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Outpatient Internal Medicine Advice/Guidance

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I just started an outpatient IM gig; have been there for a month; it’s part time.  All of my career had been inpatient, so transitioning to this has been a learning curve in regards to patient flow and timing; very different than inpatient.

i have been there a month and currently am seeing 14 patients, it’s been slowly moving up since 10 when I started. I am sure the increase will continue and this is where I need your help:

I get  a mix of everything, physicals, AWVs, follow ups, new patients, Acute visits.    My biggest issue is keeping the appointment focused to the CC/reason as patients like to wonder into other things or simply start taking about other things.  I feel bad cutting them off; not sure what approach to use in regards to this as I don’t want patients complaining because of this.  I feel that if I can keep them focused into their reason for the appointment this can make a huge difference with my documenting.   How do you guys approach this?

i have tried to do some charting in the room, but I feel uncomfortable as I feel the patient may feel ignored, how do you guys do this?

How long do your usual/average yearly physicals, AWVs and follow ups take?

What is an appropriate number of patients for me to see in an outpatient IM practice? I work 8 hr days twice a week; I am the only other provider apart from him.  

Thanks in advance!

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30-60 min for AWV, annual PE and Advanced care planning

hard to keep on track sometimes, yes you interrupt them and re-direct - it is not a social call or beers at the bar  it is a medical evaluation. Usually you can get a feel for rather the person is hard to direct, I allow the occasional wander off the topic, but not the person that just wants to hijack the visit to talk about everything

I used to worry more about this, but now I just try to direct towards the answers I need.  


Most times the people that are off track are likely the type of folks that go off track with their friends, family and everyone so the seem okay with the redirection

On the annuals pretty much anything goes, on routine follow up I keep it to <= 3 topics (get to the 99214 level) and then I politely remind them that we are looking at XYZ today.  I will address the new complaint if it is singular, if it is just a list of stuff I ask them to pick 1 thing to talk about - and insist on it.   Rarely has this not worked.

oh yeah and you MUST chart during the visit......  you gotta learn how to do do this

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