How to meet expectations in a 15 minute patient visit?

[NewYorkDoctors]

Hello. So at my residency, we do clinic every 5th week. Anyway, they started us off very light with 5 patients a day, now up to 10. This was to facilitate us to get to know how to do all the charting and administrative details of the outpatient clinic.

On the other hand, patient continuity is not always ideal due to lack of followup, inability for them to accomodate coming again on a multiple of 5 number of weeks, etc..

the biggest issue is when the reason for the visit is not apparently clear. (Previous note was from many many months ago) The biggest one is when the patient comes in with a laundry list of things to address.

The higher residents have already advised me not to try to to tackle everything. Prioritization of the acute issues come first and the other things can be left for the CPE (if it is not an urgent, acute matter. e.g. how come I hear this ringing in my ears when it is very quiet at night and I cannot sleep)

But I find it hard to say no to a patient. Perhaps it's just my intern fresh out of school ways. Any suggestions on how to say "no schedule another visit?" I could just say that next time... but any subtleties? Thanks

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[CanIMakeIt]

Hello. So at my residency, we do clinic every 5th week. Anyway, they started us off very light with 5 patients a day, now up to 10. This was to facilitate us to get to know how to do all the charting and administrative details of the outpatient clinic.

On the other hand, patient continuity is not always ideal due to lack of followup, inability for them to accomodate coming again on a multiple of 5 number of weeks, etc..

the biggest issue is when the reason for the visit is not apparently clear. (Previous note was from many many months ago) The biggest one is when the patient comes in with a laundry list of things to address.

The higher residents have already advised me not to try to to tackle everything. Prioritization of the acute issues come first and the other things can be left for the CPE (if it is not an urgent, acute matter. e.g. how come I hear this ringing in my ears when it is very quiet at night and I cannot sleep)

But I find it hard to say no to a patient. Perhaps it's just my intern fresh out of school ways. Any suggestions on how to say "no schedule another visit?" I could just say that next time... but any subtleties? Thanks

Make the expectation clear what the visit is going to be about and ask the patient to pick the most important item of that laundry list (that way they can decide what is important) and also when the pt talks, let them talk uninterrupted for 2-3 minutes (most people are done by then and make it seem like you are listening - studies have shown doctors interrupt patients within first 20 sec or so). Obviously there will be exceptions to these but you can minimize disruption to the schedule if you just follow those 2 simple rules.

 

[Bostonredsox]

Focus on treating their HTN, DM, Lipids, CAD, CHF and COPD. Controlling those have the best chance at extending their life. Ignore everything else. No joke.

Im kidding.

Sort of.

 

[DrSnips]

As my upper level residents told me, you basically say to them, "I've got 15 minutes to see you today. Pick 3-4 issues you'd like to tackle and we'll deal with those. If there is still more to do after that, we'll set up another visit soon."

 

[VentJockey]

As the great Conrad Fisher said in one of his videos that is widely pirated among medical students around the world: LET MORTALITY GUIDE YOU.

You look at the patient, and then you determine which interventions are most likely to decrease this patient's mortality. These are the ones you push like a door-to-door vacuum salesman or a sleazy red light district pimp. PUSH THOSE INTERVENTIONS WHICH HAVE EVIDENCE OF REDUCED MORTALITY.

 

[Bostonredsox]

As the great Conrad Fisher said in one of his videos that is widely pirated among medical students around the world: LET MORTALITY GUIDE YOU.

You look at the patient, and then you determine which interventions are most likely to decrease this patient's mortality. These are the ones you push like a door-to-door vacuum salesman or a sleazy red light district pimp. PUSH THOSE INTERVENTIONS WHICH HAVE EVIDENCE OF REDUCED MORTALITY.

This is the non sarcastic way of saying what i said. Treat the things that will most likely kill him in our society, an mi, stroke, resp failure, esrd from dm2, etc. (htn,lipids,COPD,cad,afib).