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

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