I really liked the sound of this method, so I tried it out in clinic last week. Didn't work so well for me. My patients definitely went on for longer than 3 minutes...one of them literally went on for 10 minutes and I had a hard time getting a word in edgewise. Once I gave her the floor, it was impossible to take it back. Still, I'd really like to learn how to use this method well, and I'd appreciate your advice.
So-- when you use this method, how do you deal with those patients who can't seem to wrap up their story in 3 minutes? And once you've identified those folks, how do you approach them at future visits?
Right now the big thing I'm working on is becoming more efficient in my continuity clinic, so any tips along these lines are much appreciated.
Well, just as nabeya mentioned, everyone has their own style. And I'd say for the MAJORITY of people, this probably is not the method for them. But I can say that for me personally, this has been a great method for me to use.
I thought about what you wrote, and thought about the other things that make my clinic go faster. I'm sure you know these already, but perhaps there may be a few things that you may use. There are exceptions (I'm no longer a resident, so I always have the same M.A. who knows my style and expectations...):
-I review the chart, and have a mental note of issues address things that should be done or the patient might ask about (re-order labs, radiology results, health maintenance, etc.)..anticipate some of their interests
-My M.A. already knows the chief complaint, but will ask about "anything else". Yes...pandora's box for a lot of people. But I like to know ahead of time. She'll write the list down (one or two words each) and yeah, maybe it will be 10 items long. But if you look at the list, you'll probably find 2 or 3 issues/symptoms and they may be related to each other and you can condense "the list". Since I've reviewed the chart (for the established patient), I may be able to answer the questions off the bat. Also from that list, I always think "what is really the most important one that can really have a bad outcome". Obviously that becomes #1.
-I have a good working relationship with my M.A., and I had a good 30 minute meeting when we first started working together about some things she can do to prep the patient for me. Like all diabetics to remove their shoes, check their blood sugar if they didn't check it that day. EKG automatically if they came in for "chest pain" (but she'll ask if one was just done very recently). peak flow and O2 sat for shortness of breath. urine dips for all women with abdominal pain and a pregnancy test if their period is not regular. This is just a short list. There are many more to list, but I'm sure you have many ideas
-For a screening physical, I already have lab slips labeled in the chart by my M.A.; I just check the usual "screening labs" and add the rest after I finish the visit
-having the cryo already in the room for warts, eye tray out for eye issues
-prepping the patient for procedures by having the paperwork ready
-coming in for f/u of fractures that I splinted/casts....patients automatically go to xray with my orders
The point I'm trying to make is that I really depend on my M.A. to take care of the "little things" that add up quickly and extend the visit. My M.A. is excellent, and anticipates what I need and is a quick learner.
Because she is already anticipating what I may need, and I have reviewed the chart beforehand, I usually have all of the information I need. Afterwards, it really is just me listening and I do try to keep it about 3 minutes max. (there are always exceptions). I know about the "10 minute stories", and we've all heard them. But that's why I have that list before I walk in the room, and my M.A. will make the list but will interrupt the patient when they start moving away from making a list (and very politely...she just defers to me to address more in detail).
For me, it really was preparation before actually walking in the room...and a lot of it was how well my M.A. can anticipate what is needed.
And about what I do: I am a Family Med/Sports Med doc, but I'd say about 65-85% of my day is primary care (the rest are consults or musculoskeletal patient visits of my own).
But I do admit, as a resident this method would never work. I always had a different M.A. with different skill levels of anticipation. Depending on the attending I had to discuss the patient, sometimes not at all, and sometimes from scratch (ugh, some attendings were just uber picky no matter what level resident you were). We've all been there...."oh by the way" was frustrating while I was a resident. But now, with what I am doing, I don't mind them anymore and when it does happen, I think about how if it's something minor it can actually upcode my visit, or add a modifier.
But it was these experiences where I thought about how I can make things more efficient, and once I had my own M.A. and receptionist, it became my own style and it was easier to see a lot of patients. And it was just a lot of trial and error to find what worked and what didn't.
Just please keep in mind, as I've mentioned before, I would say MOST people hate doing it this way, and that's okay. But for me, the reward of having the patient say to me "you're the first doctor I've ever had to just listen and not write/answer their phone/type in the room/etc." is just so gratifying. But it did take me a while to get to the point where I could just listen by making other parts of the visit more efficient to compensate.
And on a final note...having a great working environment can make a world of difference. My M.A and receptionist work together as a team, and believe it or not....if things are very busy and my M.A. is let's say doing an EKG and another patient is here...I will check them in myself and just start the visit (vitals and all). Little things like this speeds up things, makes the M.A. feel less pressure, and the patient is happy.
Hope this helps.
