As trainees and young retina specialists, we have the opportunity to learn from many fantastic mentors. One skill many young vitreoretinal surgeons want to improve is balancing clinic efficiency with excellent patient care. Here, I discuss tips, tricks, and advice with some of my mentors at Mid Atlantic Retina, Allen C. Ho, MD; Sunir J. Garg, MD, FACS; and Omesh P. Gupta, MD, MBA.

THEODORE BOWE, MD: HOW DO YOU KEEP YOUR CLINIC FLOWING EFFICIENTLY?

Dr. Ho: There are times when emergencies, new patients, and challenging issues back up the clinic. We tend to think about efficient clinic flow through the lens of the provider, but the key is to think about it from the patient’s perspective to make sure their needs are met and their questions are answered. Ensure schedules are streamlined, safety measures are in place, and staff is on the same page about each patient encounter. Having experienced, focused, and engaged team members makes all the difference.

Dr. Garg: One of the most powerful habits you can develop is starting your day on time. Your punctuality—good or bad—sets the tone for your team and patient encounters. It takes time to establish a connection with your patients while doing what we have to do in a timely manner. As you get busier, being direct in an empathetic way is key.

Dr. Gupta: The biggest issue that affects efficiency is doctor distractions. Inevitably, physicians are pulled in many different directions. I try to limit, if not eliminate, distractions completely during clinic hours. The responsibility of running an efficient office does not fall on one person, and the culprit for an inefficient office is usually not one issue. Team effort and a multifactorial solution are both required.

DR. BOWE: WHAT PATIENT COMMUNICATION TACTICS WORK BEST FOR YOU?

Dr. Ho: Optimizing efficient communication with patients is based on trust. I make notes about significant life events in addition to their medical issues. Knowing that a patient just celebrated a milestone birthday with extended family at the beach, for example, creates human interest for me and makes the patient feel more connected to our care team.

Dr. Garg: I tend to use a lot of analogies. Geographic atrophy becomes “there are holes in my old t-shirt, and the edges are fraying and get bigger over time.” Blood vessels leaking from diabetic eye disease become “old pipes are starting to leak and ooze, and I have to put a sealant on them to get it to stop.” While in training, listen to how attendings describe these concepts to patients. You’ll glean useful metaphors and learn what language to avoid.

Dr. Gupta: I describe wet AMD as a weed growing through a crack in the cement sidewalk. The crack in the cement is the break in Bruch membrane, and the weed is the neovascular complex. The weed spray is the anti-VEGF agent. We spray this weed killer once a month until the weed is dead. Once the weed is dead, we can use the spray less often, but sometimes the weed grows back if the interval between sprays is too long. Also, be consistent in your messaging.

DR. BOWE: HOW DO YOU OPTIMIZE COMMUNICATION WITH PARTNERS AND REFERRING DOCTORS?

Dr. Ho: I try to think about what partners and referring doctors would need and what I would want to know if I was in their shoes. For example, if a patient had surgery with me and has a gas bubble, I will include a note that reflects whether the patient has a long- or short-acting tamponade. If we have an emergency surgery and I need to pass the case to one of my partners, I communicate necessary medical and personal information. Some referring doctors want more frequent communication than others. We have hotline phone numbers for specific referring doctors so their team can reach ours more efficiently.

Dr. Garg: When updating a partner on a case, I stick to the critical pieces of information. For referring doctors, I mostly rely on the examination note from our electronic health record (EHR) that gets sent out. If it’s a more unusual case, I’ll expand as necessary. If  something is time-sensitive, a phone call can be a big time-saver for everyone.

Dr. Gupta: It is paramount to keep the lines of communication open with partners and referring doctors. I would encourage all retina specialists to reach out to referring doctors as often as possible.

DR. BOWE: WHAT ADVICE CAN YOU OFFER ON NOTE WRITING AND EHR USE?

Dr. Ho: Keep notes about each particular patient in a way that helps you better understand them and their visual needs. It makes the experience more meaningful for me, as I enjoy the privilege of being invited into my patients’ lives as their retina specialist.

Dr. Garg: I always have a scribe with me. Their level of expertise and engagement can be variable, so make sure to get on the same page from the start.

Dr. Gupta: Spend time getting to know your EHR beyond a superficial level. Customize your profile based on your preferences, edit smart phrases if possible, and eliminate options that you don’t find helpful. This can be time-consuming, but the amount of time you save when seeing patients is invaluable. As you become more familiar with your EHR, you will be able to simultaneously talk to patients about one topic and update their chart on another.

DR. BOWE: DO YOU HAVE ANY OTHER PATIENT CARE ADVICE FOR AN EARLY-CAREER RETINA SPECIALISTS?

Dr. Garg: If you’re starting off in an office, learn to pace yourself as the patient volume grows. Some techniques can be learned; others come with experience. Don’t feel like you need to reinvent the wheel. Try to get all your documentation and patient emails done before you leave the office for the day so you’re not taking your work home with you.

Dr. Gupta: Becoming more efficient takes experience and develops over time. Put patient care first, and the rest will fall into place. Those who place a priority on speed often make mistakes or eventually regret their misdirected priorities. In today’s health care landscape, efficiency is more crucial than ever for the successful practice of medicine. It is important to take the time to identify any scheduling and efficiency challenges your practice may be facing and then implement the necessary changes to address them. By doing so, you can ensure your practice remains financially successful and on track to provide quality care to your patients.