Six ways to make more time in your clinical day (and stave off decision fatigue)

Organizing your clinical day so you can focus on the task at hand can be a challenge. Dr. Sarah Smith presented a session at OntarioMD’s digital virtual health symposium in June with tips on finding time in the clinical day. Dr. Smith is a practicing rural family physician in Edson, Alta. who runs a business called the Charting Coach. She helps clients design time spent in clinic to better promote work-life balance.Notably, Dr. Smith advised attendees not to adopt all the tips simultaneously. “Take teeny, tiny small steps. Don’t try and do it all at once,” she said.1. Choose a dedicated time to tackle your inboxQuickly checking your inbox between patients isn’t a good idea, Dr. Smith said. It makes you work twice when you look at it once, read it, then look at it again later. Instead, make sure you have dedicated time to work on the inbox. Before you begin, have a plan to how you will prioritize the work.When working on your inbox, keep it simple. Try to use as few words as possible (while still communicating effectively) and using as few clicks as possible, she said.Read: New guidance: minimum spacing between common lab tests2. Use the patient encounter to complete tasksFinishing up all tasks within the clinical encounter is one key to better efficiency. While the patient is in front of you, document the encounter, request any referrals, prescribe any medication and fill out any forms, she said. Ensure you book an appropriate length time to finish everything.This is a way of being kind to your own working memory. It’s harder to make decisions when you’ve got many things to remember, so the solution is to complete tasks as they come up. “Minimizing the number of tabs open in your brain is achieved by completing work as you go,” she said.Make sure patients also know about follow-up, such as when to arrange a test, how long test results might take and when to make a new appointment.3. Learn to “triage” doorknob questions in your brainAppointments can get longer when you have your hand on the exam room doorknob, and the patient adds: “Oh, and Doc...” Or when a crinkled form gets pulled from a back pocket. “Patients are selfish. They don’t care if you’ve had lunch,” Dr. Smith said. “They just want to have their 15 minutes with you and your brain.”“You’re the boss. Triage the question,” Dr. Smith said. Start with asking questions about red flags (i.e., are you having chest pains) and then decide if you’ll deal with the question now.If you decide to help the patient now, you may leave the patient in the room while you see another patient or deal with another task. Don’t feel trapped in the room,” Dr. Smith said. Let the patient know how long it will take. You can also do part of the work to answer the question now and follow-up later. For example, for a sore back on a patient who has to travel far for an appointment, do the exam now and schedule a phone call later. If you decide to deal with the question later, use phrasing showing the patient that their problem is important and deserves time—and that’s why you’re asking them to book another appointment.For forms, Dr. Smith said she only deals with forms that a staff member has touched first. That way any initial work is done by staff. Dr. Vandana Ahluwalia, a community rheumatologist in Brampton, Ont. who moderated the session, shared that she only fills out forms in front of a patient. “I say please book another visit for the form. We can book a visit in the next two to three weeks and we can fill out the form together,” she said. This way the patient has definitely approved what is on the form. 4. Delegate to staff . . . and to patientsThere are many things a physician doesn't need to be the one to do. Patients can book their own tests, or specialists can book appointments. One physician participant shared that when a patient calls about a urinary tract infection, the staff start the patient on the questionnaire and booking a test before they see the patient.Read: Universal primary care access by 20355. Get your staff on the same page One way to minimize interruptions in your day is making sure administrative staff know the answers to questions ahead of time. Make sure your staff knows what to do if a patient is late, if a test result comes in and what your rules are for other situations. “My rule is, if it’s crowning, coding, bleeding or seizing, come get me. Or, if Dr. X is returning my call, come get me. Anything else, I want in a work list. I don’t want to know about it during my clinical time,” Dr. Smith said.“Every time we take you off-task to think about a new question, you get decision fatigue because you’re starting to think about if you have the information you need to answer this question.” 6. Try to control internal interruptionsOf course, your brain is perfectly capable of interupting itself without outside annoyances. One participant asked Dr. Smith how to manage those internal interruptions. Dr. Smith used the example of quickly checking your social media feeds or something else in between patients, or any point in the clinical day. Why do we do this? “We are humans, we are ancient machines. We like doing fun things. We hate doing painful things.”“You’re not broken when it’s much for fun to check your work list than the patient you’re dreading in the next room that’s back with headaches and you’ve got no idea what to do because it’s your fourth round with them,” she said.Checking your phone is a way of escaping the internal feelings you’re having, whether it’s dread, anger, being tired or something else. But it's not a solution to that negative feeling, “because it’s actually creating a negative in your day” because you’re late for the patient.Dr. Smith suggested turning off social media apps on your phone so you’re not tempted to check it during the clinical day. Practicing relaxation methods (i.e., deep breathing) in order to reduce cortisol levels before a patient encounter could help deal with some of those internal emotions.More tips can be found on Dr. Smith’s website. Read: Taking the ‘paperwork’ out of your inbox

Six ways to make more time in your clinical day (and stave off decision fatigue)

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