During a recent team training session, we reviewed telephone triage techniques, tricks for obtaining the true chief complaint and tips for narrowing down the most pressing issue during evaluation. In most practices, if staff members aren’t properly educated, there is often a discrepancy between what is recorded in the schedule, what the patient relays to the medical assistant upon rooming and what the patient explains to the doctor upon evaluation.

Sound familiar? 
If so, you understand how this can wreak havoc on an already busy schedule leading to frustrated patients, staff and doctors.

Another common disruption in patient flow falls on the doctor. . . well, sort of. 

Have you ever been in a treatment room wrapping up a routine foot care visit when your patient says “oh, I almost forgot, can you take a look at my ankle, it’s been bothering me for a few weeks.” Or, the same patient who is scheduled for a recheck of his ankle pain that says “since I’m here, could you “do” my nails?” It happens all the time, right?

So, what do you do? Add on another evaluation and care plan or procedure and set the entire morning’s schedule behind (keeping in mind that you will most likely have to appeal to get the E/M paid along with the nails and calluses- even if your documentation supports the separately identifiable reason) or do you tell the patient that you don’t have time and they need to schedule another appointment.

For practice management and efficiency sake, I would choose the latter, but how about taking a slightly different approach. During your morning huddle (yes, you should review the clinic schedule for the day with support staff each and every day), assign a “bad guy” who will come to your rescue when patients put you on the spot and ask for additional services not previously scheduled. Simply say “let me have Cindy (aka the daily bad guy) check to see if I am able to do that today.” Then back yourself out of the room and let your bad guy take over.

He or she should be able to confidently relay to the patient that they were only scheduled for _________ and since the doctor likes to have adequate time to treat each issue, we will need to follow up next week.