Peru – Fine Tuning

The clinic has been open for 1.5 weeks now.  We had a chance to see the Good Doc in action and now it is time for some refinement of our processes.  Rene and I met with the Good Doc at his new apartment and we had a very effective meeting where we discussed how we can improve the delivery of medicine at the clinic.

Problem 1)  Patient care is be sacrificed in an effort to see more patients.  Does this sound familiar?  While I can’t change the way my primary care physician in the states filters patients in and out in a matter of minutes, I can have a say over how my clinic in Peru operates.  Doctors in Peru have been conditioned to see as many patients in one day as possible.  Their performance is usually measured by quantity.  We told David to forget about quantity and focus on quality.  After all, there are no HMOs involved and we are not making a bigger profit from seeing more patients.  It is important to find a balance.  I don’t want people to wait for several hours before they are seen yet I don’t want the doc to feel rushed.  The doc had been seeing 34 patients per day.  We asked him to instead see 24 patients in the same amount of time.  Once there is 24 patients on the list, the nurse is able to kindly ask incoming patients to return the following day if their condition is not an emergency.

Problem 2)  The solution to every medical condition is to prescribe medicine.  Patients are being seen by the doctor, offered a diagnosis, and given a goody bag of meds which will magically cure their illness.  Bye bye.  Bada boom…bada bing.  That’s what the patients expect.  They come to the clinic and they expect to receive medicine to make them better.  It appears that overmedication is commonplace.  “You have a cold?  Heres some antibiotics!  You have an upset stomach?  Heres some antibiotics!  Your knee hurts?  Heres some antibiotics!”  Prescribing medicine can be effective in many instances but it is the easy way out and it really needs to be complemented with preventative medicine.  Attention is rarely given to explaining the patients illness, nor what they can do to prevent the illness in the future, nor why they need to take the medicine.  The patients are not being educated.  We implemented a plan to incorporate patient education into every facet of their experience with the clinic.  Maybe a prescription does not call for medication.  Maybe the prescription calls for eating more fruits and vegetables…or doing certain exercises to strengthen patient’s back muscles…or to wear a dust filter mask.  If a women comes in with a UTI, we now explain to her what a UTI is, why she has the UTI, and how she can prevent the UTI in the future.  Pictures are drawn.  Questions are asked.  If medicine is prescribed, special attention is given to ensuring the patient understands the dosing indications.  This is reiterated by Rosy, the Pharmacist, when the patient picks up the meds.  They are hit with education and prevention from all angles.  Maybe down the road, patients wont have to make as many trips to the clinic because they are leading healthier lifestyles and passing their newfound knowledge onto their families.

Problem 3)  Patients are taking advantage of the “free” nature of the clinic.  Many people come to the clinic, not because they are sick, but because they want something for free!  They want free medicine!  Doctor David is quite experience in community medicine.  He knows that patients in Pisco are picky.  Bad word spreads.  If someone visits the clinic with the expectation that they will leave with something, even if it is 2 tabs of ibuprofen, and they actually leave empty handed, then they may be inclined to speak poorly about the clinic.  Soooooo…the doc typically prescribes something to everyone so they don’t have to leave empty handed.  It is the doc’s responsibility to act ethically and responsibly.  If he believes the patient can benefit from medication, then great.  If not, then he is not encouraged to prescribe anything at all.  Instead, spend the time to educate the patients as to why they do not need medication.  No more handouts will be given just because.  If the clinic receives a bad wrap because the patients aren’t receiving medicine they don’t need, then that is my problem…not Doctor David’s…and we made this very apparent.

When someone gets sick, I want them to think of our clinic first, not because we give free medicine, but because they know they will receive superior patient care.  The 3 problems listed above are not specific to Doctor David.  They are common problems in every medical facility we visited in Peru.  We are doing what we can to change the way medical services are delivered and hopefully patients will appreciate better patient care and begin to expect it at other nearby health centers.  We are starting a trend and we want to infect the other medical centers with crazy ideas of excellent patient care so the community benefits.  I think Doctor David agrees with many of the philosophies and he is thankful that we are empowering him and supporting him to administer the quality of patient care he is capable of.

We all felt great after the meeting as we were proud of the direction we taking things.