APPOINTMENT MANAGEMENT

I follow an appointment system in my clinic. I believe that my patient’s time is as precious as mine, and try to ensure that they do not have to spend too much time waiting in my clinic. I also feel that as my patients are emotionally distressed, waiting could worsen their condition. I try to ensure that no patient waits more than 15 minutes in my clinic. The maximum time a patient has waited in my clinic is about 1 hour.

 

About 50% of patients, who are scheduled to see me for the first time (New patients) don’t turn up. And they do so without informing me, which means I wait for them and after half an hour of ‘no show’, conclude that they will not come. About 40% patients coming for follow up are delayed by at least 15-20 minutes. Around 10% patients schedule appointments repeatedly but fail to make it with/ without informing. A small percentage, walk in without appointment and insist on being seen.  Another (surprisingly common) patient is the one who arrives in clinic after I have reached home and then phones me requesting me to come back to clinic or that the patient will come to my home for consultation. Their logic is: now I have the time- see me. I never entertain such requests.

 

To ensure proper time management, I never schedule anything else near my clinic timings. I ensure that I leave home early and always arrive on time. I prepare in advance for my therapy appointments and long review appointments. I schedule the patients carefully, so there a few who require more time and few who require shorter consultations. I always schedule regular and punctual patients in the first slot. No matter what time the patient arrives, I always end my consultation at the same time. (Yes, I do charge full consultation fee, why should I not do so?) If there is not enough time left, I reschedule the appointment. For habitual latecomers, I do not give appointments, but tell them to walk in a range of timings and wait. Due to the large numbers of new patients coming late (cant estimate commute time?) or not coming at all, I never schedule appointments but ask them to attend the walk-in clinic on weekends.

 

I often feel that the appointment system is counterproductive for me. The no-show and latecomers throw my schedule out of gear and it is quite unfair on the patients who arrive on time.  Some patients who arrive on time, don’t understand that the earlier patients had come late and so their appointment is getting delayed. Another set of patients who come late just want to be seen right away, without realising that the next patient who is likely to arrive on time, will get delayed because of them. I feel I should detain the first type of patient and make him/ her explain to the second type- but both usually fight loudly with me.  Patients who come late are seldom remorseful and never care to mend their ways. This way everybody is a loser.  Meanwhile, I am paying for the overheads, I don’t get to express my disappointment and my family always has to see me home later than expected.

 

I sometimes feel, that I should abandon the appointment system as it affects me badly. I can tell all patients to come and be prepared to wait indefinitely and see them on a first-come-first –seen basis. This is followed by most doctors. It clearly places the doctor at an advantage as the doctor does not waste time waiting for the patient. But I feel it is not fair, to make the patients wait like that. I don’t know how much longer I can act with regard this principle of propriety and stick to the appointment system.  

 

But of late, I do turn away patients who habitually come late, or are delayed by more than 30 minutes. I charge full fees for the second missed appointment. This way I feel I can control my schedule as well as have some sense of justice for my efforts.

 

MEDICAL IMAGE- MAGAZINE OF IMA

From,

Dr Vani Kulhalli,

Psychiatrist,

Life Member,

IMA BWS Branch,

Mumbai.

To,

President and Editor,

Medical Image,

IMA,

Mumbai.

Subject- Consider converting Medical Image to e-magazine

Date-27-9-2012

Dear Sir,

I am a member of the Editorial committee and have noticed that we spend a lot of money in printing and distributing the MEDICAL IMAGE every month. This puts us at a disadvantage as we have to solicit advertisements and have to restrict the number of articles published. We may lose out on good quality articles. I also feel that we have developed a bias towards publishing articles from persons who are able to arrange for sponsorships. In other words, persons who have the resources to fund our magazine have developed the power to control editorial decisions. This is unacceptable standard of conduct for an august association as ours.

 Besides, we must consider the environmental impact of using so much paper, ink, plastic packaging and fuel for transport of copies. Therefore, I suggest that we must do away with the paper version of ‘Medical Image’ and send our members the electronic version only.

The argument of ‘not having time to access internet’ or ‘not being able to deal with new technology’ is no longer tenable. All our members use the latest mobile phones and learn to drive the  latest models of cars. Most habitually use Facebook and web albums as well as Skype to keep in touch with their children and friends. Then why the bias against learning the technology required for reading an e-magazine?

I think that we must waste no further time in converting our magazine into its electronic version only.  Kindly, consider this decision.

Note that I am sending a copy to some members, who are not in our Editorial committee but who are significant opinion-makers of our organisation.

Sincerely,

Dr Vani Kulhalli

CAREER PLANNING FOR YOUNG PSYCHIATRISTS- CONTACT IPS

After several years of complaining to all the high and mighty about the dearth of mentoring opportunities for young Psychiatrist, I was completely thrilled that Dr Vishal Reddy took up this task and formulated a CME based on it. I heartily congratulate Vishal and the other Editors on bringing out this book.

This book is a collection of the material presented in the CME. I think the cover is quite apt, and the 'wings' look really nice. Does the orange-yellow colour scheme suggest 'burning ambition to succeed'? Also the the teasing statement 'what you dont learn at college' is very apppropriate. The book is 170 pages and enables reading in one day.  The initial write-ups provide with an adequate and appropriate introduction.  

Most of the chapters are on careers in specialty psychiatry. The Chapters titled ‘Mastering the Art of Private Practice’, ‘Balancing academics with practice of psychiatry’, ‘Beyond Money!’ are very good and practically helpful. The chapter ‘Gender issues’ seems to have missed the point.  Overall, the book succeeds in providing guidance to young psychiatrists on important matters. 

I hope this will only be the first edition, and the beginning of an initiative which grows larger. Psychiatry is among the best professions and provides a most needed service to the community. By providing directions to the new crop of Psychiatrists and helping them survive, Psychiatry will survive.

In the next edition, I would expect a survey/ study of the common difficulties faced by young Psychiatrists and the means used to deal with them. I want someone to write honestly and practically about the career prospects and concerns of women Psychiatrists. (For now, I recommend Dr Syyeda Ruksheda’s article, on this topic). I wish we could set up a careers  cell in IPS, which helps psychiatrists find jobs and assignments. I also wish we could have some mentor-groups, who help youngsters settle into their profession.

 I would say, this initiative is not only innovative but also a very noble one. The contributors seem to have honestly shared all things they know, and this is a remarkable feature in the context of competitiveness and somewhat selfish nature of most doctors (I am sorry, but it is true).

I would recommend this book as a useful (not necessary) reading for any young Indian Psychiatrist. I cannot comment on how you can get your hands on a copy; though I have planned to give mine for display in the library of KEM Hospital, Mumbai. I don’t know if the IPS will be making this compilation widely available. At least they could put it on their website.

 

 

PHENOMENOLOGY OF CANNABIS-RELATED PSYCHIATRIC DISORDERS.

IMPACT OF HEALTH EDUCATION ABOUT LEPROSY- INTERNSHIP PROJECT

BOVINE SPONGIFORM ENCEPHALOPATHY

PUBLISHED IN GOLDEN JUBILEE SOUVENIR OF BYJEMEC, B J MEDICAL COLLEGE, PUNE IN 1996.

THE WORLD AROUND YOU

I have worked in private practice as well as in an institute. My impression is that the amount of work a psychiatrist gets does depend on the setting of work.

In an institute, I have observed that the threshold for asking a Psychiatrist to get involved is rather low. We get referred any case and every case. Hence the workload is considerably high. Whereas, in private practice the referrals are slow to come. Even serious and purely 'Psyhciatric case' like suicide attempts and psychoses are retained by doctors from other specialties. Thus cases are fewer.

One explanation for this is due to the desire to work less and also to make more money; both being at the cost of the patient's welfare.

 In the first instance, the patient would benefit from continuing care of the Physician/ orthopedician, etc. But the salary remaining constant, this doctor has nothing to gain from keeping the patient in the wards and increasing his/ her workload. This doctor also has a culture of concrete thinking, where seeing ONLY is beleiving and quality of life has no meaning. But if patient is not accepting his explanation that everything is ok, and the relatives refuse to take the patient as he/ she is still distressed or troublesome, the doctor bounces off the patient to the Psychiatrist. No Psychiatrist can refuse to take care of a patient who is obviously uncomfortable. So the patient with many medical problems, and just mental symptoms (not mental illness) gets shifted to the Psychiatry ward. Now the Psychiatrist and the patient have to keep begging the referring doctor to come  regularly and have a look to maintian the physical status. This gives the additional incentive of 'ego massage' to the referring doctor, who believes that Psychiatrists are lesser mortals and anyway dont have any work to do.

The scenario is much different in private practice. Every doctor believes that Psychiatric disorders are not disorders at all and counseling will set everything alright. They are scared to use psychiatric drugs in proper doses, but since they are so intelligent they will open some book, find a few names of psychotropics and discharge the patient with a scolding and 'good advice' (which is their version of counseling). After all by treating the patients themselves, and keeping them ill as long as possible, there is money to be made. When the patient becomes fed-up or very ill, they will, very reluctantly refer to the Psychiatrist. By this time the disease has progressed to such an extent that it is a tuff situation even for a Psychiatrist and the improvement proceeds slowly, partially or not at all. Then they confirm their delusion that 'Psychiatrist know nothing and do nothing' and malign them.

I feel every professional should spend some time educating themselves about the thresholds for referral to Psychiatrists. They can just make it a habit to talk to the Psychiatrists about the cases they have referred; over the years they will learn. Of course, one can do nothing aboout unscrupulous persons who dont want to refer patients.

I am sure this discussion applies to referrals between other specialties also.