Time Management Tips: An Interview With The World's Most Productive Nurse Practitioner
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Show notes:
Ever find yourself at work until all hours finishing your charting – or, even worse, taking charting home with you? Wondering how you might possibly get a handle on all of this stuff before you drown? You are most definitely not alone.
Time Management Challenges Are Super Common For New Grads, Seasons NPs, And Almost Everyone In A Patient-Facing Position
And the time management challenges go double for primary care; it’s a demanding environment, with the widest variety of clinical presentations and levels of care (even some that should be at urgent care or emergency). Anything could (and will) be waiting for you each day; if your time management game needs a little work, this could be a recipe for burnout. Let’s not let it get to that.
This week, we talk with Jessica Reeves, a Nurse Practitioner with a knack for time management (and author of Secrets From The World’s Most Productive Nurse Practitioner). We’ll cover:
✅ Where to start with time management
✅ The impact of the schedule on your time management – and what you can do about it
✅ The life-changing magic of dictation
✅ Using body language to manage the flow of the visit
✅ Setting limits (focused visit = focused note)
When it comes to clinical topics, things often get better over time and with experience. When you have clinical questions, there are usually more experienced colleagues that can guide you. Time management is different; it’s the distinct minority that is really excelling in that game. If you are struggling with time management now, you will likely continue to struggle unless you change your approach.
School prepares you for the clinical aspects of practice, but offers little (if any) guidance for how to actually get through the day. The good news is that with reflection, time, and practice, you can get your time back into your control and find the work-life harmony that works for you.
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Hey there, welcome to the Real World NP podcast.
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I'm Liz Rohr, family nurse practitioner, educator, and founder of Real World NP, an educational
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company for nurse practitioners in primary care.
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I'm on a mission to equip and guide new nurse practitioners so that they can feel
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confident, capable, and take the best care of their patients.
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If you're looking for clinical pearls and practice tips without the fluff, you're in
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the right place.
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Make sure you subscribe and leave a review so you won't miss an episode.
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Plus, you'll find links to all the episodes with extra goodies over at realworldnp.com
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slash podcast.
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So I had the absolute honor of bringing Jessica Reeves, a family nurse practitioner
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onto the channel for an interview.
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So Jessica is a family nurse practitioner, she is a member of the Real World NP team,
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and she is also an author.
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The name of her book is The Secrets from the World's Most Productive Nurse Practitioner,
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which I'll link to down below.
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She's really just fantastic at time management, and she shared a lot of tips when it
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comes to patient visits, charting, and other pieces that nurse practitioners really
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struggle with.
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So I really hope you enjoy this interview.
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Real quick, though, if you haven't grabbed the ultimate resource guide for the new NP,
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head over to realworldnp.com slash guide.
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You'll get these episodes and straight to your inbox every week with notes from
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me, patients, stories, and bonuses I really just don't share anywhere else.
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Without further ado, though, this is my interview with Jessica, the time
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management guru.
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OK, welcome.
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Thank you so much for being here.
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Can you go ahead and introduce yourself?
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Yes, thanks for having me, first of all.
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So my name is Jessica, Jessica Reeves.
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I'm a nurse practitioner.
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And before I was a nurse practitioner, I was completely obsessed with time
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management.
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For my eighth birthday, I got a watch, a digital watch.
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And I think that's when things really kind of changed for me and I really
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became very aware of time.
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And so ever since then, I've always been very concerned with time and how
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long things take and how they could be faster and better and that sort of
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thing.
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And so here I am.
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My husband now calls me the time guru of our household.
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So nurse practitioner slash time guru, I guess, is sort of my claim to fame.
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Oh, my gosh.
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I love that so much.
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I did not know that.
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And so yeah, so as I mentioned in the intro that you are one of our team
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members at Real World NP, and we're so happy to have you.
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Another piece of information I want to share is that you also have a book.
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Tell us about your book.
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Yeah, so the book is funny.
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I didn't sit down one day and say, like, I'm going to write a book, but I
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did realize when I was leaving my position in corporate medicine and they
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were talking about who they were going to get to replace me.
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So from like another team or something, and somebody said, well, we're
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not going to be able to get somebody who's going to be able to just
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handle the visit and handle the time the way that Jessica is.
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And I was like, oh, other people noticed that.
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Oh, wow.
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OK.
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And it became like a thing.
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And I recognize kind of like looking back, I have something to offer.
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And again, if I looked way back, it went all the way to being eight
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years old with a digital watch.
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And ironically, I have my watch on today, strangely enough.
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But so I felt like, OK, I can write an article and get
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this published somewhere.
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And I've got some tips.
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I'm sure I've got something that I can share.
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And I sat down and started writing and wrote a little more,
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wrote a little more before I realized I had enough to fill a book.
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So, you know, that's kind of how it came together.
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I never really thought that would be my future on the radar.
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But it was a really gratifying experience.
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And it's been so gratifying.
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Also, you know, it's brought me into contact with lots of folks I don't
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think I would have otherwise been in contact with.
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I think that real world MP counts as part of that as well.
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So that's kind of how we cross paths there.
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And it has been it's interesting to help fellow MPs.
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You know, it's one thing to help a patient and you've gone through all
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this stuff and you're like, OK, when you've got your blood pressure,
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you need your list and apparently, you know, and it's kind of that's it.
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But this is like I've really been I don't have high blood pressure yet
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someday, but but the time management, I've been there, you know,
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and these are things that I know have worked for me.
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So it's really gratifying to be able to share that with other MPs
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It sounds corny, but to be part of the solution instead of, you know,
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I didn't realize that I was as much of a time guru until until that happened.
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And so, yeah.
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And I really am almost almost a little too much, depending who you ask.
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But ultimately, it's a good problem to have.
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Yeah, that's awesome.
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And can you refresh us again on the title of your book?
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Sure. The book is called Secrets from the World's Most
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Productive Nurse Practitioner.
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And I know, right, isn't that fun?
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And that's when I knew actually that I was going to because I thought
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that was just going to be the title of an article.
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And I was like, no, this is like this is a great hook
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to kind of put everything around.
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You know, we've got a lot of stuff in there
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that's about like nuts and bolts of like, you know, how to get through the day.
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But then there's also like some bigger picture stuff about, you know,
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how to know whether their job, like the culture is going to be the right fit.
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Because there's more than one way to approach time management.
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And there's not really one right answer.
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But there's kind of one right answer for you or for me or for the individual.
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So it makes people think a little bit about what they need.
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Because it's not one size fits all.
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I love that.
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It's exciting to have that kind of stuff too.
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Totally.
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And I really appreciate you saying that in the context of time management.
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So we have a couple of questions that we're going to share,
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that we're going to talk through.
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But I guess just to start, like I just appreciate you sharing
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that not only are you really good at time management for like life,
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but also you recognize that it's an individualized custom approach.
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Because as you and I have sort of shared before,
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I have probably what's called time blindness.
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So I probably like the polar opposite.
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I think it's actually a real term.
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Well, there's some person that coined that term.
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I don't know if it's in, I think it goes along with ADHD.
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But yeah, in terms of the time, like I appreciate
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that you can recognize that there is not one right way to do it
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and not one right way of advising.
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Because I think that so many nurse practitioners
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come to real world NP and they're struggling with time management.
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And I feel like, at least in my personal perspective of time
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management, we'll get into this with the questions.
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But it's just it seems very individualized.
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Like I think that there's definitely some things,
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there are some core principles and definitely things we can learn
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and also, yeah, it's a really custom.
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Well, why don't I just going to build on that
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and just say that even for me, it's not one approach.
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It depends on the situation.
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So then, for me in situation A versus situation B,
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I need to kind of come at this a little differently.
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And it's well, then of course.
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Somebody with time blindness, they can also get things.
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We can help you see the light.
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But we need to help out at a little different place.
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There's a lot of different ways to get it right.
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It's really just about intent.
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That's awesome.
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Well, let's get into some of the questions here.
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OK, so I guess for some context,
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so you and I have talked about this.
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But the people that we serve with real world NP
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tend to be nurse practitioner students, newer graduates,
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or in the first couple of years of practice,
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but then also people who have been practicing
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in another specialty that are either coming back
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or coming into family medicine for the first time.
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And so it sounds like there's some overarching challenges
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that I've heard about.
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And I'm sure you've heard about, too,
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based on the stuff we talked about before this of the
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visits themselves, challenges with time management
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in the visits themselves, challenges
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with the time management of charting and paperwork.
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In my mind, those kind of go together,
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as well as the challenges of the schedule of the office
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play, like the situation of where you work.
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So those are the main challenges.
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So I just maybe want to start with one.
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So is there one that you'd like to start with?
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Do you want to talk about charting?
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Do you want to talk about patient visits in the room?
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Where do you want to start?
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What are your thoughts about those?
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Yeah, the visits, because I tend to be very methodical.
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One, two, three, four.
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So the first thing that you do is
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you're seeing the patient and pre-charting.
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So even before that, before you actually walk
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through the door and get face-to-face with the patient,
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a lot of people want to pre-chart.
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And it feels like the thing to do, right?
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Because you're being productive and you're like,
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OK, I'm going to go in and I'm going to be so prepared
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and I'm going to be ready for this, this, this.
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And I know that it's a physical,
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so I have to order all these labs
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or all these imaging or whatever.
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And then the person doesn't show.
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How much time did you just invest in that, right?
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And you just wander out the window.
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Or in like a worst case scenario,
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the patient doesn't show,
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but then you've got the note open.
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Now you have to figure out,
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how do I undo everything I did?
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Now you're wasting even more time, right?
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Like, oh my God.
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So forget that, right?
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Pre-charting rarely, really benefits you.
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It feels like it should.
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And for the amount of people in the case,
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it really should benefit you, but it doesn't.
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And I think that that time could be so much better used
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for a lot of other things.
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So you have to be ready to see the patient, right?
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You have to know what you're walking into, right?
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OK, this is an annual exam.
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And last time,
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so I haven't seen this person in a year,
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they're pretty healthy,
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but these are the things that they have going on.
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So you want to do, you want to glance at the chart,
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but you don't need to read the whole thing.
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Literally five minute tops,
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and going with a loose plan.
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Because the other thing is,
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they come in for the annual physical,
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and then they're like, oh my God,
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but I think I broke my toe yesterday.
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Well, OK, right.
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Brand new complaint, yeah.
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Yeah, yeah, the exam will come back for,
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but let's see if that toe's actually broken.
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And, oh, I need x-rays.
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So things change.
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That's primary care.
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It's, you're always kind of surfing.
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You have a plan,
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but you also have like 10.
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So pre-trial, I would say,
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is like a huge, huge, huge no-no,
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as far as I'm concerned,
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because I haven't seen for myself,
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or for other folks that I've worked with,
236
00:10:58.680 --> 00:11:00.620
I haven't seen that benefit them.
237
00:11:01.100 --> 00:11:01.580
Yeah.
238
00:11:02.400 --> 00:11:03.220
And when it does,
239
00:11:03.460 --> 00:11:05.000
it's such a long shot.
240
00:11:05.840 --> 00:11:09.060
It's like 50 that it actually is worth doing.
241
00:11:09.880 --> 00:11:11.660
That's a very good return, right?
242
00:11:12.140 --> 00:11:14.840
In the amount of time that you spend doing that,
243
00:11:14.840 --> 00:11:17.780
you could knock out some tasks in your inbox.
244
00:11:17.920 --> 00:11:20.240
You could call for that pre-off.
245
00:11:20.460 --> 00:11:22.280
You could do x, y, z.
246
00:11:22.320 --> 00:11:24.360
There are a lot of other things that you could do
247
00:11:24.360 --> 00:11:25.640
that would be a better
248
00:11:25.640 --> 00:11:29.120
and more concrete use of your time than the feature.
249
00:11:29.400 --> 00:11:32.000
So it's a gamble, and I don't think it's worth taking.
250
00:11:33.360 --> 00:11:35.720
Yeah, that's the first thing I would say.
251
00:11:36.120 --> 00:11:36.960
It's tempting,
252
00:11:37.300 --> 00:11:39.540
but don't, you gotta avoid that temptation.
253
00:11:41.720 --> 00:11:43.780
Or mark my words, try it, and it's not gonna work.
254
00:11:43.780 --> 00:11:45.420
So there's that too, right?
255
00:11:45.720 --> 00:11:47.040
There's that, prove me wrong.
256
00:11:47.400 --> 00:11:48.340
Absolutely prove me wrong.
257
00:11:48.440 --> 00:11:49.400
I'm like science, right?
258
00:11:49.400 --> 00:11:50.600
You can prove me wrong.
259
00:11:50.800 --> 00:11:51.900
I would love that.
260
00:11:52.340 --> 00:11:54.540
And then tell me how, how you did that.
261
00:11:57.020 --> 00:11:57.500
Totally.
262
00:11:58.140 --> 00:11:59.420
And just to set some context
263
00:11:59.420 --> 00:12:01.940
for if a nurse practitioner student is listening,
264
00:12:02.320 --> 00:12:04.240
one of the common pieces of advice
265
00:12:04.240 --> 00:12:07.160
is to look up your patients either the day before,
266
00:12:07.380 --> 00:12:10.380
the morning of, and then read through their whole chart,
267
00:12:10.540 --> 00:12:12.620
open a chart, come up with a plan,
268
00:12:12.620 --> 00:12:14.580
write all the things you predict is gonna happen,
269
00:12:14.720 --> 00:12:16.420
order all the things you think you need to order.
270
00:12:17.040 --> 00:12:18.880
And some people really stand by it,
271
00:12:18.880 --> 00:12:21.520
but I think it's important to offer that
272
00:12:21.520 --> 00:12:23.300
as not a requirement, right?
273
00:12:23.480 --> 00:12:25.620
Because it is really disheartening
274
00:12:25.620 --> 00:12:27.180
when you put in all of that work
275
00:12:27.180 --> 00:12:28.840
and it hasn't come to anything.
276
00:12:29.160 --> 00:12:31.020
I found value in it for a little while
277
00:12:31.020 --> 00:12:32.120
when I was a new grad
278
00:12:32.820 --> 00:12:34.960
because I felt like it really forced me
279
00:12:34.960 --> 00:12:37.180
to engage my brain in a very specific way.
280
00:12:37.200 --> 00:12:38.900
But then when I realized the utility of it
281
00:12:38.900 --> 00:12:39.960
wasn't really measuring out,
282
00:12:39.980 --> 00:12:42.400
I was like, okay, let's try something else.
283
00:12:42.400 --> 00:12:44.480
That did not work for me long-term,
284
00:12:44.620 --> 00:12:46.760
but it was helpful for a short stint.
285
00:12:47.260 --> 00:12:48.460
Yeah, so it sounds like for you,
286
00:12:48.460 --> 00:12:50.720
it was helpful to kind of help to organize your thoughts
287
00:12:50.720 --> 00:12:51.720
and your approach to the visit.
288
00:12:51.980 --> 00:12:52.400
Yeah. Totally.
289
00:12:52.760 --> 00:12:54.580
Just like, you can do that on a piece of paper.
290
00:12:54.580 --> 00:12:54.960
Yeah.
291
00:12:55.680 --> 00:12:58.780
If I had somebody that really wanted to stick with that,
292
00:12:58.980 --> 00:13:00.860
okay, well, how can we modify that
293
00:13:00.860 --> 00:13:02.840
so that then in the worst-case scenario,
294
00:13:02.840 --> 00:13:05.100
you just rip that paper up and put it in the shred pile?
295
00:13:05.600 --> 00:13:06.000
Exactly.
296
00:13:06.540 --> 00:13:07.360
Yeah, that's the difference.
297
00:13:08.540 --> 00:13:09.620
Yeah, I was gonna say, that's very different
298
00:13:09.620 --> 00:13:11.440
than when you pre-chart,
299
00:13:11.500 --> 00:13:13.040
going through the whole pre-charting process
300
00:13:13.040 --> 00:13:15.360
versus looking at all the patients up the night before
301
00:13:15.360 --> 00:13:17.300
is a different process.
302
00:13:17.540 --> 00:13:19.020
Yeah, so that still may be serving,
303
00:13:19.740 --> 00:13:20.460
especially when you're newer,
304
00:13:20.540 --> 00:13:23.460
to look the people up and then take some notes.
305
00:13:24.040 --> 00:13:25.880
To be like, oh, I haven't seen Charcot foot
306
00:13:25.880 --> 00:13:26.900
in a really long time.
307
00:13:26.900 --> 00:13:28.620
I don't really remember what I should be assessing
308
00:13:28.620 --> 00:13:29.300
for that.
309
00:13:29.960 --> 00:13:32.020
Exactly, right, because that's definitely happened.
310
00:13:32.240 --> 00:13:33.480
I think I had that with gout.
311
00:13:33.580 --> 00:13:35.100
My first gout patient was like,
312
00:13:35.520 --> 00:13:36.900
okay, that's the foot, right?
313
00:13:37.700 --> 00:13:38.760
I've never looked this up.
314
00:13:38.760 --> 00:13:39.600
I don't wanna walk it,
315
00:13:39.700 --> 00:13:41.000
like, because you don't wanna look stupid, right?
316
00:13:41.140 --> 00:13:42.840
So you walk in and you're like,
317
00:13:43.000 --> 00:13:44.520
I expect them to have their shoes off
318
00:13:44.520 --> 00:13:45.620
and their foot should be red
319
00:13:45.620 --> 00:13:46.700
and they can't really touch it.
320
00:13:47.000 --> 00:13:48.540
Like, okay, all right, so here's my few things.
321
00:13:48.560 --> 00:13:50.800
So you do definitely wanna be prepared.
322
00:13:51.500 --> 00:13:53.120
But especially the night before,
323
00:13:53.200 --> 00:13:56.040
I think that that can also add to the anxiety.
324
00:13:56.360 --> 00:13:58.660
As a new grad, you've got anxiety all the time
325
00:13:58.660 --> 00:13:59.560
because everything's new.
326
00:13:59.740 --> 00:14:02.560
And this is the first time you're without a net
327
00:14:02.560 --> 00:14:03.980
or close to being without a net.
328
00:14:04.640 --> 00:14:07.180
If, for me, I'll speak my N of one here,
329
00:14:07.180 --> 00:14:09.500
if I looked up my patients the night before,
330
00:14:09.700 --> 00:14:11.620
I wouldn't sleep because, oh no,
331
00:14:11.760 --> 00:14:13.440
when that 10 o'clock comes in,
332
00:14:13.560 --> 00:14:15.120
I'm gonna, oh, I'm gonna screw it up
333
00:14:15.120 --> 00:14:16.620
or I'm gonna forget something
334
00:14:16.620 --> 00:14:18.960
or I'm gonna need to ask somebody else for something
335
00:14:18.960 --> 00:14:20.740
or death is gonna warm up.
336
00:14:20.820 --> 00:14:22.220
And you just psych yourself out.
337
00:14:22.600 --> 00:14:25.740
And again, I don't see the return on investment.
338
00:14:25.960 --> 00:14:28.120
So for me, not worth it.
339
00:14:28.120 --> 00:14:29.380
It's not gonna make me a better MP.
340
00:14:29.740 --> 00:14:32.680
It's going to make me closer to burnout faster.
341
00:14:33.000 --> 00:14:35.960
It's going to make me stressed.
342
00:14:35.960 --> 00:14:37.840
It's gonna make me not sleep well, right?
343
00:14:38.100 --> 00:14:39.880
All those things are all distractions.
344
00:14:40.740 --> 00:14:42.260
So for me, yeah.
345
00:14:42.260 --> 00:14:44.200
Yeah, totally, totally.
346
00:14:44.540 --> 00:14:46.240
What other thoughts do you have about charting
347
00:14:46.240 --> 00:14:49.740
aside from considering not pre-charting?
348
00:14:50.420 --> 00:14:52.280
Yeah, so for charting,
349
00:14:52.560 --> 00:14:55.620
I have three templates that I use.
350
00:14:55.820 --> 00:14:57.720
And there's one that's for the problem visit.
351
00:14:57.960 --> 00:15:00.120
And you can just add problems on, right?
352
00:15:00.120 --> 00:15:01.360
But it's like your basic thing
353
00:15:01.360 --> 00:15:03.540
where you're like, what happened?
354
00:15:03.720 --> 00:15:04.780
What are we gonna do about it?
355
00:15:04.780 --> 00:15:06.620
What are the imaging or labs or whatever
356
00:15:06.620 --> 00:15:08.400
that I needed to get like in the visit?
357
00:15:08.760 --> 00:15:10.620
So you've got your acute visit, problem visit,
358
00:15:11.140 --> 00:15:12.820
your annual exam, right?
359
00:15:12.820 --> 00:15:14.880
Which is going to, I see adults.
360
00:15:14.940 --> 00:15:15.880
I don't really see kids.
361
00:15:16.120 --> 00:15:17.000
Occasionally I'll see kids.
362
00:15:17.200 --> 00:15:19.960
So my annual exam is basically the same
363
00:15:20.560 --> 00:15:21.840
for pretty much everybody
364
00:15:21.840 --> 00:15:23.720
because I'm not doing like developmental stuff
365
00:15:23.720 --> 00:15:25.200
and that kind of stuff.
366
00:15:25.560 --> 00:15:27.260
So it's like, it's a static document.
367
00:15:27.840 --> 00:15:30.520
And then my third one is pre-op.
368
00:15:30.960 --> 00:15:33.460
So if I'm seeing somebody for a pre-op physical,
369
00:15:33.460 --> 00:15:34.940
you gotta ask the question
370
00:15:34.940 --> 00:15:36.200
so that they're safe for anesthesia,
371
00:15:36.280 --> 00:15:37.440
but you don't really need to like,
372
00:15:37.540 --> 00:15:39.320
it doesn't matter if they're up to date on their mammogram.
373
00:15:39.900 --> 00:15:42.020
So you just have to let those things go.
374
00:15:42.520 --> 00:15:44.940
And then when it comes time to chart it,
375
00:15:45.020 --> 00:15:47.640
you already know like what you're putting in
376
00:15:47.640 --> 00:15:48.860
and where you expect to see it.
377
00:15:49.020 --> 00:15:52.740
Like, okay, here's where I'm assessing their soft palate.
378
00:15:53.100 --> 00:15:54.320
Okay, here's where I put this.
379
00:15:54.560 --> 00:15:57.440
Here's where I'm putting their capacity
380
00:15:57.440 --> 00:15:59.520
to ask you to move furniture.
381
00:15:59.620 --> 00:16:00.200
Could you do that?
382
00:16:00.200 --> 00:16:00.520
Yes.
383
00:16:00.520 --> 00:16:01.300
You know, okay.
384
00:16:02.420 --> 00:16:04.480
And you can just cruise right through.
385
00:16:04.600 --> 00:16:06.140
So that's a big, big piece.
386
00:16:07.120 --> 00:16:09.600
Having templates, but also not having too many templates.
387
00:16:09.660 --> 00:16:11.040
For me, that's the right one.
388
00:16:11.660 --> 00:16:14.500
If I saw kids, I'd probably have
389
00:16:14.500 --> 00:16:16.000
like another three or four templates
390
00:16:16.000 --> 00:16:17.060
just because of the age.
391
00:16:17.220 --> 00:16:18.160
Ages, yeah.
392
00:16:19.120 --> 00:16:20.940
Conceptually, it would still be that same thing
393
00:16:20.940 --> 00:16:22.980
where it's like, don't create,
394
00:16:23.080 --> 00:16:24.420
keep it lean and mean, right?
395
00:16:24.560 --> 00:16:27.180
You can always customize in the note
396
00:16:27.180 --> 00:16:29.680
for the particular problem or the particular patient,
397
00:16:29.680 --> 00:16:32.180
but you don't need to like re-invent the wheel every time.
398
00:16:32.940 --> 00:16:34.200
That's a big one.
399
00:16:34.640 --> 00:16:37.020
Another big one is, and again,
400
00:16:37.020 --> 00:16:38.240
this is my personal preference
401
00:16:38.240 --> 00:16:41.140
and I'm sure that I am like a total black sheep with this.
402
00:16:41.500 --> 00:16:44.780
I do not open the computer in the visit.
403
00:16:46.400 --> 00:16:47.780
No, no, no, no.
404
00:16:48.320 --> 00:16:49.520
Unless there's some like,
405
00:16:49.660 --> 00:16:51.560
sometimes like one visit out of 50,
406
00:16:51.600 --> 00:16:52.940
it's completely unavoidable.
407
00:16:53.100 --> 00:16:54.200
And you know, you have to look it up.
408
00:16:54.860 --> 00:16:56.180
The patient starts asking something,
409
00:16:56.380 --> 00:16:57.020
oh, why you're in there?
410
00:16:57.140 --> 00:16:58.140
Hey, I never got the results
411
00:16:58.140 --> 00:16:59.420
from when I saw endocrinology.
412
00:16:59.980 --> 00:17:01.900
Whoa, hold on, right?
413
00:17:02.660 --> 00:17:04.680
So that's something that's something that,
414
00:17:04.800 --> 00:17:05.660
so when I'm in the visit,
415
00:17:05.940 --> 00:17:08.280
it's me and the patient and I've got my clipboard
416
00:17:08.280 --> 00:17:09.940
and I take hard copy notes,
417
00:17:10.240 --> 00:17:12.440
but I write very little, you know?
418
00:17:12.480 --> 00:17:13.859
I had cheat sheets that I used
419
00:17:13.859 --> 00:17:15.460
for like the first couple of years
420
00:17:15.460 --> 00:17:17.319
and I would highlight stuff
421
00:17:17.940 --> 00:17:20.099
so that I would make sure that I didn't forget stuff.
422
00:17:20.140 --> 00:17:21.880
So if it was like a gout patient, right?
423
00:17:22.000 --> 00:17:23.380
Okay, I wanna ask these questions,
424
00:17:23.480 --> 00:17:24.380
I wanna ask those questions,
425
00:17:24.400 --> 00:17:25.880
but like, I don't, it doesn't matter to me
426
00:17:25.880 --> 00:17:27.760
like if they're having any abdominal stuff
427
00:17:27.760 --> 00:17:30.740
or you know, so, but I wanna make sure
428
00:17:30.740 --> 00:17:32.740
that I'm asking this, this, and this.
429
00:17:32.980 --> 00:17:34.260
So you've got your little guide
430
00:17:34.260 --> 00:17:36.640
and then you've also got, you just check it off.
431
00:17:37.360 --> 00:17:40.580
Yes or no, and then you can pretext a little bit,
432
00:17:40.800 --> 00:17:42.340
but you know, you really, to me,
433
00:17:42.380 --> 00:17:44.440
that helped me to be more present with the patient
434
00:17:45.020 --> 00:17:47.220
and it also focused what I had.
435
00:17:47.260 --> 00:17:50.440
If you have a long laundry list of notes,
436
00:17:50.940 --> 00:17:52.720
you are maybe a little more likely
437
00:17:52.720 --> 00:17:55.440
to feel like you have to include all that, right?
438
00:17:55.900 --> 00:17:57.080
That's the case, right?
439
00:17:57.080 --> 00:17:58.100
Cause you don't wanna be like,
440
00:17:58.280 --> 00:18:00.060
oh, I'll just throw that away and pretend it didn't happen.
441
00:18:00.420 --> 00:18:02.200
But if you're more focused with the visit,
442
00:18:02.300 --> 00:18:05.300
then that helps you to be more focused with your charting.
443
00:18:06.260 --> 00:18:08.400
Another piece that goes with this and this is tough
444
00:18:08.400 --> 00:18:11.560
and in some cases I was very much not popular for this
445
00:18:11.560 --> 00:18:14.700
but you kind of have to, I guess, choose your battles
446
00:18:15.500 --> 00:18:17.260
and in a primary care setting,
447
00:18:17.340 --> 00:18:19.240
it was limiting the number of concerns.
448
00:18:19.960 --> 00:18:22.640
So in a limited visit, we can cover three things
449
00:18:24.100 --> 00:18:27.860
and they may be the things that you booked your visit for
450
00:18:27.860 --> 00:18:31.420
plus two more, or you may have changed,
451
00:18:31.540 --> 00:18:33.040
like something may have changed since you booked the visit
452
00:18:33.040 --> 00:18:33.840
and now you've got this,
453
00:18:34.040 --> 00:18:35.180
I think I got booked by a tick
454
00:18:35.180 --> 00:18:36.720
and okay, we need to go down that path.
455
00:18:37.140 --> 00:18:38.660
So we might have to take one of the other things,
456
00:18:38.740 --> 00:18:39.920
I've had to come back for that,
457
00:18:40.040 --> 00:18:43.120
but I can't really thoroughly investigate an issue
458
00:18:43.680 --> 00:18:45.180
if I don't have enough time.
459
00:18:45.300 --> 00:18:46.720
It's not fair to me, it's not fair to the patient,
460
00:18:46.880 --> 00:18:48.320
it's not fair across the board.
461
00:18:49.180 --> 00:18:51.100
So limiting the number of things that you really,
462
00:18:51.100 --> 00:18:55.340
unless there are always exceptions.
463
00:18:57.960 --> 00:18:59.040
There's always exceptions.
464
00:18:59.300 --> 00:19:01.720
So there are always times that like,
465
00:19:01.720 --> 00:19:03.400
it's hard for this patient to get in
466
00:19:03.400 --> 00:19:04.880
and they always miss their appointments
467
00:19:04.880 --> 00:19:05.860
and they're here right now,
468
00:19:05.960 --> 00:19:07.220
I got a strike while the iron's hot.
469
00:19:07.760 --> 00:19:11.000
But in a lot of cases, that's not new
470
00:19:11.000 --> 00:19:13.500
and if you're going over 10 things in a visit,
471
00:19:14.020 --> 00:19:15.400
you're gonna have to chart 10 things.
472
00:19:16.020 --> 00:19:17.640
You're gonna have to go to labs for 10 things,
473
00:19:17.700 --> 00:19:19.760
it's gonna turn into this middle ball,
474
00:19:19.760 --> 00:19:21.920
so try to go over two or three things.
475
00:19:22.720 --> 00:19:24.820
That's ethically appropriate to me
476
00:19:24.820 --> 00:19:27.380
and it's also going to make your charting
477
00:19:27.380 --> 00:19:29.020
that much easier because it's more focused.
478
00:19:29.780 --> 00:19:30.220
Yeah.
479
00:19:30.420 --> 00:19:34.340
It is tough and I guess I wanna normalize
480
00:19:34.340 --> 00:19:37.940
a couple of things, especially for our newer people
481
00:19:37.940 --> 00:19:39.820
who are listening or a newer person that's listening,
482
00:19:40.680 --> 00:19:42.420
that I had a real struggle with that
483
00:19:42.420 --> 00:19:44.700
when I was new of like, oh my gosh,
484
00:19:44.700 --> 00:19:46.160
do I have to write down every single thing
485
00:19:46.160 --> 00:19:47.200
that this person says?
486
00:19:47.600 --> 00:19:49.600
I just, I don't wanna be liable,
487
00:19:49.600 --> 00:19:51.900
like what if something happens with this toe pain?
488
00:19:53.620 --> 00:19:55.300
Like, that's like a, that's a judge,
489
00:19:55.540 --> 00:19:57.660
clinical judgment muscle that we all have to develop
490
00:19:58.760 --> 00:20:00.920
and yeah, and I also just wanna normalize too
491
00:20:00.920 --> 00:20:02.040
that it is really challenging
492
00:20:02.040 --> 00:20:04.900
to set those limits in visits because,
493
00:20:05.720 --> 00:20:07.160
and like my personal approach again
494
00:20:07.160 --> 00:20:08.440
is like a time-blind person.
495
00:20:08.480 --> 00:20:09.740
I have to do a lot of forgiveness
496
00:20:09.740 --> 00:20:11.100
of my own time management.
497
00:20:11.560 --> 00:20:15.840
I'm like, I'm not as orderly in my visits
498
00:20:15.840 --> 00:20:17.300
as much as I wish I could be,
499
00:20:17.300 --> 00:20:19.580
but some days and especially with boundary setting,
500
00:20:20.280 --> 00:20:22.320
some days I have the emotional capacity for it
501
00:20:22.320 --> 00:20:23.800
and then other days I'm like, you know what,
502
00:20:23.880 --> 00:20:26.460
it's easier and more supportive for me in this moment
503
00:20:26.460 --> 00:20:28.100
to choose to address 12 things.
504
00:20:28.420 --> 00:20:29.580
Okay, I don't usually address 12,
505
00:20:29.900 --> 00:20:32.040
but like maybe like five, maybe seven,
506
00:20:32.220 --> 00:20:33.200
if they're tiny things,
507
00:20:33.380 --> 00:20:35.160
but like in that moment I'm like, okay,
508
00:20:35.240 --> 00:20:36.840
you know what, today's the day.
509
00:20:37.280 --> 00:20:40.080
But yeah, I think one thing that I've been
510
00:20:40.080 --> 00:20:41.740
starting to do is like setting,
511
00:20:42.600 --> 00:20:44.080
practicing setting those expectations
512
00:20:44.080 --> 00:20:45.080
at the beginning of the visit
513
00:20:45.080 --> 00:20:48.680
and it sounds like you are doing that or setting more,
514
00:20:48.800 --> 00:20:50.800
just general expectations at the beginning of a visit,
515
00:20:51.000 --> 00:20:53.440
but especially with the problems of like,
516
00:20:54.100 --> 00:20:55.120
I think what happens sometimes
517
00:20:55.120 --> 00:20:56.360
is that patients just like start,
518
00:20:56.440 --> 00:20:57.420
we're like, how can I help you today?
519
00:20:57.440 --> 00:20:59.080
And then it's like all the things.
520
00:20:59.400 --> 00:21:01.340
And then you have to backtrack and be like,
521
00:21:01.420 --> 00:21:02.420
okay, I'm so sorry,
522
00:21:02.460 --> 00:21:05.380
we can actually only address three versus we start
523
00:21:05.380 --> 00:21:09.840
off the visit for your safety and quality of your care,
524
00:21:10.200 --> 00:21:12.400
I can only address three things, right?
525
00:21:12.400 --> 00:21:13.640
It's not about me.
526
00:21:13.640 --> 00:21:15.260
It's not about inconvenience.
527
00:21:15.400 --> 00:21:18.000
It's about like literally it is not safe for me
528
00:21:18.000 --> 00:21:20.580
to not thoroughly investigate your chief complaints.
529
00:21:20.700 --> 00:21:21.760
I mean, I don't say chief complaints to them,
530
00:21:22.220 --> 00:21:22.860
but you know what I mean?
531
00:21:22.900 --> 00:21:24.300
Like the concerns that they have.
532
00:21:24.720 --> 00:21:26.500
But it is, I just wanted to add that
533
00:21:26.500 --> 00:21:27.400
as a normalizing thing,
534
00:21:27.440 --> 00:21:28.940
that that gets easier with time.
535
00:21:29.620 --> 00:21:30.680
And it's a leadership thing.
536
00:21:30.800 --> 00:21:31.480
It's like you have to,
537
00:21:31.560 --> 00:21:33.460
I think that's another part of the role transition
538
00:21:33.460 --> 00:21:35.640
that makes time management so hard at the beginning
539
00:21:35.640 --> 00:21:37.560
is that you are in a leadership role
540
00:21:37.560 --> 00:21:38.820
when you're saying that with your patient.
541
00:21:38.860 --> 00:21:39.900
Like you are guiding them.
542
00:21:39.900 --> 00:21:40.880
You are the authority.
543
00:21:41.220 --> 00:21:43.100
And like you can still be an approachable authority,
544
00:21:43.100 --> 00:21:44.840
but you still have to be an authority
545
00:21:44.840 --> 00:21:46.840
when you are a medical provider.
546
00:21:47.380 --> 00:21:49.700
Yeah, the buck is going to stop with you, right?
547
00:21:49.860 --> 00:21:50.000
Yeah.
548
00:21:50.440 --> 00:21:53.260
And if you have been say like the past five or 10 years
549
00:21:53.260 --> 00:21:55.480
bedside and you're just sort of there,
550
00:21:55.620 --> 00:21:57.180
and you're there for 12 hours
551
00:21:57.180 --> 00:21:59.260
and you just kind of like whatever happens happens,
552
00:22:00.260 --> 00:22:02.300
that's not something that maybe you're accustomed to,
553
00:22:02.480 --> 00:22:05.660
to say like, okay, I bet we have 20 minutes together.
554
00:22:06.100 --> 00:22:06.500
Yeah.
555
00:22:06.500 --> 00:22:07.740
We'll talk about it in 20 minutes.
556
00:22:08.400 --> 00:22:09.560
What are your top three things
557
00:22:09.560 --> 00:22:11.060
or whatever the case may be.
558
00:22:11.100 --> 00:22:12.560
And so, yes, and you're right.
559
00:22:12.560 --> 00:22:14.480
So like get better with time and with practice.
560
00:22:15.520 --> 00:22:18.560
And the like, another little sneak attack thing
561
00:22:18.560 --> 00:22:20.520
is that you can practice that
562
00:22:20.520 --> 00:22:22.000
in other parts of your life, right?
563
00:22:22.340 --> 00:22:24.060
Like with friends, with family,
564
00:22:24.300 --> 00:22:25.740
you can practice that sort of stuff.
565
00:22:25.980 --> 00:22:27.440
Like, I'm going to give this 20 minutes
566
00:22:27.440 --> 00:22:29.740
and we're only going to talk about whatever,
567
00:22:29.920 --> 00:22:31.840
you know, two things, three things, whatever it is
568
00:22:31.840 --> 00:22:34.620
and set that expectation and maintain that.
569
00:22:35.360 --> 00:22:37.980
And that way it's like a lower stakes kind of thing,
570
00:22:37.980 --> 00:22:40.140
but you also, you're like getting the mileage
571
00:22:40.140 --> 00:22:40.980
of having done it.
572
00:22:40.980 --> 00:22:43.820
Oh, I love that so much because it's boundary setting
573
00:22:43.820 --> 00:22:46.380
and boundary setting is not easy for anybody,
574
00:22:46.580 --> 00:22:47.740
especially when they're new to it.
575
00:22:48.020 --> 00:22:49.940
But it's a muscle that you have to practice
576
00:22:49.940 --> 00:22:51.660
a boundary setting, especially, yeah.
577
00:22:51.660 --> 00:22:53.360
And then when you add in the imposter syndrome,
578
00:22:53.400 --> 00:22:56.520
if you're new, like, it's hard to stand
579
00:22:56.940 --> 00:22:59.060
in that grounded place of like,
580
00:22:59.060 --> 00:23:00.440
I am going to set a boundary,
581
00:23:00.600 --> 00:23:01.760
a kind and loving boundary
582
00:23:01.760 --> 00:23:04.920
that is for our best interest mutually, but yeah.
583
00:23:05.180 --> 00:23:06.680
Yeah, yeah, because it's not just a power play.
584
00:23:06.740 --> 00:23:08.460
Like there are reasons and there may be reasons.
585
00:23:09.340 --> 00:23:12.340
Yeah, and it's because you're doing your job well.
586
00:23:12.540 --> 00:23:14.080
You're not doing it to do a bad job.
587
00:23:14.120 --> 00:23:15.460
You're not doing it to whatever,
588
00:23:15.540 --> 00:23:18.080
for whatever reason it literally is to do a good job
589
00:23:18.080 --> 00:23:19.000
for them.
590
00:23:19.380 --> 00:23:21.820
And you know, it's funny because our local newspaper
591
00:23:21.820 --> 00:23:24.300
is doing some reporting about like the health care
592
00:23:24.300 --> 00:23:26.720
shortage and you know, there's such providers,
593
00:23:27.140 --> 00:23:28.840
staff members, and so wait times are crazy.
594
00:23:29.360 --> 00:23:30.940
And I was like, spoiler alert, you know,
595
00:23:30.940 --> 00:23:33.100
they have worsened for sure, definitely.
596
00:23:33.320 --> 00:23:35.160
But they were pretty crazy in the last five
597
00:23:35.160 --> 00:23:36.300
or 10 years too.
598
00:23:36.700 --> 00:23:38.880
And that was one thing that I felt like
599
00:23:38.880 --> 00:23:40.080
it was such a big thing.
600
00:23:40.180 --> 00:23:42.680
It was important to me personally to be on time,
601
00:23:42.780 --> 00:23:45.240
but like for ethical reasons too, you know,
602
00:23:45.280 --> 00:23:47.180
sometimes there are visits where it's just like,
603
00:23:47.420 --> 00:23:50.220
like you're gonna run and you can accept those, right?
604
00:23:50.420 --> 00:23:52.940
But most of the time you can run generally on time.
605
00:23:52.940 --> 00:23:56.140
And it's important to me to meet those expectations.
606
00:23:56.700 --> 00:23:56.880
Yeah.
607
00:23:56.880 --> 00:23:57.680
My time is valuable,
608
00:23:57.800 --> 00:23:59.300
but so is the time with my patients
609
00:23:59.300 --> 00:24:01.780
and the staff that I'm working with, you know,
610
00:24:01.780 --> 00:24:03.460
who are not only working for me,
611
00:24:03.480 --> 00:24:04.580
they're working with other folks.
612
00:24:04.840 --> 00:24:06.700
So it's kind of like about trying to keep
613
00:24:06.700 --> 00:24:08.060
all of those plates spinning
614
00:24:08.060 --> 00:24:12.740
and to not be disappointing people or not to be,
615
00:24:12.920 --> 00:24:14.860
well, if then I run late with you,
616
00:24:14.920 --> 00:24:16.720
then I start late with the next person.
617
00:24:17.780 --> 00:24:20.960
You know, it's a whole downhill slide from there.
618
00:24:21.440 --> 00:24:24.180
But so for me personally, it was,
619
00:24:24.220 --> 00:24:26.780
it continues to be like a big, it's an ethical thing.
620
00:24:27.200 --> 00:24:28.980
Yeah, absolutely.
621
00:24:29.520 --> 00:24:31.300
Well, you kind of mentioned a little bit about
622
00:24:31.300 --> 00:24:34.160
in the visits with how many problems you address.
623
00:24:34.500 --> 00:24:36.480
Are there any other kind of pieces of guidance
624
00:24:36.480 --> 00:24:40.420
you have about the actual time in the visit with a patient?
625
00:24:41.260 --> 00:24:43.480
Yeah, so two, a couple of big things.
626
00:24:43.840 --> 00:24:45.580
So setting the agenda is a big one, right?
627
00:24:45.600 --> 00:24:46.980
And it's because then you've got, you know,
628
00:24:47.060 --> 00:24:48.380
your transparency in office
629
00:24:48.380 --> 00:24:50.400
and it's a little easier than instead of like
630
00:24:50.400 --> 00:24:51.180
all of a sudden in the last two minutes,
631
00:24:51.260 --> 00:24:52.280
it's like, oh, sorry, our time's up.
632
00:24:52.580 --> 00:24:53.420
That's a big one.
633
00:24:53.540 --> 00:24:56.420
But you also have to know what that feels like,
634
00:24:56.660 --> 00:24:58.200
the amount of time that you have for your visits.
635
00:24:58.220 --> 00:25:01.220
So I use that 20 minutes as an example, you know,
636
00:25:01.220 --> 00:25:04.180
and again, not every visit, especially in primary care,
637
00:25:04.400 --> 00:25:05.780
not every visit is going to be the same.
638
00:25:05.780 --> 00:25:08.040
Some visits you just are going to do in the chair.
639
00:25:08.320 --> 00:25:09.920
They're never even gonna need to get on the table.
640
00:25:11.120 --> 00:25:13.240
But, you know, when you get to that halfway point,
641
00:25:13.580 --> 00:25:15.700
the patient should be getting up on the exam table
642
00:25:15.700 --> 00:25:17.040
in most cases, right?
643
00:25:17.140 --> 00:25:20.060
And then you can kind of finish the visit with them
644
00:25:20.060 --> 00:25:21.480
maybe on the table if they're safe,
645
00:25:21.640 --> 00:25:22.280
unless there's some reason
646
00:25:22.280 --> 00:25:23.920
they can't be left alone up there.
647
00:25:24.100 --> 00:25:25.960
But you can kind of end the visit there
648
00:25:25.960 --> 00:25:27.580
and step up, but you have to kind of know.
649
00:25:27.740 --> 00:25:30.440
And I have noticed also in so many exam rooms,
650
00:25:30.540 --> 00:25:31.780
there are not clocks.
651
00:25:33.140 --> 00:25:35.260
And I've also noticed a lot of nurses,
652
00:25:35.260 --> 00:25:37.220
it's like the day they graduate NP school,
653
00:25:37.340 --> 00:25:38.720
they're like, I don't need to wear this watch anymore.
654
00:25:39.120 --> 00:25:40.880
Okay, you can put the watch back on, right?
655
00:25:41.140 --> 00:25:44.080
So whether you have like a regular old school watch
656
00:25:44.080 --> 00:25:45.440
or you have a smart watch,
657
00:25:45.680 --> 00:25:46.400
if you have a smart watch,
658
00:25:46.440 --> 00:25:48.240
you could even set like a little reminder
659
00:25:48.240 --> 00:25:49.600
like your five minute warning.
660
00:25:51.140 --> 00:25:52.520
You know, and get to know
661
00:25:52.520 --> 00:25:54.380
whatever the length of your visit is.
662
00:25:54.460 --> 00:25:55.200
You know, I worked in a setting
663
00:25:55.200 --> 00:25:56.220
where I had 10 minute visits.
664
00:25:56.260 --> 00:25:58.240
So I know what 10 minutes feels like.
665
00:25:58.640 --> 00:26:00.320
But then when I got to like 20 minutes,
666
00:26:00.320 --> 00:26:01.660
I was like, okay, this is great.
667
00:26:01.740 --> 00:26:02.920
I've like got all this time off.
668
00:26:03.740 --> 00:26:05.100
It expands to fill the time.
669
00:26:05.100 --> 00:26:06.220
So you have to kind of get to know
670
00:26:06.220 --> 00:26:07.440
what 20 minutes feels like.
671
00:26:07.560 --> 00:26:10.020
You know, then also working backwards,
672
00:26:10.520 --> 00:26:12.060
if that's what 20 minutes feels like,
673
00:26:12.140 --> 00:26:14.220
this is 15, we should be winding down.
674
00:26:14.300 --> 00:26:16.360
This is 10 minutes.
675
00:26:16.380 --> 00:26:18.960
We should be halfway point.
676
00:26:19.220 --> 00:26:20.720
I should be done with the history.
677
00:26:20.860 --> 00:26:22.360
Now I should be asking them,
678
00:26:22.440 --> 00:26:23.540
they should be done talking.
679
00:26:23.920 --> 00:26:26.120
And I should be kind of like running it now.
680
00:26:26.880 --> 00:26:28.040
So those are big things.
681
00:26:28.160 --> 00:26:29.200
So having a clock, having a watch,
682
00:26:29.300 --> 00:26:31.280
and a clock that you can point to with the patient.
683
00:26:31.580 --> 00:26:33.080
We're almost out of time.
684
00:26:33.620 --> 00:26:37.100
It's a kind of a neutral way to do that.
685
00:26:37.620 --> 00:26:39.500
Other things like standing up.
686
00:26:40.020 --> 00:26:43.540
Most of my visits, they start on a chair or a stool.
687
00:26:43.880 --> 00:26:46.900
And then if the patient gets up on the exam table,
688
00:26:47.040 --> 00:26:47.680
then that's okay.
689
00:26:47.720 --> 00:26:48.620
That should be the halfway point.
690
00:26:49.200 --> 00:26:50.640
Some people just keep selling, right?
691
00:26:50.640 --> 00:26:52.220
And they talk, and I'm a talker too.
692
00:26:52.240 --> 00:26:54.000
So I feel like if I say someone else is a talker,
693
00:26:54.040 --> 00:26:56.280
they'd be like, that's really like a talker.
694
00:26:56.880 --> 00:26:58.840
They really like, darn.
695
00:26:59.640 --> 00:27:01.420
Oh gosh, they really like to talk.
696
00:27:01.420 --> 00:27:04.880
So, cues and standing up,
697
00:27:05.180 --> 00:27:07.720
putting your hand on the doorknob, opening the door.
698
00:27:08.140 --> 00:27:09.780
And then we're sitting in an area like,
699
00:27:10.020 --> 00:27:11.300
I'm sorry, but we're out of time.
700
00:27:11.440 --> 00:27:12.740
Those are big things.
701
00:27:13.780 --> 00:27:16.580
Another piece that I feel really strongly about
702
00:27:16.580 --> 00:27:18.460
is kind of knowing what you're getting yourself into.
703
00:27:18.780 --> 00:27:20.780
So if it's not the first thing
704
00:27:20.780 --> 00:27:21.940
that you're seeing the patient,
705
00:27:22.180 --> 00:27:23.980
and if there's a way in the chart
706
00:27:23.980 --> 00:27:25.800
that you can have a note for yourself
707
00:27:25.800 --> 00:27:27.440
that like the patient can never see,
708
00:27:27.740 --> 00:27:29.800
but you can have some sort of a note in the chart,
709
00:27:29.800 --> 00:27:31.340
even if it's at the end
710
00:27:31.340 --> 00:27:33.720
of their previous visit note with you,
711
00:27:33.780 --> 00:27:34.940
you have some sort of code.
712
00:27:35.440 --> 00:27:38.260
So I used to put CH for patients who were chatty,
713
00:27:38.360 --> 00:27:40.500
just so I know, this person's a talker, okay?
714
00:27:40.500 --> 00:27:42.240
So I'm just gonna go in with that in mind.
715
00:27:42.720 --> 00:27:44.420
And if they were very chatty,
716
00:27:44.440 --> 00:27:46.420
I would put like capital CH, right?
717
00:27:46.620 --> 00:27:48.400
Like to me, like very, very chatty.
718
00:27:48.540 --> 00:27:50.120
And then you just kind of know, right?
719
00:27:50.120 --> 00:27:51.680
So that's part of like looking at the chart
720
00:27:51.680 --> 00:27:54.340
before the visit, like, oh, okay, you're a talker.
721
00:27:54.460 --> 00:27:55.040
Okay, good.
722
00:27:56.040 --> 00:27:57.720
You know, things like that to just sort of,
723
00:27:57.720 --> 00:28:00.220
then you know, okay, when I'm going into this visit,
724
00:28:00.340 --> 00:28:02.160
I'm gonna need to help this person stay focused.
725
00:28:02.500 --> 00:28:04.220
I'm going to need to keep an eye on the clock
726
00:28:04.220 --> 00:28:06.580
because they've got all the time in the world
727
00:28:06.580 --> 00:28:08.080
and a lot of stuff to talk about.
728
00:28:09.120 --> 00:28:10.960
That's a big strategy too.
729
00:28:11.420 --> 00:28:12.140
Yeah, yeah.
730
00:28:12.440 --> 00:28:13.520
To be prepared.
731
00:28:14.280 --> 00:28:15.700
Yeah, oh, I love that.
732
00:28:16.100 --> 00:28:18.900
So on that note, I just wanted to add there's,
733
00:28:19.020 --> 00:28:20.300
I feel like I've quoted this before,
734
00:28:20.300 --> 00:28:23.560
but there's this like study about when providers sit down.
735
00:28:23.560 --> 00:28:24.960
I don't know if you're familiar with that study,
736
00:28:25.160 --> 00:28:26.640
but they did like a, they did a study,
737
00:28:26.640 --> 00:28:29.500
I think it was a qualitative study of like patient perception
738
00:28:29.500 --> 00:28:30.760
of how long a visit was.
739
00:28:31.000 --> 00:28:33.780
And what they perceived was three times as long
740
00:28:33.780 --> 00:28:36.960
when the provider sat down versus when they stood up.
741
00:28:37.240 --> 00:28:39.800
And so I just appreciate that you added
742
00:28:39.800 --> 00:28:41.200
that you start with your visit sitting
743
00:28:41.200 --> 00:28:43.540
because I know providers, some people come in
744
00:28:43.540 --> 00:28:45.820
and they're like charting on a computer on wheels
745
00:28:45.820 --> 00:28:47.740
and that's really great and helpful,
746
00:28:47.800 --> 00:28:49.900
but like I always kind of like use that hack
747
00:28:49.900 --> 00:28:51.820
of like sitting down, full attention,
748
00:28:51.820 --> 00:28:54.060
and then it's like the perception is much longer.
749
00:28:54.540 --> 00:28:56.340
And then I think it also reminded me
750
00:28:56.340 --> 00:28:58.140
of this other thing about interruptions.
751
00:28:58.160 --> 00:29:00.180
And I don't know if you had any suggestions for that,
752
00:29:00.180 --> 00:29:02.220
like especially with like chatty patients.
753
00:29:03.220 --> 00:29:04.620
I do love my chatty patients,
754
00:29:04.620 --> 00:29:06.520
but I am trying to be mindful of time.
755
00:29:07.280 --> 00:29:09.240
So one thing that I wanted to add,
756
00:29:09.260 --> 00:29:11.860
and if you had any to add, I appreciate it,
757
00:29:12.820 --> 00:29:16.800
is that when, instead of saying,
758
00:29:16.980 --> 00:29:19.080
instead of when somebody's talking and saying but,
759
00:29:19.720 --> 00:29:21.020
you can say and.
760
00:29:21.620 --> 00:29:23.340
And so when they're talking, oh, and,
761
00:29:23.380 --> 00:29:25.620
and then you change the, you change the direction
762
00:29:25.620 --> 00:29:27.620
because a but, it's so subtle.
763
00:29:27.820 --> 00:29:29.400
And it's, this is talking about the English language,
764
00:29:29.620 --> 00:29:32.060
not in other languages,
765
00:29:32.080 --> 00:29:33.320
because I can't speak to that.
766
00:29:34.120 --> 00:29:36.100
But yeah, so when you're saying like, and this,
767
00:29:36.180 --> 00:29:37.880
it's like not negating what they're saying.
768
00:29:38.060 --> 00:29:39.680
It's like, I've heard what you've said
769
00:29:39.680 --> 00:29:42.220
and we're gonna talk about blah, blah, blah next.
770
00:29:42.840 --> 00:29:43.620
Right, right.
771
00:29:43.620 --> 00:29:44.800
As opposed to saying like,
772
00:29:45.000 --> 00:29:46.580
but we only have 20 minutes, right?
773
00:29:46.620 --> 00:29:47.940
Yeah, yeah, yeah, yeah.
774
00:29:47.940 --> 00:29:49.320
Yeah, and we only have 20 minutes.
775
00:29:49.840 --> 00:29:51.920
So, you know, it's just like a better connector.
776
00:29:52.100 --> 00:29:54.280
Like I've heard you space and it's so subtle.
777
00:29:54.280 --> 00:29:56.080
And I don't actually know if there's research on it,
778
00:29:56.480 --> 00:29:58.660
but I appreciate it as a patient.
779
00:29:59.200 --> 00:30:01.000
Yeah, no, definitely, definitely.
780
00:30:01.260 --> 00:30:02.840
Yeah, I have, I think I've been on the receiving
781
00:30:02.840 --> 00:30:03.720
of that too.
782
00:30:04.180 --> 00:30:04.460
Yeah.
783
00:30:04.920 --> 00:30:07.240
Like, oh, okay, all right, yeah.
784
00:30:07.880 --> 00:30:10.140
Totally, but do you have suggestions about interrupting
785
00:30:10.140 --> 00:30:12.460
or kind of, I think that people have a hard time
786
00:30:12.460 --> 00:30:15.180
with that and they don't like quite know what to say
787
00:30:15.180 --> 00:30:16.740
or how to say it or.
788
00:30:17.740 --> 00:30:19.200
So to interrupt like the patient,
789
00:30:19.340 --> 00:30:20.380
like if they're really on a roll
790
00:30:20.380 --> 00:30:22.000
and you need to kind of take a break.
791
00:30:22.440 --> 00:30:23.840
Well, so one thing that I found
792
00:30:23.840 --> 00:30:27.240
it's counterintuitive and for me, it's hard to do
793
00:30:27.240 --> 00:30:29.460
because I'm a chatterbox, right?
794
00:30:29.540 --> 00:30:31.560
So like, I can't really fault patients too much
795
00:30:31.560 --> 00:30:34.500
because I'm just as bad, but like, yeah.
796
00:30:34.660 --> 00:30:36.840
But one thing is silence.
797
00:30:37.520 --> 00:30:40.100
So kind of like if you keep stoking the fire,
798
00:30:40.260 --> 00:30:41.840
like the fire's gonna keep burning, right?
799
00:30:42.040 --> 00:30:43.540
But if you just kind of like,
800
00:30:43.680 --> 00:30:46.280
if you smother a fire, it's not gonna continue to burn
801
00:30:46.280 --> 00:30:47.220
so we don't want to smother a patient,
802
00:30:47.380 --> 00:30:50.280
but like to not say anything.
803
00:30:50.860 --> 00:30:53.840
And I worked with a colleague who had this trick
804
00:30:53.840 --> 00:30:55.960
and I was like, I'll try it, I don't know if it's gonna work.
805
00:30:56.180 --> 00:30:57.220
And I was like, oh my God, it totally worked.
806
00:30:57.420 --> 00:30:58.640
And of course she was like a physician
807
00:30:58.640 --> 00:30:59.880
and she had worked for 30 years.
808
00:30:59.880 --> 00:31:01.340
So she had all kinds of insights
809
00:31:01.340 --> 00:31:02.580
that like someday I'll have,
810
00:31:02.660 --> 00:31:04.280
but I didn't have them at this point for sure.
811
00:31:04.740 --> 00:31:07.420
And she said, I let the patient say everything
812
00:31:07.420 --> 00:31:11.160
and then I count in my head to 10 and I say nothing.
813
00:31:12.000 --> 00:31:13.500
And patients loved her too.
814
00:31:13.520 --> 00:31:15.980
And I was like, that sounds like that's an eternity.
815
00:31:16.080 --> 00:31:17.960
So I was like, well, I'll do five, right?
816
00:31:19.420 --> 00:31:21.860
I'll try, and it does work.
817
00:31:22.180 --> 00:31:23.880
So I don't feel super comfortable
818
00:31:23.880 --> 00:31:25.660
doing that all the time.
819
00:31:26.000 --> 00:31:28.540
Nice to have that in the toolkit, right?
820
00:31:28.580 --> 00:31:29.460
As an option.
821
00:31:30.560 --> 00:31:32.560
So sometimes to be like, okay,
822
00:31:32.620 --> 00:31:35.460
and one, two, three, four, and five.
823
00:31:35.800 --> 00:31:38.200
And like, okay, and just to kind of do that,
824
00:31:38.200 --> 00:31:40.800
that can be used in a lot of different situations too.
825
00:31:40.820 --> 00:31:42.600
Like when you need to sort of
826
00:31:42.600 --> 00:31:44.580
slow the momentum down a little bit,
827
00:31:44.660 --> 00:31:47.440
sometimes the patient is in a different conversation,
828
00:31:47.440 --> 00:31:51.160
but if they're a little bit confrontational, not engaging,
829
00:31:51.680 --> 00:31:55.520
and just kind of letting it sort of fall where it may,
830
00:31:55.820 --> 00:31:57.280
it can work in that case too.
831
00:31:57.300 --> 00:31:59.260
I have some other tips for confrontational patients,
832
00:31:59.300 --> 00:32:00.060
that's not today,
833
00:32:00.760 --> 00:32:02.520
but it can work for that sort of thing too.
834
00:32:02.640 --> 00:32:03.640
So it really is like,
835
00:32:04.020 --> 00:32:06.440
it's the kind of multifaceted tool
836
00:32:06.440 --> 00:32:07.500
that you can kind of plug into
837
00:32:07.500 --> 00:32:08.520
a lot of different situations.
838
00:32:08.940 --> 00:32:10.320
So science, you know,
839
00:32:10.320 --> 00:32:12.240
because people will notice that you're not talking.
840
00:32:12.680 --> 00:32:14.780
And they'll go, you know, it's shaking them up.
841
00:32:15.280 --> 00:32:16.980
And that can be helpful too.
842
00:32:17.920 --> 00:32:20.680
I've also had situations where, again,
843
00:32:20.860 --> 00:32:23.840
knowing that I've had, okay, here comes so-and-so,
844
00:32:24.300 --> 00:32:26.420
and they're gonna be, we're gonna be here all day.
845
00:32:26.800 --> 00:32:28.260
And so, you know, you enjoy some of these patients,
846
00:32:28.280 --> 00:32:28.920
you enjoy them.
847
00:32:28.940 --> 00:32:31.740
Like if you have them, you enjoy them all the time.
848
00:32:32.160 --> 00:32:34.280
And so if you have a good relationship
849
00:32:34.280 --> 00:32:35.840
with the folks that you work with
850
00:32:35.840 --> 00:32:37.800
to get that kind of rescue knock,
851
00:32:38.940 --> 00:32:41.120
I'm still in here at two o'clock,
852
00:32:41.180 --> 00:32:43.340
or 4.30, or 10 p.m., or whatever.
853
00:32:43.860 --> 00:32:45.680
Knock on the door, like would you please,
854
00:32:45.860 --> 00:32:47.060
like, and it could be anybody, right?
855
00:32:47.080 --> 00:32:48.820
The patient doesn't know who it is, right?
856
00:32:49.160 --> 00:32:50.720
And you go out into the hall
857
00:32:50.720 --> 00:32:52.580
and they think it's something very important.
858
00:32:52.620 --> 00:32:53.820
And then you're just like,
859
00:32:53.860 --> 00:32:55.940
wait in the hall, count to 10, stop back in.
860
00:32:56.040 --> 00:32:57.360
You know, and like, I'm really sorry,
861
00:32:57.400 --> 00:32:58.100
but I'm gonna have to,
862
00:32:58.100 --> 00:32:59.360
we're gonna have to wrap up here.
863
00:32:59.540 --> 00:33:00.780
You know, so these are things too,
864
00:33:00.920 --> 00:33:02.620
you know, that you can kind of do
865
00:33:02.620 --> 00:33:04.880
and it helps if you know what you're walking into
866
00:33:05.900 --> 00:33:08.360
with a patient who might be a little more likely
867
00:33:08.360 --> 00:33:09.040
to do that.
868
00:33:10.700 --> 00:33:12.200
But it's always, you know,
869
00:33:12.200 --> 00:33:14.320
there are always new things to learn
870
00:33:14.320 --> 00:33:16.620
and there's always new tools to put in the toolkit
871
00:33:16.620 --> 00:33:18.200
because there's always curveballs.
872
00:33:18.760 --> 00:33:19.820
So there's that these two is like,
873
00:33:19.920 --> 00:33:21.060
yeah, give yourself a break.
874
00:33:21.820 --> 00:33:21.880
Yeah.
875
00:33:22.140 --> 00:33:25.160
I do not manage every single encounter
876
00:33:25.160 --> 00:33:26.740
in the last, you know, five years,
877
00:33:26.740 --> 00:33:27.920
like completely perfectly
878
00:33:27.920 --> 00:33:29.420
as far as time management is concerned.
879
00:33:30.080 --> 00:33:30.920
Sometimes you can't
880
00:33:30.920 --> 00:33:33.540
and you have to just sort of accept that.
881
00:33:34.020 --> 00:33:35.960
But, you know, if you run late,
882
00:33:35.980 --> 00:33:38.560
maybe you borrow five minutes from the next visit
883
00:33:38.560 --> 00:33:40.180
or something, you know, there's those things too.
884
00:33:40.940 --> 00:33:42.460
Totally, totally.
885
00:33:42.720 --> 00:33:45.180
And I guess we said this off camera,
886
00:33:45.260 --> 00:33:47.620
but I think there are a lot of choices
887
00:33:47.620 --> 00:33:48.860
when it comes to time management
888
00:33:48.860 --> 00:33:51.320
and I have time blindness.
889
00:33:52.560 --> 00:33:54.000
I try a lot of things.
890
00:33:54.120 --> 00:33:56.220
I just, I'm not great with it in general
891
00:33:56.220 --> 00:33:57.700
in my whole life for my entire life.
892
00:33:57.740 --> 00:34:01.120
And so I just give myself a lot of grace
893
00:34:01.120 --> 00:34:04.860
and my commitments are to very high quality patient care,
894
00:34:05.080 --> 00:34:06.640
strong relationships with my patients
895
00:34:07.160 --> 00:34:08.920
and just like doing a good job.
896
00:34:08.920 --> 00:34:11.820
And so some, like doing a good job
897
00:34:11.820 --> 00:34:12.900
includes time management,
898
00:34:13.000 --> 00:34:15.679
but I also get to make decisions, right,
899
00:34:15.679 --> 00:34:16.760
like of the give and take.
900
00:34:16.980 --> 00:34:19.219
Cause I think sometimes that new nurse practitioners
901
00:34:19.219 --> 00:34:21.460
especially will write in and say things like,
902
00:34:21.540 --> 00:34:23.560
you know, like I,
903
00:34:23.580 --> 00:34:25.719
I think there's this like kind of like attachment
904
00:34:25.719 --> 00:34:27.100
to like every single day,
905
00:34:27.100 --> 00:34:28.340
I see my patients on time,
906
00:34:28.340 --> 00:34:29.320
I get on on time,
907
00:34:29.380 --> 00:34:32.340
I get all my charts done on time every single week.
908
00:34:32.380 --> 00:34:33.840
And I think that people view that
909
00:34:33.840 --> 00:34:35.139
especially when they're new are of like,
910
00:34:35.139 --> 00:34:36.500
you've arrived, you've achieved,
911
00:34:36.580 --> 00:34:37.440
that's what everybody does,
912
00:34:37.440 --> 00:34:38.860
that's what you're supposed to do.
913
00:34:39.000 --> 00:34:41.860
And then also like, it doesn't have to look like that
914
00:34:41.860 --> 00:34:42.900
and it's not about perfection,
915
00:34:43.000 --> 00:34:46.199
it's about like you choosing what is gonna work for you
916
00:34:46.199 --> 00:34:49.120
and what you can accept and what you can't accept, right?
917
00:34:49.139 --> 00:34:50.080
And so for me,
918
00:34:50.340 --> 00:34:52.440
I'm also okay accepting that it's,
919
00:34:52.440 --> 00:34:54.420
you know, if I leave the clinic an hour late,
920
00:34:54.639 --> 00:34:55.580
I've made that choice
921
00:34:55.580 --> 00:34:58.220
because I have a variety of other choices in my life.
922
00:34:58.620 --> 00:34:59.500
And if that wasn't a,
923
00:34:59.560 --> 00:35:00.620
if I was not okay with that,
924
00:35:00.640 --> 00:35:01.860
then I would amend my behavior,
925
00:35:01.900 --> 00:35:04.200
but it's not at the right at this point.
926
00:35:04.820 --> 00:35:05.120
Yes.
927
00:35:05.280 --> 00:35:06.300
And that's the thing too,
928
00:35:06.300 --> 00:35:07.860
is kind of knowing yourself
929
00:35:07.860 --> 00:35:10.860
and knowing kind of what makes sense for you
930
00:35:10.860 --> 00:35:12.100
and what your boundaries are.
931
00:35:12.180 --> 00:35:13.720
Because I think that's a big thing too.
932
00:35:14.860 --> 00:35:16.860
In my book, I have like a little infographic.
933
00:35:16.940 --> 00:35:18.040
Well, it's not even as a chart,
934
00:35:18.040 --> 00:35:18.680
it's an infographic.
935
00:35:19.320 --> 00:35:22.580
And it shows my rate of closing charts the same day
936
00:35:22.580 --> 00:35:24.400
versus the rest of the practice, right?
937
00:35:24.400 --> 00:35:26.880
And there were like 30 or 40 people in the practice.
938
00:35:27.340 --> 00:35:29.660
And I was like, I know it was a busy place.
939
00:35:30.140 --> 00:35:32.500
But I was definitely above everybody else.
940
00:35:32.560 --> 00:35:34.220
I think I was like 10, 15,
941
00:35:34.320 --> 00:35:35.940
maybe even 20 points above everybody else
942
00:35:35.940 --> 00:35:38.300
because that was really important to me.
943
00:35:38.960 --> 00:35:39.780
But that doesn't mean,
944
00:35:40.020 --> 00:35:41.620
and so I was like a little like,
945
00:35:42.520 --> 00:35:44.340
way uptight about it,
946
00:35:44.520 --> 00:35:46.520
but I was unusual.
947
00:35:46.620 --> 00:35:48.120
I guess it's the point that I'm trying to make.
948
00:35:48.140 --> 00:35:49.880
And not in like a humblebrag kind of way,
949
00:35:49.900 --> 00:35:51.220
but just like that was my thing.
950
00:35:51.700 --> 00:35:54.200
Like that was my OCD of sorts.
951
00:35:55.320 --> 00:35:58.960
And the point is the average was still really good.
952
00:35:59.120 --> 00:36:01.980
Like the average was still in the like 80s to 85%,
953
00:36:01.980 --> 00:36:04.000
like closing them within 24 hours.
954
00:36:04.700 --> 00:36:06.660
You know, that's normal.
955
00:36:06.700 --> 00:36:09.260
If you really want to go, you know,
956
00:36:09.380 --> 00:36:10.860
super great with the other things now,
957
00:36:10.860 --> 00:36:13.740
I definitely had times when I had my charts closed,
958
00:36:14.120 --> 00:36:16.260
my patient satisfaction scores were not so good.
959
00:36:16.680 --> 00:36:17.260
You know, right?
960
00:36:17.600 --> 00:36:19.780
Like you kind of choose your battles, right?
961
00:36:19.920 --> 00:36:21.300
Because you can't have both.
962
00:36:25.180 --> 00:36:26.360
So that's a big thing.
963
00:36:26.420 --> 00:36:26.820
And to realize,
964
00:36:26.900 --> 00:36:28.480
I think you had a really good point by saying
965
00:36:28.480 --> 00:36:30.860
that it really, that's kind of like, okay,
966
00:36:31.120 --> 00:36:33.300
then I'll know now I'm a real MP.
967
00:36:35.140 --> 00:36:36.300
No, you know,
968
00:36:36.460 --> 00:36:38.840
because I knew I was very good at charting.
969
00:36:39.000 --> 00:36:41.820
And I knew that I was very good at like the efficiency
970
00:36:41.820 --> 00:36:42.480
and that sort of thing.
971
00:36:42.500 --> 00:36:44.100
But there were definitely things that I was like,
972
00:36:44.100 --> 00:36:44.960
like the gout, you know,
973
00:36:45.060 --> 00:36:46.380
for the first time I saw something with gout,
974
00:36:46.440 --> 00:36:48.580
or the first time I had, you know,
975
00:36:48.780 --> 00:36:49.480
maybe I don't know,
976
00:36:49.600 --> 00:36:52.080
an atypical presentation of something, right?
977
00:36:52.100 --> 00:36:53.780
And it's like, oh, you know,
978
00:36:53.820 --> 00:36:56.100
or this person who's got polypharmacy
979
00:36:56.100 --> 00:36:58.580
and you need to give them antibiotics
980
00:36:58.580 --> 00:37:00.460
and things are interacting
981
00:37:00.460 --> 00:37:01.800
and their kidneys aren't working right.
982
00:37:01.820 --> 00:37:03.240
And so you're like, oh God, what do I do?
983
00:37:03.240 --> 00:37:05.880
So those things, like definitely other things
984
00:37:05.880 --> 00:37:06.660
where you're like, okay,
985
00:37:06.820 --> 00:37:08.740
yeah, the time management might be great.
986
00:37:09.360 --> 00:37:11.980
You know, I'm working on that too.
987
00:37:12.180 --> 00:37:14.220
So that's a big, big piece.
988
00:37:15.820 --> 00:37:18.400
And this, I'm gonna give this a little pause here
989
00:37:18.400 --> 00:37:20.820
because we might want, we, right,
990
00:37:20.980 --> 00:37:22.400
you might wanna edit this
991
00:37:22.400 --> 00:37:23.960
and have this in a different order.
992
00:37:24.800 --> 00:37:27.760
But this next piece is a huge part of charting
993
00:37:27.760 --> 00:37:29.600
and I can't believe I forgot to say it.
994
00:37:29.740 --> 00:37:32.020
So from the charting perspective,
995
00:37:32.020 --> 00:37:35.660
my number one time saver is dictation.
996
00:37:37.600 --> 00:37:39.100
There's nothing else that you can do
997
00:37:39.100 --> 00:37:41.740
that's gonna get you anywhere close to those same results.
998
00:37:43.000 --> 00:37:46.200
You know, my first six months in family medicine,
999
00:37:46.840 --> 00:37:48.640
yeah, it was about six months, I was doing it.
1000
00:37:48.760 --> 00:37:50.100
I was typing, I'm a pretty fast typist.
1001
00:37:50.100 --> 00:37:51.760
I used to be a secretary back in the day.
1002
00:37:51.780 --> 00:37:52.860
So like, I'm pretty good, right?
1003
00:37:53.460 --> 00:37:54.700
And I was all right,
1004
00:37:54.700 --> 00:37:57.940
but really my numbers changed when I started dictating.
1005
00:37:58.280 --> 00:38:00.820
And I thought it's gonna be this weird thing.
1006
00:38:00.820 --> 00:38:04.040
It's not, everything's weird the first time you do it,
1007
00:38:04.120 --> 00:38:05.840
but by like the 10th time, it's not weird anymore.
1008
00:38:06.440 --> 00:38:07.480
And when you realize,
1009
00:38:07.880 --> 00:38:10.280
oh, this weird thing gets me out of here.
1010
00:38:10.660 --> 00:38:11.020
Yeah.
1011
00:38:11.920 --> 00:38:14.680
So that is a major, major game changer.
1012
00:38:15.260 --> 00:38:18.180
And, you know, looking for ways to learn that
1013
00:38:18.180 --> 00:38:19.200
if you don't already know how,
1014
00:38:19.200 --> 00:38:21.800
or to get comfortable with that if you're not there yet,
1015
00:38:22.300 --> 00:38:23.380
definitely worth it
1016
00:38:23.380 --> 00:38:26.860
because that is what is going to be just a game changer.
1017
00:38:27.540 --> 00:38:27.940
Yeah.
1018
00:38:28.300 --> 00:38:32.760
And is that something that your clinic already had,
1019
00:38:32.800 --> 00:38:34.420
or is that something that you sought out
1020
00:38:34.420 --> 00:38:36.440
or you paid for, or how did that work?
1021
00:38:36.600 --> 00:38:37.000
Yeah.
1022
00:38:37.560 --> 00:38:40.620
So we had Dragon, which plugged into Epic.
1023
00:38:40.800 --> 00:38:42.220
So we had all of the, you know,
1024
00:38:42.400 --> 00:38:43.640
top of the line sort of stuff.
1025
00:38:45.180 --> 00:38:47.540
And yeah, I was like the new kid, right?
1026
00:38:47.540 --> 00:38:48.940
Cause I was one of the new MPs
1027
00:38:48.940 --> 00:38:50.220
and I was like a younger grad.
1028
00:38:51.100 --> 00:38:54.740
And so I had like a really old handheld microphone.
1029
00:38:54.740 --> 00:38:57.420
So like we had good stuff, but my equipment wasn't great,
1030
00:38:57.420 --> 00:38:59.660
but it didn't matter because it's still like,
1031
00:38:59.880 --> 00:39:02.480
it records my voice and it's learning what my things are.
1032
00:39:03.160 --> 00:39:06.860
And I had another colleague that was at the same point
1033
00:39:06.860 --> 00:39:08.180
we had graduated at the same time.
1034
00:39:08.200 --> 00:39:10.280
And she started like a month after me
1035
00:39:10.280 --> 00:39:13.580
and she was really good with like cardiac stuff.
1036
00:39:13.720 --> 00:39:14.880
Like there were clinical topics
1037
00:39:14.880 --> 00:39:16.660
that she was like way better than they at,
1038
00:39:16.660 --> 00:39:18.480
but charting, right?
1039
00:39:18.580 --> 00:39:20.060
That's way better than her at charting.
1040
00:39:20.280 --> 00:39:23.000
So she started dictating and she got this huge improvement.
1041
00:39:23.000 --> 00:39:25.420
And she's like, oh man, I'm finishing like hours earlier.
1042
00:39:25.660 --> 00:39:26.860
And then something happened,
1043
00:39:27.000 --> 00:39:28.800
like they gave her a new computer
1044
00:39:28.800 --> 00:39:30.740
and the microphone didn't work anymore.
1045
00:39:31.380 --> 00:39:32.560
And so she just abandoned it.
1046
00:39:32.580 --> 00:39:34.260
And I was like, I take and help you with that.
1047
00:39:34.760 --> 00:39:36.640
She abandoned it and she's there
1048
00:39:36.640 --> 00:39:38.420
till like 10 o'clock at night still,
1049
00:39:38.620 --> 00:39:39.640
charting all the time.
1050
00:39:39.780 --> 00:39:40.480
I'm like, seriously?
1051
00:39:44.080 --> 00:39:45.580
All you have to do is get this thing
1052
00:39:45.580 --> 00:39:48.080
and plug it in and be like patient for them.
1053
00:39:48.620 --> 00:39:49.140
Yeah, so.
1054
00:39:49.640 --> 00:39:52.760
I have like a very not great hack.
1055
00:39:53.500 --> 00:39:57.380
So I think the ideal situation is that you discuss this
1056
00:39:57.380 --> 00:40:00.980
and I have an episode about how primary care offices work
1057
00:40:00.980 --> 00:40:02.520
and how to like navigate scheduling issues
1058
00:40:02.520 --> 00:40:03.780
and like communicate with leadership.
1059
00:40:03.880 --> 00:40:06.160
So like this is more of like on that side
1060
00:40:06.160 --> 00:40:09.660
of like getting support from like the whole group
1061
00:40:09.660 --> 00:40:12.700
instead of like you can ask yourself
1062
00:40:12.700 --> 00:40:13.640
but you might need support
1063
00:40:13.640 --> 00:40:15.140
because it's like a functional,
1064
00:40:15.460 --> 00:40:17.580
potentially expensive change for the clinic.
1065
00:40:17.580 --> 00:40:21.300
But so I do recommend you take that route first
1066
00:40:21.300 --> 00:40:23.100
but if you do have to hack it,
1067
00:40:23.700 --> 00:40:27.180
Google Docs has a dictation feature and you can,
1068
00:40:27.360 --> 00:40:28.900
it's not great for medical stuff.
1069
00:40:29.420 --> 00:40:32.120
But Google Docs is free if you have a Google Gmail account
1070
00:40:32.120 --> 00:40:34.300
and like you can dictate stuff, you have to edit it.
1071
00:40:34.380 --> 00:40:36.140
So I don't know if it would save that much time.
1072
00:40:36.280 --> 00:40:37.560
That's why I haven't used it
1073
00:40:37.560 --> 00:40:38.540
and because we didn't have Dragon
1074
00:40:38.540 --> 00:40:41.020
but I think Dragon is specific for like medical words
1075
00:40:41.020 --> 00:40:41.720
and stuff like that.
1076
00:40:41.780 --> 00:40:43.120
Like, so it's like ready for those things
1077
00:40:43.120 --> 00:40:45.280
versus Google, it's like, what is that?
1078
00:40:45.280 --> 00:40:46.960
Yeah, right.
1079
00:40:47.700 --> 00:40:49.240
And even so Dragon isn't perfect
1080
00:40:49.240 --> 00:40:52.180
but if you can, like, even if you get just your box
1081
00:40:52.180 --> 00:40:54.600
of text and then you copy and paste it
1082
00:40:54.600 --> 00:40:56.320
and then have to edit it a little bit,
1083
00:40:56.660 --> 00:40:57.880
even with Dragon,
1084
00:40:57.920 --> 00:40:59.780
you still wanna review your note each time
1085
00:40:59.780 --> 00:41:01.860
because you never, there are curve balls.
1086
00:41:02.440 --> 00:41:04.240
It hasn't been like auto-correct
1087
00:41:04.240 --> 00:41:06.040
where you're like, I didn't say that.
1088
00:41:07.100 --> 00:41:09.340
And it was that, Dragon swears I did.
1089
00:41:09.760 --> 00:41:11.520
So you still wanna be reviewing it anyway.
1090
00:41:12.060 --> 00:41:13.840
So yeah, I mean, it's still,
1091
00:41:13.840 --> 00:41:16.220
even if you had to copy and paste it
1092
00:41:16.220 --> 00:41:17.580
from like a Google Doc,
1093
00:41:17.860 --> 00:41:20.280
it's still gonna be faster than I think.
1094
00:41:20.360 --> 00:41:21.160
Yeah, totally.
1095
00:41:21.160 --> 00:41:22.340
And I kind of like, a lot of nurses
1096
00:41:22.340 --> 00:41:23.520
are just not great typists.
1097
00:41:23.820 --> 00:41:25.100
Like they're not fast, you know?
1098
00:41:25.100 --> 00:41:27.060
Like no shade or whatever
1099
00:41:27.060 --> 00:41:28.200
but like they're just not fast.
1100
00:41:28.640 --> 00:41:30.960
So it's going to be faster for you, right?
1101
00:41:31.120 --> 00:41:31.520
Yeah.
1102
00:41:32.640 --> 00:41:33.380
Totally, totally.
1103
00:41:33.740 --> 00:41:35.560
Well, I do wanna get to the question
1104
00:41:36.880 --> 00:41:38.560
about scheduling challenges
1105
00:41:38.560 --> 00:41:42.020
as well as addressing it with leadership.
1106
00:41:42.020 --> 00:41:44.100
Like I think that even,
1107
00:41:44.360 --> 00:41:46.400
and I gave this example off the recording
1108
00:41:46.400 --> 00:41:48.240
but somebody just wrote in,
1109
00:41:48.300 --> 00:41:49.700
I think it was either today or yesterday
1110
00:41:49.700 --> 00:41:51.520
and was like, I'm really,
1111
00:41:51.700 --> 00:41:52.500
but here's the context.
1112
00:41:53.140 --> 00:41:54.800
I am in this practice,
1113
00:41:55.420 --> 00:41:56.680
I have a schedule
1114
00:41:57.260 --> 00:42:00.260
and I'm willing to see patients as needed,
1115
00:42:00.500 --> 00:42:01.520
double or triple booked
1116
00:42:01.520 --> 00:42:03.560
for like emergency situations, right?
1117
00:42:03.580 --> 00:42:05.200
Or urgent, urgent matters, right?
1118
00:42:05.200 --> 00:42:06.620
And that's how most clinics go.
1119
00:42:06.640 --> 00:42:08.060
It's like, here's your schedule.
1120
00:42:08.460 --> 00:42:08.900
You know what?
1121
00:42:08.900 --> 00:42:09.960
I'm so sorry providers,
1122
00:42:09.980 --> 00:42:11.860
who can take this kid with a sore throat
1123
00:42:11.860 --> 00:42:12.420
with a fever.
1124
00:42:12.460 --> 00:42:13.380
It's like, okay, great.
1125
00:42:13.520 --> 00:42:15.260
I'll be double booked at four o'clock.
1126
00:42:15.260 --> 00:42:15.800
That's fine.
1127
00:42:16.380 --> 00:42:17.700
But then this nurse practitioner was like,
1128
00:42:17.720 --> 00:42:19.260
it happens every day.
1129
00:42:20.040 --> 00:42:22.060
And you're kind of laughing about like,
1130
00:42:22.200 --> 00:42:23.820
well, emergencies don't really happen every day
1131
00:42:23.820 --> 00:42:24.660
unless you're in the ER.
1132
00:42:25.900 --> 00:42:27.740
So I wanna talk about scheduling
1133
00:42:27.740 --> 00:42:29.460
and how it affects time management
1134
00:42:29.460 --> 00:42:33.000
and then also what your thoughts were about that
1135
00:42:33.000 --> 00:42:35.720
but then also tying in that piece of like,
1136
00:42:35.720 --> 00:42:37.400
this is not a unique problem
1137
00:42:37.400 --> 00:42:39.160
for this one person that wrote in.
1138
00:42:39.640 --> 00:42:41.540
Like this is like literally national
1139
00:42:41.540 --> 00:42:43.680
for the last three years that I,
1140
00:42:44.000 --> 00:42:45.380
like probably international too.
1141
00:42:45.400 --> 00:42:48.220
Cause like we serve people in Canada regularly
1142
00:42:48.220 --> 00:42:49.760
and I think they have the same challenges.
1143
00:42:50.500 --> 00:42:51.800
So like, I don't know.
1144
00:42:51.980 --> 00:42:54.220
What are your thoughts about that?
1145
00:42:54.840 --> 00:42:55.380
Yeah.
1146
00:42:55.380 --> 00:42:56.620
I thought I'd navigate it.
1147
00:42:57.160 --> 00:42:58.460
I agree that, right?
1148
00:42:58.500 --> 00:42:59.700
Like that is a weird trend.
1149
00:43:03.100 --> 00:43:05.120
So that person is right.
1150
00:43:05.260 --> 00:43:07.040
And they're doing the right thing
1151
00:43:07.040 --> 00:43:08.780
in that they are recognizing
1152
00:43:09.400 --> 00:43:10.960
this is what's happening to me
1153
00:43:10.960 --> 00:43:13.220
and this doesn't feel right.
1154
00:43:13.680 --> 00:43:14.860
And you have to kind of know
1155
00:43:14.860 --> 00:43:15.540
a couple of different things.
1156
00:43:15.600 --> 00:43:16.940
So when it comes to the schedule,
1157
00:43:18.320 --> 00:43:21.280
even I would kind of take it a layer back
1158
00:43:21.280 --> 00:43:22.100
from the schedule
1159
00:43:22.100 --> 00:43:23.820
and kind of you want to get a sense.
1160
00:43:24.320 --> 00:43:26.360
And I used just a time tracker,
1161
00:43:26.520 --> 00:43:27.020
just like a simple,
1162
00:43:27.040 --> 00:43:28.060
you could just pen and paper
1163
00:43:28.440 --> 00:43:29.680
and for different kinds of visits,
1164
00:43:29.680 --> 00:43:31.360
just track how long it takes you to do them.
1165
00:43:31.880 --> 00:43:33.460
So if you've got a kid
1166
00:43:33.460 --> 00:43:34.580
with a sore throat and a fever,
1167
00:43:34.720 --> 00:43:35.780
it's a quick visit, right?
1168
00:43:35.780 --> 00:43:36.360
Like it should be.
1169
00:43:36.620 --> 00:43:37.540
They've got some other stuff,
1170
00:43:37.620 --> 00:43:38.520
but like the typical visit,
1171
00:43:38.620 --> 00:43:39.600
like that's 10 minutes,
1172
00:43:39.680 --> 00:43:40.120
they're in and out,
1173
00:43:40.120 --> 00:43:41.200
they just want their antibiotics
1174
00:43:41.200 --> 00:43:42.080
and they're good, right?
1175
00:43:42.400 --> 00:43:42.760
Totally.
1176
00:43:42.960 --> 00:43:43.980
Well, not for new grads.
1177
00:43:43.980 --> 00:43:45.260
New grads, I feel like every visit
1178
00:43:45.260 --> 00:43:46.600
takes an hour, but yes.
1179
00:43:46.680 --> 00:43:47.680
Once they feel better,
1180
00:43:47.680 --> 00:43:48.700
it will be 10 minutes.
1181
00:43:49.700 --> 00:43:50.420
Yeah, yes.
1182
00:43:51.520 --> 00:43:53.460
And so it's a fairly simple visit, right?
1183
00:43:53.500 --> 00:43:55.180
It's not just a bunch of different things going on.
1184
00:43:55.500 --> 00:43:56.180
And theoretically,
1185
00:43:56.780 --> 00:43:58.040
so if you're thinking about it, right,
1186
00:43:58.040 --> 00:43:59.520
what does that visit entail?
1187
00:43:59.600 --> 00:44:01.220
Well, you obviously have to assess the kid
1188
00:44:01.220 --> 00:44:02.640
and you're going to get the history from the kid,
1189
00:44:02.680 --> 00:44:03.620
you're going to get it from the parent,
1190
00:44:03.940 --> 00:44:05.280
okay, or the guardian.
1191
00:44:06.180 --> 00:44:08.500
But the assistant in most clinics,
1192
00:44:08.500 --> 00:44:09.200
it could be a little different,
1193
00:44:09.200 --> 00:44:10.920
but you're going to probably do a rapid strap
1194
00:44:10.920 --> 00:44:12.060
or rapid something,
1195
00:44:12.420 --> 00:44:14.060
but you're probably not going to be the one doing that.
1196
00:44:14.080 --> 00:44:15.520
So you're going to have your time to step up.
1197
00:44:15.720 --> 00:44:17.560
So how much time are you really going to be spending
1198
00:44:17.560 --> 00:44:20.600
with the patient versus end charting at the end, right?
1199
00:44:20.600 --> 00:44:23.240
And then sending probably some sort of orders,
1200
00:44:23.740 --> 00:44:25.740
either imaging or whatever, right?
1201
00:44:26.020 --> 00:44:29.200
Not imaging, but like labs or meds.
1202
00:44:29.320 --> 00:44:30.380
So you have to kind of know
1203
00:44:30.380 --> 00:44:31.000
what your different things.
1204
00:44:31.020 --> 00:44:32.640
Now, of course, that's going to be faster
1205
00:44:32.640 --> 00:44:34.540
than somebody who is 50
1206
00:44:34.540 --> 00:44:36.540
with a bunch of different things going on
1207
00:44:36.540 --> 00:44:38.120
and 10 different prescriptions
1208
00:44:38.120 --> 00:44:39.440
and doing their annual physical
1209
00:44:39.440 --> 00:44:41.940
or their three-month diabetes follow-up, right?
1210
00:44:42.000 --> 00:44:44.620
It's going to take a little more time if you do them right.
1211
00:44:45.040 --> 00:44:46.020
You know, if you don't cut too many corners,
1212
00:44:46.020 --> 00:44:47.240
they should take a little bit more time,
1213
00:44:47.240 --> 00:44:49.580
but you have to know how long that takes you
1214
00:44:49.580 --> 00:44:51.380
and what are your quick visits?
1215
00:44:51.460 --> 00:44:53.160
There are some that are kind of universally
1216
00:44:53.160 --> 00:44:56.700
a little quicker, a UTI visit versus a diabetes follow-up.
1217
00:44:56.940 --> 00:44:58.880
They might be both booked as a 15-minute visit,
1218
00:44:58.880 --> 00:45:00.820
but one is really going to be faster than the other.
1219
00:45:01.600 --> 00:45:03.900
And get a sense of what that means for you.
1220
00:45:04.060 --> 00:45:07.160
Then you need to watch your schedule like a hawk, right?
1221
00:45:07.160 --> 00:45:09.640
If you have add-ons put on,
1222
00:45:09.660 --> 00:45:11.140
if add-ons are put on your schedule
1223
00:45:11.140 --> 00:45:12.500
and people don't ask you first,
1224
00:45:12.580 --> 00:45:14.520
they just put them on or they double-book.
1225
00:45:14.840 --> 00:45:16.800
Again, that depends on the culture of the practice.
1226
00:45:17.200 --> 00:45:19.320
You need to be keeping an eye on that
1227
00:45:20.040 --> 00:45:22.160
and raising your hand and saying,
1228
00:45:23.020 --> 00:45:24.580
you know, can somebody else take this?
1229
00:45:24.680 --> 00:45:26.360
In the case of the person who wrote in
1230
00:45:26.360 --> 00:45:27.980
and said like, I keep getting these things.
1231
00:45:28.280 --> 00:45:30.100
Yeah, is that true, right?
1232
00:45:30.240 --> 00:45:32.060
You know, or does it feel like you are?
1233
00:45:32.140 --> 00:45:33.900
Because sometimes it really can feel like it's always you,
1234
00:45:33.940 --> 00:45:35.300
but if you look at other people's schedules,
1235
00:45:35.420 --> 00:45:36.500
like it's happening to everybody.
1236
00:45:36.500 --> 00:45:39.000
That's a bigger problem that we need to look at.
1237
00:45:39.420 --> 00:45:41.540
Or, yeah, no, these are all falling on me
1238
00:45:41.540 --> 00:45:42.500
in the last like three weeks.
1239
00:45:42.600 --> 00:45:43.360
It's always been me.
1240
00:45:43.740 --> 00:45:45.100
Can we talk about this, right?
1241
00:45:45.120 --> 00:45:47.320
So that's an offline conversation.
1242
00:45:48.540 --> 00:45:50.500
But then also certain the way,
1243
00:45:50.580 --> 00:45:51.960
like the rhythm of the schedule,
1244
00:45:52.320 --> 00:45:53.660
the pace of your schedule.
1245
00:45:54.040 --> 00:45:56.020
A lot of places will have like their first visit
1246
00:45:56.020 --> 00:45:56.860
of the morning session
1247
00:45:56.860 --> 00:45:58.560
and the afternoon session will be for acute.
1248
00:45:59.400 --> 00:46:02.280
And those can be booked until maybe 24 hours before
1249
00:46:02.280 --> 00:46:03.860
or even the day of, right?
1250
00:46:04.240 --> 00:46:05.780
And then if it doesn't get booked,
1251
00:46:05.780 --> 00:46:07.860
then you get a little bonus amount of time.
1252
00:46:08.620 --> 00:46:10.180
But, you know, that's that.
1253
00:46:10.520 --> 00:46:12.320
You shouldn't have two physicals back to back.
1254
00:46:12.440 --> 00:46:14.860
You shouldn't have two new patient visits back to back.
1255
00:46:15.140 --> 00:46:17.040
Some visits you should have a little bit more time.
1256
00:46:17.120 --> 00:46:18.780
If it's going to be a new patient visit,
1257
00:46:19.180 --> 00:46:20.500
unless it's somebody who's like 21
1258
00:46:20.500 --> 00:46:22.080
and they just, you know, have nothing going on.
1259
00:46:22.140 --> 00:46:23.700
They just need to be, you know,
1260
00:46:23.800 --> 00:46:25.120
they actually need to be there.
1261
00:46:25.440 --> 00:46:27.100
Versus somebody who's gotten like a history
1262
00:46:27.100 --> 00:46:30.840
or a post-hospital discharge follow-up visit.
1263
00:46:31.080 --> 00:46:32.880
You know, you wanna be able to have more time.
1264
00:46:32.960 --> 00:46:34.220
If there are things that you know
1265
00:46:34.220 --> 00:46:36.340
about certain patients that they,
1266
00:46:36.340 --> 00:46:38.540
you need to use interpreter services, right?
1267
00:46:38.540 --> 00:46:40.600
Those visits, because you're kind of saying
1268
00:46:40.600 --> 00:46:41.740
everything twice.
1269
00:46:42.040 --> 00:46:43.020
So can those visits,
1270
00:46:43.020 --> 00:46:44.460
you don't want two of those back to back
1271
00:46:44.460 --> 00:46:48.000
or you don't wanna have like some crazy trifecta
1272
00:46:48.000 --> 00:46:49.780
of stress where you would have like
1273
00:46:49.780 --> 00:46:51.540
an interpreter services visit
1274
00:46:51.540 --> 00:46:53.120
followed by a new patient visit
1275
00:46:53.120 --> 00:46:54.720
followed by like a hospital discharge
1276
00:46:54.720 --> 00:46:55.800
for somebody who had like,
1277
00:46:55.860 --> 00:46:56.860
who was in the hospital for a month
1278
00:46:56.860 --> 00:46:58.640
with like COVID and an MI, you know,
1279
00:46:58.640 --> 00:46:59.960
like that is a nightmare.
1280
00:47:00.000 --> 00:47:01.640
I'm gonna have bad dreams tonight, right?
1281
00:47:02.740 --> 00:47:03.760
But like, you know,
1282
00:47:03.800 --> 00:47:05.300
so if you saw that on your schedule,
1283
00:47:05.900 --> 00:47:07.500
raise your hand, right?
1284
00:47:08.080 --> 00:47:09.780
I can't, this isn't gonna work.
1285
00:47:09.820 --> 00:47:11.360
And they might not be able to really change,
1286
00:47:11.440 --> 00:47:12.800
it might be too late, you know?
1287
00:47:13.200 --> 00:47:14.980
So what can we do about this?
1288
00:47:15.140 --> 00:47:16.020
Can somebody take them this,
1289
00:47:16.160 --> 00:47:17.620
like these patients can't be rescheduled,
1290
00:47:17.620 --> 00:47:19.800
but can we move somebody over to somebody else?
1291
00:47:20.260 --> 00:47:21.400
How can we go about this?
1292
00:47:21.480 --> 00:47:22.560
What can we do strategically?
1293
00:47:24.300 --> 00:47:26.220
So just like so many other things
1294
00:47:26.640 --> 00:47:28.540
with the healthcare and being a provider,
1295
00:47:28.680 --> 00:47:30.020
they don't tell you this in school.
1296
00:47:30.020 --> 00:47:33.480
You find this out when you are like boots on the ground
1297
00:47:33.480 --> 00:47:35.500
and stuff like that go wrong
1298
00:47:35.500 --> 00:47:37.560
and you say, okay, what can I do?
1299
00:47:37.580 --> 00:47:38.940
I don't ever wanna feel that way again.
1300
00:47:39.300 --> 00:47:41.180
How can we make it so that, you know,
1301
00:47:41.180 --> 00:47:44.320
and so having those agreed upon like booking algorithms,
1302
00:47:46.020 --> 00:47:48.820
being really like on good terms if you can
1303
00:47:48.820 --> 00:47:50.240
with the people who make your schedule.
1304
00:47:50.460 --> 00:47:53.840
So whether that's secretaries or like a phone nurse
1305
00:47:53.840 --> 00:47:55.660
so that they'll come to you itself,
1306
00:47:55.880 --> 00:47:59.200
letting them know what is maybe not working
1307
00:47:59.680 --> 00:48:02.100
and involving them maybe in a solution
1308
00:48:02.100 --> 00:48:05.160
because they see it too, you know, from their perspective.
1309
00:48:05.640 --> 00:48:08.400
So I feel like a rise in tide lifts all boats
1310
00:48:08.400 --> 00:48:10.980
and if we can make this kind of better for everybody,
1311
00:48:11.180 --> 00:48:13.520
then we all benefit or many of us benefit,
1312
00:48:14.220 --> 00:48:16.300
but that's a big, big, big piece.
1313
00:48:16.640 --> 00:48:19.560
There's also safety things that I saw a lot of
1314
00:48:19.560 --> 00:48:21.680
when I worked for a larger health system.
1315
00:48:21.860 --> 00:48:23.880
It would be 10 in the morning,
1316
00:48:23.880 --> 00:48:24.940
I would look at my schedule
1317
00:48:24.940 --> 00:48:27.020
and I have somebody booked for like 3 p.m.
1318
00:48:27.100 --> 00:48:28.160
that afternoon with chest pain.
1319
00:48:28.160 --> 00:48:30.720
Yeah, I was just going to say it must have been chest pain.
1320
00:48:31.580 --> 00:48:33.240
Chest pain or unilateral leg swelling.
1321
00:48:33.420 --> 00:48:34.080
Like, are you kidding me?
1322
00:48:34.420 --> 00:48:34.960
Like, okay.
1323
00:48:37.300 --> 00:48:38.820
So that would be bad.
1324
00:48:39.020 --> 00:48:40.020
I would say, are you kidding me?
1325
00:48:40.040 --> 00:48:41.200
And then, okay, who booked this?
1326
00:48:41.280 --> 00:48:42.000
Let me talk to them.
1327
00:48:42.160 --> 00:48:43.140
We're like, what's going on?
1328
00:48:43.820 --> 00:48:46.560
And you know, yeah, sometimes unilateral leg swelling
1329
00:48:46.560 --> 00:48:50.280
is cellulitis, you know, but sometimes it's a DVT
1330
00:48:50.280 --> 00:48:52.100
and sometimes chest pain is chest wall pain
1331
00:48:52.100 --> 00:48:53.340
and sometimes it's a heart attack.
1332
00:48:53.760 --> 00:48:54.720
Is this appropriate?
1333
00:48:55.340 --> 00:48:58.780
Also, is this appropriate to be handled in a setting?
1334
00:48:58.860 --> 00:49:00.460
Should this be in an emergent setting
1335
00:49:00.460 --> 00:49:02.480
or at least even urgent, right?
1336
00:49:03.100 --> 00:49:05.940
So things like that are also because, you know,
1337
00:49:06.060 --> 00:49:09.200
a DVT visit, I think of a DVT visit
1338
00:49:09.200 --> 00:49:10.740
as fairly black and white, right?
1339
00:49:10.860 --> 00:49:12.520
You know, okay, well, I got to get some imaging
1340
00:49:12.520 --> 00:49:13.920
and probably grab some labs.
1341
00:49:14.020 --> 00:49:15.960
You'll come back, we'll talk, we'll come up with a plan.
1342
00:49:16.480 --> 00:49:18.360
But it's two visits, right,
1343
00:49:18.360 --> 00:49:19.360
because you're going to see them.
1344
00:49:19.560 --> 00:49:20.720
Then you're going to send them out
1345
00:49:20.720 --> 00:49:22.960
for their stat imaging, their stat labs,
1346
00:49:22.980 --> 00:49:23.720
and they're going to come back.
1347
00:49:23.720 --> 00:49:25.500
You're going to wait for those results to come back.
1348
00:49:25.900 --> 00:49:28.220
They're going to beat it, like they're hanging out
1349
00:49:28.220 --> 00:49:30.380
for the afternoon or the morning, you know?
1350
00:49:30.380 --> 00:49:33.640
So there's that piece too, and that can be stressful,
1351
00:49:33.680 --> 00:49:36.020
even though the issue is black and white.
1352
00:49:36.180 --> 00:49:38.400
It can be really stressful, especially as a new grad
1353
00:49:38.400 --> 00:49:41.640
and like the other things you have going on in your day.
1354
00:49:41.700 --> 00:49:42.140
Yeah.
1355
00:49:42.900 --> 00:49:44.600
So that's a lot, that's a lot of answer.
1356
00:49:45.080 --> 00:49:46.640
No, that's good, no, that's good.
1357
00:49:46.680 --> 00:49:48.660
And I think one thing I realized
1358
00:49:48.660 --> 00:49:50.300
is that I think I took for granted
1359
00:49:50.300 --> 00:49:56.940
that I had a template that had the same types of visits,
1360
00:49:57.320 --> 00:49:59.420
like they had rules about booking,
1361
00:50:00.140 --> 00:50:02.240
where physicals were a pink color
1362
00:50:02.240 --> 00:50:04.260
and then sick visits were like yellow
1363
00:50:04.260 --> 00:50:05.280
and blah, blah, blah, blah, blah.
1364
00:50:05.340 --> 00:50:07.360
And like your template is done out for like a month
1365
00:50:07.360 --> 00:50:09.440
or three months or however long your template goes.
1366
00:50:09.720 --> 00:50:11.020
So not everybody has that.
1367
00:50:11.060 --> 00:50:12.880
And so if someone's listening and is like,
1368
00:50:13.260 --> 00:50:14.400
oh, you get that?
1369
00:50:14.460 --> 00:50:16.160
Like you get to ask for stuff like that
1370
00:50:16.160 --> 00:50:18.000
and you get to have an opinion about yours.
1371
00:50:18.000 --> 00:50:21.280
Because for me, like I would have procedures
1372
00:50:21.280 --> 00:50:23.800
on Thursday afternoons and it was so delightful
1373
00:50:23.800 --> 00:50:25.700
cause it's like, I love procedures,
1374
00:50:25.700 --> 00:50:26.720
but then it was just this nice,
1375
00:50:26.720 --> 00:50:30.200
like mental, physical, energetic break in between.
1376
00:50:30.540 --> 00:50:31.700
Like it was just so nice.
1377
00:50:31.700 --> 00:50:33.020
And so that's what my request was
1378
00:50:33.020 --> 00:50:34.720
and that's what the demand of the clinic was.
1379
00:50:35.120 --> 00:50:36.660
And I think the other thing I wanted to highlight
1380
00:50:36.660 --> 00:50:37.860
about what you said is like,
1381
00:50:38.020 --> 00:50:40.540
I think that there's a component of individual
1382
00:50:40.540 --> 00:50:43.060
and a component of systems
1383
00:50:43.060 --> 00:50:45.360
and the whole ecosystem of a clinic.
1384
00:50:45.780 --> 00:50:47.820
Because I think that the common thing
1385
00:50:47.820 --> 00:50:49.020
that I hear from new grads,
1386
00:50:49.040 --> 00:50:51.160
especially if they're coming from a nursing background
1387
00:50:51.160 --> 00:50:53.580
and they're thrown into this, not thrown into,
1388
00:50:53.760 --> 00:50:56.240
we walk ourselves into these roles,
1389
00:50:56.740 --> 00:51:01.340
but like we are asked to step into a leadership position
1390
00:51:02.120 --> 00:51:04.500
without really a ton of training for it.
1391
00:51:04.580 --> 00:51:05.680
And then we're just, like you were saying,
1392
00:51:05.820 --> 00:51:06.880
it's just like boots on the ground
1393
00:51:06.880 --> 00:51:08.540
and now you have to be the end of the line
1394
00:51:08.540 --> 00:51:10.860
and you're a leader who sort of formally
1395
00:51:10.860 --> 00:51:13.840
slash informally supervises people, right?
1396
00:51:13.960 --> 00:51:16.480
And I think that, I think a lot of people
1397
00:51:16.480 --> 00:51:17.700
are intimidated by that
1398
00:51:17.700 --> 00:51:19.700
and then they also don't wanna make waves
1399
00:51:19.700 --> 00:51:22.700
is what people say a lot in terms of like,
1400
00:51:22.740 --> 00:51:24.300
oh, I don't wanna cause trouble,
1401
00:51:24.500 --> 00:51:26.080
like I'm so lucky to have this job.
1402
00:51:26.300 --> 00:51:27.640
Even if they don't say that out loud,
1403
00:51:27.660 --> 00:51:28.840
like I know that I had that,
1404
00:51:28.860 --> 00:51:29.900
that's why I'm saying that,
1405
00:51:29.900 --> 00:51:30.940
because it was in my head
1406
00:51:30.940 --> 00:51:32.380
and I've heard it from some people.
1407
00:51:32.780 --> 00:51:35.820
But when we speak up about things
1408
00:51:35.820 --> 00:51:38.420
in a healthy environment of your workplace,
1409
00:51:38.960 --> 00:51:41.320
you speak up, people listen.
1410
00:51:41.560 --> 00:51:42.580
If they don't listen,
1411
00:51:42.640 --> 00:51:43.660
and I talked about this a little bit
1412
00:51:43.660 --> 00:51:45.260
in another time management video I talked about,
1413
00:51:45.260 --> 00:51:47.360
but like if they're not responding,
1414
00:51:47.920 --> 00:51:49.600
then it's not escalated,
1415
00:51:49.740 --> 00:51:52.220
escalated sounds like a confrontational word,
1416
00:51:52.220 --> 00:51:53.540
but it's really like, okay,
1417
00:51:53.760 --> 00:51:55.560
well now we need a couple more voices
1418
00:51:55.560 --> 00:51:57.140
and then we need to all get on the same page
1419
00:51:57.140 --> 00:51:59.520
and what are our policies too, right?
1420
00:51:59.520 --> 00:52:02.960
So like we had a policy about the nurses only
1421
00:52:02.960 --> 00:52:05.780
got to approve those double book visits
1422
00:52:06.300 --> 00:52:07.880
because they would clinically assess a person
1423
00:52:07.880 --> 00:52:09.060
and see if they actually needed
1424
00:52:09.060 --> 00:52:10.360
that urgent visit that day,
1425
00:52:10.500 --> 00:52:11.900
kid with a sore throat for example,
1426
00:52:12.180 --> 00:52:14.640
at 4.30 p.m. on a Friday, right?
1427
00:52:14.640 --> 00:52:16.140
Or any day really,
1428
00:52:16.560 --> 00:52:18.820
but yeah, we have rules in place
1429
00:52:18.820 --> 00:52:20.480
and so I just wanna offer that too
1430
00:52:20.480 --> 00:52:22.480
of like that's how that works
1431
00:52:22.480 --> 00:52:24.260
and definitely go back and watch
1432
00:52:24.260 --> 00:52:26.460
the how primary care offices work episode
1433
00:52:26.460 --> 00:52:28.040
to like learn a little bit more
1434
00:52:28.040 --> 00:52:29.880
about the kind of chains of command parts,
1435
00:52:29.880 --> 00:52:33.360
but yeah, it's really tricky
1436
00:52:35.500 --> 00:52:38.060
and it's heartbreaking to hear about
1437
00:52:38.060 --> 00:52:40.080
how dysfunctional a lot of primary care offices are
1438
00:52:40.080 --> 00:52:41.020
and that's like the norm,
1439
00:52:41.400 --> 00:52:43.580
but do you have any other thoughts about that,
1440
00:52:43.580 --> 00:52:45.620
about like leadership or I actually,
1441
00:52:45.940 --> 00:52:47.180
this conversation is reminding me
1442
00:52:47.180 --> 00:52:50.660
I have two good friends who are now medical directors
1443
00:52:50.660 --> 00:52:52.960
and so I'm thinking about asking them
1444
00:52:52.960 --> 00:52:56.540
if they wanna come on and share from their side
1445
00:52:56.540 --> 00:52:57.900
what it's like, right?
1446
00:52:57.900 --> 00:52:59.120
I think that that would be really helpful,
1447
00:52:59.640 --> 00:53:01.940
but yeah, any other thoughts to share about that?
1448
00:53:02.360 --> 00:53:04.300
Yeah, I mean, I definitely,
1449
00:53:05.100 --> 00:53:06.520
when you were saying the whole like,
1450
00:53:06.640 --> 00:53:07.720
I don't wanna make waves thing,
1451
00:53:07.920 --> 00:53:10.140
I think that's very understandable and relatable
1452
00:53:10.860 --> 00:53:12.660
and I kind of like wagged my finger
1453
00:53:12.660 --> 00:53:14.340
like metaphorically at the person who says that,
1454
00:53:14.460 --> 00:53:16.480
like don't think that, I get it, right?
1455
00:53:16.480 --> 00:53:17.320
Like I can definitely,
1456
00:53:18.100 --> 00:53:21.920
but, and I am in general an optimist,
1457
00:53:22.020 --> 00:53:23.640
even though what I am about to say
1458
00:53:23.640 --> 00:53:25.180
might not sound very optimistic,
1459
00:53:25.680 --> 00:53:27.860
nobody's gonna look that out for you but you,
1460
00:53:27.860 --> 00:53:31.200
you busted your ass to get where you are,
1461
00:53:31.580 --> 00:53:33.920
you spent time, you spent money,
1462
00:53:34.220 --> 00:53:36.640
you spent just years of your life,
1463
00:53:37.000 --> 00:53:39.400
the opportunity cost of becoming a nurse practitioner,
1464
00:53:39.600 --> 00:53:41.600
you're invested, you're in this, right?
1465
00:53:41.600 --> 00:53:44.160
You now have to protect you
1466
00:53:44.160 --> 00:53:46.620
and the secretary isn't gonna do it,
1467
00:53:46.620 --> 00:53:47.960
the nurse is not gonna do it,
1468
00:53:48.080 --> 00:53:50.520
the medical director isn't gonna do it, it's you, right?
1469
00:53:50.620 --> 00:53:54.340
And so you have to assert yourself, right?
1470
00:53:54.340 --> 00:53:57.100
And that is, that's harder than being an MP, right?
1471
00:53:57.160 --> 00:53:59.940
And also because they teach you how to be an MP, right?
1472
00:54:00.100 --> 00:54:01.960
And then you can speak words and you're assessed,
1473
00:54:02.100 --> 00:54:03.620
okay, yes, you are fit to practice,
1474
00:54:03.900 --> 00:54:05.040
but nobody is like, okay,
1475
00:54:05.080 --> 00:54:06.580
so are you good at speaking up for yourself?
1476
00:54:06.920 --> 00:54:08.120
Do you know when you need to?
1477
00:54:08.320 --> 00:54:09.780
Like nobody cares, right?
1478
00:54:09.780 --> 00:54:12.980
It's actually kind of better for them if you don't.
1479
00:54:13.100 --> 00:54:14.380
So now I'm gonna get on my like,
1480
00:54:15.100 --> 00:54:16.640
I'll get on a big, too big of a soapbox.
1481
00:54:16.860 --> 00:54:20.640
But the reality is you have to recognize the need
1482
00:54:20.640 --> 00:54:23.860
for that and backfill coming to real world MP
1483
00:54:23.860 --> 00:54:25.000
is a great way to do it,
1484
00:54:25.060 --> 00:54:27.020
to backfill those skills so that you can get
1485
00:54:27.020 --> 00:54:28.600
to that point so that you're comfortable
1486
00:54:28.600 --> 00:54:31.500
speaking for yourself or working with others
1487
00:54:31.500 --> 00:54:33.000
so that as a group you can say,
1488
00:54:33.200 --> 00:54:34.840
hey, this is something that I think we need to look at
1489
00:54:34.840 --> 00:54:36.720
as a practice, as a group, as a blah, blah, blah
1490
00:54:36.720 --> 00:54:38.820
and get that kind of consensus.
1491
00:54:39.900 --> 00:54:41.800
Because nobody's going to do it for you.
1492
00:54:42.140 --> 00:54:45.900
And when I've been in supervisory positions in the past,
1493
00:54:46.600 --> 00:54:48.480
it's a lot easier to make a decision,
1494
00:54:48.760 --> 00:54:50.680
especially a decision that potentially
1495
00:54:50.680 --> 00:54:52.060
could impact the bottom line
1496
00:54:52.060 --> 00:54:54.280
or that could impact a lot of folks, right?
1497
00:54:54.280 --> 00:54:55.200
It's not just about like,
1498
00:54:55.260 --> 00:54:56.320
oh yeah, you can have next week off.
1499
00:54:56.440 --> 00:54:57.780
Like no, like a bigger picture decision.
1500
00:54:58.700 --> 00:55:00.680
Easier to make those decisions if you have data.
1501
00:55:01.800 --> 00:55:03.680
And otherwise you're always like,
1502
00:55:03.960 --> 00:55:05.580
even leaders are human too.
1503
00:55:05.640 --> 00:55:06.940
And so they may be like,
1504
00:55:07.100 --> 00:55:08.540
hey, did I do the right thing?
1505
00:55:08.540 --> 00:55:10.420
But if you've got some kind of data
1506
00:55:10.420 --> 00:55:11.340
that you can match with,
1507
00:55:11.680 --> 00:55:13.280
you could get a little bit better about that.
1508
00:55:13.280 --> 00:55:14.600
You still might not get it right,
1509
00:55:14.780 --> 00:55:16.000
but you feel better about it.
1510
00:55:16.440 --> 00:55:18.700
So that's where like tracking your time,
1511
00:55:18.720 --> 00:55:20.240
seeing how you're doing,
1512
00:55:20.480 --> 00:55:21.480
what's not going well,
1513
00:55:21.580 --> 00:55:22.620
why isn't it going well?
1514
00:55:22.640 --> 00:55:24.640
And then having that to bring with you
1515
00:55:24.640 --> 00:55:26.320
when you do need to speak up for yourself,
1516
00:55:26.320 --> 00:55:28.180
I think can go a long way.
1517
00:55:28.660 --> 00:55:30.540
It doesn't always guarantee it, unfortunately,
1518
00:55:30.540 --> 00:55:32.260
but it can go a long way.
1519
00:55:32.380 --> 00:55:34.080
And if nothing else,
1520
00:55:34.380 --> 00:55:36.960
it can help you to understand what you need
1521
00:55:36.960 --> 00:55:39.460
and what you need in a certain work environment.
1522
00:55:39.800 --> 00:55:41.460
So that if it is time for you
1523
00:55:41.460 --> 00:55:43.020
to switch to another work environment,
1524
00:55:43.020 --> 00:55:44.800
you can have those questions
1525
00:55:44.800 --> 00:55:45.940
that you know you need to ask.
1526
00:55:46.060 --> 00:55:47.980
Like, how do you guys handle X, Y, Z?
1527
00:55:48.520 --> 00:55:49.840
Because I know I haven't liked
1528
00:55:49.840 --> 00:55:50.940
the way it's been in the past.
1529
00:55:51.960 --> 00:55:53.800
But you have to look out for yourself
1530
00:55:53.800 --> 00:55:56.540
and treat yourself,
1531
00:55:57.440 --> 00:55:58.360
advocate for yourself
1532
00:55:58.360 --> 00:55:59.800
as much as you would advocate for your patients,
1533
00:55:59.840 --> 00:56:00.820
if not more so.
1534
00:56:01.100 --> 00:56:04.120
Because if you don't and you end up burnt out,
1535
00:56:04.460 --> 00:56:06.340
what's going to become of your patients then?
1536
00:56:06.340 --> 00:56:09.300
You have to put your options down first.
1537
00:56:10.040 --> 00:56:10.920
Totally, totally.
1538
00:56:11.040 --> 00:56:12.280
And I always say that too,
1539
00:56:12.280 --> 00:56:14.280
because I think that was a transition for me
1540
00:56:14.280 --> 00:56:16.720
of like, if it's not for me,
1541
00:56:16.740 --> 00:56:18.640
it's for my longevity in this career
1542
00:56:18.640 --> 00:56:19.600
and for my patients.
1543
00:56:19.720 --> 00:56:21.100
And now I'm at the point of like,
1544
00:56:21.100 --> 00:56:22.220
no, it's for me too.
1545
00:56:23.220 --> 00:56:25.480
But that was a nice bridge for me
1546
00:56:25.480 --> 00:56:27.660
because I was so in that place.
1547
00:56:28.040 --> 00:56:30.080
But thank you so much for being here.
1548
00:56:30.140 --> 00:56:31.360
I'm going to leave a link to your book
1549
00:56:31.360 --> 00:56:32.560
in the description.
1550
00:56:32.880 --> 00:56:34.960
Any parting words you'd like to share?
1551
00:56:36.340 --> 00:56:37.260
You know,
1552
00:56:38.680 --> 00:56:41.420
don't be afraid to ask for what you need.
1553
00:56:43.060 --> 00:56:44.920
If you need more time,
1554
00:56:45.040 --> 00:56:45.920
if you need more support,
1555
00:56:46.120 --> 00:56:48.020
if you need more blah, blah, blah,
1556
00:56:48.140 --> 00:56:48.920
think about it.
1557
00:56:48.980 --> 00:56:50.240
Think about what works for you.
1558
00:56:50.320 --> 00:56:53.040
Reflect on it and find the way,
1559
00:56:53.040 --> 00:56:55.100
whether it's through colleagues,
1560
00:56:55.220 --> 00:56:56.380
through friends, through family,
1561
00:56:57.700 --> 00:56:59.880
through working with Real World MP,
1562
00:57:00.820 --> 00:57:03.160
get those skills, backfill those skills
1563
00:57:03.160 --> 00:57:05.660
so that you can ask for what you need.
1564
00:57:06.300 --> 00:57:08.660
And time management is a huge piece of it.
1565
00:57:08.660 --> 00:57:09.720
You can work on your skills,
1566
00:57:09.720 --> 00:57:11.740
but if you're in the wrong setting,
1567
00:57:12.020 --> 00:57:14.260
great time management skills aren't going to save you
1568
00:57:14.260 --> 00:57:16.300
because I have them and I was in the wrong setting
1569
00:57:16.300 --> 00:57:17.080
and so I had to leave.
1570
00:57:18.240 --> 00:57:19.520
So I'm setting it with a better fit.
1571
00:57:20.380 --> 00:57:21.740
So, you know, time has really gone a long way,
1572
00:57:21.800 --> 00:57:24.020
but really my bigger takeaway is that
1573
00:57:24.020 --> 00:57:26.480
you need to not be afraid to ask for what you need.
1574
00:57:26.500 --> 00:57:28.140
Know what it is, ask for it.
1575
00:57:28.640 --> 00:57:29.260
Love that.
1576
00:57:29.340 --> 00:57:30.440
Thank you.
1577
00:57:30.980 --> 00:57:31.320
That's awesome.
1578
00:57:31.340 --> 00:57:32.280
Thank you for having me.
1579
00:57:32.620 --> 00:57:32.980
Totally.
1580
00:57:39.020 --> 00:57:41.000
That's our episode for today.
1581
00:57:41.140 --> 00:57:42.900
Thank you so much for listening.
1582
00:57:43.240 --> 00:57:44.660
Make sure you subscribe,
1583
00:57:44.880 --> 00:57:47.520
leave a review and tell all your NP friends
1584
00:57:47.520 --> 00:57:50.480
so together we can help as many nurse practitioners
1585
00:57:50.480 --> 00:57:53.260
as possible give the best care to their patients.
1586
00:57:53.680 --> 00:57:55.140
If you haven't gotten your copy
1587
00:57:55.140 --> 00:57:57.800
of the ultimate resource guide for the new NP,
1588
00:57:58.080 --> 00:58:01.280
head over to realworldnp.com slash guide.
1589
00:58:01.560 --> 00:58:03.520
You'll get these episodes sent straight
1590
00:58:03.520 --> 00:58:06.340
to your inbox every week with notes from me,
1591
00:58:06.640 --> 00:58:08.420
patient stories and extra bonuses
1592
00:58:08.420 --> 00:58:10.540
because I really just don't share anywhere else.
1593
00:58:10.980 --> 00:58:12.460
Thank you so much again for listening.
1594
00:58:12.620 --> 00:58:13.860
Take care and talk soon.
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