3 Time Management Plans for the Challenging Patient

Sometimes working with a patient is like herding chickens! They run all over the place, and it’s hard to get to the heart of the matter. Or the patient may be so focused on the appointment, you have a difficult time ending the visit. We talked to other NPs and found these tips and tricks that work for them and might work for you too!

Scripts to Focus the Challenging Patient’s Attention
Redirect patients to the subject at hand. “I love catching up with you, but I really want to be able to address your medical needs. How are you tolerating the X that we started you on last time?” At the end of the visit, “I don’t mean to cut you off, but we only have 5 minutes left, and I’d like to discuss X with you. Can we focus on that now?” Then change directions with direct questions, if possible.  
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When patients come in with a laundry list of complaints (isn’t this all the time?!), say something along the lines of, “Wow, you have a lot of concerns. Since we only have X minutes, what do you feel is most important to focus on today?”

Tactics for Ending the Appointment
Practice scripts to end your patient visit politely and kindly. “I’m so sorry, but I really need to get to my next patient,” or “I’m so sorry, but we really need to end the visit for today.” You might feel you need to add, “Do you want to schedule a follow-up to address this more?” “Why don’t we follow-up in X days/weeks/months to see how things are going.” “You know, I really want to be able to fully understand and address this issue. Can we schedule a follow-up appointment to discuss it?”

If you’re still having trouble, assign office staff to knock and say, “Excuse me, but Dr. Black is on the phone for you,” or a similar code word when an allotted time is passed, especially if you are in a room with a known Chatty Cathy. Telehealth/telepsych providers also find this technique helpful. Alternatively, staff can announce on the overhead intercom that you are needed to help end the visit. 

Telehealth/telepsych providers can also try saying, “Oh, it looks like my next patient is online. I’d better wrap this up. Is there anything else we need to talk about, or should we get you scheduled for a follow-up?” 

Near the end of the appointment time, review the most pressing problem and possible treatment plans. As appropriate, suggest 2-3 options for plans: Do we change the dose or therapy? Do we start or change medication or treatment? Do we refer? Do we want to give it some more time? If appropriate, bring the patient into the decision-making. The answer can help guide the timeframe for the next step. Then, sum things up. Review any med changes or instructions and head towards the door. One hand on the doorknob helps give patients the hint.  

If that doesn’t work, walk the patient to the scheduler to make their follow-up when you need to get them out the door. Most patients appreciate this extra step. Yes, it takes a little more time, but it can help show the end of the visit. (Hopefully, your scheduler can manage him/her!) 

As you walk away, remind patients they can message or call you, as needed and can always move up a visit. I often end with a very warm, friendly comment. “It was so good to see you, and I’m glad you are well,” or “I’m so glad you came in to discuss this with me. We’ll work together to get to the bottom of this.”

In the end, you may need to just schedule a longer appointment for some patients that always need more time. 

Benefits of Digital Communication
Not every patient question or concern requires an office visit. Educate your staff on how to screen calls and messages before they come to you. Provide guidelines for when the patient needs an office visit or when it needs to be referred to you for a call-back or follow-up. (Err on the safe side though. Your MA may not understand what is important!) Along this line, one popular suggestion was that if a patient message requires more than a yes or no answer, an appointment should be scheduled.

Some clinicians find messaging back instead of calling back is a more effective way to respond to patients, however, if a patient is always calling in or messaging you, consider scheduling him/her for more frequent follow-up visits or a telehealth call where you can at least bill for your time.

I love working with my patients and helping them address their health concerns, but we all have patients who require more time than others. What tactics have you found to help you manage your time with these challenging patients?