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GENERAL PRACTITIONER'S SECTION
UNSAVOURY TRENDS IN OFFICE PRACTICE
OP Kapoor
When I started office practice over 40 years back, things were different. The consultant physician saw patients strictly by appointment. His work load consisted of difficult medical problems or undiagnosed cases. Some were sent for second or third opinion. Most of them had chronic ailments, the acute ones going to the emergency room or were directly admitted into hospitals. My assistants took a detailed history, and re-arranged the long list of investigation reports and X-rays, brought with them. Like some physicians, we also checked urine, stool and blood of the patient, before finally seeing him. Fluoroscopy and ECG was done when indicated. By the time the patient came to the consultant he was at ease and the physician primed with basic information. The consultant conducted his own interrogation and examination as necessary. Second and third timers did not have to undergo the entire routine; the tests were conducted selectively. Because of this orderly system, routine examination of the patient hardly took 15 minutes and the patient went back satisfied that a thorough checkup had been carried out.
The situation has changed now. Lot of vertical specialists, super specialists and sub specialists have come up. There are doctors who specialise in a single system (e.g. gastroenterology). Some specialise in a single organ (e.g. liver). With the coming in of new hospitals and health insurance some patients are getting directly sucked into large hospitals. This is bound to affect office practice and most consultants have accepted it with equanimity. It is the other new development that is unsavoury. Patients have developed a lackadaisical attitude towards doctors and their own ailments. Keeping up with a general fall of moral values of today; patients no longer take the appointments seriously. Some don’t even have the courtesy of informing that they are unable to come. And this habit is not confined to the affluent class only. Some of the reasons for not being able to keep appointment are obvious like dug up roads, processions, strikes, festivals, traffic jams, Bombay bandh and ofcourse, the ubiquitous cricket matches which paralyse the working life of the whole country. It must be realised that a cancelled appointment, a no-show or delayed arrival has a cascading effect on other patients. The doctor may be twiddling his thumbs in his vacant time or may have to cut short the time he spends with each patient leading to dissatisfaction. For doctors like me, who do not want to miss a single diagnosis, this may affect the quality of his work, for which the patient himself is to be blamed. Some times the patients may arrive in clusters. This may influence the closing time of the doctor and may create problems of over-time with his staff.
People who neatly send a slip inside for “showing reports only” add to the confusion. Some of these investigations were ordered weeks before and the doctor may have forgotten the details, having to start anew with the same patient.
What is the way out of this quagmire? Advance fee collection from the patient before giving the next appointment? Noting down patient's address so that a bill can be sent? or the computer!! Allowing online appointments and accepting credit cards? A true
answer remains elusive!!
Acknowledgement I am very thankful to Dr. P Madhok for going through my article and updating the same, especially the ‘flowery’ language.
