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One of the long-term hot topics on ODs on Facebook is that of patient scheduling and volume. We each have our individual styles, some of which are self-determined, and some of which are forced upon us. Let’s look at how you might be more successful in practice, yet maintain the individuality that your patients seek in you.

Think of the benefits of compressing your schedule just a bit.

Imagine moving smoothly from patient to patient, and reducing your labor expenses by an hour a day in the process. Seeing two per hour? How about getting more help, and going to three, or even four? Seeing five per hour made my career, though I’ve geared down to four at the bent old age of 60.

Think of your duplication and inefficiency of effort. Is your exam targeted, or are you collecting data like a field climatologist? Does anyone care about your vertical vergences on an asymptomatic, longtime patient? You may, but no one else does, including the patient.

Here are some bullet points on efficiency in practice:

*Don’t trial fit soft lenses if the Rx isn’t in your sample inventory. With modern lens technology and success, it’s a five minute waste of time. Finish the complete exam and order empirically. You’re going to have to recheck it anyway.

*Pre-dilate. Review each day’s schedule and decide which returning patients are amenable to being dilated prior to your entry to the exam room. “We would like to dilate you now so that you don’t have to wait for the doctor twice.” Contact lens wearers and suspicious angles are out! Pre-dilation has no effect on my final eyeglass Rx (!?!?!?!?!) or other exam results when done properly.

*Order soft lens trials from two suppliers, but NOT with the intention of “trying them both.” “Mrs. Smith, I have a first choice and a second one. Let’s try the first, best lens out of the office before we go to the second.”

Don’t like all of these ideas? Like the smorgasbord that we call life, see if you can pick out what works…

*Avoid moving patients while dilating. You’ll spend 30 minutes per day explaining the move, directing them, and waiting while purse, cell phone, Starbucks latte, and kids are gathered for The Big Move. Then you get to repeat it. Oh, and where IS the bathroom, Doc?

*Add a “finishing” exam room if you can’t add a third or fourth full lane. Slit lamp and indirect.

*Body language. Get your mug out of that nasty EHR. NEVER counsel a patient while you are entering data. Take a deep breath, face the patient, and fold your hands on your lap. Make eye contact. Your 2-3 minutes of discussion will feel longer if you speak slowly and clearly, and give plenty of time for patient questions.

*The Handoff. Get the patient to a staffer, who will continue your message. Progressive designs, proper contact lens care, when/how long is the next appointment…………get help. You deserve it.

*Excessive appointment triage will RUIN you. A vast structure of rules and nomograms will result in staff being afraid to fill an appointment slot, and you’ll never know it. Streamline your exams so that a late call for an appointment won’t seem like reinventing the wheel. Get them in.

What, you only do “left eye” exams at 4:00 pm?

You can triage yourself into a bunch of empty exam chairs, based on the efforts of a well-meaning but misguided staff. We don’t care what service is needed in which slot. All slots are open for all services at the primary care level. I do request a “double” slot if I am doing punctal plugs or a glaucoma workup with gonioscopy. Otherwise, it’s all fair game.

*Always know where you are in your schedule. Chit chat is great and makes us human to our patients. But, remember that your position on the timeline will determine whether you will trade recipes for the elegant bouillabaisse, or a simple cheese sandwich.

*We aren’t big fans of monster pre-testing. Our auto-refraction is selective and not done universally. We don’t do “wide field imaging” and do precious little photography. The techs’ emphasis is meds, basic history, acuity, and government compliance. This approach frees techs to move patients in, and move on to the next one in less time than it takes me to do an exam.

Clearly, the theme is to work smarter, not harder! We’ll look at some more ideas next month.

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Bill Potter
Associate Editor, Dugout Dirt Editorial for Dr. Bill Potter is the senior optometrist at Millennium Eye Care in Freehold, New Jersey. Millennium is a multi-subspecialty optometry/ophthalmology practice, where Bill has practiced for 31 years. Prior to this, he served for 3 years as a Captain and optometrist in the U.S. Air Force. Bill is a graduate of the University of Pennsylvania and the Pennsylvania College of Optometry. He serves as a member of the Review of Optometry’s Editorial Board. The Primary Care Optometry News honored Dr. Potter in 2016 by listing him as one of the “PCON 250” top leaders and innovators in his field. Dr. Potter has a special interest in uveitis and other ocular inflammatory diseases and has lectured and published many articles in this area. Most recently, Bill’s CE article on “Red Disease in Glaucoma” appeared in the March 2017 Review of Optometry.


    • Dr. White, I typically stay for 10 minutes after patient care. Staff e-mails, etc. with an occasional lab consultation for specialty contacts. If you have hours of clean-up time after a day of primary care, I’d say it may be your prioritizing as well as your system. No system for primary care should require you to go back and finish charts. (It’s either a terrible EHR, or you are over-documenting.) Same with treatment plans, really. It’s primary care.

    • These are repeat patients who have been dilated within three years, with have a history of wide angles and refractive errors of under +3.00. 1 drop of Paremyd or 1% Mydriacyl. I review all of them in advance. They aren’t muggd by the procedure–it’s by verbal consent. Most are very appreciative of the time saving aspect. Personality disorders are ruled out.