1. Time Management Strategies AIMGP Seminar Series UHN/MSH July 2007 Ken Locke

2. Time Management Skills: Objectives Learn the components of each AIMGP clinic afternoon Understand the differences between new patients and followup patients Learn strategies to prioritize problems when they are multiple

3. Time Management Skills: Objectives (cont.): Appreciate the patients perspective on time management in clinic: what are their expectations and needs ?

4. Time Management Skills: Time Components (group discussion) What are the individual activities that the resident must perform in the course of each clinic half day ? What is the expected time that should be allocated for each activity ? Over which of these activities is there the most potential for time variability ? Over which of these activities does the resident exert the most time control ? The least time control ? Should the resident carefully examine her/his complete schedule at the start of each clinic ?

5. Time Management Skills: New Patient CASE: Family Dr. X refers Mrs. Y, a 65 y/o type 2 diabetic who has been poorly controlled on Glyburide monotherapy, for overall assessment and management of her diabetes Mrs Y has background retinopathy, dense stocking glove neuropathy, and microalbuminuria She has a new ulcer on her R 5th toe She has intermittent claudication and shortness of breath with 2 blocks walk on the level

6. Time Management Skills: New Patient CASE (cont.): Mrs. Y acknowledges symptoms of both hyper and hypoglycemia in the past week She is moderately obese and does not know her cholesterol status She is a current smoker but desperately wants to quit She has a positive family history for premature coronary artery disease She informs you that she read an article on osteoporosis this week and is concerned that she may be osteoporotic and wants assessment and treatment

7. Time Management Skills: New Patient As a resident seeing Mrs. Y as a new patient in clinic what are the tasks you need to accomplish ? How do you prioritize these tasks? Should the patient have input into this prioritization ? How much is it realistic to accomplish in an hour long initial visit ? What is vital to accomplish in this patients initial visit ? How do you plan follow-up for this patient ?

8. Time Management Skills: Follow-up Patient CASE (follow-up): On Mrs. Ys initial visit you decided to perform a full history related to her glucose control and monitoring You also performed a complete cardiovascular history and physical examination (no worrisome symptoms, baseline EKG was normal) You treat her ulcer with Abx and Ixs for osteomyelitis are negative

9. Time Management Skills: Follow-up Patient As a resident seeing Mrs. Y as a follow-up patient in clinic what are the tasks you need to accomplish ? How do you prioritize these tasks? Should the patient have input into this prioritization ? How much is it realistic to accomplish in a half hour long follow- up visit ? What is vital to accomplish in this patients f/u visit ? How do you plan further follow-up for this patient ?

10. Time Management Skills: Strategies Consider again all of the daily activities in clinic that a resident must perform, and in the context of Mrs. Ys new patient and follow-up visits, what might be strategies at the various steps of clinic and patient flow that could improve time efficiency ?

11. Time Management Skills: Ambulatory Clinic Philosophy How does this whole strategy compare with how she would be approached if she had come to ER?

12. Time Management Skills: Patient Perspective Consider Mrs. Ys perspective, and that of our other patients on time issues regarding the AIMGP clinic What might they think is a reasonable duration for an initial visit? Follow-up visit ? Should you ask them directly about their expectations at the start of your physician-patient relationship ? Do you need to educate them about expectations for duration of future visits ? Should our clinic staff educate them about the expected duration of their first visit ?

13. Time Management Skills: Patient Perspective Do you need to factor in: transportation time, parking time, waiting time to see the resident, waiting time to see the staff MD, waiting to get test and follow-up appointment slips, waiting in the line up at the phlebotomy/EKG lab, waiting time at the Xray dept ? How do you handle the patient when you are already running late or expect that you will be running late ? Do special modes of patient transportation like scheduled Wheel-Trans or a pre-booked ambulance alter your considerations ?