Efficiency Without Compromise: Rethinking the Patient Visit

The average daily schedule for me is 20 to 27 patients a day. As a hematologist and oncologist, I am thankful to have the privilege to serve patients with a wide variety of conditions. Every second counts. Hard work alone does not bring about efficiency – and I learned that firsthand. By examining your day and yourself, you get to become more efficient. It is possible to go home on time with your work done.

To be efficient during the patient encounter, it starts with your morning. Remember why you are practicing medicine and working where you are working. Ultimately, no matter what your reasons are, focus on the reason that brings you joy. When you are efficient, you get to do more in less time. You get to see more patients in less time. Which means you get to have more time to do something else. Be mindful of what attitude you bring to work. If you are dreading to start your day, the rest of the day is going to feel like an uphill battle. You get to decide what attitude to face that day. Decide in advance, and not let how the day unfolds to determine your attitude.

What time do you arrive at work in the morning in relation to what time your schedule starts? My first patient starts at 8 am. I usually get to my office around 40 minutes before 8 am for several reasons. One, traffic is very different even if I leave 10 minutes later. Second, when I arrive early, there is time to settle down. There is time to catch up – review lab results which were available overnight, handle messages from the inbox and do some final preparation work for the day. This pre-clinic time is also a good period to prepare your mind for your day. If you are in primary care or specialty care, it is best to review the patients’ charts before entering the exam room. This is to remind you who the patient is. For a new patient, reviewing the chart allows you to know why the patient is seeking your help. With that information, you can start formulating your treatment plan even before entering the exam room.

For patients receiving ongoing care, this is especially helpful. Preparing in advance allows me to save time while I am in the room with the patient. Before entering the room, I know the patient’s diagnosis and current treatment plan. Based on the patient’s complaints and lab results, all I have to focus on is to care for the presenting problems and make new plans if needed.

When you are in the room with the patient, be mindful of the time. Use your watch, the little digital clock at the corner of your computer or the clock on the wall. If you have 15 minutes to see an established patient, the goal is to complete the encounter, write all the orders for tests and prescriptions, and finish the chart within that time frame. Type as much as possible while you are in the room. Utilize a scribe or AI scribe if you have the resources. You want to aim to finish most of the notes while you are still in the room. If you have to order any tests or medications for the patient, complete them while you are still in the exam room. This way, you will not forget to do it later, and the patient knows and sees that you ordered.

Let the patient talk while you are actively listening to the complaints and concerns. Do your best not to interrupt. This is the time to connect with your patient on a deeper level. There may be more problems for you to address and the patient does not know how to express it. On the other hand, a patient may be sharing information beyond the scope of your expertise. By listening attentively, you get to redirect the conversation and allow the patient to focus on problems pertinent to the visit. You are the interviewer and you get to ask questions and find out the underlying issues and provide solutions to the problems.

Before exiting the room, summarize for the patient what your plan is. Some of you may think that you are too much in a rush to provide that summary. When you are feeling rushed, your patients will feel that they are being rushed. Who wants to see a physician who is rushing – which, to many patients, means the doctor does not have time to take care of me? When you give the patient a summary of your management plan, it gives the patient a review of the encounter. It does not hurt to say things more than once. Sometimes it takes several discussions for some ideas or concepts to sink in. When you summarize for a patient, it is also an indication that you are concluding the visit, and it is the last chance to ask any last minute questions.

As a physician, you have the power to improve your efficiency with the patient encounters. Remember why you are there to serve the patients. Choose a helpful attitude to start your day and continue that attitude throughout the day. Besides prepare your mind, prepare and know your patients before the encounter. While you are in the exam room, type as much of the note as possible. Utilize dictation, a scribe or AI if you have those resources. Always practice active listening and address the patients’ concerns (pertinent to your expertise). Complete the orders for tests, medications, etc. while you are still in the exam room. Finally, summarize the encounter with your patient. All these to increase your efficiency in each patient encounter, which translates to an overall more efficient day.