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    Time and agenda

    2016 Physician Writing Contest Third Place Winner

    Dr. LawsonI have recognized a recurring theme among physicians. “Medicine is not what it used to be,” a colleague had once said. 

    I would hear statements like, “I used to be able to take care of my patients without having to convince anyone or insurance companies of the value of my work. I could see so many more patients in the past than I can now. Now they want us to document the BMIs and our counselling in the chart. Meaningful use? I think I spend more time charting than actually seeing patients. Maybe I need a scribe.”

    The ever-changing scope of medicine, and its various requirements undoubtedly have had an effect on the practice of medicine. Many providers find it challenging to balance all the requirements with actually spending quality time with their patients. With the frequency of new regulations, it is not hard to imagine the disillusion some feel.

    There doesn’t appear to be enough time for the issues that patients want to discuss, and there don’t seem to be enough appointments in the day to accommodate all the patients that need to be seen while also returning other patient calls and addressing labs and phone messages.

    Combining that with patients’ complaints of higher copays for doctor visits and therapy, one may be tempted to sacrifice a quality patient experience for a perceived sense of efficiency (or in come cases, just getting through the day) so you can get back to sorting out the pile of paperwork on your desk while keeping a seemingly positive outlook so the office runs smoothly.

    Listening to them reminded me of an experience I had during residency training that informed my outlook on patient visits and time management. 

    I was advised of the immense value in negotiating an agenda at the beginning of every patient encounter and inasmuch as it made sense to me, there were times I felt like I could do without it, counting on the encounter turning out OK anyway.

    One particular encounter did not turn out OK.

    I had a patient who was brought to the clinic by a representative from the adult foster home where he lived. He was accompanied by a female family member who was visiting from out of town. I entered the encounter room and noticed various things: a form that needed to be filled out, bottles of medication that needed to be refilled, and in the relative’s hand a list of all the issues that they wanted to address.

    I surveyed the room and I felt it was my job to do the best I could for him. To me then, that meant trying to deal with all his concerns in the time allotted. I wanted to save them the “stress” of coming back for multiple visits.

    After introducing myself and my role, I took the patient’s medication list, which was outdated, and started updating it in the patient’s electronic health record (EHR) from the laptop computer I had in my hand. After a little while, I turned to them and asked, “What is the first thing on your list?”


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