1. Pre-visit plan to understand what YOUR agenda items are as the provider. (abnormal labs or DI?, referred to specialist last visit? Anything deferred today from last visit?)
2. When asking the patient what his/her concerns are, elicit all the issues up front! Avoid diving into detailed diagnostic questioning until you’ve identified the issues you will address that visit. This will decrease the chance for unmet needs to be brought up later in the visit. (Remember to use the language “Is there something else that concerns you?”- avoid “Anything else?”) Heritage, JGIM 2007
3. Once all agenda items are collected (both YOURS and the PATIENT), it is time to prioritize. This is the trickiest part and will improve with practice. As you progress through training, you will be able to address more per given visit. But for patients with multiple problems or comorbidities, it is often not possible to address everything.
a. In general, try to address the patient’s chief concern, even if relatively minor. This will help preserve the relationship.
b. If multiple issues are uncontrolled, try to identify and address if there is one underlying issue that might explain why (i.e. mental health issue? Able to afford medications? Poor health literacy?).
c. Are there any urgent issues that, if not addressed, will put the patient in danger by going home?
d. Remember that the beauty of primary care, is that the patient can follow up again shortly.
e. Set expectations about what you will address during the visit and that you’d like to see them again soon to address these other concerns, since they are important too.
4. Try to be realistic with the time constraints of a visit. Get in the habit of trying to stick to the designated time. (Of course some patients will take more time than others, but in general, it also helps patients understand what they can expect in a visit).
5. Know your clinic staff and utilize them to help too (CDE’s, BHI, SW)
6. Unless you need to refill medications for multiple conditions or discussed multiple issues in depth, avoid creating a lengthy assessment list. Most follow up visits should address about 1-3 issues.
7. If a patient is scheduled for a preventive “PHYSICAL” visit but has multiple acute complaints, an urgent potentially serious chief complaint, or many uncontrolled comorbidities, you may want to defer the preventive visit and focus on the more immediate concerns.