Home Forums Discussions General Discussion Exam Room Design

So, I'm building a new clinic. I've made the exam rooms spacious at 12'x12'. I am trying to come up with the ideal exam room layout, and I'm wondering if you all could weigh in. What do you do now, and what would be your dream setup?

Currently the patient starts the visit sitting in an armchair by the wall, and I sit on the other side of the exam table, laptop on table, and chat face-to-face, which seems to improve communication. However, I'd like to get away from laptops. Every design I review online shows some funky setup with your back to the patient, laptop on a counter, a weird stand up rolling cart, or some other setup that looks like an add-on. There is no website I've found with a consensus opinion on the ideal furniture and positioning of patient and doctor.

Probably the best design I saw was in the UK, where the doctor sits at a regular office desk, patient across form him, and chatting. Then they both get up and go over to the exam table. It looks like a lawyers office with an exam table. But, this requires a large room. On the other hand, in this setup you can stay in the office and have patients come to you, rather than going room to room.

Wow. I don't like the idea of their coming to your office. I could probably think of 10 reasons, but one right off the bat, would be it would seem like Sick Man Walking. You on your throne, and they walk in and sit down. In two of these scenarios you have this desk between you and your patient.

I guess in order to give advice, one has to share what they do unless they like doing it in a way they don't like.

Personally, if the door opens against a wall, imagine the left wall, I would rather the computer stuff and chairs be on the right. Then you can get eye contact right away. On our Superbills the cheap complaint is already on the sheet at the bottom, so you have some idea why they are there. Although, I have been burned a few times on this. So, I tend to sit down and ask them what they are here for today without yet going into the computer. After I do, read the HPI from the nurse and add to it. I don't know...it seems to make the patient feel like the visit is more about him or her, then the computer.

The desk is just a table with the necessities, monitor on the left near the patient who is sitting in a chair just to the left of the table. Computer and all the other computer stuff under the table. I can then not only see the patient, but we are four to five feet away and, at any time, I can set down the pen and clipboard and look directly at the patient and listen.

The monitor is angled toward me so they can't read that I am looking up Type 2b heart block (I know nothing of this so please don't pick on me). But, many times I show the weight curve or a Google image, and it is easy, because I can just turn the monitor a little. There is another chair adjacent to that chair where another historian can sit. There are a couple of other chairs on the other wall facing the patient where the people that interrupt and know more than everyone sit and can talk and talk.

Then to the far left against the wall is the exam table. I suppose it could be out from the wall, so you can walk to the other side, but blood pressure cuffs, etc. can be there, and I am a pediatrician so you don't want two-year-olds falling or jumping off.

The wall on the other side of the patient can have a little 27 inch TV that shows information with a counter showing them how long they are waiting. When I hit the CPT code, it flashes the charge and tells them they owe a $400 balance. JUST KIDDING, but, hey not a bad idea; lol.

Just my way. I have used it for ten years and never changed it, partly because our rooms tend to fit this design.

You don't like the idea of coming to my office? That's not how they office is designed, but the advantage of that format is the patient is looking at your face to face. Do you have the exam table behind you when you are sitting at the desk? Is the TV also behind you? I wish we could post pictures/drawings on here.

It all depends on how big the patient is (ours go from about 5# to about 500#, in the same exam room), whether you can examine them in the same chair where you interview them, and of course, how many family members and other kibitzers they insist on bringing in. Also, whether they come on foot, with a walker; in a wheelchair or in a power chair or scooter -- we have to change the approach accordingly.

I just use a laptop (currently SurfacePro4, but I am partial to X200Tablet) which I can prop almost anywhere, including on my lap. Sometimes I sit next to the patient, sometimes across from them, sometimes I sit on the exam table with the family arrayed around the room in chairs, if it's that kind of problem.

Mainly, I can't see how a fixed desk and computer monitor could work very well -- not flexible enough. Bringing a parade of people into an "office" would surely slow things down -- I imagine Doc Martin when you say that.
I don't notice any speed problem with the wireless laptop -- you can speed the wireless connection up some by using Remote Desktop to a wired computer, though.

I guess this is all ideas. I think it makes a big difference whether you are FP, Peds, IM, specialist. I just couldn't see someone sitting across from me with an office desk in between. That just seems like the time when you are giving some type of news.

I actually cannot envision any other way but a desk, a desktop computer and sitting there while looking at the patient or parent. The exam table is to my left in one room and behind be in the other. But with the stool, I can turn and look at everyone.

So it sounds like Bert uses a desk, but Tom does not. It seems like the best setup is to have parent/patient facing away from the wall and doctor facing toward the wall/desk. Then they are almost lined up and facing each other with just a turn of the head.

Yes, exactly. Not necessarily the best setup. Just the way some do it. I took quite a few pictures of my office setup and other interesting things (I think -- well for those who are interested). I will post them this weekend.

So, I tried to upload them, but my phone takes such large pixel pictures. So, these just show a couple of office photos, my slides (I have about 30) and some pictures of our movies. These just run off a WD media drive. Just copy DVDs to them. Kids love them. There are about 30 movies. I do need to add some for sure. But, probably the best thing you can do for a pediatric office.

The slides came out of an idea at lunch. We would always come up with ideas, then type them on an 8 1/2 by 11 sheet of paper and tack them/tape them to the wall. No one reads them. The parents read the slides. They are generally informative but cynical and sarcastic. But, it is easy to add and remove slides.

https://app.box.com/s/qqjeqclyny87ztr4qx4pjqykt5tddp2c

FYI: The HDTV is straight, it is the ceiling which is crooked. I guess we should have gone by the ceiling.

As long as I'm logged on.....
In my former life each room had a small desk and an exam table. We would start with me and the laptop at the desk and the patient next to the desk facing me. I had an IM practice, so it was almost always just the patient and me. I considered workstations at each desk, but never got there. It felt right.
My new life is way weirder. The buildings are concrete (typhoon rated) with resultant horrible acoustics, my hearing is shot from too many years of noise exposure, and all patients have one of 6 or 7 heavy and unique accents. EVERYONE comes with at least one other family member, often several. (In the hospital several family members invariably share the patient's room, sleeping on the floor. It's like stories I read of caring for gypsies. But I digress..) so, my only hope is to use my relatively quiet office for the interview, go across the hall to the exam room, then back to the office for follow up. It is about as inefficient as possible, but I'm not in control.

We've setup a lot of exam rooms over the years. One of the best ones I have seen uses touch screens w/ monitor arms. You can bring the computer right next to you or keep it out of the way when it's not needed.

Something like this:
http://amzn.to/2ge3wVQ or http://amzn.to/2gD4n5K

The monitor and keyboard arms are articulating.

I would prefer something like this though where you have freedom of motion in all directions (Sitting/standing height)

http://amzn.to/2gf9nK5
http://amzn.to/2gvFGqT

Thanks for the input guys, and I'm curious if more people can chime in about how they do it. I've just never had a desk in the room before, as the previous offices just used laptops. So many designs you see out there really are not practical for keeping any kind of eye-to-eye contact with patients.
Here's a fancy new office the illustrates my point. http://www.msasf.com/healthcare/#sutter-east-bay-orinda-healthcare

In the sutter east bay orinda healthcare, it is impossible, because once again, you can see it was done by someone other than a physician. And, not so much that, but it was not designed by the one using it.

It appears the only thing they worried about was spending money. I don't want to offend anyone, but once you get into the furniture that is designed specifically for a computer, it makes it difficult.

For me, I like a desk. The monitor and printer and DYMO printer are all right there. Do you use a laptop that you put on your lap or the exam table. I like having the monitor on the desktop, because I research so many things all the time, and it is easy to have a cordless mouse and fly through websites.

I'm trying out a desk, and I agree. I've been putting the laptop on the exam table while chatting, but no laptop hinge can stand up to this use day in, day out, year after year.

Kevin: thanks for the photos. Do you like having carpet in the exam room? What size are those rooms. They look big.

They are big, 12 x 15. I have one smaller room, 8 x 10, but use the same sort of arrangement with desk and patient chairs with the screen in the middle. I hate having carpet but it was a deal, lasting 10 years now. Rent is cheap and my wife is a general contractor so I got a spousal discount on the build out.

I have laminate flooring, which looks nice, but the water from snow melt off people's boots is damaging. Also, some people with very pointed high heals, boot spikes, or sharp canes have left a few marks. I'm thinking about vinyl tiles in my new office, which will be over heated concrete. I do worry a little about someone falling on concrete - carpet would be a little better in that regard. However, I think carpet is unhygienic in a procedure room, but okay for a psychiatrist.

We used name brand self stick tiles from Home Depot years ago at Village Medical and for the most part they held up really well. Scuff resistant and made clean up pretty easy for the most part although greasy foot prints from Mechanics or stepping in crud in the parking lot from older cars leaking badly sometimes were difficult to get clean in their sculpted design, ala slate like. But that made them more slip resistant for those same wet snowy melt issues you discussed here. We kept a small mop near by in a non pt space to mop up really bad spots so LOL (Little Old Ladies) didn't take a header or face plant...

But it was cheap and easy and they were still in good shape 10 years later. We had landlord installed no nap commercial carpet in the hallways and waiting rooms which helped to capture a decent amount of wet stuff before it make it to the hard flooring. They even held up well to sliding the Ritter 104 tables back and forth once in awhile when it struck my Ex to try and new arraignment in her Exam, working space. And she wore heels sometimes and it held up pretty well to CHITT Kicker Boots and lady's heels and such too. Just the Paving Crew Guys with pretty nasty fresh tar on their boots made for some cleaning problems. But I'd bet that would happen with any floor regardless of type and such....

Lastly, I got us a capture like sculpted entrance rug for snow and small pebbles and the like that sat in our small vestibule where folks had no choice but to step on it to scrape off at least some of the worst of it and in the winter I added a second more absorbent one in the second doorway off that vestibule to capture more water and crude. In this way at least most of the worst of the crud was half gone before they walked down the hallway to the Exam Room... It was imperfect but there is No Perfect Solution to Lake Effect Snow, Cow Crud and Pavers' Tar boots

I practice in Paradise! Paradise Family Healthcare in Venice, Florida. Dealing with the seasons is just a matter of keeping the AC working, and a hurricane backup laptop.

But what do you have to say about exam room design Kevin?