so valuable when we're thinking about trying to improve access for patients and reduce using other systems like the urgent cares or emergency departments when they're not appropriate. So we're gonna be looking at this from all the angles, looking at you within your clinical day, how are we currently looking after those requests for same day access, What else could be possible if we didn't wanna try and squeeze them into our lunch break before work or after work and increasing and increasing and increasing our work hours? I know for me, the hours I work are the hours I can work.
Dr. Sarah Smith [00:20:51]:
If I keep going beyond that, I am going to get significantly fatigued. It will not be sustainable. So now what? How do we start to be curious about when we fit in these urgent and necessary follow ups, And what else could we be doing differently so that it isn't just extending our work hours? How are we using what we're doing within our in basket to help us with regards to follow ups? There are ways when we're seeing a patient, we can help them understand. For instance, if you're giving out a CT requisition, you may let them know. I don't know when your CT appointment will be, but I know I wanna talk to you about it. Please book in. As soon as you get that appointment, rebook to see me so we can go through those results together. That's gonna reduce the time it takes you to see that result in your in basket and give you opportunity to discuss that result with your patient without trying to add them in to an already full schedule.
Dr. Sarah Smith [00:22:00]:
We look at other parts of the team that could help you. For instance, we have an access for patients who can come in and get a urine dip done with our nurse. That way, if it's positive, she can find a place to put you in the clinic. It may not be with you, the usual and preferred physician, but it's with one of the physicians, knowing that this is a way that we can look after our patients early in their symptoms, and we're seeing them when it's necessary, not just on those early symptoms that aren't necessarily showing us true signs of infection. We start looking at the team, and not just the team who are within our clinic walls that we're paying money for. We look at the team beyond the walls of the clinic. I love walking the pavement is a way of describing this. And I think we've talked about this on the podcast previously.
Dr. Sarah Smith [00:23:02]:
Who's in your circle? Who's in your patient's neighborhood, medical neighborhood? For instance, social workers who work with our homeless or disadvantaged patients in community, by having really good relationships with those amazing humans who are doing great work in the world, they can help advocate for their patients who need care. I had no issue with my local social worker having my cell number and being able to coordinate care because it helps link in those people who may not be able to advocate or stay on a phone for 20 minutes waiting for someone to answer. Having relationships with the pharmacist near us. I have an advantage as a rural physician to have a limited number of pharmacies near me. And those relationships are crucial because it can reduce the time in the room for the patient within that appointment, which increases my capacity to potentially add more patients to my day. If I can ask the patient to go and see the pharmacist to have that explained, Because I know the pharmacist, the pharmacist knows me, and if I ask them to do something like that on the prescription, they will be able to do that for the patient and provide some of that education and have the time to do that better than me within the room. And in language, a patient can understand and then providing them written information when required. Who else is within your sphere of influence that you could bring into some of those patient visits that could help you reduce the time in the room or increase the quality of care for your patients? What else is your team doing that could help reduce your time in the room? Thinking about that cumulative patient profile, health summary, recalls based on those pieces of data that come in, like the mammogram requisition and when that next one needs to be done.
Dr. Sarah Smith [00:25:11]:
Some of these items could be done within the team that exists within your clinic. What this does is it can help reduce the number of administrative things you're doing in the consultations or reducing the time in the room knowing that the recall or the screening maneuvers are being handled for you. That's gonna save you significant time in the room when that process is developed as a team and done well, the quality assurance is in place, and we have those systems and processes to look after our patients within this patient medical home. So many ideas. Okay. As we enter 2025, I'm excited for some of the guests that we have coming up, and I am delighted by the expertise that we've already had inside our podcast here. I wanted to read another testimonial here from who is that from? Oz f x m e d. Thank you.
Dr. Sarah Smith [00:26:29]:
I've often listened to doctor Sarah Smith on many of her podcasts with her lovely lilt to her voice and curiosity to why people do what they do. She's generous in sharing her wisdom and strategies for sustainable medicine and how to get the workload done. I'd highly recommend this podcast to anyone wanting to get some practical tools to keep themselves in the game. Thank you so much. As some of you know, this year in August, I relocated back to Australia. I am now living in tropical North Queensland, which is similar place to where I've worked before. And this time, I'm considering doing more locums, and that's so that I can keep fresh with seeing how others do it, other systems and processes that I notice that I like, more ideas, more innovation, and how I tackle working within new systems all the time keeps my brain fresh for you and for the members inside our communities. So that's an exciting change that some of you know about, especially if you're members inside the program, but others might be hearing for the first time.
Dr. Sarah Smith [00:27:46]:
It's part of where that LILT comes from, my Australian background, and learning how to speak to Canadians within our community context because we've been in Canada for the last 12 years. So that's why there's a little bit of an accent, which isn't really easy to place one way or the other. So I'm excited for that, and I'll be keeping you abreast of all the things I learned, especially if you're inside the communities. We talk about some of the things I notice about the clinic and the clinical processes that I love and some things that I still get frustrated by just like you, especially things like electronic medical records. Thank you for being here with us as we celebrate 100 podcast episodes. Hopefully, you've had a little glimpse into some of the things we've been doing within, beyond just how to get home with our charts and paperwork done. So that remains a very central part of the teaching. And I look forward to hearing your stories of how you've created a clinical day that is more sustainable for you.
Dr. Sarah Smith [00:28:57]:
Now as a podcast listener, one final big important thing to know. Keep listening. We have coming up for you something that is just for you. A special thank you for being a listener of the podcast. So as you keep listening, you'll hear ways to enter for that, which is very exciting. I look forward to next time. Thanks for being here. Have a great day.
Dr. Sarah Smith [00:29:25]:
Bye, everyone. Thank you for being part of the sustainable clinical medicine podcast. If you'd like to learn more or join us to help you get home with today's work done, go to chartingcoach.ca. There you'll find all the information on the premier lifetime access charting champions program that is helping physicians get home with today's work done with all the proven tools, support, and community you need to create time for your life outside of medicine. We would love to see you there. Until next time. Thanks for listening.
