The 15 Minute Visit

How can we manage a new patient in a practical manner given a very limited interaction time? A full medical student history and physical can take up to an hour, but certainly we cannot afford that luxury in the real world. Dr. Kopes-Kerr, one of the program directors for Santa Rosa Family Medicine, tries to maximize the efficiency of a 15 minute first visit. Here's what he suggests:

-Start with the medication list.
-From the medication list, build a problem list.
-Get basic demographics, household information, occupation (especially for those of lower socioeconomic status).
-Defer family history, which is often complex, time-consuming, and low yield. Do this only if you have a clinical indication (cardiac risk profile, breast cancer, alcoholism, mental health disorder).
-Immunizations, which I personally never think of, but it's an important aspect of family medicine. Document last tetanus, flu, and pneumococcus vaccines. Copy immunization cards for children and give any that are clearly behind.
-Cancer screening: last Pap smear and if there has ever been an abnormal result. Defer all other cancer screening (mammogram, PSA, colonoscopy) for later visits.
-Lifestyle review: exercise, diet, tobacco, alcohol, drugs, stress. This gives information and also centralizes the importance of lifestyle in family practice. Do a coronary artery disease risk profile.
-If there's no chief complaint, then a physical exam isn't necessary. It may reassure the patient and build rapport, but beyond that, it's low yield in a first intake H&P.
-Instead, focus on the message the patient leaves with: what is the principal action or behavior they need to do now and why; how should they take their medications; when do you want to see them next and why.

Many people lament the lack of time in a standard clinic visit. I don't know what the answer is, but here's a possibility.