Subject: WHO reports: About 20%–40% of all health spending is wasted due to poor-quality care

Hello Friend,

The WHO recently reports that about 20%–40% of all health spending is wasted due to poor-quality care.

The reports states that safety studies show that poor diagnosis skills due to incomplete history taking, physical examination and work up in addition to poor physician-patient communication skills cause additional hospitalization, litigation costs, infections acquired in hospitals, disability, lost productivity and medial expenses cost some countries as much as US$ 19 billion annually. The economics of addressing these issue to improve patient safety are therefore compelling.

In current busy clinical environment and short patient interview time, how can physician work efficiently and comprehensively at the same time?!

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.  

Read more about the OSCEhome Systematic Approach at

Have a nice day.

Dr Al Imari.