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A practice’s ‘bump list’ approach to patients


Fred N. Pelzman, M.D., writes of his practice’s “bump list” approach:
“Patients are advised that they should arrive in the practice at the beginning of either an afternoon or morning session, and expect to wait, and expect to have a provider take care of this single-focused issue.
“Explicit instructions are given: these are not routine care visits, management of their multiple medical problems, or a laundry list of complaints, essentially nothing but what they are put down by the triage team as needing to be seen for.
“And one of the stipulations is that at the end of each one of these bump list visits, each patient will leave the practice with a follow-up appointment scheduled with their primary care provider — no exceptions.

“Our hope is that patients will leave the practice satisfied, and with a plan for follow-up, and that the providers will get a little bit of a flavor of what has traditionally been going to urgent care or the emergency room, but is probably more appropriately handled in the outpatient setting.”

A farewell visit in the outpatient world


Fred N. Pelzman, M.D., tells of a resident growing teary-eyed over a long-time patient farewell visit.

“Out here in the outpatient world — in the ‘real world’ as we like to call it — the relationships may start out smaller {than in a hospital}, but they have great potential to grow. We may be fine-tuning or wholesale changing medicines, learning about barriers to medical literacy, overcoming patients’ fears of undergoing certain tests or procedures, or adapting our preset notions of what is right and best for our patients to a patient’s own set of personal and cultural beliefs. This builds connections, and it only matures with time.”

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