How I get home in time for dinner

August 23, 2002

Tired of wolfing down meals and working late, the author decided to do something about it. His solution may surprise you.

 

How I get home in time for dinner

Tired of wolfing down meals and working late, the author decided to do something about it. His solution may surprise you.

By Robert W. Secor, MD
Family Physician/Willard, OH

It's 10 am, the schedule's packed, and the front desk wants to know where to put call-ins that need to be seen today. The patient in Room One is hyperventilating because she's afraid to tell her parents that she's pregnant. My blood pressure's up and my mind is spinning. Instead of me running the practice, the practice is running me.

Until recently, that pretty much described a typical day; only the patients and their complaints changed. Wouldn't it be great if every day could be like the few that go without a hitch: steady pace, a full hour for lunch, and done at 5 pm?

Since the previous day had actually been one of those rare occasions, I asked my office manager to show me the appointment schedule. I quickly detected some obvious patterns: no two or more complicated cases in the same hour; few patients to be worked in at the last minute; a good balance of sick vs. routine visits; and ample time allowed for procedures. Years of frustration, yet the answer was right there! Why hadn't somebody noticed it and done something earlier?

I take most of the blame. Rather than communicate my frustrations to the office manager and the front-desk staff, I'd gritted my teeth and slogged through each day. I never took the time to explain how I wanted the schedule to look. They just filled in the spots as best they could, allotting the time they thought I'd need with each patient.

There was no reason we couldn't do a better job with the schedule. We already alter it to accommodate meetings, illnesses, vacations, and holidays. So why not tailor it each day, to allow us to see patients and preserve our sanity?

We began by dividing all visits into two basic kinds: planned and unplanned. The planned are easier to control, because you generally know how much time you'll need. Of course, a "planned" visit could include Mrs. Smith and her litany of complaints. We decided to identify all the Mrs. Smiths and make sure we didn't schedule more than one of them per hour.

Within the category of planned visits are the sick vs. routine visits. Patients with acute illnesses, such as flu bugs and earaches, can usually be seen more quickly than those who come in for routine follow-up on chronic diseases. Though these latter visits can be rather short when all's going well, the patient will often have questions about the illness, medications, and treatment plan.

The unplanned visits can be trickier but not unmanageable. First, try to find an open spot in the schedule. If it's booked, look for a few sick visits that you don't expect will take much time and try to work in the unplanned visits. Also, remember that what a patient considers an "emergency" may not always be that serious. In those situations, you might be able to do a phone consult or schedule the visit for the following day. In short, use all of your options without compromising care.

On those days that you do run behind, give patients in the reception room the option to reschedule or continue to wait. If you empower them, they'll feel less anxious because you've allowed them to decide for themselves whether they want to stay or leave.

Most doctors who get fed up with falling behind haven't taken enough time to work on their scheduling, or to clearly communicate their desires to their staffs. If everyone knows beforehand what constitutes a good mix of appointments, I bet you'll finish most days on schedule.

Good luck! I hope you make it home in time for dinner.

 

For more on improving scheduling, see our Web exclusive, "This is no way to run a medical office".

 

 

Robert Secor. How I get home in time for dinner. Medical Economics 2002;16:40.