When I was a little girl, attending the circus was the highlight event of the year. I remember looking forward to it each year – perhaps because it was something fun, and each year something new. Never the same show twice. Very busy behind the scenes, yet at the same time, quite organized and appearing smooth on the surface.
In the same way, the clinic can be a truly hectic scene. But with me as Ring Master, I was able to magically eventually learn to conduct my three rings of fire for a much smoother overall show, with spotlight on the dedicated patients, meticulous staff, and me with my super chic top hat.
I have to admit that there have been days in which I have magically seen up to nineteen patients in one half day. However, I wouldn’t say that I am proud of that, or that it went smoothly. That is how many patients the average physician sees in one full day. But, I did learn greatly from the experience. I was forced to learn how to become very efficient. It’s survival of the fittest. If you aren’t efficient, you can easily become prey to your tigers and lions when seeing this many patients a day.
It was a gradual learning process, one that included some trial and error. But I have learned a few magic tricks to make my days run smoother. Here is what I learned as the clinic Ring Master, which may perhaps be helpful for others who put on a similar show:
Practice your magic tricks. Review the patient chart thoroughly before you walk into the exam room. First of all, it’s too distracting to review the chart when the patient is talking to me. Second, I may be construed as “rude” by the patient while doing so. I need to refresh my memory and review pertinent details of the patient’s case. I write all over the progress note and come up with their diagnosis list and my plan for them before I even walk in. For instance, if I have a diabetic that comes in for headaches, I come up with a plan for their diabetes – retinal photo, diabetic foot exam, and a pneumonia vaccine that they are overdue for. I write this in the chart. Then I walk in and address the patient’s concerns about the headache, and at the end take care of their diabetes. Reviewing and writing in the chart before I walk in saves me a lot of time, and gives an idea of how I want to manage my time with the patient knowing that they need other items addressed besides their headache. In this way, I am prepared to show off my magic tricks before I perform for my audience.
Aim for the Cirque De Soleil. I train my medical assistants (MA) and aim for the best show. We have an occasional shifting of MA’s in my clinic. That means that every once in a while, there’s a new MA that needs to be trained on how I expect them to room my patients. Therefore, I have made a list of how I would like the patients to be roomed based on their symptoms. For instance, every patient with chest pain gets an EKG. Every patient with burning with urination gets a “urine dip” test. Every patient with a breast complaint needs to be dressed in a special gown for examination. This saves me time since I have these items completed before I even see the patient. I may even make a “pocket version” of this list and dispense one to each new medical assistant. My MA’s are then the elite of all performers.
Construct the stage and props meticulously. Take photos of rooms. When I have to leave the exam room to look for a band-aid, or goodness forbid a pap smear speculum in the middle of performing a gynecological exam, this wastes a lot of time (not to mention is also quite a disturbing experience for my patients). Rooms should be stocked frequently, and with items that I personally use frequently. Simply telling the staff to “stock the room” is not sufficient. Stock the room with what? One trick I learned is to create the ideal exam room myself, and then take photos of each cabinet, drawer, and tray. I then printed those photos and labeled each item in the photos. These photos were placed in a central location that the staff grabbed to take with them when stocking the rooms. And the stage is ready for show!
Print your show itineraries. Keep a stack of commonly used forms and handouts in the exam rooms. This saves me time; I no longer have to walk out of the exam room to fetch the handout from my office and return to dispense it to my patients. Every seat is prepared with an itinerary.
The ring leader calls the shots. Delegate. Seeing this many patients a day, I am not able to respond to every patient message or request. I am not able to call every patient with their normal lab results. I delegate a lot to my very efficient staff. This delegation has truly been key to running a successfully busy clinic. As Ring Leader, I call the shots and put on the show.
“Jill of All Trades” is a family physician who blogs at her self-titled site, Jill of All Trades, MD.
