When to broach end-of-life issues; Making time for same-day appointments; Handing out the keys to your office; Subpoenas and scheduling conflicts; Postponing bills around the holidays
Q:Some of my elderly patients or their guardians have willingly discussed end-of-life choices with me. Should I prompt those who haven't to start considering this issue? If Yes, how? At what age is it appropriate to bring up the topic?
A: Let your guide be a patient's health status and willingness to broach the topicnot age. Stock your reception area and exam rooms with information on the subject. That may be all you need to spur a patient to talk.
Q: I'd like to leave one afternoon a week open to see patients who might otherwise have to wait several weeks for a visit. If the slots don't fill up, I could use the free time to catch up on paperwork. Which afternoon would be best?
A: There is no "best" afternoon. It's better to leave two half-hour slots open each dayone in the morning and one in the afternoonfor patients who must be seen the same day.
Q: Which employees should get keys to my office? What should I do to make sure these keys won't fall into the wrong hands? Do I need to change the locks when a staffer leaves?
A: Give keys to the employee who opens your office, the one who closes it, and your office manager. Keep track of how many keys you have and who has them. Assign each key a code instead of tagging it, so only the employees with keys know which locks they fit. Staffers should turn in their keys just before leaving the practice, but you shouldn't have to change the locks unless a worker has been fired or quit in anger.
You might also investigate buying a security system that's controlled by an electronic keypad, which eliminates the need for keys. Access can be changed at any time by programming a new entry code.
Q: I've been subpoenaed to testify as an expert witness in another physician's malpractice trial. But the court date is scheduled during my plannedand paid forvacation. What should I do?
A: Ask the defense lawyer to find another expert to take your place. Although you could try asking him to seek a new date for your court appearance, he's not likely to agree. You also could ask whether it's possible to videotape your deposition or testimony, but the court may not permit this.
Failing these suggestions, your only choice is to reschedule your vacation. You'll risk being in contempt of court if you don't appear.
Q: My office manager suggested that during the two weeks before Christmas we send greeting cards instead of bills. We'd resume our normal billing schedule after New Year's. Is this a good idea?
A: No. Your billing and collections will suffer, which could lead to cash-flow problems. Plus, when you do send out bills, it's likely that they'll get buried among patients' holiday credit card bills, which may tempt them to pay other debts before yours. In addition, putting off two weeks' of bills will swamp your claims clerks at the beginning of the new year. Besides, anyone eligible for a tax deduction might want to pay you before Jan. 1.
Do you have a practice management question that may be stumping other doctors, too? Write: PMQA Editor, Medical Economics magazine, 5 Paragon Drive, Montvale, NJ 07645-1742, or send an e-mail to email@example.com (please include your regular postal address). Sorry, but we're not able to answer readers individually.
Kristie Perry. Practice Management Q&As.
Dec. 5, 2003;80:100.