Surviving Appointment Pile-Ups
It was 11:15 am and my waiting room contained my 10:20 appointment (who had just shown up), my 11:20 wellness examination, an emergency “squinting dog,” and a woman desperate to talk with me about whether I thought her sister’s dog might have Cushing’s disease.
If you’ve ever worked a Saturday in veterinary medicine, you know the feeling—almost as if all the local pets and owners have secretly staged a flash mob performance for that very moment. The slammed schedule is an unavoidable reality in every clinic.
Prolonged client wait time is one of the top reasons clients change veterinarians, and it inversely correlates with veterinarian income.1 This means that the longer clients wait, the less likely they are to return—and the lower their veterinarian’s personal income tends to be. Obviously, the ability to juggle patients (and their owners) is vital to success.
Fortunately, there are steps that lead to better performance when working-up multiple cases simultaneously. Here are 5 tips for more effective movement between exam rooms and decreased wait time without sacrificing quality.
1. Abandon Multitasking
Often, it feels like the quickest way to get things done is to work on two things at once. For example, it is tempting to have a technician review the signalment for the next case while writing in the preceding patient’s chart. However, science tells us that if you need to accomplish multiple things within a short span of time, it’s better to focus on the component tasks sequentially than to do so simultaneously.
When it comes to paying attention, the brain simply doesn’t multitask. Attempting to take in two sources of information at once means that pieces of both are ignored.2 In addition, studies have shown that people who are interrupted take about 50% longer to finish a task and make up to 50% more errors.3,4
True, some of us are more adept at toggling between tasks than others, and moving between familiar tasks is certainly easier.2 Ultimately, however, multitasking is not a shortcut. Discard it and embrace the “one at a time” approach to catch up faster.
2. Structure Your Appointments
Keeping the intricacies of multiple cases and conversations straight in your mind is tricky. Apparently, so is remembering complex food and drink orders for a dozen restaurant patrons. In a 2008 Behavioural Neurology article, Buenos Aires traditional waiters who had memorized all orders shared an interesting technique for keeping information from multiple sources straight. They thought of patrons’ orders in terms of courses, with each meal having a defined and well-known structure (ie, drinks, then appetizers, then salads, etc). Once the meal pattern was defined and memorized, the waiters could organize information quickly and easily by using the courses as an informational scaffold.5
In the same way, you can structure appointments into segments by mentally compartmentalizing case information (see Creating a Mental “Menu” below). This allows you to move between examination rooms and address segments of different cases sequentially—and more effectively.
3. Fill in the Gaps
Good veterinarians are also good technicians. This doesn’t mean veterinarians should take on technician tasks all the time, but doctors should not be shy about jumping in to help when technical work is required to move backed-up appointments forward. At the same time, don’t micromanage your staff and let them utilize all of their skills to assist you.
4. Don’t Forget the Drop-off Option
As the saying goes, “When you’re up to your neck in alligators, it’s hard to remember you came to drain the swamp.” Look for opportunities to suggest that a client could leave a pet for a few hours. The owner may prefer to relax at home or get a bite to eat instead of waiting. By offering to turn a scheduled appointment into a drop-off, it is possible to turn a complex appointment into a flexible one—while also preventing client irritation.
5. Exercise Regularly
Exercise is highly beneficial to your ability to successfully juggle cases, and not just because it gives you the stamina to dash between exam rooms all day. People who exercise regularly can expect to have greater long-term memory, problem-solving abilities, and attention spans, as well as decreased anxiety. They also show greater capacities for improvising based on previously learned information, thinking abstractly, and reasoning quickly.3,6 All these skills increase effectiveness when faced with different problems (and pet owners) in rapid succession. Even a small amount of exercise will help reap mental rewards: 30 minutes of aerobic exercise 2 to 3 times per week has worked in laboratory studies. Mental benefits appear in as little as 4 months.3,7
Creating a Mental “Menu”
A typical appointment can be organized into 4 menu “courses”:
Interview. Patient history, signalment, body weight, and temperature are recorded. This section can be carried out by trained technicians using a standardized hospital protocol. Veterinarians do not need to be present.
Physical examination. The veterinarian reviews the history and continues the interview while conducting (and explaining) the physical examination.
Diagnostics and treatment. Once the physical examination is concluded, treatments (eg, ear cleanings, bandaging, medication, etc) and/or diagnostics are performed. While the veterinarian may be needed for diagnostic interpretation, many diagnostic and treatment procedures can be carried out by technicians. Doctors are thus able to move to another case during this phase.
Results, summary, and discharge instructions. Following diagnostic and treatment steps, the owner must be updated and given clear instructions. Be sure to summarize all diagnostics, findings, and treatments performed to ensure client understanding and compliance going forward. This is an excellent way to emphasize the value of the services you performed. At this time, your portion of the appointment is concluded or further diagnostics or treatments are undertaken (return to Diagnostics and treatment).
You could simply let long waits become a habit at your practice. You could also keep staff members late to handle backed-up appointments. However, since labor costs are the greatest expense most clinics incur and clients exhibit a clear trend for switching veterinarians when waits become too long, it seems unwise to ignore the costs of that pattern. Practicing ways to work up multiple cases more efficiently saves not only your sanity but also your business. And a healthy business means more healthy patients. | EVT