This month, we focus on becoming more efficient in day-to-day training/practice. Jeff Liu offers several valuable suggestions that will help you during your first year as an ophthalmology resident and beyond.
—Sumit “Sam” Garg, MD, section editor
As residents transition from internship into their ophthalmology residency, not only do they have to struggle with learning a new set of clinical skills, but they also need to appreciate the practicalities of working in an outpatient setting. How do they best balance providing high-quality care to patients while facing time constraints? This article provides a few pointers for residents and fellows as they progress through their training and into practice.
INTERACTIONS WITH PATIENTS
Treat Patients Like Family
We hear this over and over during our training, but it is worth repeating. Although the patients may not be your family members, they are someone else’s family members. We should accurately and appropriately treat their ocular pathology, and our interactions with them should reflect our care for their well-being. Take time to answer questions and provide education. Not only is this good medicine, but if a patient understands the rationale for a particular treatment plan, he or she is more likely to adhere to it. Also, if patients are happy with their care, they are more inclined to help refer other patients to your practice.
Understand Patients' Goals
I have repeatedly witnessed early residents overlook this fundamental step. Understand what your patients want from that day’s visit. Although a patient may have been referred for diabetic retinopathy screening, not addressing his or her concern about glaucoma or symptoms of dry eyes will lead to an unhappy patient. It is as easy as asking, “What is your goal for today’s visit?” Second, this clarification of a chief complaint is also important for billing and coding purposes.
Schedule Multiple Visits When Necessary
Patients with multiple ocular diseases may need multiple visits to tackle all their problems. For example, you do not need to do a full workup for glaucoma when the patient comes in for conjunctivitis. It is OK to put secondary issues on hold and have patients return for additional testing when appropriate. You will be able to focus your discussion and patient education on the patients’ more active issues.
Focus on Developing Strong Fundamental Skills
Medical decision making can slow down physicians in training but is rarely a factor that slows down the overall pace of the clinic for experienced clinicians. During training, focus on developing strong clinical fundamentals to provide quality care for your patients. As you see more patients and become more comfortable with managing different pathologies, you will become more efficient without consciously making an effort.
OFFICE SETUP TO IMPROVE EFFICIENCY
Use a Scribe
A scribe can save 3 minutes or more per patient and can act as a helping hand while in the room. Not only does this person increase efficiency, but he or she also provides more face time between the physician and patient, because the physician is no longer filling out the chart while the patient is still in the room. The financial expenditure for a scribe should be offset by the additional number of patients the physician is able to see.
Use Your Technicians
A physician can become more efficient when technicians prepare patients correctly before the physician even enters the room. Technicians may take a thorough history, check the patient’s vision and IOP, perform refractions, dilate the patient’s eyes, and perform any special testing. Physicians should create protocols for what needs to be done for patients depending on the diagnoses. After the patient is seen, technicians can also write prescriptions to be signed and provide patient education. It is important to educate your technicians to think about the patient’s pathology and to proactively perform appropriate testing/ questionnaires to improve the efficiency of your practice.
Plan Your Clinic Schedule
The patient schedule should be balanced between new patients and faster follow-up patients, such as IOP checks and postoperative visits. This type of plan avoids the two extremes of downtime (physician waiting for patients to be screened) and backlog (too many new or complex patients scheduled together). A steady flow of patients will keep the clinic pace moving and optimize efficiency.
Show up on Time (or Even Early)
Review the day’s schedule with your technicians to spot any potential hiccups and to order testing for patients. Not only are you now seeing the first patient on time, but you are also helping to make the rest of the day run more smoothly.
Minimize Distractions
During clinic hours, try to minimize cell phone calls and meetings with vendors. Questions for the physician not pertaining to direct patient care in clinic should also be avoided if patients are waiting to be seen.
CONCLUSION
Incorporating these tips in your practice may not only help you to become more efficient and manage time constraints but will also keep your patients happy.
Section Editor Sumit “Sam“ Garg, MD, is the medical director, vice chair of clinical ophthalmology, and an assistant professor of ophthalmology at the Gavin Herbert Eye Institute at the University of California, Irvine, School of Medicine. He also serves on the ASCRS Young Physicians and Residents Clinical Committee and is involved in residents’ and fellows’ education. Dr. Garg may be reached at gargs@uci.edu.
Jeffrey W. Liu, MD, recently completed a fellowship in cornea and refractive surgery at the Gavin Herbert Eye Institute at University of California, Irvine. He is joining the Peninsula Laser Eye Medical Group in Mountain View, California, and will be practicing corneal, cataract, and refractive surgery. Dr. Liu may be reached at (650) 961-2585; jeffreywliumd@gmail.com.
