Tuesday, July 24, 2012

Why I do all my consultations myself

A new patient just called the clinic and asked the receptionist for an appointment with the doctor . She then asked, Will I get to see Dr Malpani ? My receptionist was a little surprised by this question, because I always do all the consultations myself. She explained our policy to the patient, who was quite pleasantly surprised, because she was used to seeing only assistants when she had been to other IVF clinics in the past.

We don't have any assistant doctors in our clinic and we take pride in the fact that I see all my patients myself . I also answer all my e-mails myself ; and Dr Anjali does all the scans , egg collections and embryo transfers herself . We have a very hands-on personalized approach in our  clinic . One problem with this is it limits the number of patients I can see , because it takes me about 20 minutes to do a consultation . This is quite unlike other IVF clinics, where the main doctor can see many more patients, because the initial history taking and consultation are done by a small army of assistant doctors. The obvious question is – Why don’t we employ an assistant and allow the assistant doctor to take the history,  so that I can increase my throughput and efficiency ? See more patients will allow us to increase our income considerably !

This is a conscious decision we have made , because I feel the major role of a doctor is talking to the patient and taking a history . This is the foundation of good medicine , and I do not want to outsource it to someone else. Other IVF doctors also realise this, but they only do a consultation for the VIP patients – the “ordinary” patient needs to see an assistant ! We treat  all our patients like VIPs ! While talking to the patient allows me to understand her medical problem clearly , this is something which a competent assistant can do equally efficiently. The reason I do this myself is that it provides a far more valuable function – it allows me to get a much better insight into the patient's psyche, as compared to just reading her medical notes. Talking one on one to my patient allows me to understand what the patient understands about her problem , and what she doesn't , so that she has more realistic expectations of what I can do for her . It also allows me to empathise with them ; and ensure that they are actively engaged in their treatment .

The time I spend with the patient during the consultation is extremely valuable to both the patient and me, It gives the patient confidence that I have understood her and her medical problem. Consultations are one of the things senior doctors do extremely well – and this is something which juniors may not perform as well. I am not saying assistants cannot be trained – of course they can ! It’s just that many doctors think taking a history and talking to the patient is not very important, because they are so focused on performing procedures ! After 20 years of experience, communicating with a patient is a skill which I I hopefully have mastered ,and this allows me to provide far better medical care to my patients , than using the traditional model of having an assistant take the history , so that I merely need to review it and then go over the salient points with the patient.

A better way of increasing my efficiency would be to allow the patients to fill in a detailed medical history form, something which they can do online , or after coming to the clinic . I can review this form with them when I do the consultation. This will ensure that I spend quality time with the patient ; and will also allow me to get better insight into what my patient understands about her problem. It would help because then I wouldn't have to do as much writing when filling in the medical record, since most of it would have been done by the patient herself !

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