To maintain high-quality care and patient service while coping with the demands of yourself to working harder these days. But working harder isn't your only option. Sometimes you can also work smarter. Working smarter means being more efficient, which not only takes some of the stress out of your day but can free up your time (and your mind) to focus on the most important part of your work day: your patients.

The following ideas aren't new; you've probably heard them before. I'd be willing to bet, however, that few doctors follow them all. Each one you make part of your daily routine can improve your efficiency, which benefits your practice, your patients and you.

Start your day on time. Seeing the first patient 15 minutes late can put you behind and in catch-up mode the rest of the day. Get to the office at least a few minutes early to get settled in and to plan your day, then hit the first exam room right on time.

Dictate your charts. If you belong to the minority of physicians who keep records in longhand, change your ways and dictate your charts. With the time you will save, you should be able to see enough additional patients to pay for the service easily. As a bonus, your notes will inevitably be more complete and more legible.

Physician time saved: 2 minutes per chart, 50 minutes per day.

Dictate notes ASAP. Immediately after you see a patient, dictate your note (some physicians even do their dictation in the patient's presence). Don't let anything stand in the way of this rule. Dictation takes longer if you are trying to remember the patient's history or what your plans were even an hour after the encounter, much less at the end of the day. In addition, when the patient encounter is not fresh in your mind, errors are inevitable and will lead to wasted time during the patient's next visit or call.

Physician time saved: 2 minutes per incident, 50 minutes per day.

Dictate hospital notes, too. As with your office notes, you should dictate hospital H&Ps as soon as you've seen the patient and dictate discharge summaries before you leave the nurses' station. The patient's hospital course and your plans will be fresh in your mind, and the time you spend looking through the chart will be less than half of what you would spend trying to reconstruct things a week or a month later.

Physician time saved: 5 minutes per incident, 5 minutes per day.

Avoid needless breaks. When you are in the office, move directly from one patient to the next. A surprising number of doctors fall into the habit of taking a break between each patient encounter — drinking coffee, making personal phone calls, casually conversing with colleagues and so on. Of course an occasional break or conversation is necessary, but it shouldn't be a habit. Doctors who stay on schedule and manage their time must stay on task.

Physician time saved: 3 minutes per incident, 75 minutes per day.

Keep busy. Instruct your support staff to keep you busy at all times. All office activities stem from physician activities, either directly or indirectly. If the physician isn't making good use of his or her time, the practice will eventually suffer the effects. Train your staff that it is their responsibility to make sure you always have something to do.

Pull only the charts you need. Re-evaluate whether you need to have the patient chart pulled for every phone call. You may find that many of your telephone queries or requests can be handled without the chart. If you help your staff understand this issue, you'll save them several minutes each day.

Staff time saved: 5 minutes per incident, 15 minutes per day.

Bundle refill requests. Consider a separate telephone line answered by an automated attendant for prescription refill requests. The instructions to callers can explain that refill requests will be processed within 24 hours, twice each day or within whatever time frame you decide. The instructions can also give a phone number for more urgent requests. Then assign a staff person to manage the refill line. The staff person will save time by taking the day's requests off the machine all at once and dealing with them concurrently.

Staff time saved: 2 minutes per incident, 14 minutes per day.

Beware of the doctors' lounge at the hospital. You may need to spend a certain amount of time at the hospital lounge for political and social reasons, but visiting the lounge shouldn't be taking 30 minutes, much less an hour, out of your day.

Physician time saved: 15 minutes per incident, 15 minutes per day.

Examine your hospital load. Without getting into the hospitalist debate, it's clear that taking care of only two or three patients in the hospital is not efficient. Considering the amount of time spent traveling to the hospital and making rounds, hospital care is a loss to the practice unless the physician is seeing several patients, at least six. The problem is compounded if you use more than one hospital. This may be a patient service on which you choose to spend the time even though it is inefficient, but it's helpful to realize what you're doing. You might want to consider rotating weekly hospital duties among your partners or even integrating hospitalists into your practice.

Be easy to find. Staff members can waste precious time in the office simply trying to find you, but paging over the PA system may be disruptive. Another option is an internal beeper paging system like those used by some restaurants to notify servers when food is ready. Relatively inexpensive, the systems have a limited range and most can be set to audible or silent paging. The paged doctor then calls the central operator, or the call is parked in the phone system to be accessed at the number given on the pager.

Staff time saved: 2 minutes per incident, 10 minutes per day.

Rethink referral letters. Referral letters aren't always critical. For example, if you are referring a patient to a consultant, you may be able to forego a letter and instead send a transcribed copy of the note of the office visit in which you decided to make the referral.

Physician time saved: 6 minutes per incident, 12 minutes per day.

Staff time saved: 14 minutes per incident, 28 minutes per day.

Send paperless faxes. If your office does a lot of faxing, consider adding faxing software to your computing armamentarium. Your staff will be able to send faxes with just a few keystrokes rather than having to print copies, walk over to the fax machine and wait while the faxes are being sent. Make sure, particularly, that your transcriptionist has faxing software to send copies of notes to other physicians more efficiently.

Staff time saved: 5 minutes per incident, 10 minutes per day.

These are just a few ideas for boosting your efficiency in the office. The time you save won't necessarily become free time, but it can be reinvested into more meaningful activities, such as patient care (or self care!). Being more efficient will ultimately help you feel more in control of your time and more satisfied with what you have accomplished at the end of each day.