Using the Fourth Exam Room (Part 5 of 12)
Thursday, December 15, 2005
Many physicians bog down their workflow by batching a lot of
work for the end of the day. When it's finally time to go home,
there are charts to dictate, calls to make, and so on. It's
frustrating - and inefficient. At the end of the day, a physician
will need to spend a minute or so remembering his or her thoughts
about a patient visit before dictating a note. Those minutes add
up: it takes a minimum of 15 minutes to rebuild your memory for 30
charts. Why not dictate, instead, while you are with the patient?
Like all of us, patients retain less than a third of what they
hear. Dictating in front of them, in a conversational way, will
increase retention of information and demystify their care. Tell
the patient what you are about to do.
Did you know it takes at least 15 minutes to
remember the notes you need to take for 30 charts? Dictate during
your exams to avoid wasting time.
Alternatively, we've seen a scribe attend each exam, often a
medical assistant who can also serve as an escort during internal
exams. The scribe takes all the notes and stays on after the
physician leaves the room to answer additional patient questions
and provide instructions. Meanwhile, the physician is already in
the next exam room with another scribe.
If that seems too odd or too expensive, consider setting up a
virtual - or real - fourth exam room. After every third patient
visit, duck into the nurse's station, dictation station, or some
other semi-private space. Return whatever calls have come in during
those exams, review test results, do your dictation, and complete
any forms that are pending. In short, do the work throughout the
day instead of holding it for the end.
Our essay next month will be "Using Nonphysician Providers."