Monika, The biggest problem I've heard of is patients getting 'cold feet' and not showing up for appts, leaving big holes in your schedule that could have been used for someone else. In my practice, I ask for a $$ cash deposit before the appt. to cement the patient's readiness and commitment. That may be difficult in an HMO environment, but you may wish to consider a refundable cash deposit that the pt agrees to beforehand. If the pt does not appear, the $ could be donated to an acceptable charity. The second problem is pt's fearfulness of the early withdrawal period. I Rx small amts of clonidine, bentyl, phenobarb & possibly quinine sulfate to help control sx and "bridge" them until induction. A brief phone contact with the pt during the pre-induction period helps as well.
Best wishes. I wish more HMO's realized the benefits of ORT programs.
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