I am ill and visit a physician in his office. I am sick, am admitted to the hospital and a physician comes to my bedside.
The above situation is often frightening to most persons. We think about the worse possible scenario. We accept whatever the physician says or does without questions.
Medicine has evolved to allow the patient to be an active participant in their care. The physician is no longer “Lord, God and Almighty;” that existed when I started my long career in the practice of medicine.
Three situations allow contact between patient and physician: the first-time visit to a physician or first admission to the hospital, a follow-up appointment with the same physician and routine annual checkup. The time spent on the encounter is longest with the first and shortest with the second.
The components of a complete visit include:
History (story) taking – what brought you to the doctor today
Physical examination – observation and use of the hands on the patient Tentative diagnosis (what is wrong) Performed or requested investigation – body fluids analysis and imaging What is the current understanding of the cause of your illness?
Treatment – medications and lifestyle changes
Followup appointment if needed – to determine the response to treatment and results of the requested investigation.
Referral to specialist or institutions with better facilities compared to that existing at the site of this visit.
The nature of the visit determines the extent of evaluation.
A physician is expected to ask questions and obtain a history of the patient’s illness, perform a physical examination, arrive at a tentative diagnosis (what is the cause of the complaints), completed or request tests if indicated and render treatment as required.
The extent of each component is dependent on the type of visit and the cause of the complaints.
Too often an encounter goes like this:
Doctor – tell me what is wrong with you
Patient – I have a headache doctor
Doctor – OK, take these pills, and you will feel better.
Please note the doctor did not examine the patient. Many diseases have the same complaint but differ in the findings on physical examination.
Should a patient pay for such a visit? I believe not.
Information volunteered by the patient and information obtained on direct questioning by the physician.
The physical examination:
Using the powers of vision (observation) noting such things as facial expression, swellings, gait, and deformities. The use of the hands follows the visual perceptions. During the physical examination, the physician should inform the patient of what to expect.
The number of areas examined is determined by the nature of the complaints and the type of visit.
The physician must explain the elements of the reason for the complaints to the patient, ask of their understanding and invite a discussion.
The patient is advised of any test planned, their nature and the reason for same.
Discussion with the patient must include all elements of the management. The patient must be given the opportunity to ask questions, elicit their understanding of their illness and the physician should ensure that the patient understands the name, the reason for its use, side effects of any medication and expected outcome.
It is essential that the physician sees the patient at a subsequent visit to determine the success or failure of a given treatment. It may require more than one visit to treat an illness successfully.
I offer these guidelines to foster a better understanding between patient and physician resulting in better medical care for our
Dr. Winston Mitchell, MBBS, FACS
Past acting Medical Director of St. George’s General Hospital