Continuity Clinic Tips
Written by Lindsey Ulin, MD
Intern year, a time of so much transition and new responsibilities. Depending on your specialty, you may suddenly find yourself with a patient panel and a continuity clinic. While this can be an incredibly rewarding part of your residency experience, it is a tough initial transition. We spend most of our clinical time as medical students in the inpatient setting, and the vast majority of residency there as well. The outpatient learning curve is steep and it can feel like you aren’t making progress as quickly as on the inpatient side. I’m here to normalize this feeling, and offer some tips for your new role as an outpatient provider.
Similar to the inpatient setting, outpatient care is a team environment so lean on your team. Along with learning medicine, you will also be figuring out the clinic operations and workflow. The front desk staff, medical assistants, and nurses are critical for making outpatient care happen and you will learn so much from them. It’s also important to understand what resources your clinic has such as phlebotomy, pharmacy, social work, and behavioral health for both your visits and inter-visit care. Talk to residents at your clinic for advice, they’ve been in your shoes. My cointerns and I also use our group text to triage outpatient questions.
Inter-visit care is challenging while on inpatient rotations. Find out what the expectation is for covering the in basket at your clinic site, for example do you or your preceptor manage it? At my clinic it is my responsibility, however if I’m on nights or in the ICU my preceptor helps out so care does not get delayed. If your clinic uses Epic, I highly recommend the remind me and sticky note functions. The remind me function will send you a message on the date of your choosing associated with a patient’s chart. For example, want to see how a patient is doing on a new medication in 2 weeks? Set up a reminder for yourself to call them in 2 weeks. Forgot to ask about something during the visit you want to make sure to address at the next visit? Type it into the sticky note which pops up when you open a patient’s chart.
Now to the actual visit- how am I supposed to cover all healthcare maintenance and acute concerns, staff with my preceptor, fit everything into 20 minutes, and not run behind? Realistically you can’t, and that’s okay. Meet patients where they are, and find out what are the most important things that they want to make sure to discuss today with you. Prioritize the most pressing concerns and schedule a follow up visit for those you can’t address at this visit. Make time to build patient-provider relationships, understand that patients may express frustration with having their care transitioned between different residents every few years.
