Archives > October 2018

You’ve been invited to join a scientific planning committee: Now what?

Your role in certified program development
With the recent changes CFPC has made in establishing firm quality criteria for programs seeking Mainpro+ certification, the need for planning committees with superb skill and knowledge capacities is essential to a highly functional CPD system.

If you’ve been invited to join a committee to plan a certified CPD program, and will be attending FMF 2018, this workshop presented by Drs. Jamie Meuser, Christie Newton and Rick Ward is for you – W160 You’ve been invited to join a scientific planning committee: Now what?
FMF 2018 – Toronto, November 14-17

From Resident to Family Doctor: Time Management Tips to Help Keep You Sane

Are you a new family physician who struggles to stay on time in clinic? Are you a resident who worries about managing a full patient panel alone? Do you ever ask yourself: “How will I possibly pay off my student debt if I am limited to only seeing 10 patients a day!?”

It can be incredibly daunting to go from splitting a full patient list with your preceptor to your first day as a locum or new staff in a clinic with a full list of 20-30 patients whom you may know nothing about… This blog post is aimed at providing a quick (but by no means exhaustive) list of tips, tricks, and pearls to foster time management and efficiency in clinic! These pearls have been collected from multiple docs in their first five years of practice as well from some seasoned past preceptors – let’s learn from their experience of trial and error.

  • Pre-planning: A little planning goes a long way
    • On or prior to your first day speak with the front desk staff about expectations:
      • If a patient is late and you are already back-logged be firm about having them re-book or that you will see them at the end of the day. (understanding life happens and you will sometimes make exceptions, just don’t make it a habit and patients will respect your time)
      • Set boundaries early regarding double booking and walk-ins/add-ins
      • Be clear about how much time you would like patients to be booked for. Consider less time for prescription refills (5-10 mins) and more time (30 mins) for complete physicals, patient with long insurance forms, AISH forms, etc.
    • Early on find out how many patients you can comfortably manage in a day/per hour. This may increase as you get more comfortable or as you get to know your patient panel and you can change your appointment slots accordingly.
    • Plan breaks into your clinic day. Every 2-5 patients block off an appointment slot to catch up or act as a buffer for appointments that go over time.
    • Purposefully leave day-of appointment slots free if you’d like your patients to be able to see you on short notice or for small emergencies (and avoid being put behind schedule by “squeezing little Timmy in to look at his sprained ankle”)
    • Educate your patients at your first meeting – tell them to show up 10 minutes before their appointment in order to get vitals etc. so you can see them at their given appointment time. Train your staff to facilitate this process.
    • Identify the complex patients that might require more time and ask staff to book two time slots for them.
  • Delegate, delegate, delegate: get comfortable asking for help or asking others to do tasks that don’t need to be completed by you.
    • Have your MOA or nursing staff proofread and format your referral letters prior to sending them. Also have them collect information such as lists of medication or long past medical histories to attach to letters rather than you having to type it out.
    • Have your nurse or MOA collect information and start the paperwork for first prenatal appointments, or complex care plans prior to you seeing the patient.
    • Train your staff to get patients and equipment ready for you. E.g. if it’s a complete physical for a female who is due for a pap, make sure they are already undressed with a drape before you get into the room. If you’re doing a procedure, have the staff have all your equipment and gloves out and ready to go.
    • Have staff communicate lab/test/imaging results to patients if a phone call needs to be made
  • Paperwork/Charting
    • Build time into your schedule to do paperwork, review labwork and answer faxes (eg. A half day once per week or 30-60 mins every morning before clinic). If you don’t it quickly becomes overwhelming and WILL interrupt your work day.
    • Don’t reinvent the wheel – using a template, stamp, or quick text (based on your EMR functionality or ones you have personally created/saved) for encounters you see often (eg. Complete physicals, URTI, biopsies, sutures, IUDs…) saves you time not having to re-type everything by just having to modify it slightly per patient
    • Try to type while you are speaking with the patient;
      • Ergonomics of the room may not be ideal for this and certain clinical scenarios may require more of your full attention but typing as you are collecting information from the patient will cut down on time spent charting after the patient leaves.
    • Try to finish charting a patient encounter before moving onto the next patient (much more efficient to do it while your memory is fresh) rather than at the end of the day.
    • Hate typing or slow at it? Consider investing in software that allows you to dictate all patient encounters.
  • Billing
    • As a new grad billing is a steep learning curve – try to complete it on a daily basis while everything is fresh in your mind. Not only will you learn quicker but you will also be more efficient.
    • Once you know your billing codes a bit better do your billing as soon as you finish the patient encounter so none of the work is left for the end of the day.
    • Know which services are uninsured services and have a guide visible for patients and staff that lists the costs you/your office will charge for these services.
  • Getting the chatty or long-winded patients out of the room
    • When patients say they have a “list of things” hear them out but then ask them to identify which ones they want to focus on today as you want to ensure to give due attention to their most pressing concerns and book follow-up for others if you have to
    • Senior patients – ask them “what has changed since the last time I saw you” and you’ll often be able to avoid rehashing their chronic, unchanging hip pain or the lump they’ve had on their wrist since they were 4 years old.
    • Have the printer(s) located outside the visit rooms this allows for a very natural “come with me to get your prescription/x-ray req/lab req on your way out the door!”
  • Remember to be polite and courteous
    • Have front desk staff warn patients of time delays Eg. “Dr. X is 45 minutes behind schedule but you are next in line” – this will manage patient expectations as well as prevent a frustrated patient stewing in your waiting room for 45 minutes while waiting to be seen.
    • When you are behind schedule acknowledge your patients who have waited and apologize or thank them for their understanding.
    • Patient’s time is valuable too and simple acknowledgement goes a long way in securing a strong doctor/patient relationship.

And finally BE HONEST with yourself if you are feeling overwhelmed in clinic and/or constantly running behind schedule and modify accordingly. Be supportive and appreciative of your staff while being clear about expectations; they are there to help. The smoother your clinic days run the happier you, your staff and your patients will be.

If you are interested in reading more on the topic the PDF below entitled “Doctor on Time” by J.W. Crosby has come to me highly recommended as a must read for new in practice family doctors!

Author: Jennifer Ortynski Bsc, MD, CCFP

Message from the President

Read Full eNews

This month, as we honor our award winners, I am reminded of the hard work and dedication of so many around the province in delivering care to our patients every day. Our awards recognize that family physicians, both experienced and newer in practice, have so much to contribute to enhancing primary care delivery in our province.

The ACFP’s Outstanding Family Practice award winners remind us that it takes a team to practice medicine and exemplify how working as a team with a common goal of improving the care our patients receive make a difference in our communities. We also acknowledge those who have committed time to helping the ACFP further our role of influencing and improving the delivery of primary care throughout Alberta. It is important to recognize that improving the well-being of Albertans takes the efforts of not just our past and present honorees but every one of us putting forth our expertise and compassion to ensure Albertans get the care they need.

Earlier this month, we hosted another successful PEIP conference. Over 600 attendees, who took part in person and remotely by Webcast, experienced two days of stimulating learning that they can carry forward to their colleagues and practices throughout the province, and the country. Congratulations to the Planning Committee and Staff.

I would like to remind you to save the date for the ACFP’s Family Medicine Summit (formerly known as Annual Scientific Assembly) being held in Banff on March 1-3, 2019. This popular conference is a wonderful opportunity to reconnect with colleagues, representatives from the College. Join us and experience three days of excellent learning opportunities and to celebrate excellence in family practice. The planning committee is working hard finalizing a program that will be relevant to your practice and provide an opportunity to ‘connect, learn and celebrate’. Registration for the Summit opens in mid-November!

Please contact me any time at acfppres@old.acfp.ca.

Vishal Bhella, MD, CCFP
President
Alberta College of Family Physicians

Treating Chronic Pain…Who you gonna call?

As family physicians we really do see everything when it comes to our patients.  From prenatal to palliative care, our patients trust that we will help them through all their medical complexities.  In turn, we put pressure on ourselves and our teams to meet their expectations.

A couple of months ago my colleague, the shared care psychiatrist who travels to Pincher Creek to see patients with us, told me that the hardest thing he sees family doctors deal with is chronic pain.  Initially this comment surprised me, but on further reflection, and a review of my next day’s patient list I realized he was absolutely correct.

The increase of opioid use disorder in my practice, the lack of supports for alternatives to medication for pain relief in my area and the new guidelines for pain management and opioid use have led to increased stress and frustration for patients, families, and health care providers.

Like most family doctors, I have relied on my “go to” people to consult with when my patients and I are struggling to manage chronic pain or addiction, including opioid use disorder.  These relationships have helped me to build my capacity to manage increasingly complex issues.

I’m pleased to be the Medical Director for the ACFP’s new Collaborative Mentorship Network for Chronic Pain and Addiction which aims to provide the infrastructure for a more formal mentorship relationship so that all family physicians can feel confident in treating their patients with pain and addiction.

About the Author

Cathy Scrimshaw, BSc (Hons), MD, CCFP, FCFP

Cathy is a fulltime family doctor in Pincher Creek, where she has been doing comprehensive care for over 25 years.  She works with members of the Piikani First Nation and the residents of Pincher Creek.  Last year Cathy was recognized for her continued active involvement in the work of the ACFP by receiving the ACFP Long -term Service Award.  Currently, Cathy is the Medical Director for the Collaborative Mentorship Networks for Chronic Pain and Addiction initiated by Primary Health Care Opioid Response Initiative.

The Highs and Lows of Medical Cannabis

Tools and Supports for Primary Care

In 2017, the ACFP with their collaboration with the PEER group, published three Tools for Practice articles.


Simplified guideline for prescribing medical cannabinoids in primary care

Abstract
Objective To develop a clinical practice guideline for a simplified approach to medical cannabinoid use in primary care; the focus was on primary care application, with a strong emphasis on best available evidence and a promotion of shared, informed decision making.

Methods
The Evidence Review Group performed a detailed systematic review of 4 clinical areas with the best evidence around cannabinoids: pain, nausea and vomiting, spasticity, and adverse events. Nine health professionals (2 generalist family physicians, 2 pain management–focused family physicians, 1 inner-city family physician, 1 neurologist, 1 oncologist, 1 nurse practitioner, and 1 pharmacist) and a patient representative comprised the Prescribing Guideline Committee (PGC), along with 2 nonvoting members (pharmacist project managers). Member selection was based on profession, practice setting, location, and lack of financial conflicts of interest.

The guideline process was iterative through content distribution, evidence review, and telephone and online meetings. The PGC directed the Evidence Review Group to address and provide evidence for additional questions as needed. The key recommendations were derived through consensus of the PGC. The guideline was drafted, refined, and distributed to a group of clinicians and patients for feedback, then refined again and finalized by the PGC.