Jarrod Shapiro, DPM
Practice Perfect Editor
Mountain View
Medical &
Surgical Associates,
Madras, Oregon
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Exiting With Grace
One of the most challenging parts of patient care — indeed much of the “art” of medicine — is the simple act of leaving the patient’s room once the visit is over. How does the doctor exit the room with grace? This may sound like a small issue to write an editorial about, but it actually has ramifications, and is for me one of the most challenging parts of medicine’s social aspect.
One common patient complaint is that their doctor doesn’t spend enough time with them. This is understandable in our age of "volume healthcare." With the pittance we doctors are paid and the high costs to do business, it makes sense that we would try to see as many patients as possible with progressively shortened visit lengths. As doctors, already crammed for time, and our patients unhappy about the short amount of time we can spend with them, a smooth exit can make a huge difference in patient perception. They will either perceive the doctor’s exit as a pleasant ending to an efficient and beneficial office visit or the hasty exclamation point on a rushed and unsatisfying appointment. Which impression the patient is left with is, to a great extent, up to the doctor.
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With this in mind, how can we exit our patient interviews gracefully? By no means am I an expert at this — in fact I have a pretty hard time extricating myself from some patient visits. I’ve listed below those methods that I’ve found to be most effective in helping me tactfully exit my patient appointments.
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Schedule enough time for the visit. Easier said than done. Consider evaluating your scheduling methods. Do all your patients equally receive 10 minute appointments? Are you scheduled the same time for a nail debridement as for a new heel pain patient? If so, train your staff to vary appointment times based on your preset criteria. For example, you might schedule new patients with musculoskeletal complaints for 30 minute appointments while your postop bunionectomy may require only 10 minutes (perhaps even 5 minutes). A new patient wound will require more time than a new patient diabetic palliative care issue. Create a protocol for your front staff to follow when making appointments to smooth the way. Consider scheduling extra time for those “high maintenance” or delicate patients.
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Don’t run late. If your patient has already waited a half hour in your waiting room and then you rush through the appointment and get up to leave in a rush, they are unlikely to feel satisfied. Try to stay as on time as possible, which again requires preplanning.
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Listen carefully during the visit and ask if your patient has any questions. If you’ve listened attentively to your patient’s complaints, shown them that you understand their concerns and have answered all their questions – before getting up to leave the room – your patient will likely be more satisfied with their visit and will not feel their doctor has left them abruptly.
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Keep the patient on track. Many patients have the tendency to ramble and get off track during an interview. This eats up precious minutes and requires tact to bring the patient back to their original complaint. Gentle redirections and questions usually bring the conversation back on point.
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Use nonverbal cues. Most people understand social cues and will realize without your verbally telling them that the interview is over when you stand up, wash your hands, and move toward the door. Unfortunately, many don’t understand these cues.
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Set a time limit with staff for a “strategic interruption.” My office recently had a temporary nurse practitioner helping the office while another doctor was on vacation. She did well but had a very difficult time leaving the room and would consistently run late. To remedy this situation, my office manager had the medical assistants politely interrupt the visit if it ran too long. Interruptions like “excuse me for interrupting Dr Takestoolong, but can I borrow you for a moment?” work well.
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When all else fails firmly end it. Some patients just will not let you out of the room. In these cases, a firm but polite statement may be required. Something like the following may work: "Mr. Talkstoomuch, I’d love to keep talking, but I have some other patients waiting. I’ll see you in 3 weeks at your follow-up appointment. Call me if you need anything."
Unlike the technical component of medicine, treating the social aspect of our patients is rarely straightforward and simple. For me, exiting the exam room in a timely fashion is a skill I’m continuing to work on. For those with tips and pearls, get in on the eTalk at PRESENT Podiatry and share your wisdom. Best wishes.
Keep writing in with your thoughts and comments or visit eTalk on PRESENT Podiatry and start or get in on the discussion. We'll see you next week. Best wishes!
Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]
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