These steps will thwart ‘clinic stoppers’ before they disrupt your flow.

Every optometrist has had patients whom we might call “clinic stoppers.” These patients can range from the elderly person with a three-page list of medications to a crying 3-year-old. These patients have the capacity to destroy both your schedule and your peace of mind, but with these four steps, well-trained technicians can stop these problems before they start.

Step 1: Decide the Technician’s Role
Some optometrists feel the best part of their day is interacting with patients. These doctors might want technicians to minimize small talk and gather and enter information more quickly, allowing the doctor more time for chatting with the patient. Other optometrists are more interested in determining refractive error and diagnosing cataracts than hearing about little Johnny’s soccer victory. These practitioners might want the technicians to play the role of a host, ensuring the patient feels comfortable before the doctor sees her. Either strategy can work if you are deliberate during hiring and training, ensuring that technicians start with a clear understanding of their role.

Step 2: Perform Strategic History and Pre-Testing
History taking can be one of the most time-consuming portions of the exam, and in most offices the technician at least initiates it. If it’s done well, you as the doctor will be able to enter the room with a good understanding of the chief complaint and gather any additional information needed with a few well-directed questions. If done poorly, you may have to spend significant time repeating questions your technician just asked. Prevent this by asking your technician to use the accepted history HPI elements (location, quality, severity, duration, timing, context, modifying factors, and associated signs and symptoms) when discussing the patient’s complaint. Having this information in the chart makes it easy for you to ask productive questions focused on the chief complaint.

Pre-testing is another portion of the exam in which your technician can lose valuable time. To streamline pre-testing, be sure that technicians understand how to vary standard pre-testing based on the patient’s chief complaint. For example, a patient presenting with red, itchy eyes probably doesn’t need to perform stereopsis or color vision testing. Consider developing pre-testing templates for the comprehensive exam, contact lens fitting, contact lens check, red eye, or binocular vision exam depending on the focus of your office. This will allow your technician to efficiently gather the information important to your examination.

Step 3: Streamline!   
Encourage your technician to multitask by cleaning the exam equipment while greeting the patient and beginning to discuss their chief complaint.

Focus on performing tests in a logical order to minimize transition time and encourage flow. During pre-testing, the technician spends significant time giving the patient directions or handing her equipment. Organizing testing well can minimize this transition time. For example, I see many pediatric patients who require sticky patches for occlusion. For this reason, I encourage my technicians to test visual fields and distance/near acuity sequentially with the right eye before switching to the left, minimizing patch application time.

For adults, consider doing all tests that require distance fixation sequentially, then switch to near fixation testing. Testing that requires less direct supervision (stereopsis/color vision) can be performed near the end of pre-testing. During this time, the technician can enter data gathered earlier in the exam.

Step 4: Return to the Big Picture
Once your technician has the skills to examine patients efficiently, be sure to re-emphasize the most important part of your technician’s job: providing quality patient care. Be sure the technician remains polite and does not make the patient feel rushed during the exam. Your technician needs to know that you understand about those “clinic stoppers,” some of whom are going to take extra time no matter how well-trained your technician!

Amanda Huston is an optometrist specializing in pediatric and family eye care and Children’s Eye Physicians/Stapleton Family Eye Center in Denver, CO.


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