‘The Rule of Six 2s’: teaching learners simple strategies for structuring an outpatient adult primary care follow-up visit in the 21st century

Many primary care doctors view their personal connection with patients as the most rewarding and satisfying part of their work,1 even more than salary.2 Adherence and satisfaction are also enhanced when doctors listen, and effectively communicate health information, to patients.3 Pressure on physicians to see a larger number of patients during their clinic sessions has strained these relationships. The combination of time constraints, persistent paperwork, electronic medical record demands4 and obstacles to delivery of care by insurance carriers and others threatens doctors' ability to feel satisfied with their profession and increases their risk of poor decision-making and burnout.5 Indeed, research at one large institution found that more than two-thirds of internal medicine academic faculty considered patient care to be the most meaningful aspect of their work.6 Physicians who spent <20% of their time engaged in the activity they identified as most meaningful were at higher risk of burnout.7 Hence, although it is increasingly important for learners to develop targeted and effective ways to improve efficiency and time management skills, it is equally critical for trainees to master techniques that assist them with feeling connected, engaged and satisfied with their relationships with patients. Medical learners receive a great deal of education about how to structure an initial visit. Unfortunately, there is a dearth of literature about how to best help medical learners efficiently structure the equally important follow-up visits and, in particular, how to manage the conundrum of navigating an electronic health record and their need to feel engaged with their patients. Indeed, the goals of improving efficiency and time management skills, while also remaining connected and satisfied with relationships with patients; appear to be at odds with one another. Below, we present a possible consultation framework, the ‘Rule of Six 2s,’ as a …