Teach patients to prioritize their problems

How many times have you popped into the exam room for a quick re-check of a patient, only to get hit with a barrage of new symptoms and concerns?

My guess is that at least a third of my day is spent wading through new symptoms, rather than focusing on the problem that originally brought the patient to me in the first place.

Don’t get me wrong. I get it that once problem A is improved, problem B raises its hand.

The problem is, as physicians, we can’t see positive results and know when to change course if patients don’t tell us which of our treatment plans are working.

You need to take the lead and guide your patients to prioritize their lists of symptoms. Prioritizing will result in:

  • more streamlined and directed visits
  • more efficiency in scheduling
  • more focus on fixing the most urgent problem first

I believe it’s our responsibility as doctors to teach our patients how to have better physician-patient communication. And in my experience, prioritizing is key.

It starts with direction from our staff.

Here’s what I mean:

  • When patients with multiple medical problems come in for a recheck, ask your staff to triage each patient’s symptoms. Ask the patient to rank their top three concerns, and then name the number one concern of those three.
  • Have your staff prime the pump by discussing the top three symptoms as they are preparing for you to enter the exam room.
  • Encourage patients to create checklists of their medical concerns whenever you speak to them.
  • If the patient gets off course and starts going on about problem #37, gently steer them back to their list of the top three, with particular attention to #1.

Patients can be persistent, so be forewarned: Asking them to limit themselves to only three symptoms won’t be easy.

One of my favorite mentors, Dr. David Saunders, used an adage that holds true to this day: “If it were easy, everybody would be doing it.”

He usually was referring to one of a multitude of surgical procedures he taught me in my training. But, like all good counsel, it fits in many situations.

I have come to use his saying as one of my mottos.

Helping patients prioritize will take consistent practice by you and your staff.

However, after a few visits, your patients will start to “get it.” They will learn that being focused makes their brief time with you more effective and efficient.

And that points to improved patient care, which is what we’re all about, anyway.

Starla Fitch is an ophthalmologist who blogs at Love Medicine Again.

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  • Steven Reznick

    I have a primary care general internal medicine practice that deals with a great many senior citizens. They need time. There is very little one can do to make the visit much more efficient. They have chronic multisystem disease, see numerous physicians, dentists and health care providers and are on multiple prescribed and over the counter medications, vitamins, minerals , herbs and supplements. Yes you can do your homework and be prepared to review their multiple problems in advance. Yes your staff can help you with medications and vital signs and brief history, but without allowing them the time to express their concerns you never get the full story. As an opthalmologist you probably generate more revenue in two months than most family practice and general medicine offices generate in a fiscal year. You can afford the numbers of staff and quality of staff that most primary care offices can not. I do not begrudge you your earnings potential based on your education and training but lets keep it real, you are examining a very important but very narrow scope of these patients entire health . Those of us seeing the aging American population need to be more efficient but what we really need is appropriate compensation so that we can devote the time necessary to be thorough, complete , compassionate and advocates for our patients health.

    • DoubtfulGuest

      You’re right on target. I’m not a senior citizen but I have a chronic multisystem disease. I didn’t mind trying to be more efficient in explaining symptoms before I got a diagnosis. It took some practice. At a certain point, though, we’re not seeing the forest for the trees. That wastes time and resources in the long run.

    • NewMexicoRam

      So right on.
      But don’t hold your breath.
      I predict it will take another 10 years before primary care starts to see appropriate reimbursement.
      Until then, it will be more patients, more stress, less income.

      • Steven Reznick

        Hopefully you are generating enough income to succeed until changes take place. We went into this because we wanted to help people. I do not think they can take that away as much as they administratively and bureaucratically try.

    • goonerdoc

      Well said, Dr. Reznick.

    • SarahJ89

      I’ve had nurses convey the wrong information to the doctor more than once. I have a written, prioritized list when I go and don’t want to waste my time going over it twice. Practices where the patient sees five people before the doctor sweeps in, godlike and complete with note-taking minion, for a brief visit may be efficient, but they reduce the patient to the status of widgets and the practice to being nothing more than a factory assembly line.

      They provide poor quality care because the patient is so rushed and intimidated they can’t ask questions that arise during the actual few minutes the doctor is in the room. And no, all questions cannot be thought of BEFORE you see the doctor. After the doc rushes out to see the next widget questions pop up and you get told “Oh, I can’t answer that. You’ll have to ask Dr. God.” Except you can’t talk to the doctor on the phone and an appointment takes months to get. This really is not good medicine, although it seems to make the staff, employer and insurance companies feel good.

  • guest

    I wonder: has anyone checked in with our patients to see what they want? Just a guess, but I would think that they would not feel too pleased about being redirected into “efficient” communications with their doctor.

    At the end of the day, “efficiency” has become a euphemism for the rationing of the doctor’s time with you. Don’t think our patients aren’t perfectly aware of that, a lot of them.

  • goonerdoc

    Hmmm…an ophthalmologist giving me, a general internist, advice on how I should run my practice. Thanks but no thanks, Dr. Fitch. If I had a cadre of staff to triage complaints, get a complete review of systems, and if I only had to address one body system, then hey, this might work. However, her reimbursement is ever so slightly higher than mine, so she can afford multiple staff members, and thus her advice is meaningless to me.

    • SarahJ89

      I wrote of my experience with factory medicine above. It was, in fact, an ophthalmologist.

  • Suzi Q 38

    My doctor knows my case is difficult, so he gives me the time that I need, within reason.
    Good thing I am somewhat focused and state my purpose after our greeting. I get to the point, rather than talking pleasantries.
    He seems to respond well to that.
    All doctors are different.
    I am not leaving without the information and treatment that I came in for.

  • Pauline Lambert Reynolds

    So, say my top three are: pain in my groin, headache every morning, and a cut that won’t heal. Does this mean I cannot mention that I experience daily diarrhea? or periodic pounding heartbeat? Etc., etc.

  • T H

    Doctors have a hard time facing reality:
    > patients get frustrated with the ‘one appointment, one problem’ mentality that is becoming the standard for clinics. They (rightly) think you are performing a wallet excision.
    > Patients prefer to tell us their interpretation of what is going on instead of what their symptoms are: they start with ‘my kidneys hurt’ or ‘it’s my pancreatitis, doc’ and the framing biases start. It’s a rookie mistake that we all get caught up in.
    > Medical priorities do not always jibe with patient priorities (witness those diabetic neuropathy patients who want their pain meds and don’t care about getting their antidiabetic agents and FSBG testing supplies refilled). IF you are surprised by this, start actually listening.
    > A physician’s job is to provide the best medical advice that they can: it is up to the patient to make the decision as to whether or not it will be followed.

    Patients have a hard time facing reality:
    > A doctor’s job is to do the right thing. When that connects with doing the nice thing, all is well… but often it does not. Telling you that you need to be admitted on Christmas Eve isn’t what I want to do, but it is the right thing to do. Get mad at me if you wish, but don’t expect me back down.
    > Everyone wants to thoroughly discuss everything: if we did that with every patient, then we would see one or two a day. I can’t tell you every last little thing because there’s not enough time in the day, much less a 10-20minute appointment. If I spend 40 minutes with you, I’m shorting 3 or 4 other patients on their time.
    > Even if you are exceedingly well informed on any one of a number of medical topics, please don’t assume that your medical opinion equals that of a physician. It doesn’t.
    > A physician’s job is to provide the best medical advice that they can: it is up to the patient to make the decision as to whether or not it will be followed.

    >