Why systemisation in healthcare is essential


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Why systemisation in healthcare is essential

  1. 1. Why Systemize Of Health Care Is Essential To Modernise Medicine Unplanned hospital admission is costly for the healthcare system and for children, straining finite hospital resources. Once admitted, children are at risk of hospital-acquired infections, medical errors, drug reactions and emotional trauma.’ A reduction in unplanned hospital admissions for children was one of the targets in the NHS Outcomes Frame work which has failed. Do We Need To Change? Asked Collin Powell, in the Editorial. YES!! Because of reasons I explain below that will make you think it is essential to reduce cost, protect patients and make sure we help reduce spreading infections in the community. My PROJECT In 1990s, the new batch of SHOs who came to work in the hospitals where not keen to learn nor confident to diagnose and mange sick children. Some of them were simply calling me to review every child brought in to hospital. Initially I made a list of symptoms to help the SHOs decide when to call me, treat or send home. I reviewed the ones who required admission.. Then I wrote a small simple programme in my Psion PDA called "PAT" (Pediatric Assessment Tool) that worked very well. The SHOs also learnt a lot using the tool and were becoming confident. In 1996, I criticized hospitals using “Pre- Printed Assessment Sheet” and said this will result in doctors not adequately trained and so not safe. I did not think my tool would one day help until I started working in a Nurse- led Pilot GMS practice as a salaried GP in 2003. Article in BMJ is asking for a tool to help (differentiate common from serious illness) in-experienced doctors. One dose of antibiotic is said to kill all the good bacteria and the patient becomes a reservoir of antibiotic resistant bacteria. This is not one we can brush aside because it is un-ethical to harm but also threaten our existence by increasing resistant bacteria. Colonization Of Bacteria In Surgery & Hospital Visiting various surgeries in and around London gave me an opportunity to learn about infection control and how bacteria spread from patient to patients.
  2. 2. What Made Me Think Different? I was employed as a Salaried GP in this “Pilot PMS Nurse-led Practice” (First one to be established) linked to local Walk-in-clinic. Here I stared identifying minor and serious mistakes committed by nurses working in the local Walk-in-clinics and the practice I was working. I was also hearing what goes on in hospitals as my wife working in St Georges Hospital, Kings College Hospitals as the SPR in Paediatrics. Wrong diagnosis and treatment were making patients suffering and develop complications. Diagnosing snuffles, ear infections, cough, fever, sore throat, diarrhea, vomiting and rash is often wrong. Majority of doctors I asked to define “Inflammation” often said “Infections”. This made me realize medical professionals have been thriving on emotions and not necessarily using medical knowledge. Some incompetent and in- experienced doctors are using published guidelines to shield their incompetence and use them to protect themselves when things go wrong. Problems I Identified Working As A Locum GP in Various Surgeries Ear Infections   Pain in one or both ears is often labeled as URTI and treated as infection but in UK, doctors and nurses do not use pneumatic otoscope but document as “Red ear”. This costs NHS £24 Million every year and help increase antibiotic resistanant bacteria. Majority of patients notes say wax++, red ears. But how can wax be present in the ear when the eardrum is infected, red, hot and painful? I hve never seen “Pneumatic Otoscope” in hospital or Surgery. I have used this for years and also use tuning fork to perform Webbers & Renni test. Not many doctors or nurses have even heard about this test and why and how I use this. These are standard clinical examination methods used all over the world. Chest Infections Cough is used synonymously with Chest Infection. Not many Gps were documenting type of cough nor clearly documenting clinical findings. “Chest Clear” or occasionally Crepts, crankles, wheezy or mild wheeze are documented. When I ask patients whether the doctor or nurse examined chest, majority of patients told me the doctor did not. Examination of chest with cloths on can never be “Clear” because the cloths will rub on the diaphragm and produce crackling noise.
  3. 3. PCT also investigated a complaint against me because I requested a girl aged 18 years to undress (her mother was present). The letter clearly state she had seen numerous doctors and nurses and no one had asked her to undress. Cough is the last symptom of so-called chest infection and is said to be to help our body clear the fluids (Resolution). Giving 250mg of Amoxicillin is often routine. This is under dosing and will certainly increase resistant strain colonization. We must administer large dose of antibiotic to clear chest infection because the antibiotics will not be secreted by exocrine glands & will not enter alveoli. Urinary Tract Infection Poorly managed and now we are left with one antibiotic that may work. E-Coli threat is not simple and is likely to kill more people than we have ever seen. Swapping one antibiotic to another because the culture sensitivity report say the organism is resistant to the antibiotic patient is prescribed. I have never come across doctors contacting microbiologist and discussing or trying to find out MIC Used to test sensitivity. Even if the patient is happy and well, the antibiotics are changed. This is poor standard care. I was shocked when this girl seven presented with bloodstains in panties. No doctor or nurse even bothered to examine her. Most Gps Use Wikipedia Or Google As Reference Books/ According to a survey of the UK’s doctor’s surgery receptionists, most GP’s use a combination of Google and Wikipedia to diagnose patients and prescribe medicine. Gps look things up on the Internet or use iPad to help diagnosing patients. A lot of the time they’ll work from home and see patients via Skype, keeping Wikipedia open in another window whilst they talk about their symptoms. These are only few clinical problems I am explaining about. The number of wrong doings that go on is more than I imagined and so systemization is essential to see what and how doctors manage their patients.
  4. 4. What I Did To Help Protect Patients In 1996, I read about “Pre-Printed Assessment Sheet” in medical journal and so I have criticized this approach and so started independent study to find alternative method to offer emergency care. Since 2003, I have collected information about why patients come to consult and compiled a list of patients who must be examined by a doctor. I developed a simple set of cards that I could test and see if the tool offers the same advice as I do. The number of symptoms we choose to compile the final set of common symptoms was nine. The tool helped patients to differentiate “Common” and “Serious Illness” The number of patients demanding emergency appointment in the surgery reduced by 30%. These cards will also encourage people who have symptoms but assume it is common and so they present late with complications. In the last few years I went through all the literatures about patient access and then wrote a simple programme that could work well. To make this very safe, I created a database with the help of my friends in Bangalore. This is the tool you can access FREE only if registered and will tell you whom you must consult Doctor, Nurse or a Chemist. How Tools Help Identify Problems Early Two reasons we must systemize (1) Make doctors commit to what and how they mange their patienst and (2) Reduced unethical medical practice like wasted investigations and treatment. Standardize care will be safe and gives us the opportunity to monitor clinical practice, prevent wrong doings and allow doctors implement and incorporate advances. VirtualNHS.COM Now using the tool, I have created a "Virtual NHS" that will help NHS survive and protect patients. I have not allowed people to browse through nor registering patients or doctors. This tool allows doctors to create their own tool based on the list of common symptoms that I have identified. I am planning to offer this to NHS and make it available to every GP in UK. GPs will find the tools helpful as it reduces wasted consultation, help boost their moral and doctors patient interaction. This site will “Systemize Healthcare” and so protect patients. The doctor can access, change criteria, add or remove drugs, referral, and investigation and even perform some basic clinical examinations. The present method of offering emergency care,
  5. 5. consultation and diagnosis offered in primary care is neither standardized nor similar. Doctors and patients interaction occurs behind close doors and so only a doctors (locums) have access to the notes and so can identify wrong doings. Doctors can offer their service 24/7, 365 days because the tool will work like the SHOs in hospital and eliminate common illness and offer advice and treatment authorized by the doctors. This will reduce access by 70% and the doctor will have to only mange 30% of their patients. When the doctors set the criteria, authorized treatment, speak to doctor, referal or consultation the tool will automatically refer seriously ill patients to hospital, call Ambulance, refer and also send prescription to the local chemist. The beauty of this work is it can be installed in computers at home, surgery or create a Kiosk that can also be placed in super markets, gas stations and clinics . NHS will not have to invest in establishing IT Department or spend £Billions to implement this tool. I have created APPS for common symptoms that will work like a doctor (help diagnose, advice management and suggest treatment) that could help me cash in but am not releasing this now because I want the medical profession to survive. I am not registering doctors or patients in VirtualNHS.COM because this tool can be abused and so destroy General Practice. I feel we will need GPs to help support sick and mentally ill patients at home) I am in UK and my mission is to make sure this work is made available to every citizen in UK. It is my duty as a doctor to help protect innocent people and prevent wrong doings. You can download one of my WebApp in Desktop or visit my website and click on the iPhone image to download Maya App in your smart phone if you click on the iPhone poster. To access MAYA you will need to register (FREE) and use your User ID and Password will be sent to you directly. Once you log in you can see how this works. I need all the help you can offer knowing my ontribution is not only likely to save £Billions but also become the tool that doctors and patients can use all over the world. My work is almost complete but need to make her presentable and start saving lives, reduce spreading infections and wrong doings in the NHS. VirtualNHS will make doctors; nurses and chemist to standardize care offered by them and so will make their work transparent. Now the system does not allow patients to know or identify wrong doings that go on every day. I will be happy to come over to your office or home and show you how this works. Its simple, easy and 100% safe.