Taking the Pain Out of Time Management

The following suggestions will help you manage your time more efficiently.

1. Never allow telephone interruptions while you are seeing patients. Leaving a patient in the exam room while you answer a phone call does not make the patient feel important or that he or she has your undivided attention. However, my staff has a system of using certain numbers on my cell phone as a text message, such as 911 if there is a call from the emergency room, 411 if another physician is calling, and 000 if my wife or family must speak to me. Another option is to have the cell phone on vibrate mode, so the doctor can respond to the call as soon as he or she exits the exam room, and the patient does not see the doctor answering the call. In addition, make it a policy to return all routine calls at a specific time, such as 11:45 AM or after 3:45 PM. If your patients and colleagues know your telephone policy, they will respect it and interrupt you for emergencies only. This also alerts the patient when the call is going to be returned so he or she is not waiting for hours to hear from the doctor.

2. Touch all paperwork and mail one time. Read your mail and reports at a time of day when you can take action and delegate tasks to your employees. Make use of Post-it notes to alert you to special details that need attention from you or your staff.

3. Dictate in real-time. Do not wait until the end of the day or week to dictate letters or discharge summaries. Dictate in front of the patient when the facts are fresh in your mind. This adds to the accuracy of your history and allows your patients to make corrections or additions during your dictation. Dictating in real-time reassures your patient that you are communicating with his or her referring physician. Dictate discharge summaries when the history and hospital course are easily remembered. The same rule of real-time applies to completing the electronic medical record encounter while you are with the patient.

4. Learn effective scheduling. Leave a half hour open during morning or afternoon office hours to accommodate add-ons and emergencies. Do not fill that half hour until the office opens in the morning when the phone is transferred from the answering service to the office phone. Do not worry about this open time. That half hour almost always gets used—if not with seeing patients then with catching up on your dictation and paperwork. We refer to this 20- to 30-minute slot each morning around 10:30 and each afternoon at 2:30 as “sacred time.” It is reserved for urgencies and emergencies.

5. Estimate the length of a patient visit, and schedule accordingly. A new patient with a chronic problem may take 25 minutes of your time, whereas a returning patient with a recurrent urinary tract infection, for instance, may require only 5 minutes. However, a patient with a newly diagnosed cancer may require 35 to 40 minutes and should be scheduled at the end of the day when you have time to answer all of his or her questions. A patient to whom you are disclosing a diagnosis of cancer or revealing a significant life-threatening diagnosis such as diabetes, lupus, or renal failure deserves your undivided attention.

6. Create a to-do list for each day and week. There are a number of paper and electronic systems on the market to aid you in keeping track of your schedule. You may want to use your mobile phone or one of the personal data assistants especially for physicians. Prioritize your to-do list with 1s, 2s, 3s, and 4s: 1s are must-dos, 2s are important but not imperative, and 3s and 4s are “sliders”—you can move these to another list. Check off completed tasks. It gives you a feeling of accomplishment to see a list with check marks beside the 1s and 2s. In addition, the Little Blue Book is now available for your cell phone. This is a program designed for use on a handheld device running either the iPhone or Android. Now you can have physician email addresses and pharmacy fax numbers on your handheld device along with other physician and pharmacy information, including direct dial to pharmacist phone numbers and fax numbers. The program also provides your area’s hospital information and useful HMO numbers and can be downloaded from your computer to your iPhone. For information, go to http://www.thelittlebluebook.com/products.aspx

7. Use office videos for patient education. By using office videos to explain common procedures, I have been able to enhance my office efficiency by 20% to 30%. This translates to one additional patient per hour, which computes to $125,000 additional income per year with no added staff or expenses.

8. Learn to delegate to and empower your staff. Allow your staff to make nonmedical decisions about office procedures and equipment. Give them the responsibility to solve problems on their own. Hire and train employees who are self-starters and can take the initiative to solve problems effectively and efficiently. Just remind them to do whatever is in the best interest of the patient. Then if they make a mistake or incur more costs, you will not have any problems if you think of the patient first.

9. Do not spend time between surgical cases drinking coffee and reading the paper. Make phone calls, review lab and imaging reports, write a blog, or review e-mails in your inbox.

10. Do not see pharmaceutical reps or vendors during patient hours. You cannot be an on-time physician if you are being interrupted throughout the day by pharmaceutical representatives. Nothing is more discouraging to your patients than to see a drug rep walk into the office and be seen before they are seen, especially for patients who have been waiting for some time to see the doctor. I suggest that your office tell the rep that you do not see reps when patients are in the office and that you will schedule an appointment to see them at a time that is convenient for both of you. Most reps and vendors appreciate being seen on time and will accept this alternative. Another effective technique is to have an hourglass on your desk, and invert the hourglass when the vendor or the pharmaceutical representative sits down. This is a subtle reminder that the visitor is “on the clock”! I promise you that this very simple procedure keeps the visitor focused and suggests to them that your time is valuable and that the vendor or drug rep must be focused.

11. Start on time. If you start half an hour late, you can be sure that by the end of the day you will be 30 to 60 minutes behind schedule in seeing your last patient. You cannot expect your staff and patients to be on time if you are not on time. Be realistic when you make up your schedule: you must make allowances for rounds, coffee, and looking at mail. If you are diligent about being on time, your patients and your staff will be on time too.

12. Answer every patient’s questions at the time of the encounter in the exam room. Give patients a small card and encourage them to write down any questions that they would like answered during the encounter. If you look at the card and see their concerns or questions, then you can quickly and efficiently answer the questions while the patient is in the exam room. I suggest concluding every visit or encounter with, “Have all of your questions or concerns been addressed today?” I can assure you that offering this single question will enhance your patient satisfaction scores and your online reputation.

13. Avoid phone tag. If patients call with questions or concerns, have the staff inform the patient when to expect a returned call from the doctor. In my practice, I return calls at 11:45 AM and 3:45 PM, and patients are encouraged to be at the number that they leave for the call to be returned and to keep the phone line open to avoid receiving a busy signal or having to leave a message. Remember tag is for tots—not for doctors and their patients!

Bottom Line: In many ways, effective time management boils down to plain good manners and practice of the Golden Rule: if you treat patients the way you would like to be treated, the chances are good that they will continue to be loyal to you and your practice.