OPTIMUM DURATION OF OPD CONSULTATION

WHAT IS THE OPTIMUM DURATION OF OPD CONSULTATION?

Almost all doctors see patients in OPD and it is the most important aspect of patient care for a physician. For a surgeon, OPD consultation is important to counsel patients regarding surgery after discussing the pros and cons of the procedure.

What factors determine the success of OPD consultation?

There are several aspects of OPD consultation that determine whether it was successful or not. These include: 1. Whether doctor carefully listened to patient’s problems or not? 2. Whether the doctor was pleasant or not? 3. Whether adequate time was allotted for the consultation or not? 4. Whether adequate information was given regarding diagnosis, investigations, medications, treatment, prognosis, etc or not? Of all of these, the duration is consultation is probably one of the most important factors.

How long should an ideal OPD consultation last?

There is no uniform guideline regarding the optimum duration for an OPD consultation. Doctors complete an OPD consultation in as little as 3-4 minutes, and some doctors spend almost an hour per patient in the OPDs. Spending more time would increase patient’s satisfaction, however, that is not the only criteria ensuring patient’s satisfaction.

Longer duration of OPD consultation would limit the number of patients a doctor can see per day. This would lead to long waiting periods. Is it advisable, when there are so few doctors seeing so many patients?

Duration of OPD consultation can increase without necessarily increasing the efficiency of diagnosis and treatment. For example, patient may try to discuss in detail certain irrelevant history (symptoms or past treatment) or he may bring volumes of old documents, which may not be relevant. He may discuss certain facts that he “half-learned” from the Internet, which may not be relevant to the case. Some patients are very talkative and it is difficult to stop them.

What is the best strategy?

Most experienced doctors know the relevant factors in history taking and examination. Doctors should guide the discussion in OPD, and politely point out if the patients are drifting away. Most important points can be discussed in 8-10 minutes. In any case, patients on average remember only three points from an outpatient consultation. So, there is no real point in overloading patients with too much information in a single consultation. Also, not all patients require the same amount of time. For example, a regular patient coming for diabetes or hypertension medications may not take more than 3 minutes, if sugar and BP are normal. On the other hand, an elderly patient with multiple comorbidities on multiple medications may take 15 minutes. So, the duration can be tailored as per the needs of the patient. On an average, 8-10 minutes per consultation would suffice.

This article was first published in www.docplexus.in Can be accessed at the following link-

https://www.docplexus.in/#/app/posts/5cdf6cab-03fe-4e12-934a-cd4d472fbc23

Image above is for representational purpose only

Dr SUDHIR KUMAR MD (Internal Medicine), DM (Neurology)

Senior Consultant Neurologist

Apollo Health City, Jubilee Hills, Hyderabad

Phone: 040-23607777/60601066

Email: drsudhirkumar@yahoo.com

HIGH STRAIN JOBS LEAD TO A HIGHER RISK OF STROKE

HIGH STRAIN JOBS LEAD TO A HIGHER RISK OF STROKE

Today's job requires working long hours, often stretching into late nights. Several jobs also require doing night shift duties. With increased internet connectivity, there is a boon to communication. However, it has also blurred the boundaries of "work time" and "leisure time". It is common to see people bringing work to home. At home, instead of relaxing, they remain busy on "business calls" on their smartphones, or work on "projects" on their laptops. While all these long and unearthly hours of work have increased their productivity making these employees "valuable assets" to the company; it has also taken a big toll on their health.

A recent study, published in NEUROLOGY Journal (Nov 2015) has shown a significantly higher risk of brain stroke in people with high strain jobs. The risk was higher for ischemic stroke (where the blood supply to a part of brain gets blocked), resulting in paralysis, impaired speech, blindness, and so on. The risk of brain stroke due to high strain jobs was found to be higher in women as compared to men.

Several reasons may be involved in increasing the risk of brain stroke in high strain jobs:

1. Work strain may lead to unhealthy lifestyles such as increased smoking, reduced physical activity, unhealthy eating habits, untimely meals, reduced sleep, lack of health check ups, etc. All of them are risk factors for stroke.

2. Work stress is often associated with certain cardiovascular risk factors, such as metabolic syndrome, high body mass index (obesity), impaired glucose metabolism (diabetes), and dyslipidemia (high cholesterol), which are also known to be risk factors for stroke.

3. Work stress can also lead to neuro-endocrine disturbances, leading to increased inflammation and plaque destabilization, leading to ischemic brain stroke.

Therefore, one needs to maintain a good work-leisure balance. Maintaining good work out put and efficiency are important, however, it should not be at the cost of strain and stress.

1. Working hours should be restricted to 8-10 hours per day.

2. Work should not be brought home.

3. There should be adequate time left (after work) to spend with family; and exercise on a regular basis.

4. Smartphones and laptops should be in silent mode during sleep, so that sleep is not disturbed.

5. Avoid night shift duties as much as possible.

6. Avoid excess travel, as it leads to disturbed sleep rhythm, as well as increased strain.

7. Periodic breaks and vacations with family are advisable, to get relaxed and recharged.

DR SUDHIR KUMAR MD (Medicine) DM (Neurology)
Senior Consultant Neurologist
Apollo Hospitals, Jubilee Hills, Hyderabad
Email: drsudhirkumar@yahoo.com
Phone: 040-23607777/60601066

Online Consultation: http://bit.ly/Dr-Sudhir-kumar

VEGETARIAN DIET INCREASES THE RISK OF CANCER AND HEART ATTACK; AND REDUCES FERTILITY

VEGETARIAN DIET INCREASES THE RISK OF CANCER AND HEART ATTACK; AND REDUCES FERTILITY

A recent study done at Cornell University in US has shown a higher risk of cancer and heart attacks in people eating pure vegetarian food for generations. Scientists have found that long-term vegetarianism can lead to genetic mutations, which increase the risk of heart disease and cancer.

Traditionally, red meat is known to increase the risk of colorectal (intestine) cancer, however, a recent research found the reverse, a 40% higher cancer risk among vegetarians!

This study compared two sets of people- meat eating people from Kansas (USA) and vegetarian people from Pune (India).

Long term vegetarian people were found to have genetic mutation that resulted in rapid metabolism of plant fatty acids, leading to increased amounts of arachidonic acid (which increases inflammation) and reduced production of protective omega 3 fatty acid. A shift of diet from fish (rich in healthy omega 3 fats) to vegetable oils (rich in less healthy omega 6 fats) has compounded the problem.

This study has clearly shown the higher risks of heart disease and cancer in pure vegetarian people. The message to vegetarians is clear- either eat fish or use olive oil (low in omega 6) if you cannot eat fish.

Previous studies have shown other problems with vegetarian diet:

1. Low sperm count leading to reduced fertility,

2. Low fertility could also be related to intake of pesticides (used in fruits and vegetables),

3. Vegetarians are also more prone to deficiencies of iron and vitamin B12.

4. One study found lower bone mineral density in vegetarians.

Finally, there is some good news for vegetarians. All is not gloomy. Research has also shown lower risk of diabetes, stroke and obesity among vegetarians as compared to non-vegetarians.

DR SUDHIR KUMAR MD DM

Senior Consultant Neurologist

Apollo Health City, Jubilee Hills, Hyderabad

Ph: 040-23607777/60601066

Email: drsudhirkumar@yahoo.com

The article details can be found in The Telegraph:http://www.telegraph.co.uk/news/2016/03/29/long-term-vegetarian-diet-changes-human-dna-raising-risk-of-canc/

COMPARISON OF COST OF MEDICAL TREATMENT IN NEUROLOGICAL ILLNESSES (INDIA versus USA)

COMPARISON OF COST OF MEDICAL TREATMENT IN NEUROLOGICAL ILLNESSES (INDIA versus USA) (in US dollars; 1 USD=70 INR)

	INDIA	USA
Neurologist consultation fees	10-20	500-600
CT scan charges	30-60	1,000-1,600
MRI scan charges	150	2,600
EEG (routine)	30-60	500-600
Long term EEG recording	150	3,000
NCS/EMG	50-150	1,000-5,000
Botox (One vial cost)	300	525
Hospitalization for acute STROKE treatment	1,500-7,000	14,000-30,000

The costs in India are that of private hospitals and diagnostic centers. Also, the discussion pertains to Neurology treatments in urban areas and metros of India.

Costs are exorbitantly high in USA

It is obvious that the treatment costs are several times higher in USA, as compared to India. I agree that insurance companies cover most of the cost in USA, but individuals still need to pay at least 10-20% of the bills. You can imagine the fate of those who do not have medical insurance (about 12% of Americans do not have insurance). In 2007, 62% of filers for bankruptcy in US claimed high medical expenses. US spends about 10,000 dollars per year per person on healthcare. About 20% of GDP is spent on healthcare. The medical treatment costs in the US are the highest in the world. 

                                          (Source: Washington Post)

Waiting periods to see specialists/get procedures are long

In USA, there are long waiting periods to see a Neurologist, as well as, to get the procedures (EMG, EEG, Botox, MRI, etc) done. In India, one can see a neurologist, get the MRI done and get it reported by a Radiologist in a few hours! On the other hand, the average wait time to see a Neurologist in USA is 30-35 days. Getting the MRI done and its report would take several more days. The situation in UK and Canada are worse, where one may have to wait for 2-3 months to see a specialist and get an MRI done. 

The charges are higher in several other countries too, including Singapore, Australia and Thailand.

Indian Neurologists are well trained and experienced

Regarding the expertise of Neurologists, training in premier Indian Institutes such as AIIMS, PGI Chandigarh, NIMHANS, CMC Vellore, Sree Chitra, Tiruvannathpuram, JIPMER Puducherry, etc are at par with the best in USA. The clinical experience of treating neurological illnesses is several times more among Indian Neurologists, simply because they see more number of patients. There are about 2000 neurologists to cater to 1.25 billion people (one Neurologist for every 6,25,000 people). In comparison, US have about 18,000 neurologists for a population of 320 million (one Neurologist every 18,000 people). On an average, Indian neurologists see 3-4 times more number of patients as compared to American or British Neurologists.

In summary, Neurological treatment costs are much lower in India as compared to US and many other countries. The access to Neurology care is easy, and has little or no waiting times. Neurologists in India are well trained in the subject and have a vast clinical experience. 

DR SUDHIR KUMAR MD (Internal Medicine) DM (Neurology)

Senior Consultant neurologist

Apollo Hospitals, Jubilee Hills, Hyderabad

Phone: 0091-40-23607777/60601066
Online Consultation:  http://bit.ly/Dr-Sudhir-kumar
Email: drsudhirkumar@yahoo.com

TIPS FOR GOOD AND RELAXING SLEEP (on WORLD SLEEP DAY)

TIPS FOR GOOD AND RELAXING SLEEP

Today is World Sleep Day (celebrated on Friday of second full week in March).  You must be wondering why should we celebrate World sleep day. This is because about 45% of population suffers from one form of sleep disorder or other or are sleep deprived. Sleep problems are not only associated with un-refreshed feeling, but are also associated with major health hazards. So, the World sleep day is aimed at raising awareness about benefits of good sleep and ways to ensuring a good sleep. This year’s slogan for World sleep day is “Good sleep is a reachable dream”.

Normal Sleep

     1. Normal sleep duration is 7-9 hours in adults (10-11 hours in 6-12 year olds; 9 hours in teenagers)
     2. Natural sleep occurs at nights, as melatonin (sleep hormone) is released during nights (when there is no light)
     3. Adults need to sleep only once (at nights). This is called monophasic sleep. People older than 60 may have biphasic sleep (in addition to nights, they may sleep in afternoons too). Newborn babies and infants may have polyphasic sleep (they sleep and get up multiple times).
     4. The best time to go to bed is between 9 PM to 11 PM and the best time to get up is between 5 AM to 7 AM. It should be made a habit to go to sleep and awaken at the same time everyday to avoid sleep problems.
     5. People who work until late evenings may benefit from a short post-noon sleep, called as siesta or power nap. Typically, it should not last more than 15-20 minutes. Siesta energizes the individual improving their work efficiency.

Functions of Normal Sleep
1. Sleep is restorative in nature and makes us fresh and energised to do the day’s work,
2. Growth hormone (GH) is released at nights during sleep. GH secretion may get affected in nights shift workers (and day sleepers). (Prolactin and testosterone are also maximally secreted at nights)
3. Consolidation of memory occurs during sleep. So, it is a better habit to have a good nights’ sleep for better memory, rather than burning midnight oil! The best long term memory is achieved when learning is followed by sleep within three hours.

Risks and Hazards of Sleeping Less
1. Attention and concentration are impaired the day after less sleep. This could result in driving errors, poor efficiency at school or work, as the case may be,
2. Some people complain of general tiredness or heaviness of head/headache after sleeping less,
3. Memory impairment may occur in people sleeping less,
4. Increased irritability and behavioral problems are seen in sleep deprived people,
5. Less sleep may make you fat and lead to obesity,
6. Increased incidence of diabetes mellitus, hypertension, cancer, stroke and coronary artery disease is seen in people sleeping less,
7. Lack of sleep kills sex drive,
8. Less sleep may lead to depression and anxiety; also, people with depression and anxiety sleep less,
9. Lack of sleep leads to skin ageing, and makes it lackluster. Dark circles may form under the eyes.
10. There is also an association between less sleep and higher death rates. Reducing sleep duration from 7 to 5 hours on a regular basis may double the risk of death, mostly from cardiovascular causes.

Tips for Ensuring Good and Sound Sleep
1. Have a light dinner and avoid heavy meals at nights. Eat at least two to three hours before sleeping time. A full stomach may cause sleep disturbance. Late dinners may cause acid reflux in the stomach,
2. Avoid tea, coffee other stimulant drinks at nights, as it may cause less sleep,
3. Avoid smoking at all times, especially at nights,
4. Maintain a good sleep hygiene (try to sleep and wake up at the same time every day)
5. Avoid night shift duties and doing duties in changing shifts (occasional night duty is alright),
6. Avoid frequent travels to places with different time zones (this can lead to jet lag and impaired sleep),
7. Avoid arguments and heated discussions just before sleep,
8. Avoid watching negative news on TV about various crimes, etc at nights. Instead it may be better to listen to some soothing music or read a relaxing novel.
9. Exercise in the evenings improve night’s sleep quality,
10. A glass of milk would also improve sleep,
11. The bedroom should be used only for sleep (and sex) and office work should not be brought to bedroom.
12. It is better to keep the phones and other gadgets away during sleep, and keep them in silent mode
13. Sleep is better in dark, so, ensuring that would improve sleep quality.
14. Also, maintain a good ambient room temperature. Too hot or too much cold temperature may hamper good sleep.
15. Avoid taking sleeping pills, as they can lead to addiction or dependence on them. After that, you would not get sleep without them and over a period of time, much higher doses of sleeping pills would be needed.

DR SUDHIR KUMAR MD (Internal Medicine) DM (Neurology)

Senior Consultant Neurologist

Apollo Health City, Hyderabad

Phone- 0091-40-23607777/60601066

Email: drsudhirkumar@yahoo.com

Online consultation:  http://bit.ly/Dr-Sudhir-kumar