In the first few weeks of September, I had the opportunity to visit a well-known hospital in Stuttgart, to spend a few hours each day, "observing" the system. Not knowing the language, was a drawback for me, impeding any medical knowledge from coming my way. However, it was a chance to learn a few basic things about the "system" and how it works here. Here are some of the things I would love to implement back home.
In India, bedside rounds were nearly always, a tedious affair. Doctors would crowd around the patient to discuss the progress (or sometimes the lack of it). The poor patient would lie in the midst of this mob-like discussion of the facts of his/her case, often having to listen to the dismal details of their condition. Moreover, if the resident in-charge was to be reprimanded for any of his/her errors, it would be done right there, in the full galore of all the ward patients!. I always wondered if this entire exercise was necessary or if we could do it in a better way.
Seems there is a better way. Here, the case discussions are done in the doctor's room, before the real meeting between the head doctor and the patient. The resident doctor does his/her clinical rounds before the discussion. Then, they all sit it out in the doctors room, before their electronic gadgets, going over all the patients details. All lab data is just a click away [no need for the resident to memorize (or be tempted to lie about!) nitty numbers!]. The nurse in-charge of the patient is also party to the discussion and often provides valuable inputs on symptoms and complaints. It is a relaxed and mature discussion. It is more fruitful for the patient as his/her case is better discussed and analyzed.
Having the discussion in the doctors room, also has the advantage of being able to access valuable information related to individual clinical decisions, at the click of a button or at the hand's stretch (at the book library). Doctors can't keep everything in their head. Using technology effectively and in timely manner is important.
Having taken care of the clinical details of the case, the bedside visit is now focussed on exchanging pleasantries with the patient. The patient is more comfortable with the talk directed to him/her rather than between the doctors in-charge. I have often felt, that we don't do this enough in India.
After the discussion and bedside rounds are done with, the resident's task is to call on the nurses and instruct them in a clear format what is to be done for their patients on that day. Everything is written and undersigned by the doctor and the in-charge nurse!. Here, the nurse's role is supreme- in fact she is the primary care-giver here who co-ordinates all the orders.
In India, nurses are given a raw deal. We never really acknowledge them as equals. Of course, in many cases, nurses are not really inclined to work!. But this mature interaction between the doctor and nurse, is something that needs to be emulated.
Before any intervention, the doctor and nurse, arm the patient with a superbly descriptive patient information sheet, written in a language the patient and family can understand. This is given to the patient well before the time of the procedure. The patients are required to sign the form, as having consented to the procedure, having understood the risks.
Back home. we vaguely describe the procedure (orally!) and take a hasty consent (if at all!). This needs to change.
In the discharge sheet of every patient, the primary referring physician is sincerely acknowledged. A detailed story of the patient's stay at the hospital is written down for their reference.
Very rarely, do we in India, even turn the pages of the case file to see who has referred this patient to us!. Networking is everything.
It only takes 5 minutes to get acquainted with any new case in the wards here. Everything in the patient's medical history is neatly typed out on a summary sheet placed on the front of the file, which is complete with dates and events.
Cleanliness is one thing; but, having a beautifully designed ward is another thing altogether!. Its amazing how comforting, for any visitor/patient, a brightly lit ward with colorful pieces of art and windows streaming in sunshine, can feel like.
Keep bedside discussions away from the bedside!
In India, bedside rounds were nearly always, a tedious affair. Doctors would crowd around the patient to discuss the progress (or sometimes the lack of it). The poor patient would lie in the midst of this mob-like discussion of the facts of his/her case, often having to listen to the dismal details of their condition. Moreover, if the resident in-charge was to be reprimanded for any of his/her errors, it would be done right there, in the full galore of all the ward patients!. I always wondered if this entire exercise was necessary or if we could do it in a better way.
Seems there is a better way. Here, the case discussions are done in the doctor's room, before the real meeting between the head doctor and the patient. The resident doctor does his/her clinical rounds before the discussion. Then, they all sit it out in the doctors room, before their electronic gadgets, going over all the patients details. All lab data is just a click away [no need for the resident to memorize (or be tempted to lie about!) nitty numbers!]. The nurse in-charge of the patient is also party to the discussion and often provides valuable inputs on symptoms and complaints. It is a relaxed and mature discussion. It is more fruitful for the patient as his/her case is better discussed and analyzed.
Access technology/ resources when making clinical decisions
Having the discussion in the doctors room, also has the advantage of being able to access valuable information related to individual clinical decisions, at the click of a button or at the hand's stretch (at the book library). Doctors can't keep everything in their head. Using technology effectively and in timely manner is important.
Keep bedside visits pleasant and comforting
Having taken care of the clinical details of the case, the bedside visit is now focussed on exchanging pleasantries with the patient. The patient is more comfortable with the talk directed to him/her rather than between the doctors in-charge. I have often felt, that we don't do this enough in India.
Talk to the nurses
After the discussion and bedside rounds are done with, the resident's task is to call on the nurses and instruct them in a clear format what is to be done for their patients on that day. Everything is written and undersigned by the doctor and the in-charge nurse!. Here, the nurse's role is supreme- in fact she is the primary care-giver here who co-ordinates all the orders.
In India, nurses are given a raw deal. We never really acknowledge them as equals. Of course, in many cases, nurses are not really inclined to work!. But this mature interaction between the doctor and nurse, is something that needs to be emulated.
Patient information sheets for every intervention
Before any intervention, the doctor and nurse, arm the patient with a superbly descriptive patient information sheet, written in a language the patient and family can understand. This is given to the patient well before the time of the procedure. The patients are required to sign the form, as having consented to the procedure, having understood the risks.
Back home. we vaguely describe the procedure (orally!) and take a hasty consent (if at all!). This needs to change.
Acknowledge the primary treating physician
In the discharge sheet of every patient, the primary referring physician is sincerely acknowledged. A detailed story of the patient's stay at the hospital is written down for their reference.
Very rarely, do we in India, even turn the pages of the case file to see who has referred this patient to us!. Networking is everything.
Have a summary sheet out front which reads like a biography
It only takes 5 minutes to get acquainted with any new case in the wards here. Everything in the patient's medical history is neatly typed out on a summary sheet placed on the front of the file, which is complete with dates and events.
Ward design and care
Cleanliness is one thing; but, having a beautifully designed ward is another thing altogether!. Its amazing how comforting, for any visitor/patient, a brightly lit ward with colorful pieces of art and windows streaming in sunshine, can feel like.
