This concept is about the 24 hrs medical group assistance I would like to see this in the Philippine setting. It has some derivatives from what i saw in US but totally different in the sense of procedure and culture. I have added so many other things that is only applicable to our Philippine setting. The goal of the program is to provide 24hrs continuous/ teachings/ information medical assistance to a certain group pf patients by a certain group of private doctors or community doctors employed in a hospital.
Lets focus on the middle/ lower income population to be able to help more Filipinos. Those that may seek medical consultations in provincial hospitals and or private doctors who charges below 400 pesos per visit.
The normal consultation process ( this process is also practiced in expensive hospitals and doctors ex. St Lukes and Medica City) is mostly to individual doctors who have no partners, and no group support. Or if patients go the government hospitals, it is to whoever is available in the ER or to a certain doctors who come on a special day of the week. The problems i have seen and encountered is that after the visit, if any questions or any problems like allergies to the medication arises, there are no way to contact the doctors, Most secretaries will not contact the doctors unless the patients are personal friends. The patients are then referred to the ER where the doctors on duty doesn't know the history, asks questions from families who are not medically informed and thus the treatment/ consultations start again. Labs are usually repeated because doctors don't trust all laboratories and some medications are changed because doctors do have their preferences and their different experiences. Many questions and problem's need not to be brought to an ER setting, Instructions may have not been complete from the office/ or just information families forgot to mention, or just other symptoms that may come up and not relevant to the case are so common to a sick person who doesn't understand. No ER doctor will report or update another doctor regarding a patient unless they are in the same hospital / institution and who may use same patient charts or records.
The concept is to groups doctors, preferably in their medical field of expertise. This doesnt' have to be always the case. Groupings can be with different fields too. This will provide a shared office and time slots, same secretaries and nurses for support and shared expenses like office equipments.The important is that there will be an on call doctor who can really sleep if the nurses are trained to answer questions after hours. The nurses can refer to the charts or records of what happened during the day/ and the written plan / diagnostics being ruled out by the same physician. Nurses can teach patients in simple words even over the phone what to do or things they dont need to worry about . Of course taking into consideration the knowledge of the nurses. And in times of not knowing what to do and say, the nurses have the option to call the doctor on duty for their expertise. There are so many ways for arrogant consultants not to be on duty , a lot of doctors moonlight in ERs and so they can do the same here.Nurses play a big role in educating and teaching patients that will prevent non compliance due to ignorance. Doctors are not so patient, are busy and tired and their time too is expensive. If there is a good system where doctors share patient informations and plan of care, nurses learn quickly by experience and from mine, i can honestly say that this is attainable .The doctor moonlighters( general practitioners) have no choice but to document on the same charts, report on the same doctors what / how his shift went. Follow up care and history will be no problem.
Lets focus on the middle/ lower income population to be able to help more Filipinos. Those that may seek medical consultations in provincial hospitals and or private doctors who charges below 400 pesos per visit.
The normal consultation process ( this process is also practiced in expensive hospitals and doctors ex. St Lukes and Medica City) is mostly to individual doctors who have no partners, and no group support. Or if patients go the government hospitals, it is to whoever is available in the ER or to a certain doctors who come on a special day of the week. The problems i have seen and encountered is that after the visit, if any questions or any problems like allergies to the medication arises, there are no way to contact the doctors, Most secretaries will not contact the doctors unless the patients are personal friends. The patients are then referred to the ER where the doctors on duty doesn't know the history, asks questions from families who are not medically informed and thus the treatment/ consultations start again. Labs are usually repeated because doctors don't trust all laboratories and some medications are changed because doctors do have their preferences and their different experiences. Many questions and problem's need not to be brought to an ER setting, Instructions may have not been complete from the office/ or just information families forgot to mention, or just other symptoms that may come up and not relevant to the case are so common to a sick person who doesn't understand. No ER doctor will report or update another doctor regarding a patient unless they are in the same hospital / institution and who may use same patient charts or records.
My concept will prevent an expensive and stressful ER experience that is not necessary, will educate and calm patients, and will give a chance for a continous medical assessment over the phone or the next day by the same doctor.The wholistic approach till illness resolves gives you a sense that the doctor is part of the family.
The concept is to groups doctors, preferably in their medical field of expertise. This doesnt' have to be always the case. Groupings can be with different fields too. This will provide a shared office and time slots, same secretaries and nurses for support and shared expenses like office equipments.The important is that there will be an on call doctor who can really sleep if the nurses are trained to answer questions after hours. The nurses can refer to the charts or records of what happened during the day/ and the written plan / diagnostics being ruled out by the same physician. Nurses can teach patients in simple words even over the phone what to do or things they dont need to worry about . Of course taking into consideration the knowledge of the nurses. And in times of not knowing what to do and say, the nurses have the option to call the doctor on duty for their expertise. There are so many ways for arrogant consultants not to be on duty , a lot of doctors moonlight in ERs and so they can do the same here.Nurses play a big role in educating and teaching patients that will prevent non compliance due to ignorance. Doctors are not so patient, are busy and tired and their time too is expensive. If there is a good system where doctors share patient informations and plan of care, nurses learn quickly by experience and from mine, i can honestly say that this is attainable .The doctor moonlighters( general practitioners) have no choice but to document on the same charts, report on the same doctors what / how his shift went. Follow up care and history will be no problem.
Another big aspect of care is teaching which the on duty nurse can expound to prevent worsening of the illness. Examples are for children who may have mild diarrhea and who don't need hospitalization, nurses may call them at home /or teach families if diarrhea exceeds 6 in the last 2 hrs to call the office for further plan. Nurses can teach what symptoms to look for if fever is already causing dehydration which families just let patients to sleep and rest. Dehydration kills kids fast.Families in the process will learn and can apply the vital information too next time. And if hospitalization is necessary, the nurse can call information to the ER for better and accurate history. History is very important. There will be slow and busy nights for the on call personell but surely it is cheaper than the unnecessary hospitalization. Here in the Philippines,if there is a vacant room, mostly.patients not doctors decide to be hospitalized due to fear of what they don;t know how to handle at home. 3
This is in the line with patient care, but in line with business, as the business grow which it will because of the care provided, the same group can open its own drug store, its own laboratory and other allied services to provide their needs. The right service will bring in profit. Doctors are not usually good business managers, more so in a group like this. They should focus on their patient care and treatment. That is when we business graduates of Ateneo come in .
Thank you
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