FOCUS | PROFESSIONAL Ten tips for becoming a Time Lord Andrew W Knight, Tony Lembke TEN YEARS AGO we published a blog that and so are better able to concentrate on summarised our tips for becoming a the person in front of them. Their reception ‘Time Lord’ (Box 1).1 Most of us can recall staff are less frazzled. Their waiting rooms Background colleagues who rarely run late and yet can have fewer chairs. And they eat lunch. There is evidence that extended seem to meet all their patients’ needs. Here we have reconsidered our tips waiting is the most important cause These doctors are Time Lords. In this after another decade of thinking and of patient dissatisfaction with a visit to their general practice. While waiting is article we update our tips to help you to experience. We have re-ordered them sometimes unavoidable in primary care, become a Time Lord. The tips outlined chronologically, considering some as sometimes its causes are systemic and in this article are our opinions for you to preparation for a session of consulting and modifiable. Our experience is that some consider and we would love to hear if you others as relevant to the consultation itself. doctors rarely run late and yet seem have others. It is clear that some changes to achieve to meet their patients’ needs. We call Extended time in the waiting room running on time require more fundamental these colleagues ‘Time Lords’. recurs as the most important cause of changes to practice systems and so are less Objectives dissatisfaction for patients with a visit to in the control of individual practitioners. The aim of this article is to revise their general practice.2–5 In a European Some of these organisational aspects we and share tips to help others become study of 10 countries,4 time in the waiting have dealt with in detail in subsequent Time Lords. room was rated with the least satisfaction. articles, which are referenced.6–8 Tips 3 Discussion A US study found that time in the waiting relating to those organisational aspects We describe four tips that depend on room was inversely associated with we have de-emphasised or removed. good preparation. A further six involve satisfaction with the GP. On the other We have taken the original 12 tips and, maximising the value of consulting hand, time with the doctor had a major from our experience, added, subtracted time. Waiting is sometimes unavoidable corrective influence on satisfaction. Long and compressed them into the 10 in general practice. Our patients accept waits and short consultations resulted described below. this and so must we. However, we in most dissatisfaction, while long waits can do much to improve our patients’ satisfaction by taking waiting as for a longer consultation were associated Preparing seriously as they do and minimising it. with improved satisfaction. The highest satisfaction was associated with short waits 1. Fifteen minutes late is not early (<15 mins) and reasonable consultation Running on time starts with an attitude. length (>10 mins). Will you commit to being on time? This Running late from time to time means getting to work before the first is inevitable. General practice is appointment. Years of running late can unpredictable, which is part of its desensitise us to the issue. We can feel like fascination. However, some of us always being only 15 minutes late is doing pretty seem to run late, which suggests a system well. Time for a coffee and a rest! Will problem. Time Lords, on the other hand, we place as high a priority on calling the seem to inhabit a different space–time patient in on time as they do? plane. While dealing with patients’ priorities, they avoid appearing rushed. 2. Do the warm-up Time Lords seem to have more satisfied Prepare for the day so you can hit the patients. They seem more relaxed at work ground running. Desk tidy? Computer on? 188 | REPRINTED FROM AJGP VOL. 47, NO. 4, APRIL 2018 © The Royal Australian College of General Practitioners 2018 TEN TIPS FOR BECOMING A TIME LORD FOCUS | PROFESSIONAL It may increase efficiency and efficiency of our interactions. A Time Lord Box 1. Becoming a Time Lord (2008) timeliness if you consider your patient appears focused, not rushed! presentations in two broad families: acute 1. Fifteen minutes late does not mean you and non-acute. Patients requiring acute 6. Get the agenda are early care are less concerned about seeing a How many times have you dealt with the 2. Work your appointment book 3. MaxPack particular doctor and are more tolerant first issue thoroughly only to find that 4. Control the patient’s list of some waiting. Non-acute patients are there was another and another even more 5. Use the annual check often dealing with follow-up of issues, important? And then, with the hand on the 6. Get in the red zone – use your practice and chronic and complex conditions. door handle yet another! teams Continuity is more important to them and There is some evidence that if you 7. Engage the patients in the process while they are quite content to wait weeks keep silent initially, the patient will keep 8. Breaking up is hard to do for a scheduled appointment, they may talking until they have told you most of 10,11 9. Make waiting time productive be more frustrated by long waits in the what they have come for. Don’t panic, 10. Group your ‘care-families’ reception area. most will stop talking within 60 seconds, 11. You gotta dance with them what brung ya Many practices run a ‘jeopardy doctor’ and probably all by 150 seconds. Try then 12. Pain is inevitable. Suffering is optional system in which one doctor each session to extract anything not yet mentioned. is ‘on call’ to take all acute presentations. A colleague teaches his registrars to ask This allows the other doctors to focus on ‘Is there anything else? Is there anything non-acute patients without interruptions. else? Is there anything else?’ until there isn’t Logged in? Appointment diary scanned? Continuity with an individual clinician can anything else. If the patient comes with a Every second lost in each consultation be maximised as well as booked team care written list, it is even better! You have the adds up. Thirty seconds wasted looking with nurses, diabetes education and others. opportunity to ‘control the list’, get hold of it for pathology request paper or refilling the There is a lot you can do as a practice to and record the agenda in the clinical record. script print bin per consultation adds up to improve capability to meet patient demand A few years ago a colleague added a key 15 minutes at the end of a full day. Spend on time. We have gone into some detail on strategy for us, which revolutionised our time at the beginning of the day checking this topic in our other articles.6–8 approach to managing the consultation you have everything you need. Are there agenda. He advised we ask the patient to plenty of otoscope tips, a jug of water, and 4. Weight the wait prioritise the list. Which issues are most enough alcohol swabs? Put as much as you Can you add value to the wait time? Can important to them? Which issues must can within reach so that every possible the practice nurse take a blood pressure, be dealt with before the consultation is second is valued. Where can you save collect and test urine or prepare request over today? Once we know the patient’s time? Can you use window envelopes so forms? Can any preventive issues, such priorities, we can become more patient- that you don’t need to write the specialist as diabetes tests or screening tests, be centred in our responses, meeting the address on the envelope? Is the antenatal discussed or ordered while the patient pressing need and confidently postponing share care protocol filed just to hand when waits? Is there information your patient less urgent issues. you need it? can read or provide while they wait? All of these can save time when the patient is 7. MaxPack 3. Work the diary with the doctor and can be used either for ‘Do today’s work today’.12 Wherever The need to see patients urgently when other activities or to catch up. possible, do as much as you can in this you are fully booked will throw your visit. This will provide value to the schedule, and is completely predictable. Consulting patient as well as reducing the need for There actually is no such thing as a a repeat visit. By doing this you preserve ‘squeeze in’ or a double booking. Only 5. The golden minute future capacity, which helps you to run a real Time Lord can bend time or be in Baker, Cordaro and Platt9 tell us that on time tomorrow. If we ask people to two places at once. By thinking about the first seconds of an interaction with come back unnecessarily, we waste their your diary in advance and working with a patient are golden for creating (or time as well as blowing out the queue for your nursing and reception team, you can harming) trust. They describe nonverbal an appointment. Some have advocated prepare for the demand that is coming. cues that can increase oxytocin release and an approach of confining the agenda to Obvious tips include making sure you trust in patients: eye contact, warm vocal only one problem per consultation.