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Put Creamer in the Coffee First

Posted By Alan Lorenz, Friday, February 14, 2014
On the way to work the other day, I was listening to an interview of an efficiency expert on NPR. He spoke about his work consulting with companies on how to be more efficient. Some recommendations were fairly obvious, some were more obscure, but one was stunningly brilliant and forever changed my life -- put creamer in the coffee first.

I drink coffee every day. I had always poured my coffee first, then added creamer, then stirred with a spoon. Granted, I’m not as alert before the coffee, but it had never occurred to me to put the creamer in first. Look around – most everyone does it this way. If you put the creamer in the cup first, the magic concoction is blended as you add the coffee. There is no need for the spoon!

Think how much greener this is. How much less energy will I use in my lifetime by not washing a dirty spoon?  How much less polluting detergent will be used? How much less landfill will be created? Not to mention what’s involved with wiping up that bit of mess on the counter, or the time it takes to find a spoon, and wash it.

I know it’s a simple analogy, but here’s my point – How many simple changes are there right in front of us that can make our lives easier, more efficient, and greener?  In particular, how many health care practices are done the traditional way – like using a spoon -- but could be done more efficiently and greener much of the time? Even more specifically, and to really push the analogy, what is the right mix, and what is the right way to mix, the Behavioral Health Consultant (BHC) and the Medical Provider? Who should see the patient first? Should a triage person see the patient first and then direct them to the professional that makes the most sense? Should they come in the room together? Should a BHC always see them last to ensure understanding and agreement about how to move forward?

By this time, most all of us have seen the advantages of shared location. Nothing beats great access of the "other” health care professional. Sometimes it’s a quick question; sometimes it’s a curbside consult; sometimes it’s an important update; and, sometimes it’s an urgent need to see someone now. There is some debate, and of course practical considerations, to decide between shared building, shared floor, shared hallway, or even shared office. Joint appointments are the best, if you can swing it (both financially and operationally), if even only for a few minutes of shared time.

Over 25 years ago, Michael Glenn, MD1 experimented with a medical provider and behavioral health consultant seeing all patients together, at least initially. I think we still don’t have that initial bit right. There are some out there who have tried "on the fly” triage. How is that working? There are some out there who have had a BHC stop in to visit with each patient for a "medical” visit either before or after the face-to-face with the medical provider. There are some who have experimented with universal availability of behavioral health consultants. Perhaps some have experimented with the scheduling person asking about the need for co-consultation during the visit when the appointment is made. Chime in.
Think outside the cup

My purpose here is to stir things up for those who are more separated, traditional, and in their own silos. I would like to encourage those who have thought "outside the cup” to speak up. I am particularly interested in the mix, from point of first contact to checking out. It’s probably even more than that -- what is the wording in the brochures, signs in the waiting room. Maybe there is something simple, right in front of us, that we can change that would simplify our lives, lead to better care, and conserve resources. Let’s mix it up and see what happens. Like the creamer in the coffee, it’s not just what the right proportions are, but what is the best way to mix together.

Now that the everyday coffee drinking behavior of some readers has changed, let’s think about why it took us so long to figure out how to put wheels on suitcases …

(1)  Glenn, M.L. (1987). Collaborative heath care: A family-oriented model. New York: Praeger.

Alan Lorenz, MD is a charter member of CFHA and now works at the University Health Service at the University of Rochester where he is an Associate Professor in both the Departments of Family Medicine and Psychiatry.

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