As a surgeon, running an outpatient clinic effectively is critical to patient flow, patient safety, and patient satisfaction. In the United States, typically 15 to 20 minutes are allocated for an outpatient visit. Patients are often double booked. Recognize that in some Asian countries, outpatient clinic visits are only 3 minutes long. Clearly, much of the key work in clinic visits can be completed in a very short amount of time, but it requires a very focused discussion.
Recognize the possible destinations for patients after being seen by you in clinic. The majority will return home. Some will need urgent admission, possibly through the emergency room, or as direct admissions. A few will require urgent surgery. Others will be sent to a different specialty or primary care clinic as a result of your evaluation, to have an elusive diagnosis made by being seen in a different specialty clinic. For these patients, what you can do to be most helpful is to expedite that evaluation by a different consultant, perhaps by calling him or her directly. You will realize that a few patients have been sent to the wrong clinic; they may be quite frustrated and refunding their insurance copayments for the visit might be indicated. Some patients will have traveled long distances to be seen, and may be tired or anxious. Some patients are most appropriately seen by the chief resident because of the complexity of their chief complaints, whereas others are suitable for junior residents or interns. In some clinics, interns are assigned primarily to perform history and physical examinations within 30 days of surgery for patients who have already received a diagnosis and treatment plan. Performing examinations and reviewing final lab and x-rays are critical roles you can play. You can demonstrate your value if you identify key elements that may have been overlooked by the attending in the preoperative assessment (carotid bruit, abnormal EKG, incomplete preoperative consults).
Preoperative and Postoperative Clinic Visits
Clinic patients will fall into 1 of the following 2 phases: (1) preoperative and (2) postoperative.
Postoperative visits are relatively straightforward. A clinic schedule should be configured to allow a mix of preoperative and postoperative patients, with the easier postoperative visits an opportunity for the clinician to catch up on the schedule.
The key things to do in a postoperative visit are:
To review the surgical incisions for possible infections, hematomas, seromas, lymphoceles, or incisional hernias.
To check the pathology report and ensure that further treatment plans (particularly for cancer diagnoses) and referrals (ie, oncology) are in place.
To ensure adequate pain medication refills, work notes, and disability paperwork are complete.
To answer the final questions from the patient, with further instructions about activity level (no heavy lifting after hernia repair, bathing and the care of steri-strips, symptoms about which to be vigilant).
To transfer the patient back to the care of ...
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