The Dysfunctional Medical Practice – Part II of a Five Part Series

Last week, we discussed the dysfunctional office of a client where the provider and his staff rarely left until well into the evening because he was chronically late. The average tenure of an employee was less than six months because long days were untenable for most of the staff.

Issue #2: The Chatty Physician

After tracking the schedule for a few days, it became apparent that our sociable doctor was taking much longer with his patients than the time-slot allocated to the appointment. Variation in visit length is a fact of life but when it exceeds the estimates almost 100% of the time, there’s a problem. Another study revealed that the acuity of the patients was rarely the contributing factor. Instead, because patients vented their frustration about the long wait, the physician felt compelled to defend himself. He also was not skilled at managing the conversation to remain on track with the visit. Naturally, he loved his patients but a 15-minute chat about grandkids and vacations with a large number of patients only perpetuated the problem.

CCG’s solutions were multi-faceted: The Office Manager began to communicate frequently with the waiting patients to apologize and pre-empt the venting. She also monitored the patient flow – while training the physician’s assistant as well – and they developed code-words to extricate him from a room if the side conversations became too long. In addition, the physician’s habit was to escort patients to the exit window, where he charted and often continued conversing. The office flow was revised so patients were escorted by the Medical Assistant and the physician could chart and go on to the next waiting patient.

One final challenge was the physician’s frequent distractions with personal calls to his cell phone or personal visits to the practice that delayed him during and between appointments. CCG elicited his cooperation to limit calls to every two hours unless an emergency arose, and to discourage drop-ins from family and friends during the work-day. Visits from pharmaceutical reps were scheduled for slower days with specific time-slots for this purpose.

Read Part III of the series next week.

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