Some surprising comments from my July evaluation…

“Slow but Reliable” well, I won’t argue that I feel slow sometimes, but when I’m aware of it, I really don’t know how to increase volume…I mean, eventually you have to look up lab results, follow-up and discharge people, don’t you? I could keep picking up charts and leave my other patients waiting, but it makes more sense to discharge someone as soon as you can.


5 out of 5

Well, that’s a surprise, since I frequently wear khaki colored jeans, running shoes and never wear my white coat.

Patient rapport:

3 out of 5:

That’s a surprise too…why do they think I’m so slow? I TALK to my patients! If I didn’t talk or listen as long, I could crank out more labs, x-rays and throughput, but it seems to me that that’s only part the patient’s visit to the ED. I have never ever had a complaint, and the majority of my patients thank me several times when they leave…a police officer with a stress fracture of his foot thanked me for doing my job well, which made me wonder what kind of experiences he’d had before. All I did was find out what happened, get an x-ray, and give him a hard soled shoe and he even emailed me later to thank me again! (Maybe he thought I was cute.)

Technical skill:

3 out of 5

OK, this one really steams me. I can modestly say that I am pretty good at suturing, finding large veins for central lines (even in pulseless coding people on one occasion after 2 docs had failed), quickly applying splints, even performing the Epley maneuver! 🙂

Reading and knowledge:

4 out of 5

I’m flattered by this. I spend not nearly enough time reading as I should. I spend too much time on the computer, playing with the cats, watching cable animal and home design shows, etc… In fact, part of what _I_ think slows me down is indecision and feeling like I have enough knowledge.

Overall, I think the eval is total bunk. If they think I’m slow that’s fine but intead of telling me to pick up more charts, tell me how to increase my efficiency. As far as the low marks on patient rapport and technical skill, well I’m dumbfounded by those. The high marks in appearance and knowledge? Well…you can fool all of the people some of the time!

When the department is busy and I HAVE TO increase volume, I do it by spending less time talking with the patient. I form an initial impression based on the nurse’s notes, look at the patient, decide what I think I’ll find on physical exam, then find it (or not), then leave the room and order some junk, forget about the patient and repeat the process with the next one. Is that good medicine? I don’t think so, but sometimes it works well, and frequently, you get the patient to the same end point regardless (chest pain free, diuresed, admitted to medicine/ortho/surgery…)

Any thoughts on compromising time spent with patients in order to increase patient volume? How many patients do you see a day? an hour? Do you have physician extenders to do simple procedures for you? Will I be overwhelmed once I finish residency?