The Art of Scheduling: Air Traffic Control in the Medical Office

Our clinic has an advanced computer scheduling system. It gives overviews of available appointments, makes statistical reports and shows several providers’ schedules in one view. But it can’t even begin to compare with Doreen and her paper and pencil system.

Doreen was our master scheduler more than ten years ago. She moved on to become the office manager in a specialist’s office, but then got tired of modern medicine and opened a country store.

Without any formal medical training, Doreen instinctively knew who needed to be squeezed into their provider’s schedule urgently and who could wait, and how long each type of visit would take for each of our differently tempered medical providers. At the same time she was able to keep track of the future appointments each patient had without the benefit of a computer.

Doreen knew our patients well enough to know who needed an extra long appointment no matter what ailed them. She also knew which patients were straightforward enough to be squeezed in for acute illnesses. She knew that “double books” really weren’t physically possible as no doctor is good enough or fast enough to be in two exam rooms with two different patients at the same time. She was able to look at her paper and pencil schedule and see that Mrs. Smith’s blood pressure check on Tuesday morning was just a quick visit to check her blood pressure, review her potassium level and write one or two prescriptions whereas Mrs. Brown’s blood pressure visit Tuesday afternoon was likely to be an outdrawn affair because of her husband’s dementia and her daughter’s recent breast cancer diagnosis. A child with an earache could have five minutes of Mrs. Smith’s 15 minutes, but nobody could be squeezed into Mrs. Brown’s timeslot.

With the precision of an air traffic controller, Doreen would schedule the straightforward Mrs. Smith’s blood pressure visit for 10:00, little Danny Swan’s earache for 10:10 and the next regular visit at 10:15. When Doreen scheduled, everything ran on time, just like a Swiss train.

She once told me: “If I can’t tell on the phone what sort of problem they’re having, not even you can figure it out and take care of it in a double booked 5-minute visit, but if they know what they need, I’ll squeeze them in”.

Doreen constantly scanned the wide lined double page spread of her appointment book and kept an eye out for potential office bottlenecks. She would make sure several providers weren’t doing pap smears at the same time, since too many nurses would then be tied up and not available for telephone triage. She watched out for room or equipment conflicts – two cryosurgeries at the same time and needing the same equipment never happened while Doreen was in charge. Our fancy computer schedule can be used to schedule the procedure room, but doesn’t spot for the little conflicts Doreen was always on the lookout for.

Doreen effortlessly and intuitively mixed fast and slow visits throughout the day, so that two patients with the potential for running over were never scheduled back to back. If a visit ran over a little, chances were good that the next visit would allow me to catch up. Thanks to her wisdom, I seldom felt rushed, even though I regularly saw record numbers of patients during her reign at the front desk.

No amount of color-coding or drop-down menus could match Doreen and her old-fashioned system. Her compassionate dedication and the simple flexibility of her paper and pencil appointment book kept our clinic humming.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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