Patients with many needs taking up too much time

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I had a patient in the other day for a visit that was needed for DM. Now, this was a generous 30 minute appointment time with the case manager to begin with. But all she wanted to talk about was paperwork for 45 minutes and demanded it be done that day because she needs it for work. It took me over an hour to deal with her and get the basic needs met after she went on and on with the paperwork. I tried to explain to her that the doctor has other patients at this time and our office policy states that you need to give us 7-10 business days to complete paperwork (as some of it may require us to have you do an ROI and get information from specialists, etc., etc) and that I would try to work on it in the afternoon and call her on Tuesday (we're closed monday for labor day) but she wasn't having it. She said she was told she had to have this paper done by today and so she knew she had an appointment that day so she figured she'd bring it in. Now I've got 3 other patients waiting to see me at this point, and I'm 45 minutes behind basically, and need to hunt down the doctor to see if she is even willing to sign this paperwork and we have to of course do chart research and look up dates, dx codes, etc. for the form which will take more time.

Does anyone have a way to explain to patients that we don't have time to do things that we didn't schedule to do? Like obscene amounts of paperwork AT the appointment where they need their actual health problems addressed? I do hours of paperwork every week and this is just rude and selfish to me.

I guess I need to explain to patients when they schedule the appointment with me that we will only be discussing such and such problem at the appointment (which is why they were sent to me in the first place) and not paperwork or the wart you have found on your toe or your pain (seems all the patients they book with me come in with requests for pain meds/refills, etc and they can't get through on the phone, doctor says no at the appointment, so they figure they'll get in to see the nurse and beg for it there too.) If I don't address the problem at their appointment they are scheduled for (coumadin, med compliance, diabetes, birth control, etc) and just focus on what they come in asking for I have no time to do my job and will get in trouble.

Anyone have any advice or similar experiences?

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Specializes in NICU, ICU, PICU, Academia.

I am reminded of the sign that should be on every office door "Failure to plan ahead on YOUR part does not constitute an emergency on MY part!"

Does your office have a policy on this type of matter? If not, seems like you need one. Then, everyone is on the same page.

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I would LOVE that sign lol

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The patients get referred to me because they're not handling their problems well on their own to begin with though so these aren't the most responsible proactive patients already... haha.

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Specializes in NICU, ICU, PICU, Academia.

It seems like the wrong behavior is rewarded then. "You're slacking, so we're giving you a special 'slacker-enabling' nurse who will bail you out of all the messes your slacking creates!" That fails to address the problem, only compounds it IMHO.

IDK- but when my kids do this, I let the chips fall where they may and let them live with the consequences of their actions.

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I kind of feel this way too. I get referrals for diabetes case management and other chronic problems that the patients need help handling. But most of the time these patients don't care about handling their actual problems and have a million other problems that they bring to me. Paperwork for medical supplies, home health, disability, work excuses, rois, begging for pain meds, here to see the nurse but try to get me to force them in with the doctor (to beg for pain meds usually) and they don't want to talk about their carb control diet or medications or their blood pressure or their need to see nephro or anything. It's always I can't afford this cialis and my insurance won't cover it so I figured I'd come in to see if you'd do something about it. Well actually I brought you in to discuss your a1c of 14 and your problems with your insulin.....

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" I tried to explain to her that the doctor has other patients at this time and our office policy states that you need to give us 7-10 business days to complete paperwork" -------- That's all you need to say after the first explanation of why you can't do it. After that I'd repeat its policy, its policy, its policy until she gets the point. The other patients made appointments too and she doesn't deserve your time more than them. Especially in this non urgent case. Sorry mam that's policy *opens office door*. Shes not havin' it? Youre not having it either lol.

I hate it when the whiners/loud complainers get all the rewards!! It should not be that way...

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Specializes in Rehab/Brain/Stroke/Spine.

I tell pt's and family members that are difficult, "explain to me your reasoning on why I should put my license and job on the line d/t your demand that I (fill in blank) ...."

-call every cousin and up date them

-call the Dr. right now, b/c you missed speaking to him/her at the appt. time

-fill out 20 pgs. of non-urgent paperwork b/c you failed to plan ahead according to office P/P

-take double time with your less urgent need, than the 4 patients that are waiting with more urgent needs

honestly, it does work about 90% of time, unless they have are borderline personality d/o.

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I'm in allergy/asthma and with school starting back, we're getting bombarded with school forms. We tell every pt that our policy is 24-48 hours and we will call when they're ready to be picked up. If anybody questions it, we explain that it's our policy because we and the doc need time to properly fill them out specific to each pt's needs (allergy action plan, asthma management forms). If they ask very nicely and have a legitimate reason why they can't wait then we may try to get them done at that time, but after their appt and they wait in the waiting room.

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Its not fair to make other scheduled patients wait while you fill out non-urgent paperwork. I'd tell the patient that I have other patients that are waiting for me, and, at best, I'd see if I can get the paperwork done by the end of the day (only if its truly an urgent request), and would call them with an update at the end of the day. Don't feel you have to drop everything for a patient's request, especially if its at the expense of other patients. Its ok to say no.

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We get that a lot with FMLA paperwork. Patients come in to their chronic conditions follow up and say "You remember when I came in 2 weeks ago for back pain? Well I have paperwork to be off work that they told me had to be turned in today or else I have to return to work". When I ask when they got it they reply "The day after my appointment when I told them I had to be off work for a while". So I just say that I will fill it out when I have time that obviously it's not too important or they would have brought it in sooner. Same thing happened when school started. Parents would call school starts tomorrow so I need my kid seen today cause the paper they sent home at the end of last year says they need shots! Seriously!? Plan ahead. My favorite response was "well I didn't wanna ruin his summer by making him get shots"

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