Wednesday, October 17, 2007

Clinic Inefficiency

Another clinic day, another day of incompetence. We residents each have one afternoon a week devoted to our own continuity clinic -- in other words, our own primary care clinic where we have our own panel of patients. They are my patients, and I am their doctor.

More precisely, I am their slow doctor. Starting my very first clinic day, I quickly realized that I am very inefficient. We are typically assigned three to four patients an afternoon, and since these patients are all new for us we are allotted one hour per patient -- as opposed to the 30 minutes we get once they are return patients. Despite all this time we get, I still am extremely pressed for time trying to see the patients, presenting them to our attending, returning to finish up with the patient, and then typing up my note ... or at least the first half of it.

No matter how much I struggle to quicken our encounter, I cannot finish in time. Their endless complaining and my endless attempts to “briefly” touch on each of their complaints makes the clock jump forward faster than I believe. I try to rush things, but I still finish at least 15 minutes late each time. Add to this the fact that many patients arrive late, and you can easily see why I leave clinic around 7pm, even though my last patient is scheduled for 4pm.

This situation is both discouraging because I feel so incompetent, and also irritating because I try hard to be efficient ... only to end up failing.

So, all you practicing doctors, I reach out to you ... how do you do it? How are you able to handle your schedules with so many patients, and on a daily basis too? How do you deal with so many patients? the patients with 10+ problems? the patients who don’t stop talking? How do you see them in the 15-30 minutes of a typical clinic office visit? I can barely keep up with my schedule of 3-4 patients, despite the fact that I’m given over twice as much time as most practicing clinicians.

More importantly, how do you not get tired seeing patient after patient, all immediately after one another? Does it get easier? I really hope so, because at this rate I definitely will not be able to see enough patients to remain financially solvent in the future ... student loans aren’t paid back at four patients a day, you know.


Ladyk73 said...

And the first time you sharpened a long did it take? Now? How long did it take you to learn to ride a bike? you even think about it, when you ride one?

Anonymous said...

That sounds frustrating but totally normal... hang in there. Learning takes time- it's perfectly normal to be way slower and make lots of mistakes. The learning curve can be harsh when you're in it though.

Axis said...

ladyk73 -- I was actually a child genius, and so I sharpened my first pencil in 5 seconds flat. beat that!

Ladyk73 said...

Giggles...5 Seconds? Amazing! See, now the youngins have those mechanical pencils, the shame...

the evil resident said...

After three years of residency training, I've come to believe that it's a combination of not only getting better at it, but also of caring less. I definitely find it easier to interrupt people and tell them that we can only handle one or two of their problems today, and that they have to schedule another appointment (or three) to handle the other sixteen problems.

That said, even when you're a third year resident, you're still going to be staying until 7:30 pm, because they'll continue to increase the number of patients you have to see.