There are many similarities between Oasis of Hope Center, a free health clinic for the uninsured, and your everyday, family practice clinic. Time spent with each patient, however, is not one of those similarities. At Oasis, new patients are scheduled for a 60 minute appointment, while returning patients are given 30 minutes each. The medical practitioners, who are all volunteers, definitely take note of this as their positions in other "for pay" medical practices have them accustomed to appointments lasting only 10-15 minutes.
"Don't get used to the Oasis pace", the clinicians warn us students.
Of course I realize that healthcare is a business. Quotas need to be met just as in any other business, but with all the talk of the limited time with patients, I had to ask,
"How do you make efficient use of your limited, patient time?"
Andy Booth, PA-C and Director of Grand Valley State University's Physician Assistant program had a great response to this question when he said, "Providers and patients both aren't comfortable with the time restraints. Once you have practiced for a while, however, you realize that most patient concerns can be properly addressed in that time frame. That is, if you and the patient are both on the same page."
Andy elaborated on what he meant by patient and provider being "on the same page" by explaining that appointments are scheduled to address one chief complaint. After all, when scheduling an appointment, the receptionist asks the patient what the appointment is for. The response? One complaint: headaches - sore throat - you get the picture. Many times, when the patient and provider meet face to face, however, more concerns emerge. "Usually at the end of the work-up for the initial complaint -- right when you appear to be finished with the patient, they throw out the infamous...
Andy elaborated on what he meant by patient and provider being "on the same page" by explaining that appointments are scheduled to address one chief complaint. After all, when scheduling an appointment, the receptionist asks the patient what the appointment is for. The response? One complaint: headaches - sore throat - you get the picture. Many times, when the patient and provider meet face to face, however, more concerns emerge. "Usually at the end of the work-up for the initial complaint -- right when you appear to be finished with the patient, they throw out the infamous...
'Oh by the way...'"
Since having this conversation with Andy, I have asked many of the other providers about the "Oh by the way" situation, and, from what it sounds like, it can be pretty frustrating.
Every professional understands the importance of time management and prioritization, but when patients use this clause, all preparation is thrown out the window. So if you're one of those patients who feels like your time is shorted with your provider, there are things you can do to make sure that you have all of your needs met during your appointment.
1 - Although it may be embarrassing to ask the receptionist to schedule you an appointment for erectile dysfunction or increasingly heavy menstrual flow, make sure you schedule your appointment for exactly what you need to be seen for. It is to your benefit that the provider knows what needs of yours he/she needs to address beforehand, so that the proper preparations and appointment length are reserved for you.
2 - Be prepared to explain what is going on with your health: How does this problem make you feel? How long has this problem been going on? When do you feel better? Worse? Do you have an idea as to why this is happening to you?
3 - Write things down. We can all be forgetful. So before arriving at your appointment, prepare a nice list of your medications with their doses, and write down the questions you have so that you don't leave the office feeling like your needs are unmet. Also, if you are seeing a provider for the first time, it is important to have a thorough medical history with dates of procedures/events and possibly even where those procedures took place. This will ensure that your time at the clinic was efficiently spent and that the office has all the information they need to provide you high quality care.
Every professional understands the importance of time management and prioritization, but when patients use this clause, all preparation is thrown out the window. So if you're one of those patients who feels like your time is shorted with your provider, there are things you can do to make sure that you have all of your needs met during your appointment.
1 - Although it may be embarrassing to ask the receptionist to schedule you an appointment for erectile dysfunction or increasingly heavy menstrual flow, make sure you schedule your appointment for exactly what you need to be seen for. It is to your benefit that the provider knows what needs of yours he/she needs to address beforehand, so that the proper preparations and appointment length are reserved for you.
2 - Be prepared to explain what is going on with your health: How does this problem make you feel? How long has this problem been going on? When do you feel better? Worse? Do you have an idea as to why this is happening to you?
3 - Write things down. We can all be forgetful. So before arriving at your appointment, prepare a nice list of your medications with their doses, and write down the questions you have so that you don't leave the office feeling like your needs are unmet. Also, if you are seeing a provider for the first time, it is important to have a thorough medical history with dates of procedures/events and possibly even where those procedures took place. This will ensure that your time at the clinic was efficiently spent and that the office has all the information they need to provide you high quality care.
One hundred percent of the responsibility does not lie in the hands of the patient, though; providers also have to prepare. Plus, they have to know what to do with a patient who does not come prepared.
The most important thing you should do is to specifically ask the patient what their primary concern is. This way you avoid doing an entire workup for a sore throat on a patient who is really concerned about his decreased sex drive. There are many other great tips concerning time efficacy that you can implement, and Paige Boldt, a family practice PA and volunteer at Oasis, provided some that are summarized below,
The most important thing you should do is to specifically ask the patient what their primary concern is. This way you avoid doing an entire workup for a sore throat on a patient who is really concerned about his decreased sex drive. There are many other great tips concerning time efficacy that you can implement, and Paige Boldt, a family practice PA and volunteer at Oasis, provided some that are summarized below,
"By the time patient and provider meet, the patient has likely already told their story a couple of times. One way to maximize your time with the patient is to begin your patient visit by explaining what you know. When you do this, you avoid the potential for a brief story to be drawn out into an elaborate one that provides no additional, useful information, yet takes up more of your time. From there, you ask specific, purposeful questions that (hopefully) will get you the information you need without the non-pertinent details. Also, make sure you aren't asking questions that can already be answered by the patient's medical records. Not only will you save time, but will also give your patient confidence in the fact that you know what is going on with them."
When Paige explained this, I thought of a patient I had previously seen with a bruised hip. When the nurse asked an open-ended, "So what's going on here?", the patient began with her grand tale that began with walking her dog...
"It was a snowy day, the roads were slick. I was taking skipper for a walk. You know what? That was the first walk I had taken him on in over a week. Then, after a mile or two of walking, Skipper saw something. I'm not sure what Skipper saw, but it was probably a squirrel. Maybe a bird? Yeah, it was probably a bird ..."
I could go on, but I think we've both had enough.
Now that the nurse knows every single detail of how the patient bruised her hip, she is more than prepared to provide a general summary to the provider. The provider should take advantage of this summary; instead of asking a similar open-ended question that will put the patient back into story telling mode, the provider should enter the exam room with a summary.
"So I heard you were taking you dog for a walk on a snowy day when you fell and bruised your right hip. I assume that is your primary concern today? We will address that. Then, if time permits, we can see what other concerns you may have. On a scale of 1-10, how bad is the pain in that hip? Are you still able to ambulate effectively? Etc..."
Using this method, time is used efficiently, the information exchanged is pertinent, and you are prepared to deflect any "Oh by the way"'s because you had already informed the patient that you were limited with your time.
"It was a snowy day, the roads were slick. I was taking skipper for a walk. You know what? That was the first walk I had taken him on in over a week. Then, after a mile or two of walking, Skipper saw something. I'm not sure what Skipper saw, but it was probably a squirrel. Maybe a bird? Yeah, it was probably a bird ..."
I could go on, but I think we've both had enough.
Now that the nurse knows every single detail of how the patient bruised her hip, she is more than prepared to provide a general summary to the provider. The provider should take advantage of this summary; instead of asking a similar open-ended question that will put the patient back into story telling mode, the provider should enter the exam room with a summary.
"So I heard you were taking you dog for a walk on a snowy day when you fell and bruised your right hip. I assume that is your primary concern today? We will address that. Then, if time permits, we can see what other concerns you may have. On a scale of 1-10, how bad is the pain in that hip? Are you still able to ambulate effectively? Etc..."
Using this method, time is used efficiently, the information exchanged is pertinent, and you are prepared to deflect any "Oh by the way"'s because you had already informed the patient that you were limited with your time.