Doctors, Patients, and Practice Management Software

Image result for doctor with computer

A software is a technology product. I would expect it to provide benefits to its direct or indirect users.

However, when I see a computer system in a clinic OR the signage of a PMS provider outside a clinic, the thoughts that run in my mind are that this doctor has/is:

  • Licenced a software
  • Bought a few desktops/ laptops
  • Bought related hardware
  • Hired people to maintain and operate the app
  • Paying AMC for the app and systems

Consequently, this doctor will be charging me more than what he would have otherwise charged!

Does it help me, as a patient, in any way if the doctor has a PMS?

Let’s look at it from the doctor’s point of view.

Typically, a PMS app provides the following features.

  1. Appointment booking
  2. Consultation Record Maintenance
  3. Consultation Fee Receipt Printing
  4. Prescription Printing
  5. Communication to Patients

Does the PMS help him to reduce costs, or improve patient care, or get increased consultations?

This is not to say that a PMS is unnecessary, but, my question is what is its value to patients and doctors? What is its role in the patient-doctor relationship?

If you develop and market PMS, I would like to talk to you.

You are literate, but are you health literate?

Medicine, as both a science and art, often requires choices and there are no “right” answers – you need to make your own decisions – after all, it’s your life. While you obviously have a vital interest in treatment decisions and outcomes, unfortunately, you lack the medical knowledge and skill to be able to decide alone.

This is where the concept of health literacy comes in; so you and your doctor can function as a team.

Does all this talk about health literacy sound too abstract? Then let’s make it personal!

Do you know the difference between LDL cholesterol and HDL cholesterol? Can you make sense of your hospital bill? Do you know which health insurance policy offers you the best deal? Can you decipher your doctor’s medical gobbledygook? Do you know how to get a second opinion? Do you generate respect in your doctor? Are you empowered enough to hold a discussion of your illness? Have you ever commented with complete knowledge on a healthcare issue?

Health is an invaluable asset and you are given only one body. It is your duty to take the best care of it possible. Although having an expert doctor by your side is very helpful, you cannot outsource this responsibility to someone else. Your doctor cannot solve all your healthcare problems!

Just as financial literacy can help you to become wealthy, health literacy can help you to stay healthy. Remember, all the wealth in the world means nothing if you are not healthy. Healthcare today is complicated and the health care system can be confusing but health literacy can help you to deal with it effectively. If you have low health literacy, you do not have to panic, because it is a condition that is easily treatable and beatable.

Treating low health literacy can improve your ability to get the best medical care.

A doctor’s advice to a fellow-doctor on branding

A strong brand identity that is built and protected over time can create a long-term, consistent image of quality and value. Inevitably, you will attract more patients, based on how you have influenced them with your branding strategies.

Those doctors who take branding action now will be tomorrows leaders.

What about using advertising to attract more patients?

It’s well known that the most effective form of advertising is word of mouth. How we care for our patients and how they perceive our care is what brings us more patients. The next best form of advertising is to our colleagues, by communicating our experience and expertise via scientific presentations and/or publications. In the past, this much was enough.

The Code of Ethics of the Medical Council of India still does not allow doctors to advertise, and most senior doctors in India look upon advertising with suspicion. After all, doctors are professionals – why should they behave like shopkeepers in order to attract customers?

However, times have changed, and we need to change with them. Gone are the days when patients had a family doctor whom they could blindly trust, and who would provide medical care for them from cradle to grave. Today’s reality is that medical care is often provided on a fragmented, piecemeal basis by numerous specialists, and the patient needs to learn to get the best medical care for himself. This is why it is so important that he has access to information on available doctors so that he can select the best one for himself.

Most doctors feel that advertising is unethical, but we need to look at the reality more carefully.

How are young doctors who have just started practise going to get patients?

How will patients know of their skills and their expertise?

Many young professionals, who have spent long years to qualify and taken loans to start practise, simply cannot afford to sit back and starve till patients arrive on their doorstep. This is why new doctors feel they have to resort to unethical practices like cuts and kickbacks today, many of which have been institutionalized by their seniors. It is more honest to allow them to attract patients by allowing them to advertise; at least this is open and transparent.

Preventing advertising favours senior doctors, those who have an established reputation, with many hospital attachments, and lots of patients. They will do their best to maintain the status quo by prohibiting advertising; not to protect patients as they claim, but to prevent new doctors from competing with them, thus safeguarding their own interests.

In the absence of advertising, the next best situation is to educate and engage with patients, the public, and the community, to build a practise.

Advise to Patients from a Doctor

No one likes to fall ill, and as a logical extension, most of us don’t like going to the doctor.

A visit to the doctor also brings back childhood fears of painful injections and unpleasant blood tests. Thus, it is no surprise that a medical clinic is second to unpopularity only to a dentist’s chair! Consequently, most of us do not make the best use of our doctors; we tend to use them as crutches only when we fall ill. However, one should never forget that the doctor-patient relationship is unique; since it is the ultimate one-to-one relationship, in which you confide fully in your doctor and entrust him with your life, you must learn to work as a partner with your doctor!

In order to foster and nurture the relationship with your doctor, treat it with great care and respect.

Don’t forget to say thank you to your doctor when you get better. He gets fed up of attending to droves of patients
with complaints, all day long and would be delighted to hear a patient appreciate his efforts! Unfortunately, this common courtesy is something we often forget; patients tend to remember the doctor only when afflicted by an ailment. This simple expression of gratitude by you will help the doctor to remember you as a person, rather than as just another case. He is likely to then treat you as a special patient and getting VIP attention from him helps improve your medical care a good deal! As in a marriage, the doctor-patient relationship depends on good communication and trust built up over time and it is definitely worth spending time and taking the trouble to maintain a beneficial relationship. Remember that the doctors’ staff plays a key role in your medical care and you need to learn how the clinic functions.

It’s very helpful to build up a rapport with a special staff-member (who can be a receptionist, a nurse or an assistant), and this can prove to be very useful when you need to talk to the doctor on a priority basis. The simple rule is that if you treat the staff well, you will be treated well too! A small thank-you gift for the staff can help ensure that you get personalized attention. It’s useful to learn which days are the busiest and what times are the best to consult the doctor. You should also find out what steps to take if there is an emergency, or when the clinic is closed.

Patient Safety Comes From Patient Empowerment

When we think of medical errors, we think about the mistakes which doctors and nurses make when taking care of patients.

However, it is not uncommon for errors to be caused by clueless patients and poorly informed caregivers as well. The first conclusion that most people jump to when a medical error occurs is, “It was the doctor’s fault!”

Patients still think of themselves as being passive recipients of medical care who are at their doctor’s mercy. However, you need to take an active role in your medical treatment and behave as an enlightened partner, after all, your doctor is not a veterinarian!

Patients can be the first line of defense against errors, and there’s a lot you can do to protect yourself. Patient safety is not just the doctor’s responsibility, it’s the patient’s as well. Patients must play an active role in preventing medical mistakes. One of the commonest mistakes patients make is that they leave everything to their doctor. This kind of passive approach may make sense during an emergency but is completely flawed for most elective medical treatment.

An empowered patient assumes responsibility for managing his or her health, and this reduces the risk for errors.

For example, he or she will call the clinic and makes sure to get the results of the lab tests, the doctor has ordered, rather than wait passively for the clinic to say that the results are ready! When patients actively participate in the treatment plan because they have crafted it in partnership with their doctor, they are much more motivated in complying with the doctor’s advice and this helps reduce the risk of slips and mistakes.

Using the acronym SPEAK UP, JCAHO (the Joint Commission on Accreditation of Healthcare Organisations, USA) has developed a set of steps that patients and their families can follow to ensure that they have a positive healthcare experience.

S: Speak up if you have questions, or if you don’t understand something;

P: Pay attention to the care you are receiving, including medications and treatments. Don’t assume anything;

E: Educate yourself about your diagnosis, the medical tests you are experiencing and your treatment plan;

A: Ask a trusted family member or friend to advocate for you;

K: Know what medications you take and why. This is especially crucial because medication errors are the most common of healthcare errors;

U: Use a healthcare organization that has been evaluated against current quality and safety standards;

P: Participate in all decisions about your treatment.

Family Physician’s Role in Patient Care

Dr. Gayle Stephens says, “Family physicians know their patients, know their patients’ families, know their practices, and know themselves.” Stephens emphasizes patient management, distinguishing it from treatment, saying managing implies, “alleviating most effectively the total impact of illness upon that person.”

Family physicians are usually the first point of contact during an illness. Unlike other medical specialists who focus on specific diseases or organ systems, family physicians specialize in seeing patients who may present with multiple problems that are not slotted into a particular system. Ideally, family doctors have a long-standing relationship with their patients and therefore have a sound basis of understanding the patient’s perspectives and needs so they can offer options that meet their best interests. They have a holistic perspective because they are taught to put the patient first. Globally, healthcare systems that are considered to provide the best quality care are the ones with strong primary care, driven by family physicians.

Dr. Jaya Bajaj writes, “I grew up in a small town and had the privilege of experiencing the kindness of our family doctor. My siblings and I received all our vaccinations at his clinic and he would graciously make home-calls when one of my grandparents got sick. I remember him sitting next to me, reassuring that “everything will be alright” when I got sick during my HSC board exams. When my grandfather developed heart disease, he helped my father arrange medical care for him in the nearest town. He was always available for answering our questions during the long hospitalization of my grandfather. He even travelled to the hospital when my grandfather was getting discharged and discussed the prognosis, discharge instructions; medications etc. with the consulting cardiologist that he then proceeded to explain to my father in simple terms. Any surprise that he took care of three generations in our family?”

Healthcare has a language of its own. Many times healthcare professionals don’t realize how insidiously medical acronyms become a part of their normal lingo. A family doctor who is aware of his patient’s health literacy can explain the diagnoses in a language that the patient can understand, and prepare the patient for the next course of action. An important part of this role is helping to curate and interpret the almost overwhelming amount of information available to patients today, thus helping them make intelligent personal choices for their own care.

Ensuring continuity of care

An engaged patient-doctor team is needed to ensure continuity of care. A huge proportion of medical errors can be attributed to communication breakdowns because of healthcare silos. A family doctor can function as a team leader, coordinating care between the patient, family members, caregivers, and multidisciplinary healthcare providers, thus ensuring clear communication and continuity of care. This is very important for providing patient-centered care.

Doctors, Please Create Effective Partnerships With Patients

Information on its own is sterile. It needs to be put into action in order to be of any value.

Doctors, your first question should NOT be “What do I want my patient to know?” but “What do I want my patient to be able to do?”

Look at your clinic through your patients’ eyes by putting yourself in their shoes.

Patients come to a clinic, ill, scared of doctors and are worried about how much the treatment is going to eventually cost.

Creating a patient-friendly environment will go a long way towards establishing a healthy partnership and engagement with patients, which will lead to better health outcomes. The key to patient engagement lies in ensuring that physicians help patients to help themselves.

Doctor consultation is the primary bedrock of clinical medicine, and each consultation is a learning opportunity for both the doctor and the patient which, in turn, builds up `learning capital which has both individual and community benefits. Both patient and doctor, benefit by learning from each other. Encouraging patients to take control when they are ill is the need of the hour. Paternalistic styles of practice tend to create unhealthy dependency and undermine self-reliance. Promoting involvement and a sense of ownership of their health care could be the best way to ensure that people adopt healthier lifestyles.

“Patients are at the heart of the health service of the future. The principle of patient and user involvement has become ever more important and the health service has moved beyond an `informed consent to an `informed choice approach.” (Wanless Report, 2002).

Lots of doctors give their patients educational hand-outs and brochures and feel they have done their job as far as educating their patient goes. The problem with this approach is that the written word is not interactive. It cannot:

  • Answer questions that the patient asks
  • Provide alternate ways of explaining things
  • Be easily understood by the readers if their reading level is too high

What’s more, while creating suitable patient educational materials in plain language is an important step in the right direction, it is not enough. Please do not blame patients with limited literacy for their lifestyle and health practices. Low literacy limits opportunities and resources and reduces the control they have over their lives.

They do not have the luxury of being able to make informed choices about their lifestyle. They feel powerless and helpless – and they often are. Please don’t wash your hands off their problems or treat them as second-class citizens -they need your help and kindness much more than other patients do, simply because they are feeling vulnerable and lost. If you treat them with respect, your staff will also do so.

Most doctors feel they have excellent bedside manners and communicate well with their patients, so they think they do not need to worry about these fundamentals! However, as George Bernard Shaw pointed out, “The main problem with communication is the assumption that it has occurred.”

Take an iPill and call me in the morning

As all good family physician’s wives know, most complaints are self-limited and most patients will get better in the morning on their own. This is why “Take 2 aspirin and call me in the morning” is still extremely good medical advise

Tincture of time is often the best healer; and if things aren’t better by morning, then the doctor can start a more detailed evaluation.

Today, instead of advising patients to take 2 aspirins, I advise them to take an iPill. An iPill is an information therapy prescription and has an equally useful role to play. It helps to reassure patients that their symptoms are unlikely to be serious, and helps them to make better decisions.

At the end of each consultation, along with giving them pills, doctors need to give iPills as well, personalized information therapy prescriptions!

There are many ways of prescribing this – and digital tools are often the best way of delivering these.

Clinic Practice and Consistency in Patient Experience

How many times have we patients told each other, “Go to the clinic of Dr. X. Even if it takes time, wait to see only the Chief Doctor/ Dr. X. The receptionist will tell you that another doctor of the same specialization is free and ask if you would like to see him. Politely decline.”

Why do we say this?

We have a confidence in the improvement in the healthcare outcomes that a particular doctor will make, even if there is a probability attached to it.

While this is good for the ego, this will be a hindrance to the clinic’s growth. The way forward is to bring about consistency in patient experience, before his visit to the clinic, at the clinic, and post the clinic visit.

This brings up the question, how does one define consistency?

To lay it out very simply, if the processes are Repeatable and Reproducible, you have assured consistency.

Repeatable: If you are the only person interacting with the person during the entire patient engagement cycle, can you ensure the same experience for every patient and for every visit of the same patient?

Reproducible: If you have multiple doctors at your clinic, is the patient experience the same, whichever doctor a patient consults?

If these are not possible, there will always be an asymmetric distribution of workload. Patients will always want only you and the demands of clinic time on you will be the highest.

Assuring repeatability and reproducibility also helps in building the brand of the clinic and enhances the patient experience, turning them into your brand ambassadors.

Building Destinations of Good Patient-Care

Agreed, the word “Good” in the title is superfluous.

Doctors, patients are simple people. All that they look forward from you is care and a demonstration that you care! They are even willing to pay a premium or travel the extra mile to consult someone who is patient-focused.

Though it is a simple expectation, you cannot do it alone, just like an artist cannot create the magic on an audience, individually. You need a band of people to support you, while you stay in the foreground, interacting with the patients.

HealthyJio is that band.

We do not say that we offer you a CRM, or an HMS, or a Clinic Management Software, or a Prescription Software, or…

We help you:

1. Improve the care that you provide so that there is an effect on the individual health outcomes

2. Grow your practice

3. Build your clinic as a destination of good patient-care



Wondering, why we are talking in abstract terms and not with definitive details (though our website mentions some of them)?

Because, the elements depend on your context; your area of practice, your patient community, your limitations and constraints, your aspirations, etc.

Do all these involve only an online presence? The quick answer is NO.

Thinking about the costs? It will be a mixture of free and paid.

Are we equipped to deliver all elements? No, there are parts that we deliver on our own; for the others, we can leverage what you have or source from the market.

Want to know more? Leave your contact coordinates on our website and we will reach out to you.

And, to the public, let’s recognize and patronize doctors and clinics that have patient-care in their focus.