How Many Questions/Problems Do You Allow Patients In One Visit?

[857770]

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How many topics do you allow patients to discuss in a visit? This does not refer to followup visits. How realistic is it to allow only one topic a visit? I know patients will have to keep coming back.

 

[deleted87716]

How many topics do you allow patients to discuss in a visit? This does not refer to followup visits. How realistic is it to allow only one topic a visit? I know patients will have to keep coming back.

There isn't an absolute number. Sometimes, one is enough. It just depends on the problem(s).

 

[SLC]

1.63 is my usual. Patients don't seem to mind

 

[JustPlainBill]

I tell them after the first 3, it's another copay....

 

[akinetopsia]

How many times do you get your hand on the doorknob to leave the exam room before another problem/question arises??

 

[deleted87716]

How many times do you get your hand on the doorknob to leave the exam room before another problem/question arises??

Almost never, since one of the first things I do after walking into the room to see somebody for a routine follow-up visit (after the usual pleasantries) is to ask something along the lines of, "So, do you have any particular concerns today that you'd like to discuss?" Better to find out sooner rather than later.

 

[AMEHigh]

It really depends. I usually try to limit it to 1 or 2, but will let it go to 3 if my gut is telling me it'll be something quick. If they give me a long story about problem #1, then start in on problem #2, I usually let them continue talk for 30 seconds and then tell them at this visit we are only going to be able to talk about problem #1. Thankfully our MA's are pretty good about telling our patients they can only bring up 1 problem, so that does sometime help.

 

[FrustratedFamDoc]

Really depends on a lot of factors. What kind of mood I'm in, what sort of problems the patient wants to go over, what sort of day has it been and do I have any patients waiting on me after this one.

If I've got 3 more waiting on me and someone breaks out a list with more whining that actual real deal problems, I'll zero in on the main thing that brought them in and let them know that "this is really important and I'd prefer to give my total attention to X today. I want to be thorough and make sure I don't miss anything." "I promise, we'll go over SOME of the other things next time, but on this visit, I really want to focus on X." Usually the list people already have some degree of underlying anxiety (It's what prompts list formation in the first place) and this move really plays well MOST of the time. By the time you see them back next time, 99% of the things they wanted to go over from the last visit have either gotten better or have been forgotten about so it's all good and more importantly, you haven't been totally dismissive towards things that the patient truly finds important.

 

[JustPlainBill]

Almost never, since one of the first things I do after walking into the room to see somebody for a routine follow-up visit (after the usual pleasantries) is to ask something along the lines of, "So, do you have any particular concerns today that you'd like to discuss?" Better to find out sooner rather than later.

And it can change the entire course of the visit -- as everyone knows -- getting to the real reason for the visit is an art form and not necessarily what the appointment is booked for --- if you don't get that out of the way quickly and early, you'll wind up with the "Oh, by the way, my chest has been hurting for 3 days and gets worse when I'm walking upstairs to bed --sometimes so bad my arm hurts" story.

 

[cabinbuilder]

And it can change the entire course of the visit -- as everyone knows -- getting to the real reason for the visit is an art form and not necessarily what the appointment is booked for --- if you don't get that out of the way quickly and early, you'll wind up with the "Oh, by the way, my chest has been hurting for 3 days and gets worse when I'm walking upstairs to bed --sometimes so bad my arm hurts" story.

I tend to listen more when it's a very old person. They tend to have a list they write down so they don't forget. Take the time to scan their list. True story: I had a lady about 85 come in for "cough", she had a list of things to talk about. The 4th item was "black toe". Holy cow. I took her socks off and she had gangrene of her toes, got her emergently to the surgeon and she was admitted that day. She didn't have any pain due to poor circulation and neuropathy so didn't think much to mention it.

 

[deleted87716]

I tend to listen more when it's a very old person. They tend to have a list they write down so they don't forget. Take the time to scan their list.

Yeah, if it's a lengthy list, I'll usually ask them if I can take a look at it rather than wait for them to go through each issue.

 

[scharnhorst]

If new pt i scan the list and I usually get to pick what we will discuss
your chronic pain, flatulence , insomnia can wait
if A1c is 14 and you have a creatinine of 3 or 4 that is what we will address today

established pts
I scan the medlist and chronic problem list and go in order of importance
for such patients unless its a minor issues I advise them to make an appt for acute visit

does not always work but I try

 

[simpler2]

I've seen providers who try to control verbally or with cues cause many arguments with patient's in clinic or have to field frequently complaints to administration. I rarely see anyone succeed in such practice. I have never tried to limit complaints per visit and have never felt I take on more stress or make my day unmanageable than the colleagues in my system who do so.

 

[VA Hopeful Dr]

I've seen providers who try to control verbally or with cues cause many arguments with patient's in clinic or have to field frequently complaints to administration. I rarely see anyone succeed in such practice. I have never tried to limit complaints per visit and have never felt I take on more stress or make my day unmanageable than the colleagues in my system who do so.

There is something of an art to it - if you just say "we can only address 2 problems today" then yeah people are going to get angry.

My approach is something like "OK so your have wildly out of control X and Y but also are complaining of Z. Let's get X and Y taken care of first, if that doesn't fix Z then we can address Z separately".

 

[deleted87716]

Yeah, it's not what you say, but how you say it. I'll never have a "no more than x problems per visit" policy.

 

[Keona]

Sometimes we will say it when someone comes in for say an ear infection but then oh I also have athletes foot, and want a diabetes check up and also want you to evaluate my chronic hip pain. Also they showed up 10 minutes late. In that situation I'll say I'm sorry you were scheduled for an acute visit and I really can't address everything else today because I have may miss something important and want to make sure that we are able to reallly focus on these other issues as well

. Let's make an appointment in 1 week or 1 month to discuss them further. Sometimes they get upset but usually are understanding. I'll show them where I wrote about the other issues in the note to address more thoroughly at next visit and send in refills of their medications.

-obviously if someone is having a red flag symptom it has to be addressed that day; they like to tell me at the end btw I've been having thoughts of harming myself, or I'm having chest pain and my left arm is going numb.

 

[deleted87716]

Sometimes we will say it when someone comes in for say an ear infection but then oh I also have athletes foot, and want a diabetes check up and also want you to evaluate my chronic hip pain. Also they showed up 10 minutes late.

I do take a bit more of a hard line with the latecomers, especially if the primary reason for the appointment was something acute. I'll point out that since they were late for their appointment, we only have time to address their main concern. The other stuff will have to wait until the next visit ("We can see you tomorrow, if you'd like!")

 

[FrustratedFamDoc]

I'm a firm believer in grooming (training is a strong word) your patients to what your expectations are. The 30-45 minute patient visits are sometimes warranted (new patient yesterday, several decade alcoholic wanting help), but I find I rarely, if ever, do any additional good in the longer visits than I would in a concise 15 minute encounter. I really don't want to hear about your son's bad marriage, I'm sorry. You rob Peter to pay Paul. Where you extended one patient unnecessarily, you'll likely have to cut another short to try to get back on track, or kiss your (and your staffs') lunch goodbye. My established patients know that when they come in, we focus on a few things, do them well, and then move on to other things. "I can juggle 1 or two things at a time, but if I try to do more, that's when I start dropping things." If there is something that obviously can't wait, we'll do that on that visit, and the things we were supposed to do gets done on the next visit. My patient satisfaction surveys are top 3 for my entire network.

 

[Bacchus]

1 week follow ups 😆. That doesn't happen unless I need them to and then prebook a same day slot. Always can tell them call the morning of at 8:01am.

 

[deleted87716]

1 week follow ups 😆. That doesn't happen unless I need them to and then prebook a same day slot. Always can tell them call the morning of at 8:01am.

Is that because your schedule is completely full a week out? Mine usually isn't, but they're not going to have a lot of appointment slots to choose from.

 

[TableMD]

On a personal level I can generally only fix 1 - 2 things at a time (ask my wife) I joke about that with patients and they usually agree that if a problem involves having to do something new, they would like pick what is most important.

 

[Bacchus]

Is that because your schedule is completely full a week out? Mine usually isn't, but they're not going to have a lot of appointment slots to choose from.

I usually have less than a handful I can find but the rest are sick spots available.

 

[BigSib]

How many topics do you allow patients to discuss in a visit? This does not refer to followup visits. How realistic is it to allow only one topic a visit? I know patients will have to keep coming back.

Agenda setting is vital. I usually hear them out until they've listed off all the things they want to discuss, even if the list is somewhat exhaustive. But I'll only take action on what is important to them and what we have time for; somewhere between 1-3 complaints for a 15 min visit, but only 1-2 new complaints. Usually some of them can be lumped together (e.g., my knee gives out and I can't run anymore), and more often than not we don't end up addressing a large number of what they've listed. I'll say something like:

"I see you're here for HTN today. Before we get started is there something else you'd like to address?"
"I have W complaint."
"Okay, so you're here for BP and you have W. Is there something else you want to address?"
"I also have X, Y, and Z."
"Okay, so you're here for BP and want to also discuss WXYZ. Is there something else you'd like to address today? No? Well your BP med shouldn't take much time, but seeing that we only have 10 min left we probably only have enough time to address 1 or 2 more things. You may have to come back for another appointment with more time for the others. Which of WXYZ would you like to address today?"
Then we negotiate.​

 

[n3xa]

Agenda setting is vital.

Def. I've already learned this lesson the hard way in clinic.

 

[TableMD]

when people have faith that you will get them back in quickly for the other things, its much more doable. This is why having a good accessible office is SO VITAL

It also helps when they are reminded that its hard to do stuff about more than 1 - 2 issues if it involves new meds, testing, therapy etc and that if there is ever a problem, it's nice to know who the culprit is...

 

[FamilymedMD]

As noted above, I try to get their concerns out on the table early in the appointment. Then I usually have 30 minutes for my standard appointment but often my manager or I will have booked the patient for 60 minutes if we know they have a lot on the list. The specific number of problems doesn't matter, just the time it takes to address them properly.

Needless to say, I don't bill by CPT code so I'm not worried about 99214 billing criteria and amounts so that simplifies things. Sometimes though their list is too long to cover at once and we agree on triage of the problems. I have plenty of follow up appointments in the next few days in those cases.