Subject: The OSCEhome OSCE Systematic Approach Flowcharts Are The Answer To Today’s Short Patient-Physician Encounters

Are The OSCEhome Systematic Approach Flowcharts The Answer To Today’s Short Patient-Physician Encounters?

Recently, I received an email from one of newsletter subscribers concerning a valuable article in Newsweek Magazine titled “The Doctor Will See You- If You’re Quick”. In that article, the Author, Shannon Brownlee, points out that ‘they are signs that something in the world of medicine is seriously amiss’. She said patients ‘tell tales of being rushed out of the office by harried doctors who miss crucial diagnoses, never look up from their computers during an exam, make errors in prescriptions, and just plain don’t listen to their patients. Studies show a steep decline over the last three decades in patients’ sense of satisfaction and the feeling their doctors are providing high-quality care. And things don’t seem much better from the other side of the stethoscope. In a recent survey by Consumer Reports, 70 percent of doctors reported that since they began practicing medicine, the bond with their patients has eroded’. The main issue she stated is that ‘Today visits are still short… The number of required tests and conditions primary-care doctors are supposed to screen for has skyrocketed’. One physician in the article said: ‘When you have only 15 minutes per patient, then there are home visits and hospital visits, you feel like you’re on a hamster wheel’.

Then, she reported studies that concluded that ‘This is not a recipe for optimal care. One Canadian and U.S. study found that doctors interrupt their patients on average within 23 seconds from the time the patient begins explaining his symptoms. In 25 percent of visits, the doctor never even asked the patient what was bothering him. In another study that taped 34 physicians during more than 300 visits with patients, the doctors spent on average 1.3 minutes conveying crucial information about the patient’s condition and treatment, and most of the information they provided was far too technical for the average patient to grasp; disconcertingly, those same doctors thought they had spent more than eight minutes’.


On the patient clinical management side, she said ‘At the same time, doctors often prescribe too much of the wrong kind of care. Between 2000 and 2005, the number of CT scans performed annually nearly doubled to more than 75 million a year, many of them given, say experts, out of habit or fear of litigation, not because they were likely to help the doctor make a diagnosis’.


Concerning patient-physician relationship, she emphasized that ‘Numerous studies have found a link between how well the doctor and patient communicate and the patient’s sense of well-being, his number of symptoms, and his overall health.


Bottom line reality is; 1) physicians have limited time allocated to each patient visit. There are more patients than physicians and training more physicians with these economical circumstances is not possible, 2) have a wide list of differentials to cover in order to be a good physician and to protect themselves. Obviously, the focused history and physical approach became so focused that failed frequently, 3) have no time for establishing an effective patient-physician relationship, and 4) have limited time to explore patient management options.

Currently, physicians have to adopt a focused approach. It is kind of the third world out-patient approach for treating patients’ symptoms. In order to protect themselves, they instruct patients to come back if things don’t improve! It is kind of an initial screening process during which physicians omitted several important issues concerning clinical and patient-physician communication. This may work initially. The problem is that when the patient comes back for a second visit, will he be allocated more visit time and addressed differently? What if the patient will see another physician who will re-initiate this focused approach?


So, how to solve this?


Since 2004, introduced the Systematic Approach to focused history taking, physical examination, and counseling in which a set of grouped carefully phrased questions and actions sets are arranged based on patient complaints, not body systems or physician specialty. It has the same rationale of ATLS APLS, ALSO, and ACLS approaches. After memorizing and practicing all the flowcharts, physicians can pick specific sets of history taking questions and physical exam actions to perform during the patient encounter based on the presenting patient complaint.


Verbal and non-verbal communication skills are embedded within this system. By practicing these flowcharts over and over until it become a second habit, physicians can be confident that they accomplished a professional conduct. This focused approach puts the physician on an autopilot mode to cover all relevant differentials without thinking about them as they have no time in today’s short patients’ visit.


This approach ensures that the physician won’t forget to ask or examine crucial things. In stead, they’ll have relatively more time for clinical decision making, establishing rapport, and discussing the patients’ options, attitude, and compliance.  


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Have a nice day.


Dr Al Imari.