The best of times to see your doctor

Health care is a 24/7 business. After all, illnesses don’t choose when to strike. It can be any day of the week, and any time of the day. Whenever you have been unwell, am sure you have just made your way to the doctor’s and expected optimal attention regardless of the time or day of the week. For most cases all goes well, and your doctor seems to always function at their best regardless of the timing of your arrival.

But is it really true that doctors are always at their best? Is your eventual outcome related to when you see your doctor? At the face value, it may not seem any different if you see your doctor either early in the week, or towards end week. You may even deem it more practical to see your doctor towards the end of the day, when you are done with all other chores. May be you have done this all your life, and everything has always been ok.

But you would be wrong. The timing of encounters with your doctor matter a great deal. You see, the body is biologically wired to function in a certain way. After a good restful night, the body and mind are at their best in the mornings. Reaction times and cognition tend to slow down as the day advances, and are worst at night. And as the working week continues, there is the inevitable buildup of fatigue and exhaustion, with all faculties slowing down towards end week. Doctors are only human, hence they are not spared from this biological cycle.

Several studies have tried to look at whether your risk of medical harm, or death, is influenced by the timing of your encounters with doctors. The emergent bottom-line is that tired doctors are not good for you. The more hours your doctor puts in, the more the rise in rates of medical errors. That translates into missed diagnoses, wrong prescriptions, more complications, and more risks of serious medical harm or even death.

There you are. The best times for doctors’ appointments are therefore during daytime, preferably mornings or early afternoons. Early in the week is preferable, better to leave the weekends alone. Out of hours and nights are a big no. But what about if all these preferable appointments are all filled up? And what about emergencies? Well, any non-urgent cases can wait. Emergencies are a different matter.

Don’t suddenly be wary of doctors working late in the day, or on weekends. There are many safeguards in healthcare to ensure your safety. But keep your wits about you. If you select the best timings for your doctor’s encounters, you get them at their best. If you are always the last on the queue, at the end of the day, and on the last day of the week, you might come out worse one day.

Can Patients Handle the Truth? Getting Access to Doctors’ Notes

Do you want to see your doctor’s medical notes?

Doctor, What right do you have to keep the patient out of the loop?

Should Doctors Notes be open and available to the patient?

We are fast entering the era of the electronic health record, when it will be possible to call up our medical records on our computers and mobile devices. Medication lists, lab results, and appointment schedules—they’ll all be available with clicks of your mouse or taps on the screen of your smartphone, iPad or tablet. An extension and expansion of e-health, e-medicine,-e-doctor and now e-patient!

But one question that’s far from settled is whether the electronic health record should include the notes that doctors make about them. A doctor’s notes can be straightforward, such as a reminder that an additional test might be needed. But they can also include somewhat speculative observations and hunches about a patient and his or her medical conditions. The Open Notes project is a research program designed to test the consequences of giving patients access to doctors’ notes.

The last time you were at the doctor’s office, and your physician scribbled or typed something into your chart, did you wonder what it said? If so, you’re in the majority: according to a new survey, more than 90% of patients said they would want to know. Not surprisingly the doctors resist this idea.

Office visit notes constitute include not only patients’ medical history, but also a record of what was discussed with the physician in the privacy of the exam room and in some cases, the doctors’ insights into patients’ forecast of likely course of disease and guesses about what might be ailing them.

The difference in opinion is hardly surprising. After all, the Kenyan health-care system like many others around the world is built on the paternalistic view that doctor-knows-best — the physician is the gatekeeper for providing and interpreting any information related to our medical care. Increasingly, however, patients are demanding transparency and taking back control of their health and their health records.

In a recently published trial, 75% of patients said it would improve their adherence to their medications, if they could see in their chart why the doctor thought they needed the drugs and how they might help them. Most patients also said having open notes would encourage them be more in control of their care and take better care of themselves.

Such openness may pose challenges in certain cases, however. Psychiatric patients represent a sensitive population when it comes to sharing medical information, and these cases may require special protocols to ensure that patients are not exposed to undue harm by reading about how their physicians interpret their symptoms.

But the fact that patients were overwhelmingly in favor of seeing their doctors’ notes suggests that physicians may be facing a sea change in the way they deliver care They need to recognize that what they put in a chart is in fact likely available to not just patients but their families, and they should behave accordingly.

I’m in the camp that thinks the benefits of Open notes will probably outweigh the downsides

A colleague who thinks otherwise reckons, “Personally, I don’t like the idea of Open Notes,” “I think that doctors will have to spend a lot of time explaining to patients what they meant if a patient misinterprets. For example, a doctor may see a patient as ‘anxious’ or ‘depressed’ or ‘obese’ or ‘alcohol dependent’ or ‘drug dependant’ and the patient may object, perhaps because they don’t see themselves that way, or perhaps because they don’t want this description in the notes.”

Others say doctors may alter what they say in their notes so as not to upset patients, and important pieces of information may be lost as a result.

A good doctor-patient relationship should be based on honesty regarding diagnosis and treatment options, However, the medical record and notes are a place where doctors should be able to describe uncertainties, subtle observations, and speculations while an evaluation is being undertaken without having to worry about needlessly upsetting patients who may not have the medical background to interpret the process.”

So what do you think? Would you like to see your doctor’s notes? For what purpose? Is there a danger that they will be misinterpreted?

SideBar

Patients and doctors have dramatically different visions about the value of access to physicians' notes about their patients, a new survey from Harvard Medical School released recently shows.

Patients overwhelmingly favor access to doctors' records, researchers found, including:Ninety-four percent believed the records should be available.

Ninety percent said the information would give them more control.

Eighty percent said they would take better care of themselves because of the information.

More than half said the information would help them take their medication properly.

About 20% of patients said they would share the notes with friends and family, which may further increase the likelihood that they will follow their doctor’s advice and benefit from the care they receive

Doctors, on the other hand, worried access to their notes would confuse patients, that it would not benefit them because they would not change their behavior, and that it would lead to such an influx of phone calls and concerns that their practices would be overwhelmed

As many as 80% of the surveyed doctors said they were frightened by the idea of allowing the records to be accessible

Quote: "I have no idea what I'll find in my doctor's notes, but I think it may help me in the long run.”- Patient

If you are well, stay away from hospitals

The phenomenon of healthy individuals seeking unwarranted health care is well known. There are several reasons for this kind of behavior. There are also downstream negative effects affecting the individuals concerned, coupled with inevitable consequences on overall healthcare services.

But why would completely healthy individuals seek healthcare services? Some may just be paranoid, looking for the proverbial but non-existent needle in a hay stack. Others may have unused healthcare funds that they may want to exhaust, in a rather objectionable manner. Yet others may have nothing better to do with their time, choosing to waste healthcare resources unnecessarily.

If you deliberately end up at your doctor’s without a good reason, you may be unwittingly brewing trouble for yourself. You’ll have to come up with some sort of credible tale to justify your presence. Your doctor may patiently go over you, possibly coming up with findings that add up to what you just made up. One thing may lead to another, and you may end up with a barrage of tests, prescriptions, or other interventions that are completely worthless. Some interventions may eventually harm you. And all you ever did was visit the doctor on a whim.

The health system suffers too. If you are occupying a doctor’s slot when completely well, you are inevitably denying a more deserving person who may be too unwell. This can contribute to poor outcomes for others who have to wait behind you. There is also a strain on the healthcare system’s efficiency. So much unnecessary stuff gets done, wasting resources linked to healthcare personnel and ancillary services.

Can doctors tell when patients are malingering and wasting everyone else’s time? Often times yes, but other times no. Many doctors are forthright, and will not allow anybody to waste their valuable time. But given the nature of healthcare, many health workers will always give you the benefit of doubt, and try and work out if you are indeed suffering from some elusive condition.

The summative effect of seeking healthcare unnecessarily is the eventual poor productivity for everyone involved. You end up wasting your own time and resources, you could have done something more useful than bothering the doctors unnecessarily. The focus of healthcare workers is blurred, with their attention getting diverted from those sicker and more deserving. Ample healthcare investments and resources end up on the wrong pathway. Everyone takes a hit.

If truly unwell, get yourself to the doctors promptly. If your health screening interval is due, get your tests updated without any undue fuss. But if you have no business with the doctors, better to stay away. You’ll have done yourself, and others, some good.

Dr Alfred Murage is a Consultant Gynecologist and Fertility Specialist. amurage@mygyno.co.ke

Helping the injured in the face of tragedy

It’s difficult to comprehend how a whole community can continue to live in an obviously unsafe and condemned building. But there are several reasons why this is the case though. Think of the levels of poverty and desperation, and the human nature that demands some sort of shelter. For some, any place will do, they don’t have that many choices. Legislation and enforcement of safe housing standards is another matter altogether.

In true Kenyan spirit, we all rally towards each other in the face of tragedy. It wasn’t any different in Huruma. Scores of people immediately rushed to the site as soon as it was apparent that those who were trapped in the building needed help, and fast. This is pretty commendable. But from a medical viewpoint, you have to be aware of certain principles when trying to help individuals with unknown injuries.

The first precaution is to ensure your own safety. You cannot really help others if you get yourself injured in the process. And it doesn’t help to add yourself onto the tally of casualties. You must approach the disaster site with extreme caution, and in the right gear. If you happen to be a member of a trained group of first responders, this is obvious. If you are a lay person, the more the reason to be extremely cautious.

There will always be some sort of organized response in disaster zones. We are talking of the police, fire brigade, or some other specialized rescue teams like the Red Cross. Such teams have vast experience in coordinating rescues. It’s your duty to facilitate their efforts by obeying any directions they give, and not obstructing them in any way. You may be itching to help pull out an injured person from the rubble. But you may be so clueless that you might cause unintended harm, just by the way you handle the injured. Let the professional teams do it, or follow their instructions attentively.

There are other ways of helping without directly making your way to the site where disaster has struck. There will inevitably be pleas for blood donations, assisting with items of clothing, food and water, or even arranging some make-shift shelter for some. Appeals for contributions to a disaster fund may also come through. Whatever role you might play, however small, will go a long way in alleviating the immediate suffering of those affected.

We seem to court catastrophes, they happen too often in our midst. Sadly, we haven’t done enough yet to keep ourselves away from more preventable disasters. Next time it happens, choose your rescue role objectively. You may find yourself helping save lives.