This is part of our Teaching Tips series for residents. Ask us about the app.
Here are some practical tips on how to be more efficient and not be too slow.
- Set the agenda early
- yes, it should be patient centred but their first item is often not the most important
- if they have a list, ask to read the list
- Don’t get behind: this sounds obvious. But patients who have been waiting longer want to get their money’s worth, and remember other things to ask about
- Aim to Do Less, not the same things more quickly: drop low value items from your process.
- Don’t wait for the boss: interrupt me or see another patient. You can waste much time waiting.
- Poor historian?: remember that the historian is the one who records the history, not the one who tells it
- Process bottlenecks: in our clinic, the nurses get pretty busy. Go get your own patient.
Some EMR specific tips:
- Type less; trim out fluff phrases
- Use macros for common phrases
- You don’t have to ask every question in a template
- Don’t double document: system Tasks will document many of your actions.
- Learn quick keys for frequent functions: cut/copy/paste/all/find/print
- Frame your visit note with consult in mind
Expert clinicians learn which questions provide poor value. Here are some examples.
- Blood in your stool/pee/sputum etc: a normally intelligent patient will raise this.
- How much marijuana? Too many factors affect this. Ask how often.
- Threshold for pain: no patient with a high pain threshold mentions this. They think it is normal. The obverse is frequently true.
- Dizzy or lightheaded? Be more specific. Vague terms are misleading. See history section of Mildred VP case.