The trick is to be pretty much "Open Access" with modestly equal visit lengths. Some will be shorter and some will be longer and hopefully they sort of even themselves out. Also you are alway welcome and the patients need to know this, that YOU are the doctor and the doctor's office and if you feel it needs more or less, then that's Your Call.
Also, Nancy took to doing something unique with our two Biggest PIA's, super frequent fliers to make life around here for HER a good deal easier. Both get a small amount of controlled meds too, so regular appointments on a specific data is great. Also we have a 28 day supply policy around here, with almost everybody getting filled on Tuesdays. Even Thanksgiving doesn't have a Tuesday in it, right? So now we have almost NO over the weekend "I've run out of this or that", need to call in the Emergency Supply, have a follow up visit post the weekend and writing to Rx's...
So she has both of these ladies show up one before lunch and then the other after lunch... So if the major borderline one runs over as she almost always does... so we have a bit of room for that and she can sit by herself in her wheelchair comfortably and not making too much of a scene with the other patients because usually nobody's here exect walk in refills and the like. Then she takes care of the younger one who sadly is pretty messed up too and delussional in terms of common sense day to day take care of herself, no less her kids... And now the week can almost never get worse from there.... And we always know where they are, repeating visits always blocked for the two of them, one once a month or so and the other every week lately that is how much hand holding she needs...
Anyway, you can always con and nudge your difficult patients different ways and done properly like the lady who is so flippin' borderline it is mind blowing.... she is being given this "Special" above and beyond everyone else slot as far as she is concerned... And yet really for us it allows her to completely ruin the flow of the day, even the week sometimes.
But we are a low voluum low patient panel place and offer half hour slots and then we know where we can fudge them in for last minutes sick kids and other pop ups... Or with some of our walk-ins (yeah we're doing that too the last year or so... BUT only for established patients, NO NEWBIES get walk in status no matter what) I can look at them and tell them where things look empty and I'll pop them in the a slot an hour or two later and say you're welcome to hang-out if you have no place to go or do, but let me lock this in for you now and then you can go get a bite or get a few things done and come back a little later... usually they're glad to know that I've locked it up for them...
Or I'll ask them what's up and they'll say they are not feeling well and they wanted half a list of stuff too and I'll tell them well, I can squeeze you in for the sore throat and stuffed up ears and face, a Quick Sick visit for right now and how about coming back in a few days when you feel better to deal with your BP or med adjustment which might go better anyway when you're not snorting decongestants anyway??? And again, its all in the presentation and if our tiny waiting room is full (all four chairs worth) or getting there as they all know it's just basically her in the room and me up front around here.... So they get it. They're all so glad to have a doc they can get in with, who actually listens and talks to them without his or her hand on the door knob, its rarely a problem...
It basically all about nudging, schmoozing and playing a little bit of checkers with the folks... Night.
Paul
