The Doorknob Dilemma: Clinical Leadership in the Final Minutes
Handling the "One More Thing"
We’ve all been there. Your hand is on the handle, the visit feels complete, and that’s when the patient says: "Oh, by the way, I’ve been having some chest pain..."
In that moment, your clinical brain kicks into high gear. You know that stay or go, your schedule is about to change. It’s easy to feel the pressure of the waiting room, but as a Primary Care Provider, your first responsibility is to the person in front of you.
Handling the "One More Thing" isn't about ignoring the clock; it's about expert triage. It’s about using your skills to decide, in seconds, if this is a clinical priority or a deferrable concern.
🛑 Contrarian Take: Triage is a Boundary, Not a Distraction.
Taking those extra two minutes to lead the conversation isn't "running behind"; it is the highest level of patient advocacy. When you take control of a last-minute concern, you are protecting the patient from harm and yourself from the stress of the unknown.
The Strategy: The Expert Triage
When a patient drops a significant symptom at the door, you don't have to guess. You use a focused assessment to determine the "Why" behind the "What."
1. The Focused Assessment (The 2-Minute Triage)
Stop the exit and ask the critical questions immediately. Your goal is to differentiate between an acute emergency and a non-urgent musculoskeletal or chronic issue.
The Clinical Spectrum: That chest pain could be Acute Coronary Syndrome (ACS) requiring an immediate ER transfer, or it could be costochondritis because the patient started a new pushup regimen at the gym.
The Result: Your triage determines the path. If it’s potentially cardiac, you escalate. If it’s musculoskeletal, you can provide reassurance, suggest a simple fix (like ibuprofen and rest), and move to the next step.
2. Decide: Escalate, Resolve, or Defer
Once you have the data from your quick triage, you lead the patient to the next logical step:
Escalate: "This needs a full workup immediately. I’m starting an EKG and we may need to get you to the hospital."
Resolve: "It sounds like those new pushups are the culprit. Take some ibuprofen, rest that chest wall, and let's move on."
Defer: If the triage shows the concern is stable but complex (like a year-long skin tag or mild fatigue), use the warm deferral: "I hear that you're worried about that. To give it the time it deserves, let’s get you back in next week for a dedicated deep dive."
Proactive Agenda Setting: Inviting the Concern Early
The most effective way to prevent the doorknob dilemma is to make the patient feel safe sharing their "big concern" in the first two minutes, not the last two.
The Script: "We have 15 minutes today, and I want to prioritize what’s most important to you. What are the top two things on your list so we can address them first?"
💡 Master the Visit Flow with Chart Smart Mastery
Handling the unexpected is part of the job, but it shouldn't be the reason you miss dinner. Chart Smart Mastery gives you the tactical systems to manage clinical surprises with empathy and speed.
Focused Triage Tools: Use our High-Volume Triage Templates to document these encounters quickly, whether they end in an ER transfer or simple reassurance (Module 9).
Leadership Scripts: Master the "Warm Deferral" for non-acute issues so you can protect your 40-hour workweek (Module 4).
Implementation Support: Join our Bi-Weekly Live Coaching to role-play these exact scenarios with your peers.
➡️ Ready to lead your visits with expertise and empathy? Enroll in Chart Smart Mastery today.
🚀 Recommended "Start Here" Path
If you are new to the Chart Smart philosophy, we recommend starting with our foundational guides:
