EFFICIENCY -- 51 minutes from start to finish
51 MINUTES. What in a doctor's office can be 51 minutes? Admit it. You thought, "the wait before I see the doctor."
That is not uncommon in the standard medical office. But it does not have to be that way.
A doctor's office with fewer barriers for communication, scheduling and provision of care can run more efficiently for true patient care. Metrics for medical office "efficiency" too often do not really consider what the patients need and want.
Let's examine the time line below. It is for a recent bladder infection appointment. Consider how the simple design of my practice helped me match the care provided with the service the patient wanted and needed.
On this particular day, I was to leave the office at 5:30 to go to my son's soccer game. I had no one booked after 4pm and was doing phone calls, emails and other paperwork. This patient's symptoms had progressively worsened all day.
4:25PM -- FIRST CONTACT
Patient emails me (as only person in my office, any email is to me) and writes:
"Hi Tim,
I started to experience pain when urinating yesterday (pain in the bladder area, like a cramp). It has continued today and now this afternoon I have the urgency to repeatedly go to the bathroom. There are no other symptoms.
Do you think this could be a bladder infection? What should I do?
Thanks"
4:34PM -- DOCTOR REPLIES
I read her email and reply:
"I'm here until about 5:30 doing paper/phone/message work. Want to stop by and we'll check the urine, consider treatments and possible culture?"
Consider how, in a way, the appointment for her condition has essentially started as I know about the problem.
4:50PM -- TRY PHONE
I have not received an email reply while I continued working on other messages/emails. So I call her home and her daughter reports the patient had already left to come to my office. I enter her name into my online scheduler for 5PM.
4:55PM -- PATIENT ARRIVES
As noted, the appointment had essentially started before the patient arrived in the office as I already had the basic history for the problem, plus I am well acquainted with her medical/social history. After greeting her, I give her the cup for a urine sample. She returns about three minutes later.
5:00PM -- URINE DIP TEST
Simple urine test in office strongly suggests bladder infection. While doing the test, patient and I continue talking, and I get the rest of the details of the condition. I then complete the remainder of the physical exam.
5:05PM -- OTHER HEALTH ISSUES
On the computer, I note a recent pathology report and I explain how I'd received it from her specialist and verify her understanding about the condition.
She then reports that a certain medicine she is taking may be causing undesirable side effects. She has already decreased the dose and feels things are going just as well as with the higher dose. We discuss further tapering, and perhaps ultimately discontinuing the medicine. She's happy with that plan.
5:10PM -- PRESCRIPTION
Prescription has been sent electronically to her pharmacy. We discuss reasons to be in touch and how antibiotic may be changed depending on urine culture results. I verify she understands plan for decreasing other medicine.
5:11PM -- PATIENT HOMEWARD
Patient leaves, happy and on-time for getting her children to three sports practices in the evening.
5:15PM --OFFICE NOTE DONE
Her chart note is completed by dictating with voice recognition.
5:16PM --LAB PICKUP REQUESTED
Hospital lab notified to pick up urine culture sample this evening.
... And I'm right on schedule for getting to my son's soccer match.
51 MINUTES from patient trying to contact me to completion of appointment and related work.
Patient's needs and wants were met because there were no barriers to her communication with me, no barriers to her booking an appointment and a stream-lined system to get the job done.
Now, honestly, this worked well, and at other times I am not this efficient. But my office design now allows this to be the reality more often than in the traditional office design I worked in for 13 years.
Today, I more frequently can be the physician and not have system-based hassles keeping me from giving the best care to my patients.
And for that I am grateful.
