You can get home in time for dinner

I admit that I like to be the first one out the door at the end of the day. I have better things to do with my evenings than sit in the office with stacks of charts and piles of messages. Even when I'm on call-which is all too often-I usually beat my partners home by a wide margin. If you'd prefer to drive home to a setting sun rather than a rising moon, you might find these tips useful.

The early bird gets to see the patient

The key is an early start. Starting hospital rounds sooner has a host of benefits. But you can't expect to hit the floors at the same time every day and make it back to the office on time. You've got to be flexible when more of your patients are hospitalized than usual. Get there extra early before patients are taken for tests and before the patient's family will be there to intercept you. I also try to talk to radiologists or lab personnel before they do a test, so I don't have to deal with "What exactly are you looking for?" calls during the day.

The same thing works well for unexpected lab results, unless they require immediate action. "I'm a little concerned about your sugar, let's check it again next week," works better than "Bruce, I'm about 90 percent certain you've got diabetes-and I'm 100 percent certain I'm an hour behind already." The following week, allow enough time to do your "Welcome to Diabetes" visit properly.

Scan your appointments, scan your charts

A smooth day in the office actually starts days earlier. You need to look at your appointment list frequently for potential problems. Has someone given the loquacious Mrs. Black a 4:30 appointment? She can talk for hours. If you catch it early enough, you can have her come in at two o'clock instead. If you miss it, your evening is doomed. Check to see if you have a few open slots or patients who'll be quick visits. Then schedule your talkative patient for that time period.

I flip through my chart rack a couple of times an hour. A patient who comes in for an 11 o'clock appointment at 10 o'clock doesn't necessarily get seen early. I'll push a couple of brief follow-ups ahead and move up patients who are just in for lab work.

Patients who've come in for a physical usually have their history taken, go to the lab, and come back to be examined while the blood tests are being done. I'll usually see another couple of patients before they're back.

I try never to have a patient wait for anything in an exam room. I have chairs and benches everywhere, so I can say, "Have a seat down the hall and we'll talk as soon as your reports are back." This allows me to minimize the number of calls I'll have to make by having patients wait for results that take less than an hour.