Prof. Dr. Sundeep Mishra provides smart and useful pointers for doctors to bring in new as well as retain older patients in their medical practice.

“The only constant thing in this world is change.” This applies equally well, to the profession of medicine which is constantly changing with time. Thus if a previously successful medicine practice doses not change with time, it will lose steam and become redundant. On the other hand steps taken to adjust with upcoming future will bear huge dividends.

Here are 10 smart ideas which will align any practice with future.

---

Heart Sounds- Offer better discharge summary

Cardiology patients and patients with some other speciality often leave the hospital with a complex discharge summary, a heap of high-risk medications, post-procedural care prescription and recommendations for drastic lifestyle changes, all delivered in a time-constrained discharge discussion.

This can result in an ineffective hospital discharge communication which can significantly impact patient understanding, safety, and treatment adherence. In this context, audio/video recordings can supplement the usual discharge communication to improve cardiology patients'/caretakers ability to understand and manage care after leaving the hospital.

Patients could choose their preferred method of audio/video recordings: MP3/MP4, smartphone or other options. This medium could help increase patient and family engagement in healthcare by providing preference sensitive options for the delivery of important medical information.

---

Embrace technological advances and have some of these gizmos in the clinic

Young patients are keen on having a technologically-connected healthcare experience, and physicians can easily achieve it through the use of cost-effective/cost-free state-of-art technology clinics/hospitals. A few examples:

• State of art technology like a digital stethoscope and google glass can create an impression that the practice is aligned with modern times
• EarlySense Proactive enables doctors and their medical staff to capture all a patients vitals (heart rate, respiratory rate) in the clinic instantaneously which not only reduces the time but also reduces mistakes of recording incorrect readings
• Infrared thermometers now give accurate temperatures in one second, with no contact required
• VScan is a pocket-sized ultrasound, allowing doctors to access many systems of the body including the abdominal, cardiac, urology, fetal, thoracic and others, and the device helps speed decisions doctors normally would need to make after receiving x-rays; unnecessary testing is also reduced
• Use of photoplethysmography to measure ankle: brachial index
• AV300 Vein Viewing System is a handy gadget that makes viewing clumps and other issues with veins simple
• Using App based risk scoring and providing these scores to patients with explanation free of cost
• The Wacom Intuos system instantly converts what physicians write into a digitally readable format and they can be good for generating prescriptions or record keeping
• Smart pill containers can be given to the patients as they emit light and sound alerting patients when it’s time to take their medication, and if the dosage is skipped, an alert is sent to the caregiver or patient and they can also allow doctors to monitor patient’s prescriptions 
• Ability to download lab results at the convenience of their home from clinic/hospital portal

---

Be Internet and Social Media Savvy

The present age is of information and communication. The essence of communicating with healthcare and lay community is through writing, speaking, and making use of the Internet. Electronic media is the way physicians’ message/philosophy can reach potentially millions at practically no cost.

As more and more individuals become e-literate, this technology is going to be the major medium for information gathering in the near future. It has been estimated that 70% of patients expect a well-maintained website and social media presence and 1 out of 6 access social networks when trying to identify medical practice they wish to avail at least in the West.

---

Build a mobile-responsive website and host contents

• Start a blog
• Encourage online reviews
• Open social media accounts
• Post technical and educative videos on YouTube
• Case discussions @ WhattsApp
• Monitor your/group's online presence

---

Be available at all times

Physician accessibility is the number one factor driving a successful practice. The doctors will have to make themselves available at the convenience of the patients. Some dos can go a long way:

1. The physician should make an alternative arrangement for the patient if he/she is unavailable.
2. The patients should always be given emergency numbers where their calls can be answered, at least the emergency calls.
3. It is a good idea to set up a dedicated time to receive patient calls at least for an hour or so every week. Of course, diagnosis and treatment cannot be initiated during these calls but some issues can be clarified and some mis-understandings removed.

---

Deliver quality service

Quality of service is the key to a successful practice. On an average, a satisfied patient will refer 4 new patients but a dissatisfied one will prevent 10 patients from reaching the clinic. There is no way patients will refer others to the practice if they aren’t satisfied with the services of a clinic / hospital or attitude of their personnel. On the other hand, 70% of the complaining patients will come back if the issue is resolved in their favor. Some simple ways to improve the quality of healthcare are:

• There should be standard practice protocols for all broad conditions
• The protocols should comply with national and international guidelines
• Active multispecialty support should be readily available
• Most important investigations should be available under the roof/nearby
• Improving the quality of the decision-making process for patients with a detailed, video patient decision aid and an online, interactive patient decision aid
• Providing educational material during in-patient and out-patient period
• The look and feel of the clinic/hospital and the manners of health care providers is extremely important
• Professionals should be able to communicate well with the patients and their presence should be positive and uplifting, not creating panic in the mind of patients/caretakers
• Electronic record-keeping and detailed discharge summary with all instructions including those dealing with lifestyle modifications; diet, and exercise should be maintained
• Rigorous clinical practice assessment (clinical data collection, questionnaires) should be done, as it is a key factor to improve patient's care and prognosis
• All patients and all their complaints should be taken seriously

---

Active paramedical support

Many a times the physician may not have enough time to go into each and every aspect of diagnosis and treatment personally. When overloaded with cases, physician attention capacity and clinical performance can be grossly challenged.

A physician assistant, nurse, pharmacist, nutritionist, physiotherapist or other paramedical staff can be invaluable in filling up these gaps in healthcare delivery.

---

Support Groups and Group Appointments

Conducting a support group is an excellent way to target a specific patient group (elderly, women or ethnic group) diagnosis/disease state. Although the majority of older patients admitted to a cardiology/medicine practice present with at least one geriatric syndrome, guidelines on managing disease often do not consider the complex needs of frail older patients.

Geriatric co-management has demonstrated potential to improve functional status and prevent functional decline, complications, mortality, readmission rates, reducing the length of stay and improving quality of life in older patients. Likewise, women or some ethnicities or patients with certain disease conditions like heart failure, end-stage heart disease or post-transplant patients may benefit from a group approach. Support group for caregivers is another attractive area.

---

Self-care Interventions for Family Caregivers

Family caregivers are the key to the long-term outcome in the cardiac patients, especially those with heart failure but they are themselves prone to emotional and mental stress. Lack of training and social support puts them at risk of depression, anxiety and failure to take care of their own/loved one's healthcare needs.

The following steps can be undertaken to improve their emotional wellbeing and minimize the harmful effects of chronic stress on the heart:

• Developing a structured support group focused on psychoeducation, patient and self-care and an introduction to complementary medicine
• Psycho-education and physical exercise

---

Long term monitoring

Long term effective monitoring of formerly in-patients is another way of demonstrating to patients that physicians care and ensuring that patients return to the same clinic/hospital again and again. While we are currently living in the information age, the next age is going to be of artificial intelligence and wearable devices are going to be a future of medicine.

Using these devices is the smart way into future. Several such devices can be used for monitoring various aspects of diseased and even healthy individuals:

1. ECG monitor devices are available that connects to a smartphone app and can monitor various ECG parameters remotely. The physician app can not only monitor but also analyse readings and detect aberrations like AF automatically. Doctors can view trends, act promptly in case of an emergency, and integrate the readings into the patient’s EMR from their end as well.
2. Heart monitor devices are also available which can monitor various vital parameters like heart rate, blood pressure and alert the physician of an impending emergency.
3. Fitbit is another activity tracker and monitoring device that can monitor various parameters of the patients, allowing them to stay fit. It also provides motivational tips and helps patients lead a healthy lifestyle.

---

Best Practice Alerts

Redundant and repetitive testing not only adds burden to the health care system but can also lead to increased cost, delay in therapy, unnecessary procedures, investigation related “iatrogenic” complications but most importantly are amongst the commonest cause of patient dissatisfaction with the medical system. Avoiding un-necessary testing is perhaps one sure way of building patient trust.

An electronic medical record Best Practice Alert (BPA or “pop up”) can reduce duplicate laboratory tests and hospital costs. The BPA pop-up alert can inform the ordering physician if a recent identical order already existed along with the “ordering time”, “collecting time”, “resulting time”, and the result itself.

Disclaimer-The information and views set out in this article are those of the author(s) and do not necessarily reflect the official opinion of M3 India. Neither M3 India nor any person acting on their behalf may be held responsible for the use which may be made of the information contained therein. 

The writer, Dr. Sundeep Mishra is a Professor of Cardiology.