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Doctor's visit

From Wikipedia, the free encyclopedia
A doctor meeting with her patient in Egypt. Doctors develop a close relationship with their patients in order to build trust and better diagnose and treat disease.

A doctor's visit, also known as a physician office visit or a consultation, or a ward round in an inpatient care context, is a meeting between a patient with a physician to get health advice or treatment plan for a symptom or condition, most often at a professional health facility such as a doctor's office, clinic or hospital. According to a survey in the United States, a physician typically sees between 50 and 100 patients per week, but it may vary with medical specialty, but differs only little by community size such as metropolitan versus rural areas.[1]

Procedure

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The four great cornerstones of diagnostic medicine are anatomy (structure: what is there), physiology (how the structure/s work), pathology (what goes wrong with the anatomy and physiology), and psychology (mind and behavior). In addition, the physician should consider the patient in their 'well' context rather than simply as a walking medical condition. This means the socio-political context of the patient (family, work, stress, beliefs) should be assessed as it often offers vital clues to the patient's condition and further management.

A patient typically presents a set of complaints (the symptoms) to the physician, who then performs a diagnostic procedure, which generally includes obtaining further information about the patient's symptoms, previous state of health, living conditions, and so forth. The physician then makes a review of systems (ROS) or systems inquiry, which is a set of ordered questions about each major body system in order: general (such as weight loss), endocrine, cardio-respiratory, etc. Next comes the actual physical examination and other medical tests; the findings are recorded, leading to a list of possible diagnoses. These will be investigated in order of probability.

Jan Steen's The Doctor's Visit, c. 1663

The next task is to enlist the patient's agreement to a management plan, which will include treatment as well as plans for follow-up. Importantly, during this process the healthcare provider educates the patient about the causes, progression, outcomes, and possible treatments of his ailments, as well as often providing advice for maintaining health.

The physician's expertise comes from his knowledge of what is healthy and normal contrasted with knowledge and experience of other people who have had similar symptoms (unhealthy and abnormal), and the proven ability to relieve it with medicines (pharmacology) or other therapies about which the patient may initially have little knowledge.

Duration

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Time that doctors spend with a patient.[2]

A survey in the United States came to the result that, overall, a physician sees each patient for 13 to 16 minutes.[1] Anesthesiologists, neurologists, and radiologists spend more time with each patient, with 25 minutes or more.[1] On the other hand, primary care physicians spend a median of 13 to 16 minutes per patient, whereas dermatologists and ophthalmologists spend the least time, with a median of 9 to 12 minutes per patient.[1] Overall, female physicians spend more time with each patient than do male physicians.[1]

For the patient, the time spent at the hospital can be substantially longer due to various waiting times, administrative steps or additional care from other health personnel. Regarding wait time, patients that are well informed of the necessary procedures in a clinical encounter, and the time it is expected to take, are generally more satisfied even if there is a longer waiting time.[3]

Web-based health care

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Further information: Health information on the Internet

With increasing access to computers and published online medical articles, the internet has increased the ability to perform self-diagnosis instead of going to a professional health care provider. Doctors may be fearful of misleading information and being inundated by emails from patients which take time to read and respond to (time for which they are not paid).[4] About three-quarters of the U.S. population reports having a primary care physician, but the Primary Care Assessment Survey found "a significant erosion" in the quality of primary care from 1996 to 2000, most notably in the interpersonal treatment and thoroughness of physical examinations.[5]

Research and development

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See also: Clinical decision support system

Analysis

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See also: eHealth

A study systematically assessed advice given by professional general practitioners, typically in the form of verbal-only consultation, for weight-loss to obese patients. They found it rarely included effective methods, was mostly generic, and was rarely tailored to patients' existing knowledge and behaviours.[6][7]

The National Institute on Aging has produced a list of "Tips for Talking With Your Doctor" that includes asking "if your doctor has any brochures, fact sheets, DVDs, CDs, cassettes, or videotapes about your health conditions or treatments" – for example if a patient's blood pressure was found to be high, the patient could get "brochures explaining what causes high blood pressure and what [the person] can do about it".[8]

Virtual doctor's visit

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This section is an excerpt from Telehealth.[edit]

Telehealth

Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies.[9] It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions.[10][11] Telemedicine is sometimes used as a synonym, or is used in a more limited sense to describe remote clinical services, such as diagnosis and monitoring. When rural settings, lack of transport, a lack of mobility, conditions due to outbreaks, epidemics or pandemics, decreased funding, or a lack of staff restrict access to care, telehealth may bridge the gap[12]

as well as provide distance-learning; meetings, supervision, and presentations between practitioners; online information and health data management and healthcare system integration.[13] Telehealth could include two clinicians discussing a case over video conference; a robotic surgery occurring through remote access; physical therapy done via digital monitoring instruments, live feed and application combinations; tests being forwarded between facilities for interpretation by a higher specialist; home monitoring through continuous sending of patient health data; client to practitioner online conference; or even videophone interpretation during a consult.[9][10][13]

A scientific review indicates that, in general, outcomes of telemedicine are or can be as good as in-person care with health care use staying similar.[14]

Telemedicine as predicted in 1925[15]
Advantages of the nonexclusive adoption of already existing telemedicine technologies such as smartphone videotelephony may include reduced infection risks,[16] increased control of disease during epidemic conditions,[17] improved access to care,[18] reduced stress and exposure to other pathogens[19][20] during illness for better recovery, reduced time[21] and labor costs, efficient more accessible matching of patients with particular symptoms and clinicians who are experts for such, and reduced travel while disadvantages may include privacy breaches (e.g. due to software backdoors and vulnerabilities or sale of data), dependability on Internet access[16] and, depending on various factors, increased health care use.

Software and health records

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This section is an excerpt from Electronic health record § Use in research and development.[edit]

Electronic medical records could also be studied to quantify disease burdens – such as the number of deaths from antimicrobial resistance[22] – or help identify causes of, factors of, links between[23][24] and contributors to diseases,[25][26][27] especially when combined with genome-wide association studies.[28][29]

This may enable increased flexibility, improved disease surveillance, better medical product safety surveillance,[30] better public health monitoring (such as for evaluation of health policy effectiveness),[31][32] increased quality of care (via guidelines[33] and improved medical history sharing[34][35]), and novel life-saving treatments.

See also

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References

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  1. ^ a b c d e Medscape Physician Compensation Report: 2011
  2. ^ "Time that doctors spend with a patient". Our World in Data. Retrieved 7 March 2020.
  3. ^ Simple Tips to Improve Patient Satisfaction By Michael Pulia. American Academy of Emergency Medicine. 2011;18(1):18-19.
  4. ^ ECRI. Special Article: Internet Influence on Doctor/Patient Relationship Archived February 6, 2007, at the Wayback Machine. Health Technology Trends. June, 2006.
  5. ^ Safran DG (February 2003). "Defining the future of primary care: what can we learn from patients?". Ann. Intern. Med. 138 (3): 248–55. doi:10.7326/0003-4819-138-3-200302040-00033. PMID 12558375. S2CID 1336772.
  6. ^ "People may not always get helpful weight loss advice from their doctors, study finds". ABC News. Retrieved 17 January 2023.
  7. ^ Tremblett, Madeleine; Poon, Annabel Y X; Aveyard, Paul; Albury, Charlotte (13 December 2022). "What advice do general practitioners give to people living with obesity to lose weight? A qualitative content analysis of recorded interactions". Family Practice. 40 (5–6): 789–795. doi:10.1093/fampra/cmac137. PMC 10745272. PMID 36510443.
  8. ^ "Tips for Talking With Your Doctor" (PDF). National Institute on Aging. May 2014. Retrieved 3 February 2023.
  9. ^ a b "What is TeleHealth?". Office for the Advancement of Telehealth. The Health Resources and Services Administration. March 2022. Retrieved 12 January 2024.
  10. ^ a b Shaw DK (June 2009). "Overview of telehealth and its application to cardiopulmonary physical therapy". Cardiopulmonary Physical Therapy Journal. 20 (2): 13–8. doi:10.1097/01823246-200920020-00003. PMC 2845264. PMID 20467533.
  11. ^ Masson M (December 2014). "Benefits of TED Talks". Canadian Family Physician. 60 (12): 1080. PMC 4264800. PMID 25500595.
  12. ^ Mashima PA, Doarn CR (December 2008). "Overview of telehealth activities in speech-language pathology". Telemedicine Journal and e-Health. 14 (10): 1101–17. doi:10.1089/tmj.2008.0080. PMID 19119834.
  13. ^ a b Miller EA (July 2007). "Solving the disjuncture between research and practice: telehealth trends in the 21st century". Health Policy. 82 (2): 133–41. doi:10.1016/j.healthpol.2006.09.011. PMID 17046097.
  14. ^ Albritton J, Ortiz A, Wines R, Booth G, DiBello M, Brown S, Gartlehner G, Crotty K (February 2022). "Video Teleconferencing for Disease Prevention, Diagnosis, and Treatment : A Rapid Review". Annals of Internal Medicine. 175 (2): 256–266. doi:10.7326/m21-3511. PMID 34871056. S2CID 244923066.
  15. ^ Novak M. "Telemedicine Predicted in 1925". Smithsonian Magazine. Retrieved 1 February 2022.
  16. ^ a b Gillman-Wells CC, Sankar TK, Vadodaria S (February 2021). "COVID-19 Reducing the Risks: Telemedicine is the New Norm for Surgical Consultations and Communications". Aesthetic Plastic Surgery. 45 (1): 343–348. doi:10.1007/s00266-020-01907-8. PMC 7471549. PMID 32885319.
  17. ^ Monaghesh E, Hajizadeh A (August 2020). "The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence". BMC Public Health. 20 (1): 1193. doi:10.1186/s12889-020-09301-4. PMC 7395209. PMID 32738884.
  18. ^ "Telehealth Key to Maintaining Access to Addiction Recovery". www.aafp.org. Retrieved 27 January 2022.
  19. ^ Portnoy J, Waller M, Elliott T (May 2020). "Telemedicine in the Era of COVID-19". The Journal of Allergy and Clinical Immunology. In Practice. 8 (5): 1489–1491. doi:10.1016/j.jaip.2020.03.008. PMC 7104202. PMID 32220575.
  20. ^ "Benefits of Telemedicine". www.hopkinsmedicine.org. 18 January 2022. Retrieved 1 February 2022.
  21. ^ Molfenter T, Boyle M, Holloway D, Zwick J (May 2015). "Trends in telemedicine use in addiction treatment". Addiction Science & Clinical Practice. 10 (1): 14. doi:10.1186/s13722-015-0035-4. PMC 4636787. PMID 26016484.
  22. ^ Murray CJ, Ikuta KS, Sharara F, Swetschinski L, Aguilar GR, Gray A, et al. (Antimicrobial Resistance Collaborators) (February 2022). "Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis". Lancet. 399 (10325): 629–655. doi:10.1016/S0140-6736(21)02724-0. PMC 8841637. PMID 35065702.
  23. ^ Kuan, Valerie; Denaxas, Spiros; Patalay, Praveetha; et al. (29 November 2022). "Identifying and visualising multimorbidity and comorbidity patterns in patients in the English National Health Service: a population-based study". The Lancet Digital Health. 5 (1): e16–e27. doi:10.1016/S2589-7500(22)00187-X. ISSN 2589-7500. PMID 36460578. S2CID 254129048.
  24. ^ Levine, Kristin S.; Leonard, Hampton L.; Blauwendraat, Cornelis; Iwaki, Hirotaka; Johnson, Nicholas; Bandres-Ciga, Sara; Ferrucci, Luigi; Faghri, Faraz; Singleton, Andrew B.; Nalls, Mike A. (19 January 2023). "Virus exposure and neurodegenerative disease risk across national biobanks". Neuron. 111 (7): 1086–1093.e2. doi:10.1016/j.neuron.2022.12.029. ISSN 0896-6273. PMC 10079561. PMID 36669485.
  25. ^ Solomon DH, Liu CC, Kuo IH, Zak A, Kim SC (September 2016). "Effects of colchicine on risk of cardiovascular events and mortality among patients with gout: a cohort study using electronic medical records linked with Medicare claims". Annals of the Rheumatic Diseases. 75 (9): 1674–1679. doi:10.1136/annrheumdis-2015-207984. PMC 5049504. PMID 26582823.
  26. ^ Newschaffer CJ, Bush TL, Penberthy LT (June 1997). "Comorbidity measurement in elderly female breast cancer patients with administrative and medical records data". Journal of Clinical Epidemiology. 50 (6): 725–733. doi:10.1016/S0895-4356(97)00050-4. PMID 9250271.
  27. ^ Spiranovic, Caroline; Matthews, Allison; Scanlan, Joel; Kirkby, Kenneth C. (2 January 2016). "Increasing knowledge of mental illness through secondary research of electronic health records: opportunities and challenges". Advances in Mental Health. 14 (1): 14–25. doi:10.1080/18387357.2015.1063635. ISSN 1838-7357. S2CID 57541937.
  28. ^ Byun J, Schwartz AG, Lusk C, Wenzlaff AS, de Andrade M, Mandal D, et al. (September 2018). "Genome-wide association study of familial lung cancer". Carcinogenesis. 39 (9): 1135–1140. doi:10.1093/carcin/bgy080. PMC 6148967. PMID 29924316.
  29. ^ Loukides G, Gkoulalas-Divanis A, Malin B (April 2010). "Anonymization of electronic medical records for validating genome-wide association studies". Proceedings of the National Academy of Sciences of the United States of America. 107 (17): 7898–7903. Bibcode:2010PNAS..107.7898L. doi:10.1073/pnas.0911686107. PMC 2867915. PMID 20385806.
  30. ^ Desai, Rishi J.; Matheny, Michael E.; Johnson, Kevin; Marsolo, Keith; Curtis, Lesley H.; Nelson, Jennifer C.; Heagerty, Patrick J.; Maro, Judith; Brown, Jeffery; Toh, Sengwee; Nguyen, Michael; Ball, Robert; Dal Pan, Gerald; Wang, Shirley V.; Gagne, Joshua J.; Schneeweiss, Sebastian (20 December 2021). "Broadening the reach of the FDA Sentinel system: A roadmap for integrating electronic health record data in a causal analysis framework". npj Digital Medicine. 4 (1): 170. doi:10.1038/s41746-021-00542-0. ISSN 2398-6352. PMC 8688411. PMID 34931012.
  31. ^ Hoelscher, Deanna M.; Ranjit, Nalini; Pérez, Adriana (20 March 2017). "Surveillance Systems to Track and Evaluate Obesity Prevention Efforts". Annual Review of Public Health. 38 (1): 187–214. doi:10.1146/annurev-publhealth-031816-044537. ISSN 0163-7525. PMID 28125393.
  32. ^ Paul, Margaret M.; Greene, Carolyn M.; Newton-Dame, Remle; Thorpe, Lorna E.; Perlman, Sharon E.; McVeigh, Katherine H.; Gourevitch, Marc N. (1 June 2015). "The state of population health surveillance using electronic health records: A narrative review". Population Health Management. 18 (3): 209–216. doi:10.1089/pop.2014.0093. ISSN 1942-7891. PMID 25608033.
  33. ^ Moloney, Max; Digby, Geneviève; MacKinnon, Madison; Morra, Alison; Barber, David; Queenan, John; Gupta, Samir; To, Teresa; Lougheed, M. Diane (17 January 2023). "Primary care asthma surveillance: a review of knowledge translation tools and strategies for quality improvement". Allergy, Asthma & Clinical Immunology. 19 (1): 3. doi:10.1186/s13223-022-00755-2. ISSN 1710-1492. PMC 9843861. PMID 36650578. S2CID 255966861.
  34. ^ Shah, Shahid Munir; Khan, Rizwan Ahmed (2020). "Secondary Use of Electronic Health Record: Opportunities and Challenges". IEEE Access. 8: 136947–136965. arXiv:2001.09479. Bibcode:2020IEEEA...8m6947S. doi:10.1109/ACCESS.2020.3011099. ISSN 2169-3536. S2CID 210920454.
  35. ^ Sunjaya, Anthony Paulo (1 July 2022). "Uplifting Primary Care Through the Electronic Health Record". The Annals of Family Medicine. 20 (4): 303–304. doi:10.1370/afm.2860. ISSN 1544-1709. PMC 9328708. PMID 35879075.
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