Why is the Patient Here?

Looking at my EMR patient schedule in its usual display, I can’t see quickly if I have appointment slots open. I would have to think 8:00, 8:30, 9:30 – so 9:00 must be open. There is a grid display, too, which lets me quickly see the unfilled slots. But the grid view gives no indication of why the patient is coming to see me. The standard version prominently displays 15 minute or 30 minute “visit type” but I am at the mercy of the scheduler as to whether there is a freetexted comment about the purpose of the visit.

For a busy clinician, it is crucially important to know why the patient is coming in. A wound check is not like a “doesn’t feel well” visit. When you’re always asked “where can we squeeze somebody in”, you need to know “why” in order to guess “how much time”.

I actually have no tolerance for “not feeling well” visits. Come on, use some common sense: Does the person have the sniffles or are they desperately ill with shortness of breath, chest pain or something equally dramatic? In my opinion, even offices that don’t have an automated phone system that says “if this is a life threatening emergency, please hang up and call 911” should have that triage step first and foremost in the mind of whoever answers the phone.

“Why” is also crucial when it comes to planning what needs to happen. If someone is coming in to have a wart frozen, the cryo equipment from down the hall needs to be available. A “3 month diabetes” visit needs a glycosylated hemoglobin, either a result from the lab or a fingerstick done in the office, whereas “followup blood sugars” is an interim visit to just review the blood sugar log.

Even the word followup means something. For me, a “followup blood pressure” visit is a predictable visit at my request, not something urgent. Theoretically such a visit could be “bumped” in a pinch to make room for an urgent hospital followup or something similar. But a patient’s own request to be seen because their blood pressure is skyrocketing must be labeled as “BP high”. Such a visit should obviously not be bumped and should not be labeled the same as a routine visit.

This may seem picky, but think of hailing a ride or making a dinner reservation. The driver might benefit from knowing how far and how many passengers, just like the restaurant might want to know how many guests and a regular meal or a birthday party and so on.

Another scheduling issue in my opinion is the “physical”. I hear family members worry about someone being ill and saying “he needs a complete physical”. First of all, there is no such thing as a complete anything in medicine. Second, billing for a physical implies that you did a lot of preventative things that would be inappropriate when somebody is very ill. I sometimes actually say “you are too sick to have a random physical, tell me what’s going on instead”.