How to Improve your Medical Practice.

By: Maged Taman

The ultimate improvement in health care will happen when we will have universal health plan with early security and responsibility to the patients. Until this happen as physicians we ought to improve our health care for patients who trust us and want to have a good and appropriate care.

These are some of the advices to myself and colleagues.

1- Have the charts contain two sheets one for medical problems and one for routine health care screenings.

2- Order blood work one week before the patient visit so when he/she comes back he/she can see his/her blood work.

3- Be thorough when you read the patient medical problems, medications and test results before you see him you know what you are looking for when you take history from him or examine him.

4- After examining patient sit with him and go over his concerns. Luckily, you may have one to three problems that you can answer to him.

5- Be problem oriented an 85 years old lady may not be interested in having colonscopy or mammogram, controlling her arthritis pain could be her main issue.

6- Talk to patient with respect do not be authoritative or father like figure. Patients always like to be on control. So explain, educate and give him choices.

7- Make yourself clear when the medical decision is black and white or in the grey area where patient have to make the decision fully in his own after getting all the facts. Thus when a test or treatment that has very low yield patients have to make their mind.

8- Use hand out and educational materials to make patient understand you.

9- Do not shy to check your computer or a book to get all the information when talking to patient at times. No one would expect you to know 100% of the information.

10- If you are unable to diagnose the patient for something not urgent you can have them return after you think about it more deeply and consult your readings or colleagues if you need to.

11- Define the types of visits to your patients: new patient visit which is usually the most thorough, established patient yearly physical visit, follow up visits and lastly sick visit.

12- For follow up visits make it appropriate a young healthy patient is likely to need a visit only once a year unless sick he can call for a sick visit. A patient with diabetes commonly need a visit every 3-4 months.

13- In sick visit be focused in the problem with the understanding of the background of chronic medical problems and medications the patient is taking.

14- Always review patient allergies before writing a new prescription.

15- Remind patients of the need to follow up with other doctors as necessary like routine eye or skin examination or follow up visits with other doctors. However, patients have the responsibility to follow up with other doctors since the other doctors have mechanism like you when to ask the patient to be seen again or have certain test done.

16- Think common and exclude the rares. Thus a patient with headache like to have migraine or tension headache, however ask the questions that will make you safely role out a serious condition.

17- Order the routine investigations that are appropriate and think of the uncommon investigations when your history and physical suggest more rare diagnosis not in the top of the common list for the diagnosis of a particular condition.