#exam tip

Exam prep mind map!

Has to uploaded pictures or PDFs as answeres in you exam

Write by hand in OneNote

○     In this episode I’ll cover:

■      How to organize yourself for the visit

■      How to guide the visit

■      How to get in and get out with all you need

■       ...and so much more!

  Last episode, if you have been following, was how to make that patient connection. How to start that very first visit to connect with your patient to improve the patient experience and how that benefits the patient, as well as yourself. There are many things that we have touched on along the way in this podcast, that you might be thinking, “oh my goodness this is so much to take in and how am I ever supposed to fit all of this into a visit! If I get 15 minutes for my patient. How do I ask them everything that needs to be asked in 15 minutes?”

 What if I told you that most often 15 minutes is more than enough time to get the information you need?

  What if I told you that I could make your visit very efficient?

 And what if I could tell you that the patient would be satisfied with that 15 minute visit also? 

 Now, obviously, sometimes there are unforeseen circumstances to the situation and something may present that is more complex, but I’m talking about your general average patient experience.  And…. if you are able to follow the steps to do a very concise efficient visit, it will also make your charting much easier. You’ll be able to do templates, get a flow, and get your rhythm going so that you will be able to consistently see your patient in a timely manner and make everyone happy in the end. Oh, and yes, you will gather all of the information that you need.

 The key to all of this is staying organized and having a system. How do you do that you might say? Every patient visit is different. But are they? If you listened to the last episode, you will remember that I said you guide the encounter. This remains true, no matter what encounter. Whether it is the first one or each subsequent one. Whether it is acute or chronic. And in an episode prior to that, I talked about doing your homework before each visit. Always being prepared. 

 To review, that means before you go into the room look at the important information. Here’s what I do. 

 1.        I look at the date of their last visit, so I know if this was a scheduled follow up or if maybe something happened before our next scheduled visit that brought them in sooner. 

2.        Then I take a look at the vital signs. Have they gained weight or lost weight? Is the blood pressure stable? What is the heart rate? If there’s a big change, my brain is triggered to ask about that, so I will jot that down. 

3.        I of course will review their past medical history real quick and social history.

4.        Was there anything that we may have started in the last visit. Did I add a medication? Did I take something away? Was there an abnormality in their lab? Was there something that I wrote in my follow up plan that we would address at the next visit? Or did I give them a goal?

 I have to say that I have worked closely with my medical assistants to streamline this process. If you are lucky enough to have a great medical assistant like I do, then you are golden! If you haven’t worked to form a team building relationship with your assistant yet, I highly recommend you get that started. Meet up to discuss workflow and help them to understand what you need done prior to the visit and in the process of bringing the patient back to the room. This small proactive step will make your life much easier.

  Everything is a system. When things work like a well-oiled machine, you’re actually more preparded for any glitches and you will know how to roll with it. If you’re working in chaos all of the time, you’re going to feel stressed and anxious and flustered. That’s not good for you or the patient. Or your staff, I might add.

 5.        So now that I have gathered my data, and I know if the patient is stable or, if there’s something that has changed that I need to address, I look at their medication list. I will already know in my mind if there is a medication they are on that may be involved in what we are going to be addressing in the visit.

 All of this process should only take you 2 to 3 minutes. Because again, with a good medical assistant all of your stuff is ready to go. If you have an electronic health record, all of the data should be in there for this quick review.  if you do not, make sure that your assistant has been trained to have everything on the chart that you need.

 Since we’ve already went through making that connection in the first patient visit I’m going to bypass that part. What I am going to say is that  

 6.        I walk into the room with my smile on, address them personally, ask them how they’ve been and address any other pertinent topics or familiarity.

7.        Next, I am going to review:  “I see that you were here for…”. Let’s say “your diabetic follow” up as an example.  “Is that right?”  And they will either say yes or no of course. Then I will say, “before we get into all these numbers, is there anything else that you’re concerned about today?” “ Or is this just doing our regular visit?”

 The reason that I do this, is so that if there is something new…which may take a little bit more investigation or time… I want to know at the beginning of the visit rather than at the end of the visit. You see, it is our nature to assume what the visit progression will be, because when we scheduled the follow up appointment with intention. At the end of the previous visit we have in our mind what we’re going to address the time. Typically, that is reviewing labs and the status of any comorbidities. Then we will add a little bit of education in there on whatever else we may need to address. Patients don’t always know that plan. 

 8.        So, now, if this is just a regular visit, with no new complaints or concerns I will go into the numbers. Having done my homework, I will be able to review in the following manner “I see that your blood pressure looks great” I will give the numbers. “you’ve lost 4 pounds!” 

 Notice, these are positive findings that I start with.  I’m boosting the patient with the positive findings. Now, if they were worried about anything, I have given them some good feedback.

 9. Next I will transition into anything that may not be as good. Your hemoglobin A-1 C went from 6.8 to 7.2. Why do you think that is? 

 10.  Then I start to guide the discussion by asking some very direct questions. Have you been under more stress then usual? Have you been eating out more often? Are you snacking between meals? Are you drinking soda or sweet tea? I try to really be pointed and directed about the things that can increase the hemoglobin A-1 C. That prevents the topic from getting off to something that isn’t relevant.

 11.  Education and care plan development follows.  If, by chance, the patient has been eating more snacks, I will go into some of the risks of an elevated hemoglobin A-1 C and that we need to find a way to get that down. If it were isolated, I often will not make medication changes, I will again partner with the patient, to see what it is they believe can be modified to make improvements.

 To this point, what we have done is create a tone for the visit. We have given positive reinforcement. We have given the numbers. We have started to address anything that may have interfered with goals. And we have used the word “we” to show that is a partnership. Do you see how that works?

 I am asking the patient to take ownership into their own health with that questioning. I am not being confrontational or accusatory. We are discussing the situation.

 Then if they have more than one comorbidity, which they usually do, I will guide each thing in the same manner. I will inquire in a consistent fashion. Starting with the positives and the things that may not need as much attention at the time. Then I transition into the things that will require more of our attention. This allows you to manage your time.

 12.  If their chief complaint is associated with new symptoms, I will ask those questions directed as well. Instead of letting the patient ramble on about things that may not be of value to the treatment, I will be specific. Are you having any numbness or tingling in your feet? If they say yes, I follow with “does it go all the way around or does it go up one side or down the other side, do you have any back pain with it? 

 Again, guiding the visit and asking pertinent questions. 

13.  Now the assessment. How do you have time to do that also? You can use your assessment piece as a way to manage any new positive review of systems or address anything that may not have been touched on. 

 14.  With every concern, I try to summarize that at the end with an etiology and what we can or cannot do about it. I will make my recommendations. I will ask if that seems doable or if there are any limitations to that. If there are certain limitations, we will see what we can do about that within the patient’s comfort level.

 15.  Visit complete! And A LOT has been accomplished! Now, go dictate that note with confidence! (Another podcast coming up!)

 A special bonus to this podcast:  

 I am going to be doing a video for fine tuning your assessment skills.  I want to be able to help you with an efficient assessment that may pick up on clues ..as well as  how to address those findings as you’re doing the assessment to keep yourself on track.

  To get access to that video you’re going to  want to go to  nphealth interventions.com/assessmentpearls to sign up for it! Totally Free!

 Wooo! Another long one! So sorry if I kept you too long on this topic!

  I want to thank you again for your time. Let me know if you are enjoying the podcast!  Subscribe so you don’t miss an episode! Share your thoughts. And if you’re feeling connected, give me a review! That will help others find this podcast to help with their practice also! 

 You can find more of me and what I’m up to on healthinterventions.net,  Facebook and Instagram.

If you know what you’re talking about but can’t remember what it was called just describe it. If you know the thing you’ll get points just for knowing it. It works.

So don’t feel as though omg I shouldn’t look through notes before the test because all these popular posts said don’t. Do whatever works for you!!!