In my travels as the ExtraMD, I have seen many different practices, different styles and hundreds of ways practices waste time and annoy patients. In my quest to help primary care physicians stay afloat, I will list my observations of time wasters that suck the joy out of medicine. I will also include my incredibly astute suggestions for positive change. Beware, you may even see your practice here.
1) The doctor checking the patient in while the medical assistant stands there. (Really.)
2) The doctor calling every patient to tell them their labs were okay, while the MA stands there. (Is there a pattern here?)
3) Not having the patient undressed and ready for the gyn exam. There I am, setting out the speculum, diving around for the gown, searching for the pen to write their name on the specimen cup, while trying to keep up the patter.
4) Not having the diabetic patient’s shoes and socks off. C’mon, it’s standard of care.
5) Spending a lot of time arguing with the patient. Give your viewpoint, listen to theirs, and then agree to disagree. You will not convert everyone into exercise zealots in a day!
6) Not having preprinted check off forms if you don’t have an EMR.
7) If you do have an EMR, not learning how to type. Get a typing a program and stop with the hunt and peck!
Not telling patients when to come back–be specific!
9) Waiting for late patients. Have a policy that you if the patient is more than 10 minutes late, you will reschedule them, or try to work them in. Caveat: YOU MUST BE ON TIME! (Guess what patients complain about the most? Waiting for you!)
10) Not having charts pulled when you return phone calls. Document the phone call, or have your malpractice lawyer’s phone number handy if you don’t!
11) Not having notepads in every room, so you can write instructions down (legibily) for your patients. How much do you remember sitting in a paper gown in your tighty whities?
12) Not having a stock phrase down, as in, “Mrs. Malady, which two problems would you like to focus on today?”
13) Complaining. Oh puhleez, nobody wants to hear you whine. If you want to whine, start a blog. Better yet, be the change you want to see. (Thank you, Ghandi.)
14) Not giving out educational material. You look like the hero if you have some handouts, and it’s good medicine to boot. Have info stocked in each room in a standardized fashion.
15) Not relying on your staff. You’re paying ‘em, and they WANT to be useful! Use them to make calls, double check medications and allergies, hand out educational info, and answer questions.
16) Losing stuff in your office. Have a systemized approach to patient care, from check in to check out and follow up. Your best approach is to go through a day with your staff, and see where stuff goes. You will also gain a lot of insight into what everyone is doing. You probably need to do this every quarter. It is helpful to try to systematize every aspect of care delivery, so it is repeatable and reliable. E.g.: all labs must have a physician signature before filing, all patients are asked to disrobe according to the exam, each room is stocked with the same supplies in the SAME places.
17) Sloppy hand writing. ‘Nuff said.
18) Thinking you are superman/woman. You need to allow other people to do their job, so you can do yours. Even Batman had Robin.
19) Charts that aren’t. I have seen (not fibbing here!) a simple file folder with everything stuffed in it, in random order. As a locums MD, how easy do you think it was to find important info? Most charts have tabs–use them. And train your staff to file properly.
20) Not having your staff notify you immediately when the patient says the magic words, “Chest Pain.” They should immediately mobilize the EKG and get you in the room. So what if it’s NOT the big one–better to err on the conservative side then have some poor slob infarcting while waiting for you for 30 minutes to finish up with the fibromyalgia patient next door.
21) Chatting about yourself. Patients just don’t care, and find it annoying. There are actually studies demonstrating this. (Who funded those studies?…)
Hope this helps. Don’t be afraid to look at your practice as an experiment, change stuff, and then see what works out. Most of all, enlist your staff. You will be hugely surprised at how innovative and involved they will be!
As promised, here is the quick and dirty primer on motivating patients to change unhealthy habits to healthy habits. I found a good piece on behavior change on the AMSA website. It seemed fitting, as we are all students in this area! Let’s get schooled!