60 MIN- That is as much time
as you have in an hour to practice
medicine! How much of every
hour do you actually spend delivering
medical care? That may
sound like an odd question to a
doctor who works many hours a
day, has a long lead time in the
appointment book, and drags
home tired at night. Nevertheless.
there are many ways in which a
physician can lose time during the
practice day . . . and thereby decrease the number of patients he or she can effectively see (and unnecessarily tire him or her out).
Two issues need to be addressed.
One concerns ways in which doctors
lose time, and the other is ways
in which doctors can get more
medical practice time out of every
hour. Some of the ways that doctors
lose precious minutes every hour
include:
    1. Escorting Patients - The doctor goes to the reception room and calls the patient back, or escorts the patient back, or escorts the patient to check-out when the exam is over.
    2. Sitting and Waiting -- Physicians while away their time in the hall because no patient is ready to be seen.
    3. Scheduling Patients - The
doctor takes the patient to the
scheduler after the exam, takes the appointment book, and schedules the patient (both special procedures and return appointments).
    4. Phone - The doctor
allows continual interruptions by

'The time

management

techniques discussed

here are designed to

help you optimize your

practicestyle, to give

you greater control and

satisfaction over how

you spend your time'

telephone calls. When it is a referring doctor, that is acceptable.
When it is not, and does not directly relate to patient management, it is time lost.
    5. Progress Notes - The physician hand writes the progress note. Usually, not always, this takes more
time than dictating or using a
scribe.
    6. Nurse Hunting - The doctor
hunts for the nurse between exams. This is done sot he doctor can issue a verbal order to the nurse (such as"Get a chest x-ray Qn this patient.") or to find out which exam room is the next.
    7. Delegating to Staff - The dmtor does thing which can be done

as well by staff (and in many other
practices are done by stafo. This
has been observed to include:
     a. Getting a preliminary history
on a patient
      b. Screening or refracting ophthalmic patients
       c. Removing or applying casts.
   8. Scheduling Staff - The doctor
delegates a specialized function
which takes time (such as scheduling
surgery or getting a visual field)
to staff responsible for routine patient
flow. This makes the staff unavailable
to properly keep the doctor's
patient flow moving.
    9. The Doctor's Work Area -
The doctor does not have a good,
effective practice area to work in.
This includes:
       a. The doctor does not have a
consistent work environment. One
minute he or she is working out of

2 exam rooms, and then 3 the next.
       b. The doctor does not have
enough exam rooms, causing him
or her to wait in the hall for the next
patient to be ready
       c. The arrangement of the
doctor's exam rooms is ineffective.
For instance, if a particular doctor's
exam rooms are far apart, he or she
will spend unnecessary time (and
effort!) walking the halls. If the doctor has to walk past already-seen patients (such as at the check-out counter) in going from one exam
to the other or she can be delayed
by patient chit-chat.
       d. The doctor does not have
his or her own telephone. When the

Mr. Haines is President, Medical Design Interna-tonal, 3091 Governors Lake Drive, Suite 400
Norcross, Georgia 3007, 770.409.8123

   This article was prepared at the request of the Journal. Others wishing to contribute papers to this Section should contact the Journal Office