Patient Treatment Plans

By Jim Poggi

Begin with the end in mind

In the case of patient treatment plans, the end is always the same. It may not be fun to think about, but a disease, an accident or an act by the patient themselves ends their life. We may not think in these terms, or face this somewhat grim reality every day, but the physicians and care givers who are our customers and prospects are faced with the mortality of their patients every day, and with every decision they make. Their mission is to provide their patients with the best quality of life possible, and help patients to make personal healthcare and lifestyle decisions to provide a long and healthy life. So, how does knowing this help us?

Practice perspective
First of all, it helps ground our mindset and try to see the daily activities of our clients through their eyes and daily experience. Since 70 percent of all medical decisions involve a lab result, this information is critical to patient treatment plans.

Whether the caregiver is using lab tests to provide insight while conducting routine screening, screening for patients at risk, conducting routine follow up for a chronic condition, or taking acute intervention for a respiratory illness, what they need to know, how to get the information and how to communicate it to the patient to assure the best health outcome and encourage patient compliance is an everyday concern.

By knowing the diseases and disorders our clients face and understanding the role of lab testing to provide this critical information at the point of care, we become more valuable and more respected as useful allies. In addition, now more than ever, market realities including emphasis on improving patient outcomes and satisfaction, coupled with patients becoming more savvy healthcare consumers and an expanding array of care setting and care choices, adds importance to our consultation with current and prospective customers to keep them in the know and help them remain competitive.

The role of lab testing

First, let’s look at why physicians see patients and the role of lab testing in these situations:

Clinical situation	Who and why?	Tests that help	Are these tests waived?
General screening	Annual physical, new job, school change, patient request	Urinalysis, glucose, lipids, CBC, basic and comprehensive metabolic panel	All with the exception of most CBCs
At-risk patient screening	Patients who meet the criteria for pre-disposition to be at risk for a health condition	FOBT/FIT for patients over 50, Lipids for patients who present with weight or cardiac symptoms, Glucose related to weight, life style or personal or family history, Lead for children in older homes	Yes
Treatment plan follow up	Patients under treatment for a chronic condition	Glucose, CBC, PT/INR, CMP, BMP, lipids, urinalysis, organ test panels	Most; this is the broadest menu of tests applicable in primary care related to typical patient diseases and conditions
Acute respiratory symptoms	Typically seasonal incidence for influenza, strep is year round	Flu, strep, RSV, pneumonia tests	Yes; pneumonia is the typical exception

So, how does why the physician see patients relate to the most common causes of disease and death? The answer is in every primary care waiting room. Look around as you get ready to talk to your client. You will see patients who are experiencing treatment for one of the chronic conditions we are about to explore, because primary care is where they show up. The patient mix and ratio of diseases may shift a bit from practice to practice, but the reality is, this is what our clients see every day and the treatment programs they need to initiate and manage.

While the average primary care practice experiences a number of patient visits for wellness and routine check ups, the real challenge is in managing patients with chronic diseases, or patients who are on their way to chronic diseases due to risk factors in their life style, family history or both. Even with patients who are in apparent good health, the physician and caregiver need to think ahead to reduce the patient’s risk of illness. In addition to classic history, physical and vital signs, lab testing completes the picture.

Starting point

The most common causes of illness and death in the United States

Rank	Clinical condition	Lab Tests	Screen/Follow up/Both	Waived?
1	Heart disease	Glucose, BNP, lipids, PT/INR, BMP and CMP	Both	Yes
2	Cancer	Organ panels, tumor markers, CBC	Both	Some organ panels
3	Chronic lower respiratory disease	Electrolytes, CBC, CMP, Blood gases	Both	Some electrolytes and CMP
4	Unintentional injuries	N/A	N/A	N/A
5	Stroke	Electrolytes, CBC, CMP, Blood gases, PT/INR	Both	Yes, except blood gases and most CBC
6	Alzheimer’s disease	N/A	N/A	N/A
7	Diabetes mellitus	Glucose, glycosylated hemoglobin, urinalysis, albumin, creatinine	Both	Yes
8	Influenza and pneumonia	Tests for flu, strep, RSV, pneumonia	Screen	Most; some pneumonia is not
9	Nephritis, other kidney disease	Creatinine, BUN, CMP, urinalysis, microalbumin	Both	Yes
10	Suicide	N/A	N/A	N/A

As you get your head around why your customers see patients and develop treatment plans, and what diseases and disorders they see most frequently, you can focus your efforts on being a useful resource to help them think about the value of testing in general and patient specific testing for the conditions they see most often.

The result? You, your clients and their patients all have improved outcomes — faster, better care and increased care giver and patient satisfaction. And most likely, an improvement in office efficiency and patient convenience by providing needed tests at the point of care during the patient visit.

That’s a big win for everyone involved in patient care.