C L O S L E R
Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

How do you balance efficiency in practice and providing outstanding care to all patients?

Takeaway

A few physicians share ideas for how to approach this challenging question.

Lifelong Learning in Clinical Excellence | March 22, 2019 | <1 min read

Highlights

My practice is completely inefficient and my acceptance of that is important to providing care that I feel good about.

Colleen Christmas, MD, Johns Hopkins University School of Medicine
I conduct all of my other interactions with the EHR before or after the patient visit. This may appear to sacrifice efficiency, but I can do my electronic charting more quickly, in the minutes between patients or at the end of my clinic, without dividing my attention between the EHR and the patient. There is no such thing as multitasking, just divided attention.

Margaret Chisolm, MD, Johns Hopkins University School of Medicine
When rounding, before I do anything else, I identify my patients who need more education about their illness and managing their illness; then I go and spend some extra time with them.

Sam Kant, MD, University of Maryland Medical Center
As a patient, I hate waiting, so I try my best to never run behind more than 15 minutes, carefully prioritizing efforts for complicated patients. To make this work, I review charts for all patients I have on my schedule prior to starting to see patients.

Mike Fingerhood, MD, Johns Hopkins University School of Medicine
This balancing act is the Holy Grail for primary care clinicians! First, I try to set the agenda for the visit based on what the patient's concerns are.

Michael Crocetti, MD, Johns Hopkins University School of Medicine
Knowing my patient's priorities and creating a safe space for them to share their concerns allows for efficient management moving forward.

Panagis Galiatsatos, MD, Johns Hopkins University School of Medicine
Listen with care and an open mind.

Matthew Hamill, MBBCh, MPH, PhD, Johns Hopkins University School of Medicine

Colleen Christmas, MD, Johns Hopkins University School of Medicine

No one has ever used the adjective “efficient” in describing me. I would say that my practice is completely inefficient and my acceptance of that is important to providing care that I feel good about. At some point I learned that efficiency was a skill I neither had nor desired strong enough to pursue. Others have it and that is wonderful; it’s just not one I have.

Margaret Chisolm, MD, Johns Hopkins University School of Medicine

I have not let the electronic health record (EHR) significantly alter the way I interact with patients. The only visible difference in the way I practice is that I write prescriptions electronically. I conduct all of my other interactions with the EHR before or after the patient visit. This may appear to sacrifice efficiency (eg., I could be typing during the visit) but I can do my electronic charting more quickly, in the minutes between patients or at the end of my clinic, without dividing my attention between the EHR and the patient. There is no such thing as multitasking, just divided attention.

What do you think?

Do you want to add to the conversation? Please share!

Sam Kant, MD, University of Maryland Medical Center

When rounding, before I do anything else, I identify my patients who need more education about their illness and managing their illness; then I go and spend some extra time with them.

Mike Fingerhood, MD, Johns Hopkins University School of Medicine

As a patient, I hate waiting, so I try my best to never run behind more than 15 minutes, carefully prioritizing efforts for complicated patients. To make this work, I review charts for all patients I have on my schedule prior to starting to see patients.

Michael Crocetti, MD, Johns Hopkins University School of Medicine

This balancing act is the Holy Grail for primary care clinicians. First, I try to set the agenda for the visit based on what the parent/patient’s concerns are. Then I re-affirm with the patient/parent the 3 or more things they want to cover together. When discussing the topics I try and keep myself completely engaged with the parent/patient, acknowledge them with body language or a brief word, allow them to finish their words, and then respond using Heart-Head-Heart communication.

Panagis Galiatsatos, MD, Johns Hopkins University School of Medicine

I always ask, “what’s the biggest concern for you about your health?” Then, I stop and let my patient talk, making sure to listen to all of their questions and concerns off their chest. Knowing my patient’s priorities and creating a safe space for them to share their concerns allows for efficient management moving forward.

 

Matthew Hamill, MBBCh, MPH, PhD, Johns Hopkins University School of Medicine

Listen with care and an open mind. So often the key to understanding a patient’s symptoms and concerns are embedded within the history.  Listening to words and watching nonverbal cues allow us to access potential solutions. This approach can save many return visits and unnecessary tests.

Conversation

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