So often in mentoring I hear about patients practitioners have struggled to treat primarily because of irregular points of contact….you know the type, the client who is an Irregular Regular or Random Regular, booking in to see you just once or twice a year or just in acute situations & never doing the follow-up you so want them to do, in order to address the real underpinning causes. A case I heard the other day would sound familiar to many of us, about a patient who saw the practitioner only when she experienced cramping. Each time she’d have an appointment, buy some magnesium which relieved the issue and then disappear again, only to re-emerge with the same issue at a later time. During one of these subsequent visits, the patient mentioned that she was ‘exhausted’. Following the practitioner’s insistence that the patient bring in any pathology she had had done, the practitioner realises much to her horror, the patient has been suffering from macrocytic anaemia for some years but no one had bothered to tell the patient and accordingly, the practitioner has been none the wiser as well. The practitioner of course felt terrible because she’s thorough and conscientious but is she to blame? Where does the patient’s autonomy end and the practitioner’s duty of care begin?
Sometimes patients themselves can be a big barrier to their own wellness for all sorts of reasons and we can’t always resolve this but perhaps we need to consider introducing clinic protocols to try and better manage the Irregular Regulars.
This is something I’ve suggested to many practitioners with good success and it goes something like this…if a patient calls to make an appointment who has not seen you in the previous 6 months they will be automatically booked for an ‘extended consultation’ – this might be one that goes for a duration longer than an acute or follow up appointment but shorter than an initial. If a patient rings to book an appointment and has not seen you in the past 12 months then a ‘review consultation’ will be booked, which might be similar in duration to your initial but which becomes necessary because of the time passed between consultations. We can’t be expected to fit 6 or 12 months worth of information into a standard follow-up appointment and to do so often comprises the ultimate quality of our clinical decision making and care, so this is a way to promote better outcomes for both practitioner & patient.
Developing clear protocols around this means that you minimise the chance of missing the important developments in your patients’ life and health, enabling you to do your job properly and ensures that you don’t (as is often the case) simply end up doing more work for the same amount of money , in your own time, trying to play catch up!
If you do decide to develop a clinic protocol like this, it’s good to advertise it to your clientele and of course make it a firm rule that anyone involved in making your appointments understands and communicates clearly. Hope this helps you to manage your Random Regulars!