I'm just curious how others handle this. Twice last week I was seeing a er follow up for strep and Aom, I finished the follow up and asked before , during and after the exam was done if there were questions or concerns , no was the reply , as soon as I reach for the door they say oh little billy has been vomiting after dairy products what do you recommend and can you send him too a tummy specialist . A new concern so what do you do schedule a follow up appt to address it further or take care of it then and keep other patients waiting

That's the "hand-on-the-door" syndrome. Who's the patient...Little Billy or an adult patient talking about their kid?

I call it the "Oh, by the way..." syndrome.

That depends on how much time have I already spent. All my appointments are 15 minutes (except physicals, and I will not address "problems" during a well visit/preventive physical). This means the patient is paying for 15 minutes of my time, not unlimited time! If the AOM takes 5 minutes, they still have 10 left, right? I have a timer outside the door, I push it when I enter the room. When the timer goes off in 15 minutes, the visit is over. I just generally cover what I can, up to three issues, in 15 minutes. If it is going to take longer than that, it has to be another appointment.

I'm referring to routine matters only. Obvious exceptions apply, such as the patients who actually present to the clinic in chest pain, etc.

I have clinical right now at a pediatric site in which the patient population is under-insured to not insured and with poor follow up. From being at this site no well visit is just a well visit. There is usually some other issue the parents are having weather it be another sibling in the room being sick , social issues, etc. Since most of these families are bad at following up my preceptor tells me to address everything and giving them resources, referrals, patient education, scripts or whatever they need. Sometimes my well visits are over an hour if i'm seeing 2 siblings at once and of course the waiting rooms get all backed up.