Thanks to everyone who came out and participated in noon conference today.  I love clinic and love talking about it- so thanks for indulging me. The full slide deck is on medhub for the locals. But here are the highlights of the discussion.  I would love to hear more from you in the comments.  Chime in!

Communication is the key

As I said, the relationship is the key.  The key to patient satisfaction, physician satisfaction, compliance, negotiating agendas, not getting sued, working in teams, and really just getting out of bed in the morning.  The effort that you put into learning about your patients, listening to their stories, and even hearing about their grandkids will be rewarded many times over.  Plus it’s really interesting. I have a patient who was a civil rights foot soldier. Another one ran away and joined the circus.  Another plays the fluglehorn.  Your patients have these stories too, you just have to find out.

A Fluglehorn, in case you were wondering

Negotiating agendas

You can’t cover it all at every visit, and you will go crazy if you try. Know what you want to cover before you go in, and know what you are willing to give up if your patient surprises you with something. And to minimize the last minute surprises, try to give your patient the chance to speak up right off the bat.  I recommend giving time to the patient to go through their list without a lot of comment or questioning on your part. Just get the list first, then you can negotiate the top few things to cover.

Not the best attitude when negotiating agendas.

Billing in the Clinic

Billing in medicine is all about the note. We are paid for thinking and for taking excellent care of patients, and the only way that anyone knows that we are doing either is to look at the note. There are three parts of the note: History, Physical, and Medical Decision Making (aka Impression and Plan). You always need to document the Medical Decision Making, but for a return patient, you can skip either history or physical. Yep, you just need 2/3 parts.

Challenging patients

As much as I love most people, I don’t get along with everyone. When a patient and I don’t see eye to eye on something, and can’t move past it, it is hard not to let emotions get in the way. If the relationship is going to continue, however, you have to figure out a way past it. Acknowledge (to yourself) the frustration, own it, and then take a deep breath and plunge in. I find that I pay extra attention to my decisions to be sure that I am being objective and fair to the patient. The guiding question is, “What is the right thing for this patient?”  Oftentimes, that is you- since you are such a great primary care MD. Other times, that might be to find someone different to help or to take over care. Just be sure you are making that decision with their, not your, best interests in mind.

A great message, even if it didn’t come from a chief resident.

The big picture here, is think of your clinic as another place to learn medicine, practice communication skills, and meet some interesting folks. You don’t want to miss it.

Clinic is just like this, with better lighting.