The key to staying on time in a busy clinic and to finish the day unscathed is to be in battle mode from the get go. The ten rules outlined below will help you to achieve that goal.

1. Make sure your bladder is empty, and that you are well hydrated. This goes without saying. You don’t want to finish the day with hydronephrosis or a kidney stone. This would lead to sick days and bite into your productivity pie.

2. You may be loaded with caffeine, your compassion tank may be full, and you may feel motivated in the early hours of the day when you are still fresh, but don’t fall into the trap of socializing with your patients. They think they are the only patient of the day and they will drag you into deep conversations. You can talk about the weather if you really want to say something. That’s it.

3. You have seen their vitals and blood work, so you kinda know what the plan is going to be, as well as the diagnoses you will use. Stick to you plan outline, allow small room for variation. The key to this is to allow little room for two-way conversation.

4. We are in the age of electronic medical records. That gives you the privilege to look at your screen and thus avoid excessive eye contact, without being considered too rude. This will discourage the patient from talking about their cat, their broken toenail or wax in their ears.

5. No hostages, just kills. You don’t want to leave clinical questions open for further investigation after the patient leaves. Be quick to refer, prescribe a pill or order a test. Avoid multistep plans or slow medicine. Take inspiration from the deep tendon reflexes that you check. This takes practice.

6. Learn to talk fast. You have 5 to 10 minutes to see your patient, and you want to be able to counsel your patient before time is up. You can then check the boxes about counseling with a clear conscience. You can also have handouts and ask your medical assistant to hand it to them if certain diagnoses are in the patient’s chart. It doesn’t matter if the patient forgets and leaves them in the examination room, because the next patient who waits in the room will be automatically counseled in a cycle of perpetual counseling.

7. Don’t ask open questions like “what else can I do for you.” That’s suicidal.

8. Azithromycin cures a multitude of ailments, and the common cold is one of them. This one is important for your ratings.

9. Learn to examine fast, without compromising being thorough. PERRLA and EOMI are here to help, and they could also make great names if you happen to have twin girls one day.

10. If you are still running late, you may want to improve your body language. Start holding the door handle when you explain the plan. Open the door and place one foot outside if the patient demonstrates signs of separation anxiety.

Rinse and repeat, and keep shining.

“DrizzleMD” is an internal medicine physician who blogs at his self-titled site, Drizzle MD.

Image credit: DrizzleMD