Disciplined Approach to Office Visit Yields Rewards

There are five fundamental steps to an efficient and effective office visit, said Mary Applegate, MD. Physicians who routinely follow the steps and enact other office efficiencies can reap significant financial benefits, she suggested. "Saving two minutes on every patient daily can translate into two extra visits a day and about $10,000 a year in income," she estimated.

Keeping to the five steps can also help manage difficult patients. "Physicians blame some patients for 'wasting' their time, but defective interview techniques are often to blame," added Applegate, clinical assistant professor of medicine, Ohio State University.

The first (and most important) step is "opening the interview," she said. The initial questions to the patient should be "open ended" and eventually followed by the question, "Anything else?" During this first part of the visit, the physician should be an active listener and avoid interruptions from staff. Finally, the physician should summarize the symptoms back to the patient.

Second step: establish the patient's priorities and what you will address during that visit. "Remember, research indicates that in half of all office visits, the patient's concerns are not addressed," said Applegate.

Third step: elicit patient beliefs. "Patients often have beliefs about why they have a condition or have a cultural belief that influences how they will work with you," she said.

Fourth step: collaborative decision-making. "Now is the time to solicit patient ideas, list options, and seek patient understanding," she said.

Fifth step: "close the interview" by anticipating problems, providing written material and recommitting the patient to the plan of action, said Applegate.