I hate physicals
I hate physicals. I always find there is way too much health teaching to do that if the person has even one thing THEY want to talk about, I'm in there for 35 minutes and my schedule is behind. Maybe I'm too much of a talker or want to tell people too much but even to hit the salient points and get in the important stuff... it takes a long time! I help people calculate their calcium, figure out if they should be on ASA, find out if they've had their FOBT, BMD, mammogram, pap test, cholesterol, blood sugar, wear sunscreen, wear a seatbelt, are looking forward to target coming to Canada... lots of stuff! Then, someone busts out that they have chestpain and it really falls off the rails! I feel like efficiency comes from cutting out some of the things that I think are important and I don't want to do that. puts me between a rock and a hard place.
In other news, I'm working in a locum right now that's only 6 weeks long and because of that, lots of the patients are waiting for their own doctor to come back.. and I only see about 9 patients per day. How relaxing!
3 comments:
Oh, the doorknob moment when they turn around and say, "Actually doc..." Glad to hear that between such appointments you're taking it easy for a little while.
In retrospect, I did know one GP who started all "check-ups" with an enquiry as to whether anything particular had prompted the patient to come in at that time. I'm sorry to say that he still had his fair share of doorknob moments, the best of which was, "I've had this lump in my breast for a few weeks and I've been on HRT since I was 35 and my sister died of breast cancer at 40. Should I make an appointment to see you again?"
Just came across your blog. Looks like we're in similar positions - I'm a new grad as well, just a bit ahead of you timeline-wise. I think we're in the same province too!
I ran into the same problem as you - physicals were taking way too long - there's no way I can do a thorough assessment and talk about preventative care in a reasonable amount of time.
I like to educate my patients, so I refused to cut out the preventative care stuff. This is what I've come up with which seems to be working: I ask patients to come back in a couple of weeks to discuss investigation results and preventative care. I do all the checking and ordering on the "physical day". Then on the follow up visit I go over results. There's almost always something that comes up in the lab work. I also use the 2nd visit to go over cholesterol targets, osteoporosis prevention, healthy lifestyle changes, contraception, etc.
My patients seem happy with this system. A few complained that they had to come back, but once they found out that there was value to the 2nd visit, they were OK with it. Try experimenting with different methods to find a way that works for you.
- A Canadian GP
On my fam med rotation we had a similar set-up to the one described above, and I quite liked it: one appt for the lab ordering and physical exam, and one appointment for follow up. Otherwise, in the over 65 crowd the appointments would easily take an hour once you'd gone through mammo/pap/BMD/bloodwork plus education and exam. Let us know if you find something that works well!
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