CLINICAL REFLECTION PAPER #2: TIME MANAGEMENT1
Clinical Reflection Paper #2: Time Management Strategies
Diane Morris
WASHBURN UNIVERSITY
CLINICAL REFLECTION PAPER #2: TIME MANAGEMENT1
Clinical Reflection Paper #2: Time Management Strategies
Time management seems to be a particular challenge during this clinical rotation. In part, the preceptor I am shadowing struggles with managing time effectively in both the clinical setting and hospital rounds. I do not mean to say this in a derogatory way; however, each clinical day we are running behind by at least one to two hours. While occasionally my preceptor’s patients are discouraged by having to wait so long for their appointment, most often they state to me that the wait is well worth it, as they never feel their time with Dr.McGinnis is rushed or somehow compromised. Each patient states that he/she does not mind waiting a long time for every appointment because once Dr.McGinnis is in the room with him/her; he focuses entirely on their concerns and questions. I have not ever witnessed more thorough or genuinely compassionate care from a physician thus far in my career as a nurse or student nurse practitioner.
When addressing the applicable course outcome related to time management, I feel course outcome #1: “Integrate knowledge from previous courses to integrate for diverse adults in primary care settings” is a challenge. Since so much time is spent in the room with each patient, I find myself with very little time to research terms, diseases, medications, and lab values for which I have questions. I am certainly using my knowledge from previous courses and applying it during clinical, especially my courses in pathophysiology and pharmacology. It is not always possible to ask questions while in the room with patients and since my preceptor is running short on time between patients, this becomes a challenge for me; therefore, I find myself relying on this previous knowledge heavily until I can further “look things up” afterward. For example, while caring for a diabetic patient several days ago, I was reviewing the patient’s lab values in an effort to determine how effective her diabetic medications were controlling her blood sugars. I found myself challenged as one of her medications was unfamiliar to me in terms of the peak effect and duration. I was able to utilize my previous knowledge regarding the general disease process of diabetes and normal lab values (Hgb A1C), however, I felt pressed for time in being able to look up the medications that were in question. Fortunately, I have Epocrates and Medscape applications on my cellular phone and am able to utilize these quickly and effectively. Of course my preceptor is always right there to answer my questions but often those opportunities have to wait as we attempt to be aware of time constraints.
When addressing the program outcomes, I feel #4: “Demonstrate sound critical thinking and clinical decision-making” is certainly challenging while attempting to be effective in terms of time management. At this early stage in my clinical experience, I find myself needing to research so many medications, diagnoses, and laboratory tests that if I were working alone I would only be able to see three or four patients a day! Fortunately, my preceptor is a very experienced provider and is able to critically think and make quickly, yet sound clinical decisions. It is comforting for me to witness his desire to utilize evidenced based research in his practice, as he frequently use “Up-to-Date” as a resource for his own clinical inquiries. On several occasions, Dr. McGinnis has honestly mentioned to a patient that he needs to “do some reading” and get back to them via phone call about treatment options or the latest research regarding medications, etc. One particular patient we saw approximately two weeks ago had a newer diagnosis of amyotrophic lateral sclerosis (ALS). Over the course of the past few months, she had seen several specialists and had many lab tests done to arrive at the diagnosis of ALS. One test in particular was to rule out Lyme’s’ disease. Interestingly, she had a one lab test come back that was interpreted by an infectious disease physician as a “possible cause” for some of her symptoms of fatigue due to an inconclusive result for completely ruling out Lyme’s disease. She had previously been on a course of antibiotics for possible Lyme’s disease without benefit. She had done some of her own research regarding more long-term antibiotic therapy. She was hoping that Dr. McGinnis might be willing to try this approach or perhaps know of a physician specializing in Lyme’s disease who might be willing to prescribe longer therapy. Dr. McGinnis told her that he would be more than willing to further research this treatment approach but that he was unwilling at this time to prescribe that regimen, until he felt confident that the research supported this approach. I admire his resolve and willingness to explore this possible treatment. Further, he did explain that if he did not feel this treatment option to be in her best interest, he would still attempt to offer her suggestions on physicians that may be more familiar with Lyme’s disease drug therapies and potential trials for such management.
While time management is certainly a concern for all providers, it appears to be a chronic struggle for my preceptor, due to the amount of time and focus his devotes to each of his patients. Fortunately, Dr. McGinnis’s patients are very accustomed to long wait times to see him and seem to be view this as a minor inconvenience that is more than made up for by the quality of care they receive from him. I do find that this is a refreshing change from the hurried pace that I often witness having spent the past 11 years working in the emergency department, where care is often rushed and at times superficial due to the nature of that setting. It is nice to be able to really sit down and visit with the patients in the primary care setting. It does seem to allow for a more holistic approach to patient care, in that I feel I am getting to know them personally, as well as focusing on their needs medically. Being able to put the bigger picture together and account for the dynamic stressors that can affect their health including: family medical history, social history, economic concerns, occupational factors, etc. is certainly a new and rewarding experience.
While this holistic approach to patient care is somewhat new for me, I am finding enjoyment in it, while gaining an appreciation for the challenges that it presents when dealing with time management. I have also seen the ramifications that poor time management can place on the staff working with a provider who runs behind in terms of time schedules. For example, the nurses that I have been working with in the office setting are often frustrated because when patients are asking questions about the long wait times, the nurses seem to have to answer those questions and bear the burden of trying to keep Dr. McGinnis on time with his daily schedule. This has also been frustrating for the clinic nurses, as Dr. McGinnis will wait to address all the patient calls that have come in for the day until after he has finished seeing patients. This leaves the nurses working that day with a large stack of phone calls to return at the end of the day, when it is already well after the scheduled end of the “work day”. Perhaps answering two or three of these calls between each patient may be a better way for all to manage time more effectively, as well as keeping the staff working with the provider “happier”, as they are able to do their portion of the job with more efficacious time management.
All of these time management issues in this particular clinical experience are giving me a true appreciation for the challenges that time constraints have on not only my patient care but on those with whom I work.