A Perfect Day in Your Medical Practice: The Efficient and Well-Run Medical Office

Toilet paper

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  • All available appointments are full.
  • All staff showed up for their shifts.
  • No one burns toast in the toaster oven and sets off the fire alarm.
  • None of the staff show up to work wearing flip-flops or pink underwear beneath their white scrubs.
  • All patients have been reminded about their appointments so they all show up.
  • Patients calling for same-day appointments are able to be worked-in appropriately.
  • No patients give false information at check-in.
  • Established patients arrive on time with their insurance information and co-pay.
  • New patients arrive on time to complete their paperwork, and give their insurance card, photo ID and co-pay to the receptionist.
  • Patients with x-rays or other imaging studies bring the films or a CD.
  • Patients with fasting appointments arrive having fasted.
  • All patients arrive bringing their bag of medications.
  • Patients in wheelchairs and with difficulty ambulating are accompanied by caregivers.
  • Patients who do not speak English or are deaf have notified the office prior to the appointment and the appropriate technology or interpreters are available for the appointment.
  • Patients with procedure appointments have followed their pre-procedure instructions.
  • Patients with procedures have been pre-authorized by their insurance carrier and their personal financial responsibility has been discussed with them and payment arrangements have been made.
  • Patient eligibility has been checked and those unable to be authorized have been called before their appointment to gain further information about their payer source.
  • If computers go down, there are paper procedures in place to enable staff to continue seeing patients.
  • No patients arrive saying “I forgot to tell you, this is Worker’s Comp/ an auto accident/ a liability case and I was told by my lawyer not to pay anything.”
  • None of the patients pee on a waiting room chair.
  • Neither JCAHO nor any state or federal officers show up.
  • The copiers and faxes all work.
  • No subpoenas come in the mail.
    Letter Carrier Delivering Mail
    Image by Smithsonian Institution via Flickr
  • It’s not your very first day live on electronic medical records.
  • All phone calls are answered before the third ring and no one has to leave a message.
  • No patients walk in the door with severe chest pains and say “I knew the doctor would want to see me.”
  • Patients remember to call the pharmacy for refills.
  • Providers all run on time and seem in particularly good moods.
  • Patients get their questions answered with callbacks within two hours.
  • Someone delivers sandwiches, drinks and brownies to the practice for lunch.  There is enough for everyone.
  • No bounced checks come in the mail.
  • Providers spend so much time in the exam room listening to their patients that the patients leave feeling that every question they had (and a few they didn’t know they had) was answered.
  • Providers circle the services and write the diagnosis codes numerically on the encounter form, remembering that Medicare doesn’t pay for consults any more.
  • Sample medications that providers want to give patients are in the sample closet.
  • Records that providers want to reference are in the chart and are highlighted.
  • No one calls urgently for old medical records that are in the storage unit across town.
  • There are no duplicate medical records.
  • Patients checking out never say “But he was only in the room for 5 minutes!”
  • The patient restrooms don’t run out of toilet paper.
  • No bankruptcy notices come in the mail.
  • All phlebotomists get blood on the first stick.
  • No kids cry.
  • The HVAC system works beautifully, keeping it cool where it needs to be cool, and warm where it needs to be warm.
  • Congress announces that the SGR formula has been revoked and a new reasonable model for paying physicians has been discovered.
  • Everyone goes home at 5:00 p.m., glad to have a job, glad to be of service, and happy with their paychecks.

Posted in: A Career in Practice Management, Day-to-Day Operations

Leave a Comment (10) ↓


  1. Charlene Burgett August 25, 2010

    Wow! In and ideal world! I would love to have one day like this.

    One of your bullet points struck a chord with me today because I had to replace our fax machine after it died. There is always something going on!

    • Mary Pat Whaley August 25, 2010

      Hi Charlene,

      Thanks for the comment. It’s amazing how much we rely on the fax, isn’t it?

      Best wishes,

      Mary Pat

  2. Dr Robert Schertzer August 25, 2010

    Priceless! Thanks for posting a great list of what we strive for.

    • Mary Pat Whaley August 25, 2010

      Hi Robert,

      Posting this was fun and somewhat cathartic!

      Best wishes,

      Mary Pat

  3. Brenda August 26, 2010

    Terrific post! I always say that one of the reasons I love my job as a practice administrator is that I never have the same day twice. New day, new (potential)disasters!

    • Mary Pat Whaley August 26, 2010

      I agree with you, Brenda! Healthcare management is not for sissies, not now and certainly not in the future. Thanks for your comment.

      Best wishes,

      Mary Pat

  4. Mike V. September 15, 2010

    Thanks Mary Pat. This is some great insight into what it’s like to run a practice.

    I’m proud to say that our company works hard to take away the stress of having to manage computers and EMR systems systems. This allows the office leadership to focus on the rest of your list that is overwhelming enough!

  5. Dr. Lydia August 20, 2011

    I am a solo practitioner and find it very hard to locate good staff members that “REALLY” care about your practice. I think the most frustrating thing about coming to work on a daily basis is when you constantly have to remind staff members over & over again to do the above mentioned duties. I hire them so that I don’t have to remember the menial tasks, and can concentrate on quality patient care. But, I find myself on a daily basis reminding staff..”did you schedule the lunch? Why didn’t the patient bring in their medication bottles? etc etc I now have the front office hand the patient a “facesheet” and ask the patient to correct any erroneous information i.e. new insurance, new phone number, new address, etc? But, the front office STILL will forget this also…SO FRUSTRATING..! Where do you find quality help these days???

    • Mary Pat Whaley August 21, 2011

      Hi Dr. Lydia,

      Do your staff get an annual evaluations? If so, do you have performance requirements tied to the evaluations? I suggest setting up performance measures that relate to day-to-day operations. For instance, one way to measure if patient demographics are getting updated is the amount of returned statements you get. If you get a lot of returned statements from patients who were in the office in the past several months, then one assumption you can make is that demographics aren’t getting updated. There are other reasons for returned mail, but let’s assume 10% of your patient statements are being returned because of old addresses. You can set a goal for the front desk to reduce that to 1-2% by faithfully checking demographics, then reward them if they reach the goal. You can also tie patient satisfaction scores and a number of other performance measures to evaluations or bonuses or perks – taking turns leaving early on Fridays, etc.

      Staff usually underperform because:
      – they weren’t trained well on your expectations or don’t understand them
      – they don’t think there are any consequence to not meeting your expectations
      – they’re not engaged enough in the job to really care about your expectations

      I do believe there are good employees to be had today, but you must let them know from the beginning what it is you are asking them to do and train them if needed, let them know that your expectations might change as the needs of the practice change, and let them know what the potential risks and rewards are for a lack of acceptable performance. Good employees will be conscientious and will rise to the challenge of helping you have a successful practice.

      Best wishes,

      Mary Pat