Time Management Strategies

1. Time Management Strategies AIMGP Seminar Series UHN/MSH July 2007 Ken Locke

2. Time Management Skills: Objectives • Learn the components of each AIMGP clinic afternoon • Understand the differences between new patients and followup patients • Learn strategies to prioritize problems when they are multiple

3. Time Management Skills: Objectives (cont.): • Appreciate the patient’s perspective on time management in clinic: what are their expectations and needs ?

4. Time Management Skills: Time Components (group discussion) • What are the individual activities that the resident must perform in the course of each clinic half day ? • What is the expected time that should be allocated for each activity ? • Over which of these activities is there the most potential for time variability ? • Over which of these activities does the resident exert the most time control ? The least time control ? • Should the resident carefully examine her/his complete schedule at the start of each clinic ?

5. Time Management Skills: New Patient • CASE: • Family Dr. X refers Mrs. Y, a 65 y/o type 2 diabetic who has been poorly controlled on Glyburide monotherapy, for overall assessment and management of her diabetes • Mrs Y has background retinopathy, dense stocking glove neuropathy, and microalbuminuria • She has a new ulcer on her R 5th toe • She has intermittent claudication and shortness of breath with 2 blocks walk on the level

6. Time Management Skills: New Patient • CASE (cont.): • Mrs. Y acknowledges symptoms of both hyper and hypoglycemia in the past week • She is moderately obese and does not know her cholesterol status • She is a current smoker but desperately wants to quit • She has a positive family history for premature coronary artery disease • She informs you that she read an article on osteoporosis this week and is concerned that she may be osteoporotic and wants assessment and treatment

7. Time Management Skills: New Patient • As a resident seeing Mrs. Y as a new patient in clinic what are the tasks you need to accomplish ? • How do you prioritize these tasks? • Should the patient have input into this prioritization ? • How much is it realistic to accomplish in an hour long initial visit ? • What is vital to accomplish in this patient’s initial visit ? • How do you plan follow-up for this patient ?

8. Time Management Skills: Follow-up Patient • CASE (follow-up): • On Mrs. Y’s initial visit you decided to perform a full history related to her glucose control and monitoring • You also performed a complete cardiovascular history and physical examination (no worrisome symptoms, baseline EKG was normal) • You treat her ulcer with Abx and Ix’s for osteomyelitis are negative

9. Time Management Skills: Follow-up Patient • As a resident seeing Mrs. Y as a follow-up patient in clinic what are the tasks you need to accomplish ? • How do you prioritize these tasks? • Should the patient have input into this prioritization ? • How much is it realistic to accomplish in a half hour long follow-up visit ? • What is vital to accomplish in this patient’s f/u visit ? • How do you plan further follow-up for this patient ?

10. Time Management Skills: Strategies • Consider again all of the daily activities in clinic that a resident must perform, and in the context of Mrs. Y’s new patient and follow-up visits, what might be strategies at the various steps of clinic and patient flow that could improve time efficiency ?

11. Time Management Skills:Ambulatory Clinic Philosophy • How does this whole strategy compare with how she would be approached if she had come to ER?

12. Time Management Skills: Patient Perspective • Consider Mrs. Y’s perspective, and that of our other patients on time issues regarding the AIMGP clinic • What might they think is a reasonable duration for an initial visit? Follow-up visit ? • Should you ask them directly about their expectations at the start of your physician-patient relationship ? • Do you need to educate them about expectations for duration of future visits ? • Should our clinic staff educate them about the expected duration of their first visit ?

13. Time Management Skills: Patient Perspective • Do you need to factor in: • transportation time, • parking time, • waiting time to see the resident, • waiting time to see the staff MD, • waiting to get test and follow-up appointment slips, • waiting in the line up at the phlebotomy/EKG lab, • waiting time at the Xray dept ? • How do you handle the patient when you are already running late or expect that you will be running late ? • Do special modes of patient transportation like scheduled Wheel-Trans or a pre-booked ambulance alter your considerations ?