The Consultation Room

Prof. Dr. CMK. Reddy

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

Chapter 4: Qualifications, Certificates & Photos

“Sometimes we have to see to believe, when happenings are unanticipated”

To discourage unqualified ‘Doctors’ (quacks) from practicing, it is prudent that every qualified practitioner displays his academic qualifications, Medical Council registration certificate, as well as any other awards and appreciations received in profession, in the consultation room or the waiting hall.

Whenever there is dissatisfaction or distrust about the management of a patient or the conduct of the Doctor, the patient or his family would certainly be reassured to see the qualifications for themselves and any apprehensions about the bonafides would be dispelled.

Recently, to weed out quacks, Medical Councils of Tamil Nadu and few other states have installed a dedicated software, that by sending the Doctor’s Registration number (displayed in the office) by SMS to a specified number (it’s 56767 for TNMC), a prompt automatic reply will be received, mentioning the name of the Doctor, reassuring the patient about the status of the Doctor he’d seen or going to see.

If the Registered number displayed by the ‘Doctor’ is ‘bogus’ or belongs to some other Doctor, the response will reveal the name of the Doctor, to whom the number belongs. Now it’s obvious that we should exhibit our Medical Council Registration certificate in a prominent place in our office, for ‘our own good’.

“It seems all Doctors agree with you, but I’d still like to get a 5th opinion.”

Chapter 5: Reception Desk

“First impression is the best impression”

In my opinion, next to the expertise of the Doctor, this is the most important area in the entire set up. A neatly-dressed, pleasant looking receptionist, capable of communicating in the language of the patient, is an asset. If he also has some medical knowledge, it certainly helps.

It should be realized that the patients may put up with rough behavior of the consultant, but certainly don’t tolerate unwelcome conduct of the staff working with him, including junior Doctors. She has to maintain the Day’s Schedule on Doctor’s desk, to indicate details of patients waiting to be seen, whether they have appointment and new or old.

If you want to reduce your ‘over heads’, the receptionist or secretary at the front desk should be ‘omnipotent’, i.e., capable of handling many functions, such as giving appointments, streamlining those came with appointments, retrieving patients’ records & putting them back in place afterwards, fixing appointment with other consultants, scheduling scans, attending to patients requiring immediate attention, keeping the waiting patients informed in case you are delayed for some reason, assisting you in examining a female patient, doing dressings or suture removal, collecting fees and of course, oversee the total upkeep of your office etc.

Chapter 6: Furniture & Equipment

An elegant table, Doctor’s chair, chairs for the patient, an examination coach of proper height with a thin foam bed, a 3-seater sofa for attendants (and also to examine patients, who can’t climb the examination coach), and good lighting, are desirable in the Doctor’s chamber.

Basic equipments such as a stethoscope, thermometer (standard, digital or infrared), blood pressure (BP) measuring apparatus (standard or digital), tendon hammer, torch light, tongue depressor, measuring tape, room air freshener and emergency light, may be available in most of the consulting rooms.

A hand sanitizer dispenser, either manual or sensor-triggered, has become a necessity nowadays, to prevent cross infection, soon after you had examined a patient. But it would be highly desirable to also have the following gadgets, especially if the Doctor is a surgeon in any speciality:

Digital pulsoximeter, ophthalmoscope, nasal/ear speculum, rectal gloves with lubrication, a sterile dressing tray (with a tissue forceps, 2 hemostats, suture removal scissors and a few pieces of sterile gauze), a wide-bore needle (to aspirate a suspected abscess or hematoma) and a roller bandage. Any more, such as an ECG machine, suction apparatus, hand-held Doppler, transilluminoscope or personal protection equipmet (PPE) etc. are optional.

Gastroenterologists perform endoscopies, both diagnostic and interventional, in their offices. A foot stool about 25 cm (10â€) height is very useful for the patient to climb the examination coach and also to examine patient’s feet, legs, scrotum or groins, in standing position. A wash basin and a clean toilet facility are of course, essential.

Chapter 7: Assistant (ante) room

Besides the equipments mentioned, facility to administer injection, IV fluids, passing an NG tube or giving a glycerin enema (practoclys), should be available in Ante Room, where the Assistant Doctor or Duty Nurse sits. The Assistant or Nurse may also give some injections to provide symptomatic relief, till the Doctor is able to see the patient.

This is important, since the patient will be happy that someone attended on him immediately and made him comfortable, while waiting for the Doctor to see him. Having a cable TV installed at a vantage point in the patients waiting area is optional, but there’s always a risk that a woman seriously watching a TV program, when her turn of seeing the Doctor comes up, requesting the receptionist to send some other patient in, since she didn’t want to miss the program!

Emergencies are bound to occur in our profession. Facilities to give first aid and resuscitation, at least with an ambubag and emergency drugs, such as steroids, adrenaline, deriphyllin, nitropatch, analgesics (ketorol, tramadol, diclofenac, buscogast), PPIs, antiemetics etc. should be available.

Of course, CPR facilities, including laryngoscope (in working condition), endotracheal tubes, long (spinal) needle for intracardiac injection etc. are optional. Availability of a wheelchair for patients who can’t walk is definitely appreciated by the families.

A CCTV unit, to keep track with the movements in and out of your office, has become a necessity, in view of the increasing security hazards in recent times (vide infra).

Keeping an automatic vending machine for soft drinks, a snack bar or a book shop is purely optional, but may be helpful to patients, who have to wait for longer periods in the office, for various reasons.

Financial logistics may decide, if the Doctor should house facilities, such as a pharmacy, clinical laboratory, physiotherapy unit, an x-ray or an ultrasonogram unit, within the office complex. If the office is located in a hospital building, duplication of these services will be redundant.

Otherwise, the volume of Doctor’s work, to feed these units without the outside support, may be a deciding factor, besides the available financial resources.

Additional equipment may be needed in various speciality areas, such as Gastroenterology, ENT, Ophthalmology, Orthopedics, Diabetology, Dental surgery, Cosmetology etc.

“Hmmm … no health insurance. Take him to Intensive I don’t care unit.”

Chapter 8: Consultation Room at Residence

It may become a necessity for many Doctors, especially for those in Govt service, getting relocated from time to time, to improvise a consultation room in the residence itself. This has both advantages and disadvantages.

The advantages are, minimal overheads, no additional rent, no commutation time (sometimes, Doctors spend hours to travel back and forth), available all the time and if there’s no work, one can attend to any ‘home work’ required or spend time with family and children.

All that’s needed is to keep it clean with some domestic help and one assistant to help you during the consultation times. Being a part of the residence, someone in the household can remind you about taking the medications required, on time (through intercom) and send you some beverages for ‘intermittant’ hydration, during your long consulting hours.

The drawbacks are that you may be disturbed by patients during odd hours and may have to compromise on the ambience, equipments and parking facility within the available space.

“I can’t read a word of this essay of yours. Excellent work.”

Chapter 9: Appointment system

Many of our patients (especially from rural area) may not be acquainted with appointment system and they need be primed to your system in a sympathetic manner. But many general practitioners or even consultants, don’t give appointments to individual patients, they only have ‘consulting hours’ and ‘token’ system.

Under such situations, the patients, sometimes have to wait for long hours to see the Doctor, which is not fair. A genuine emergency, such as an accidental injury or cerebral/cardiac event, may be exempted from our ‘formalities’, meant for routine patients. The appointments may be requested or given on phone, SMS, WhatsApp, Email, as convenient. It is better they give sufficient advance request, if they want to see the Doctor on a particular day, provided the Doctor is available on that day.

How much time to be given for each patient to be seen by the Doctor, depends on several factors, whether it’s general practice, speciality, what speciality, how expedient is the consultant etc. New patients may require more time whereas less for review patients. In our experience, on an average about 8-10 min for each patient is sufficient, which works out to 3-4 patients in every 30min slot. In special situations, such as pandemic, more time may be needed to observe all the precautions by the medical personnel, against the infectious disease.

To avoid doubts about the genuineness of the urgency, it’s better the patient brings a letter of reference from the Doctor, who had seen him earlier. Or still better, a phone call from the referring Doctor to either the consultant or the reception, requesting for an urgent appointment, which is invariably obliged. If the Doctor is not in the office, when the patient lands, the receptionist should try to contact the Doctor to get immediate instructions, till he’s able to see him.

Under such situation, it’s highly desirable that the consultant himself directly talks to the patient or attendant, to get the first-hand information about the ‘urgency’ and decide the immediate plan of action. It not only reassures the patient, their reverence on the consultant mounts up considerably.

When we give appointments to patients, we should note their contact numbers, so that they may be informed, if there’s any change in the schedule. This will also give freedom to the Doctor, if he has to leave town, at short notice.

Patients generally prefer to see a ‘busy’ Doctor, but ironically, expect or demand an early appointment and minimum waiting time in the office. You should keep in eye on the person giving appointments, so as not to do unscrupulous business out of it by offering special favors. Beware, if we keep the waiting time to get an appointment too long, the patients may get well and cancel their appointments.

“I was so tired at work, the other nurses had to revive me with C.P.R. – Coffee, Pepsi and Redbull”

The Consultation Room