IMPROVE EFFICIENCY THROUGH DIGITAL SCRIBES

An artificial intelligence (AI) scribe is the most exciting tool I have implemented in my practice recently. I estimate it has reduced my documentation time by at least 60%. AI scribes are available as mobile apps or can be used alongside the EHR on a laptop as a separate application or internet browser extension.

I wear a portable Bluetooth microphone linked to a Chrome extension on my laptop, allowing me to leave the computer in my office versus having it in the exam room. The AI scribe listens to my conversation with the patient while I provide detailed information about the patient's chronic and new health conditions. I describe any abnormal exam findings to my patient (and my scribe). In this way, I ensure the patient understands what I'm seeing and hearing. The scribe listens to the conversation, turns it into a structured note, and suggests diagnosis codes for billing. The scribe also creates patient instructions based on the conversation, which I can immediately email to or print for the patient.

AI scribes have come a long way in terms of accuracy. Currently, they categorize the conversation into encounter sections and are able to weed out non-relevant discussion. It's important for the clinician to review the note for accuracy and completeness, but a quick scan is usually all you need to confirm the encounter was captured accurately and completely.

APPLY THE 5 A'S FRAMEWORK TO WEIGHT MANAGEMENT

Primary care physicians play an important role in addressing weight management but often face challenges such as lack of patient engagement, short visits, new medical therapies, and inadequate support for behavior change. The “5 A's” framework, originally created for smoking cessation, can be adapted as follows to address weight management challenges in primary care:¹

• Ask patients if they want to discuss weight. If they say no, don't force the issue. Let them know you are there if they become interested in discussing it the future.

• Assess their weight history with a few questions: What is their highest and lowest adult weight? How have they tried to lose weight in the past? Are mental health struggles or social needs contributing to their weight? Are they taking medications that could contribute to weight gain? What comorbidities are they experiencing? Recognize that frequent, short visits are usually necessary for weight-loss support.

• Advise them on a plan to manage their weight, including long-term behavior change. Ensure you are up-to-date on weight-loss guidelines and medications (including combinations of generic medications like bupropion and naltrexone for patients without insurance coverage for GLP-1 agonists) and become familiar with nutrition, physical activity, and bariatric programs in your area so you can advise patients on their options.

• Agree on the treatment plan. Patients must do the difficult work to change, so their buy-in is key, but patients often have unrealistic and ambitious weight-loss goals. Coach them on setting specific, measurable, attainable, relevant, and time-bound goals around diet, physical activity, and self-care.

• Assist patients with making needed connections. This may include behavioral health providers and health coaches, who have extensive training in behavior change. If you have access to these professionals, use them.

DON'T JUST MANAGE CHANGE, MANAGE STABILITY

Some change in the workplace is necessary and inevitable, but constant change is the enemy of performance. People do their best at work “when their environment is predictable, when they have some sense of control over their immediate surroundings, when they are part of a stable set of relationships, when they feel connected to place and ritual, and when the point of their efforts is readily apparent to them.” Where change management focuses on what isn't working, on the organization overall, on what will be different, and on communicating urgency, stability management focuses on what is working, on local teams, on what will be constant, and on communicating reality.