I recently spoke with a colleague who transitioned out of the military in the last year. He was previously excited about his new job opportunity, but now a year later, he tells me, “I hate civilian medicine.”
I was surprised because he had been excited about the opportunity to teach in a residency program again. He said, “I love teaching, and I love the residents. But, when I’m not teaching, they’ve got me seeing 30 patients a day! How am I supposed to do that and get all of my other stuff done?”
All too often, physicians are struggling at the end of each day to complete all of their tasks. We have to hurry and dictate notes, answer phone calls, write prescription refills, and still get home to spend time with our family. We get 15 minutes with each patient and feel like we have to shortchange the patient by rushing through their appointment. The only way to get to spend time talking to patients is to be more efficient.
The top 9 hacks that revolutionized the clinical efficiency of my practice
1. Review charts and write notes ahead of time. This is, by far, the most important clinical efficiency hack that I employ. I spend time in the week prior to each clinic visit reviewing each patient’s chart, reading prior notes, and pre-writing my new notes.
Based on the referral from their primary care physician, I know the patient’s chief complaint, so I write in all of the relevant details contained in the referring physician’s H&P. I even pre-write a lot of my assessments and plans when I feel like I have a good enough understanding from my chart review to be able to do so.
By the time of the interview, 80-90% of each note is already done. By prepping the chart beforehand, editing the note takes less than three minutes in most cases.
At the end of the day, my notes are already written, so I answer phone calls or urgent emails, and I’m ready to go home.
2. Master your EMR templates. It’s worth hundreds of hours per year to master your EMR. Here are a few simple tricks to maximize your EMR’s value.
- Take a day and get trained on using the EMR: It’s worth the time investment.
- Auto-coding: Find out if the EMR has a feature that will automatically generate E/M and CPT codes for you.
- “Dot phrases”: Most EMR systems have a way for you to type a preset short word or phrase that converts automatically to a sizable block of text.
3. Learn to type fast or get good dictation software. If you are a really slow typer (<30 words per minute), then you should consider buying a typing training program to increase your typing speed.
If you prefer to dictate notes, either hire a transcription service or get high-quality dictation software that works well with medical terms. It might be expensive, but it’s worth it if you can’t type quickly.
4. Type as you talk. This won’t work unless you can type without looking at the keys or the screen so you can maintain eye contact with the patient.
I rearranged the furniture in my clinic exam room, so I can type on the computer and look directly at the patient at the same time. I get my whole note typed and edited while we speak. Then I only have to spend 1-2 minutes finishing the assessment and plan after they leave.
5. Have the patients arrive 20 minutes early. If you tell someone their appointment is at 10:00 a.m. and to arrive 20 minutes early, they’ll arrive at 9:58 a.m.
If you instead tell them their appointment is at 9:40 a.m., they’ll arrive at 9:38 a.m. Then they can fill out whatever forms they need for the visit and get vital signs done on time for your 10:00 a.m. appointment.
6. Train your team members to be your gatekeepers. Train your team to only bring you questions, tasks, or patient complaints once they’re ready for you to take a specific action on them.
Also, set aside time for non-emergent clinical tasks to be done once or twice during the clinic day and do them all at once.
7. Record videos of education for consents. If you do procedures on a regular basis, you can record a video of yourself doing the appropriate consent process, educating patients on the procedure, and answering commonly asked questions. Patients can watch this video on YouTube, a DVD of your video, or an app that you create.
Having patients do this can reduce the staff time spent on this task dramatically. Make sure you have the video vetted by your legal team, so you know that it has all the relevant information for patients.
8. Engage with “secret shoppers.” Hire several people to be a pretend patient for you. They go through the entire clinic process, experience what your other patients experience, and report the shortcomings. You can find people in your community willing to do this for free, but there are companies that can provide “secret shoppers.”
9. Ask your staff for their opinions. Your staff observes things that you don’t observe. Everyone has an opinion about how they’d do things differently. So, ask them! Not every idea will work, but some of them will, and other non-workable ideas may inspire variations that will succeed.
Clinical efficiency: Necessity is the mother of invention
Not only can you increase your clinical efficiency, but the reality of the medical business is that you can’t afford not to! Physicians are constantly being pushed to see more and more patients, and reimbursement is increasingly being tied to productivity.
These nine tips can greatly increase your clinical efficiency to allow you to be the productive, engaging physician you want to be. I don’t believe you have to compromise patient care for efficiency.
Brent Lacey is a gastroenterologist and can be reached at the Scope of Practice.
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