From resident to family doctor

Preplan

A little planning can go a long way.

• Speak with the front desk staff about your expectations on or before your first day.

  • - Be firm about how patient tardiness should be handled. Inform staff members that if a patient is late and you are already backlogged, they should either rebook an appointment or explain to the patient that you will see him or her at the end of the day. (You are understanding that life happens and there are times when you will make exceptions, but just do not make it a habit and patients will respect your time.)

  • - Set boundaries early regarding double-booking and walk-ins or add-ins.

  • - Be clear about how much time you would like patients to be booked for. Consider less time for prescription refills (5 to 10 minutes) and more time (30 minutes) for physical examinations or completing insurance forms, income support forms, etc.

• Try to determine how many patients you can comfortably manage in a day and per hour early on. This number might increase as you get more comfortable or as you get to know your patient panel, and you can change your appointment slots accordingly.

• Plan breaks in your clinic day. For every 2 to 5 patients, block off an appointment slot to catch up or to act as a buffer for appointments that go over the allotted time.

• Purposefully leave day-of appointment slots free if you would like your patients to be able to see you on short notice or for small emergencies (and avoid being put behind schedule by “squeezing little Timmy in to look at his sprained ankle”).

• Set expectations with patients early. Advise them to show up 10 minutes before their appointment in order to measure vital signs, etc, so you can see them at their given appointment time. Train your staff to facilitate this process.

• Identify your complex patients who usually need more time and flag them for staff so longer time slots can be booked.

Delegate, delegate, delegate!

Get comfortable asking for help or asking others to do tasks that do not need to be completed by you.

• Have your medical office assistant or nursing staff proofread and format your referral letters before sending them. Many electronic medical records (EMRs) can also autopopulate information into a referral letter, so you do not have to retype a medical list or a past medical history.

• Have your nurse or medical office assistant collect information and start the paperwork for first prenatal appointments or complex care plans before you see the patient.

• Train your staff to get patients and equipment ready for you; for example, if the appointment is for a complete physical examination for a female patient who is due for a Papanicolaou test, make sure the patient is already undressed with a drape before you get into the room. If you are performing a procedure, have the staff members prepare all your equipment and gloves so that you can proceed when you enter the room.

• Have staff members communicate laboratory test or imaging results to patients if a telephone call needs to be made.

Get smart when recording

It is important to develop strategies for dealing with paperwork and charting, as well as to make the best use of technology.

• Build time into your schedule to do paperwork, review laboratory test results, and answer fax communications (eg, allocate a half-day once per week or 30 to 60 minutes every morning before clinic). If you do not create time for this, the pile can quickly become overwhelming and it will interrupt your work day.

• Do not reinvent the wheel: Using a template, stamp, or quick text (based on your EMR functionality or ones you have personally created or saved) for encounters you see often (eg, complete physical examinations, upper respiratory tract infections, biopsies, sutures, intrauterine devices) saves you time, as you can avoid retyping everything and just modify it slightly per patient.

• Use a smart electronic device. Many EMRs can now sync to our smartphones, and (as long as you have patient consent) taking a picture of a rash and linking it to a visit is quicker than describing it and gives you the benefit of visual review for follow-up appointments.

• Try to type while you are speaking with the patient.

  • - The ergonomics of the room might not be ideal for this and certain clinical scenarios might require more of your full attention, but typing as you are collecting information from the patient will cut down on time spent charting after the patient leaves.

• Try to finish charting a patient encounter before moving on to the next patient (much more efficient to do it while your memory is fresh) rather than at the end of the day.

• Do you hate typing or are you slow at it? Consider investing in software that allows you to dictate all patient encounters.

Build billing knowledge

Billing is often a steep learning curve for new graduates or early career physicians.

• Try to complete billing on a daily basis; not only will you learn quicker, but you will also be more efficient while visits are fresh in your mind.

• Once you know your billing codes, do your billing as soon as you finish the patient encounter so that this work is not left for the end of the day.

• Learn about which services are uninsured. Make a list of the costs that you or your office will charge for various services, and make this list visible to patients and staff.

Control the chatter

Maintaining the flow of the appointment can be a challenge with chatty or long-winded patients.

• When patients say they have a “list of things” to tell you, hear them out but then ask them to identify which items they want to focus on today, as you want to ensure to give due attention to their most pressing concerns. Book follow-up appointments for the other items if you have to.

• When seeing your senior patients, ask them the following question: “What has changed since the last time I saw you?” This can help avoid patients rehashing their chronic, unchanging hip pain or the lump they have had on their wrist since they were 4 years old.

• If possible, position printers outside the visit rooms. This allows for a very natural “Come with me to get your prescription or requisition form on your way out the door.”

Remember to be polite and courteous

Respectfully communicate delays to patients.

• Have front desk staff inform patients about time delays—for example, “Dr X. is 45 minutes behind schedule but you are next in line.” This will manage patient expectations, as well as prevent a frustrated patient stewing in your waiting room for 45 minutes while waiting to be seen.

• When you are behind schedule, acknowledge your patients who have waited and apologize or thank them for their understanding. Patients’ time is valuable too and simple acknowledgment goes a long way in securing a strong doctor-patient relationship.

Be honest with yourself

Finally, be honest with yourself. If you are feeling overwhelmed in clinic or constantly running behind schedule, take stock of where your “time sinks” are and modify accordingly. Be supportive and appreciative of your staff while being clear about expectations; they are there to help. The smoother your clinic days run, the happier you, your staff, and your patients will be.