Preparing for a New Year and to be Prepared

January 17, 2017

This doctor has decided on an eternal New Year's resolution to be on time. Unfortunately, she's discovered there is such a thing as over-preparation.

I have an eternal New Year’s resolution to be on time. This year, I went a little crazy and aiming at being five minutes early for everything. Unfortunately, 2017 is already looking a lot like 2016, 2015, 2014, and so on.

I consider myself a conscientious physician. I do my very best for each of my patients and will doggedly pursue records or information as needed. However, my typical morning starts with me arriving at the clinic when the first appointment starts. This means I hustle to my office, throw down my stuff, log onto the computer and race to the first exam room. Sometimes I am going into the exam room cold because I haven’t had time to review the schedule or the patient’s chart. This is never a good feeling and is probably obvious to my patient. While I’ve perfected the art of reviewing the chart quickly, I still would prefer to go into each exam room perfectly prepared.

Last Monday, in the eternal optimism and energy that marks January intentions around the world, I committed to doing it differently. I reviewed my schedule and all the patient charts over the previous weekend and entered clinic (not five minutes early, unfortunately) knowledgeable about the patients I was seeing and the purpose of their visit. This increased my confidence in making sure all the “i”s were dotted and that nothing got missed, but it also revealed that there is no foolproof planning for the inherent unpredictability of clinic. It also demonstrated that my previous way of doing things was not as flawed as I had feared.

For one patient, I realized that he was due for a repeat imaging study that hadn’t yet been done. With my new method, I was grateful that I picked this up and was ready to get this scheduled. Only, it turns out that I already had it ordered and the patient has already been contacted to schedule it. I was more prepared for that encounter than I suspected. For another patient, I had diligently reviewed her previous office visit note, identified the purpose of the visit, but had missed a more recent phone call indicating a dose change for one of her medications. My preparation made me look unprepared!

There were some pickups that probably would’ve gone un-noticed, such as repeating a vitamin D level in a patient with a remote history of vitamin D deficiency, although the clinical significance is uncertain as I recommend vitamin D supplementation for all my patients (it being January in Wisconsin).

I guess the good news is that the quality of the care I provided was no different with my new process as with my previous process. However, I did like having a good idea of what to expect in advance of the day starting. It was also helpful to huddle with my medical assistant so that she was prepared.

Going forward, I will continue to experiment to determine the optimal level of advance preparation so that I am neither entering a room cold nor spending a lot of time unnecessarily.