Wednesday, March 23, 2011

Direct Patient-Care Face Time (DPCFT)

Most doctors see one patient every 15 minutes. The economics of our medical system dictate this. In order to pay salaries, malpractice, benefits, rent, electricity, and general supplies, we needs to see patients at this pace. But what does that mean to us practically in terms of time management? Let's think about it... Because we all have responsibilities outside of our direct patient-care face time (DPCFT)—typing up a SOAP note, filling out prior authorization forms, reviewing home nursing orders, answering telephone messages from patients, refilling medications from pharmacies, reviewing notes from specialists, reviewing labs from the prior day, calling patients, doing referrals, and so on—those 15 minutes of DPCFT really get cut down to about 10 minutes. TEN MINUTES! That's all we get folks! No jibber-jabber here! No shooting the breeze about Mrs. Johnson's grandson. Although we want to spend more time talking about family, fishing, and fun with our patients, the truth is that we don't have much luxury to do so. And this can be stressful!

So here are three imperfect solutions that I have come up with:
  1. Just run late—Honestly, I'm not good at this one. My patients expect to see their doctor on time (since I'm usually on time). But every once in a while, it good to throw efficiency into the wind, take a deep breath, and truly enjoy looking at Mrs. Jone's photo album of her pet pig (true story). 
  2. Schedule 30 minute appointments—I judiciously set up 30 minute appointments. They offer a breather for me with complicated followup visits. But obviously, if I set up too many 30 minute appointments, I will not be able to pay for the overhead of our office. 
  3. Split up the visit—I do this especially if the patient has multiple complicated medical problems. I often feel like a heel for doing it. But patients are generally understanding. 
Other than those three tips, I can honestly say that I don't know how to increase my DPCFT. People are constantly complaining about how the U.S. medical system is broken. And from my perspective, the most broken aspect of medicine is that I have so little time with my patients. In a traditional practice, doctor who only see 2 patients an hour get themselves fired for being unproductive or bankrupt for not meeting their overhead. It's a strange predicament that we are in.


Anonymous said...

There are only so many minutes in a day etc. It is my humble opinion that what matters most to my patients is quality not quantity. In fact I deviced a small study for my group of 12 FPs which revealed that simple gestures increase patients perception of quantity of time spent as well as quality of time spent. #1 Remove clocks from exam room. #2 Immediately apologize for the time they have waited and acknowledge how valuable their time is. #3 Always sit to listen to their story...always! #4 Always look patient in the eye when they are talking. #5 Don't interrupt them! If they digress...gently refocus. #6 Aak if they have anything else they want to discuss. If there is...suggest another appointment so you can devote adequate time and attention...unless it can be cared for in very, very short time. #7 Never ever ask if there is anything else while your hand is on door knob as you leave. Our study indicated patients felt visits were as much as 30% longer than actual time. Quality grades increased by 25%. Time taken for each visit...decreased by 20%. There are many more little things that can accomplish the same result. We each have our own mannerisms that can make a difference. We just have to be aware and be willing to change.

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