The Consultation Room

Prof. Dr. CMK. Reddy

General & Vascular Surgeon, Halsted Surgical Clinic, Chennai, Tamilnadu, India

Chapter 86: Sharing consultation room with others

This arrangement is irksome, but inevitable, in larger establishments, with several visiting consultants, coming at various times. The available consultation chambers are efficiently allotted to the ‘outside’ consultants, at different time slots, to accommodate maximum number, in their limited facility.

Sometimes (or often rather) you may have to face embarrassment of waiting outside ‘your’ chamber, since the consultant of previous time slot is holding it. As the hospital administration has no control over such matters, there is little use by complaining. Best solution is to develop a symbiotic relationship with the consultant over-shooting his time and politely request for cooperation and respect the ‘time slot concept’.

You will be lucky to get the time slot for the room, first in the morning, but be considerate, avoid overshooting your time and make the next Doctor wait outside.

Chapter 87: Doctor going on leave

If you’re going on a planned leave for a considerable period, say weeks or months, it’s desirable you request one of your colleagues of same specialty to look after your patients during that period. Your secretary has to redirect the patients requesting for appointments, to the Doctor taking the calls, if they can’t wait till you return. This system is well stream-lined in the western countries.

It’s ethical that the Doctor taking calls handles only those problems that can’t reasonably wait and ‘handover’ the practice to the primary Doctor, as soon as he rejoins duty. If any active intervention, such as a surgery or angiogram is required, the Doctor on call should discuss the matter on phone with the patient’s primary Doctor (in whom the patient may have more confidence) and decide the course of action, including the choice of another specialist, if required.

The Doctor who attended on your patients during your absence, is entitled to charge for his service, but not to steal your practice.

Chapter 88: Professional confidentiality

We are bound by the Hippocratic oath to maintain strict secrecy of all the medical or personal information related to any patient, disclosed to or discovered by us.

The exceptions when we are allowed to disclose patient’s medical information are : the investigating officer or the court of law (as expert witness), the insurance company, the employer, the Health authorities, when a violent patient may harm others and finally to any one with the consent of the patient.

These are put as 5-Cs for easy remembrance when the Doctor may disclose confidential information :

Consent: with the consent of the patient or a legally authorized surrogate decision maker, such as a parent or guardian

Court Order: upon the receipt of an order by a court of competent jurisdiction

Community Health: necessary to the Health authority, in the interest of protecting the community or epidemiological statistics

Comply with the Law: in order to comply with mandatory reporting statutes (e.g., child abuse or domestic violence), law enforcement or authorized investigating agency

Communicate a Threat: this exception to confidentiality involves the clinician’s duty to protect others from violence by a patient.

Sometimes, a would-be spouse (fiancé or fiancée) or in-law may want to know about someone’s health issues. They can’t be disclosed without the consent of the person concerned.

Chapter 89: Supporting professional bodies

It’s very important that every Doctor becomes a member of a professional organization of his choice, preferably his specialty. It provides you regular updating facility, circulate important news and events, protects you against hostility by any individual or social threat in discharging your duties, it fights for the rights and privileges of the members and makes you feel that you’re in the main stream of the profession.

On the other hand a Doctor has certain responsibilities towards the organization: participating in programs related to public health (eg: polio, malaria, tuberculosis, leprosy, pandemics), supporting any protest against injustice done to a member or to the entire fraternity, contributing to the welfare schemes or to the ‘think bank’ of the profession etc.

Greater the strength of any medical organization, better the negotiating power with the Govt. or with the insurance companies, on genuine issues or whenever unjustified decisions are taken by them against the interests of medical profession.

In short, if we support our Associations, they will come to our rescue when we are in trouble. In elections, it’s your duty to elect people with clean track record to run the organization, weeding out any ‘black sheep’, so that we can expect dedicated, honest administration from them. Beware, most of the organizations earn ill reputation in handling money matters.

Chapter 90: Pediatric patient

Doctors working with children should have a good knowledge of child psychology and normal developmental milestones. It is important to have established rapport with parents and the child when taking the history. Assure the child that you’re not going to give an injection. Keep some chocolates and some (unbreakable and not sharp) toys in your room to make the children feel at home and to distract their attention.

Even a pen torch, ear speculum or calling bell can be a useful distraction. The approach to the examination will be determined by the age, level of development and level of understanding of the child. Avoid waking up sleeping children. Approach the child at their level; if necessary, kneel on the floor. It may be impossible to examine pyrexial, irritable children without provoking crying and they should be carefully observed before attempting closer examination.

Start examining peripherally (hands and feet), as this is less threatening. Make sure the child is comfortable in cold climates and that your hands, stethoscope and other instruments are warm. Ask parents to assist with dressing or undressing children and be aware of sensitivities about this. Inspection and observation are the most important aspects of the examination.

Observe the child’s behaviour and level of awareness and corroborate with the parents’ statememts. Consider if the child’s appearance is unusual and if there are any recognisable anomalies. If there are any bruises, note their color, shape and positions. If they are of suspicious nature, consider the possibility of being non-accidental.

Avoid examinations such as rectal examination, as it may cause discomfort, unless it’s essential. If a child requires x-ray of a limb for suspected fracture, it’s better to take normal side also, for comparison, since unfused epiphysis may cause confusion.

The Consultation Room