The visit is winding down. You’re getting ready to go, hand on the doorknob, saying goodbye. And then you hear, “Doc, one more thing.” Or perhaps you’re more familiar with the patient who has a laundry list of issues all to be addressed in the fifteen-minute appointment slot.
These visits have in common that they are both certain to back you up. Have multiple in the day, and you are most certainly working through lunch. By the end of the day, you are exhausted, cranky, and overwhelmed, left with a pile of open charts to finish at home.
What if there was a way to prevent this? Psychiatrists seem to have mastered the art. They simply say, “Your time is up. I’ll see you next week.” Maybe we don’t need to be quite that regimented, but we have room to improve.
We can learn to better lead the flow of our visits. Here are five tips:
1. Challenge your beliefs. The problem we face is that we don’t want a patient to think that we are rude, dismissive, or that we are rushing them, especially when they waited so long for the visit. That makes sense. We are conditioned at a very young age to “be nice.” In medical school and residency, we are trained that patients come first. On top of that, we are natural givers, and many of us are people pleasers. These are wonderful qualities, but they can swing too far. Is it truly “nice” to let the patient control the timing of the visit? Isn’t it rude to let the patient continue while you are thinking about how to end the visit or about the next patient? Wouldn’t it be kinder to give your undivided focused attention to the patient in front of you for 10 minutes rather than distracted attention for twenty? How does allowing the patient to run over negatively impact the other patients waiting, your staff, and yourself? I am suggesting that it is actually kind to set visit expectations upfront and when communicated properly, is not rude or dismissive.
2. Set the visit agenda upfront. Start by asking the patient everything that’s on their list for the visit. Not the details, just the high-level points. When they are done, ask if there is anything else. Doing so will help you avoid the “Oh, by the way” comment as you are ready to leave. Once you have the entire list, you can say something like, “Great. We have fifteen minutes today. What would you like to prioritize?” Then you can dig into their prioritized list one at a time.
3. Plan a strong closing. If the visit doesn’t seem to be winding down and you are nearing the end, tell the patient something like, “We only have a few minutes left. What would be most useful for you in that time? We can schedule a follow-up office or telemed visit to discuss the rest of your concerns.”
4. Be present. Knowing that you are now skilled at ending the visit in a timely manner, commit to yourself that you will fully engage with the patient while you are in the room. Take a pause and a deep breath before you enter. Let the patient speak uninterruptedly and truly listen for the first 90 seconds. Sit down. Make eye contact. When you are fully present and engaged, your patient will feel like you gave them more time and better care.
5. Lean into discomfort. Acknowledge and recognize that ending the visit feels uncomfortable and do it anyway. Focus on the people you will let down if you avoid that discomfort and let the visit run over. The patients waiting, your staff, and yourself. It is impossible to please everyone. A little bit of discomfort now will save you a lot of discomfort later. Remind yourself that you can do hard things!
We all know that emergencies and other workflow snafus are inevitable. Running exactly on time is an unrealistic expectation. But practicing these skills can bring a bit more control and enjoyment to your day.