Monday, September 24, 2012

Up the Wall

I'm now 2-3 weeks into my regular schedule at work, which consists of two 12-hour days and one 7-hour day where I am both the ICU and emergency doctor, AND see appointments (sometimes I only have 3 or 4 appointments, which is awesome because then the hospitalized patients actually get some attention, but sometimes I have 14 appointments, several emergencies, and hospitalized patients that need diagnostics and treatment plan changes during the day, and that is not an environment conducive to good patient care), and Saturday, where I work 6 hours and ONLY see appointments.

I think emergency and ICU work is orders of magnitude more interesting than annual checkup appointments and vaccines, but I have to say that it is REALLY nice to hear the receptionist page a triage nurse to emergency on Saturdays and know that I'm not going to have to deal with it.

Anyway, Saturdays have a generally calmer atmosphere overall, due to the fact that 1) most appointments are annuals or puppy vaccines, 2) there's a different doctor on emergency duty, and 3) I'm the only doctor seeing appointments so no one else is siphoning technicians away from me. But they're still busy, partly because my practice schedules 15 minute appointments for EVERYTHING. 3rd round of puppy shots? 15 minutes. Dog scratching its ear for the first time and needs cytology and a topical med? 15 minutes. First new puppy visit for clients who've never even had a PET before let alone a puppy, and know nothing about raising one and have 2 pages of questions? 15 minutes. Extremely sick dog with 4 separate medical problems, all of which need diagnostics and extensive client education? 15 freaking minutes. So it's very easy to get behind.

The more aggravating problem on Saturdays is that the receptionists apparently have no training whatsoever on how to field calls. This post was inspired by my colleague over at 2nd Career, who seems to have a similar problem. I started to leave a comment and realized it wasn't going to fit in the comment box, so I came back over here to vent more thoroughly. :)

I'm sure this happens every day, but since I'm the only doctor there on Saturday I notice it a lot more. The receptionists come back literally between EVERY APPOINTMENT to ask me a question about someone on the phone. And it's always something where I need to stop what I'm doing, close the chart I'm in, look up the patient, look through their chart, and make a decision about something. I have never been in a practice before where the doctor is expected to be at the beck and call of everyone who can dial a phone!!! The EFFICIENT way to handle these phone calls is to take a message and tell the client I'll call them back. This is made even more simple by our computerized message system, which allows reception to leave me a message with a time and date stamp under my account in our EMR system, where all I have to do is check my calls and I'll see the whole list pop up and can then work through the calls when I have time. They wouldn't even have to get out of their chair. But instead they write a note on a scrap of paper, hang out in the pharmacy waiting for me to finish an appointment, and then when I'm in the middle of writing up a record or trying to calculate a medication dose, they start talking to me about the message.

The serious risks of this habit are that I'll make a medication error (which already happened once; luckily it was both very minor and caught by my technician) or that the client won't get a call back because I lost the scrap of paper that the message was written on. But even if neither of those things happens, it's distracting, it pulls me away from what I'm working on, it takes time to deal with, and then I'm even LATER for my next appointment, which is inconsiderate of the client who has actually made an appointment to see me. So it's driving me UP THE WALL.

I don't actually have the authority to make management decisions, but next Saturday I'm going to sit down with the receptionists at the start of the shift and tell them I'd like to try a new strategy. There are 3 (and only 3) things that can happen when someone calls:

1) It's something the receptionist can handle, and then they deal with it as usual and that's the end of that.
2) The client is told, "The doctor is in the middle of seeing appointments and will call you back when she's done seeing patients for the day. It will be before 5 PM". And then no matter HOW MUCH the client insists it'll "just take a second" or they "really need an answer right now", the receptionist takes a message and puts it into my messages list in the computer and does not interrupt what I'm working on to tell me about it.
3) If it's really something that can't wait for a call back, they can come in on an emergency basis. 

That's it. Three options. We'll see how it goes.


The Snowboarding (and Crossfitting) Veterinarian said...

I like that approach and will probably steal it :) Let us know how it goes!

Ceres said...

I can see how the scraps-o-paper and instant feedback approach would work in a less busy practice, but on top of back to back 15-minute appointments? Crazy! Good luck--your new approach sounds like it will work better.

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