How many distinct complaints do you address in one visit?

Discussion in 'Family Medicine' started by Atlas Shrugged, Dec 6, 2018.

  1. Atlas Shrugged

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    I am curious how encounters go as civilian residents or staff. In the military I've been taking care of around 3 distinct (uncomplicated) problems or one complicated problem in addition to appropriate preventive health maintenance.

    Is it worth it to do this billing-wise for you? Or do you have separate appointments for preventive health maintenance and each chief complaint?
     
  2. VA Hopeful Dr

    VA Hopeful Dr Senior Member
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    Depends. If I've got time, I'll address whatever they want me to. If I'm busy, I usually cut them off after problem 1 (if those are unrelated to the reason the appointment was made, like the diabetic who oh-by-the-way has a cold) or 3-4 if they made the appointment specifically to address those problems.

    Medicare I encourage preventative stuff at the AWV only. Everyone else either at the yearly physical if they want those (as I don't recommend them) or as time permits at regular visits otherwise.
     
  3. Ironheme

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    Averaging around 3. If less time, acute visit, then 1. A few days ago, had a patient bring in a list of 10+ problems they wanted addressed in their 30 minute slot, and hadn't seen a PCP in years. I managed 5 (had a no show), told them to come back for the rest. They still were not happy. I don't understand patients sometimes...You don't go to the mechanic after wrecking your car and expect a 1 day turnaround.
     
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  4. mark v

    mark v Junior Member
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    "Mr/Mrs X. There is no way I can do justice to the numerous things that you've got going on today. It's really not fair to you to try to do everything today as I can do a few things well, or a bunch of things poorly, and I hate to do things poorly" "My suggestion is to have you come back every 2 weeks until we make some progress on this, it's really the only way"

    This has been gold on my list people as they don't feel that I'm not taking them seriously. Strangely, it usually only takes 1 or 2 of scheduling patients on a Q2W basis before the majority of their problems/complaints completely dry up.
     
  5. cj_cregg

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    One of my attendings had a very similar spiel that I really liked - "It sounds like you have a lot going on, and I want to make sure I'm addressing all your problems adequately, but I can't do that in the 15 minute appointment you have scheduled today. Let's focus on the 1 or 2 problems bothering you most today, and we can schedule a follow up visit to work on some of the other things."
     
  6. mark v

    mark v Junior Member
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    The every 2 weeks is really key in this. It show them that you're taking their problems seriously (and you are), even if they aren't (and most aren't, but they DO want to talk about them, strangely). In a way, you're kind of calling them out on it. It also lets them know in the future that if they bring in a list of several things that may not be truly big issues, that you're likely to put them back on Q2 week visits again (Mr. X, I ALWAYS have room on my schedule to work you in. We'll get this taken care of, I promise). I am taking care of their needs, I'm not minimizing their concerns, and who complains that their family doc wants to see them TOO much (I better get some act right or Dr. Mark V will want to see me every 2 weeks again)?
     
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  7. PlutoBoy

    PlutoBoy Sic transit gloria mundi
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    I go over preventative stuff almost at every visit and in all new patients. I started doing this after I learned that one of the main reasons for being sued in primary care is failure to screen.

    I usually address everything they throw at me during the visit.
     
  8. Keona

    Physician 10+ Year Member

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    2-3 I try to educate the patient too as to how they get scheduled. I physically do not have time to do more than that and it makes everyone in the office wait longer for their appt. I’ll do follow ups every month I don’t have space on my schedule for more frequently. Our office has NPs they can also be scheduled with for acute things but many of my patients refuse to see them. Our office needs another two MDs which will take a while to find in a rural area.
     
  9. Blue Dog

    Blue Dog Fides et ratio.
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    I have plenty of patients with double-digit chronic problem lists, and everything gets addressed (on some level) during every routine follow-up visit. It's the new problems that can bog me down, especially if they're potentially serious. I discourage patients from bringing up new problems during a routine follow-up visit, and tell them they need to make a separate appointment for those. I use a spiel similar to what's been mentioned above (e.g., "These are important concerns, and we need to make sure we have enough time to address them appropriately.") If somebody comes in with a laundry list, I'll usually handle it like a restaurant lunch special ("pick two.")
     
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  10. Freezeout

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    That’s what I’ve been trying to do, but it’s led to some complaints because it’s a departure from what had been the norm in the practice I joined.
     

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