Albert Francis E. Domingo, MD

my flight of ideas

Allied Forces

Posted on | June 3, 2006 | No Comments

(Part 3 of Stateside Healthcare: Art, Science, and Commerce?)

During observation duty, it was noted that the healthcare system in the US maximizes staff members by getting them to work to the “top of their license”, as was described in an American College of Physicians publication . It is asserted there that “all office staff members should be ‘working to the top of their license,’ doing what they are qualified to do, no more and no less. That means doctors, the most skilled and highly compensated members of the team, should stick to those tasks they are uniquely qualified to do and delegate the rest.”

Nurses observed in particular have shown that they help significantly in patient care, not just in clerical aspects but also in certain medical decisions. To illustrate, a KSC patient typically calls a centralized number which would have him/her connected to the Customer Contact Center. This call center is actually manned 24 hours by registered nurses who are capable of eliciting a concise medical history over the phone and, in their professional judgment, advising the caller one of several options from immediately going to the nearest emergency room for urgent cases to scheduling an appointment with the appropriate physician in outpatient cases. In calls wherein home interventions can be performed by laypersons, the nurse goes ahead and instructs the caller what to do.

The above concept of telephone triage saves time and resources, allowing the physician to see those who need professional care more than those who can be instructed the appropriate treatment. This has been a principle of KSC, wherein its manuals for managed care state that “when a consultant will not need to interview or examine the patient, a telephone consultation may save time and serve the patient better.”

Apart from triage, nurses are also maximized in that they perform several tasks otherwise delegated to other paramedical personnel in the Philippines. It was observed that nurses also do extensive patient education (e.g. diabetes education, wherein nurses can be certified by the American Diabetes Association to be a “Diabetes Educator”) in addition to explaining therapeutic regimens to patients and calling-in routine prescription refills to the pharmacy, on behalf of the physician.

Pharmacies in the US are also active members of the patient’s healthcare team. A registered pharmacist, while not part of the KSC system (in the Copperfield Clinic’s case because it doesn’t have an on-site Pharmacy), would see to it that the physician’s prescription is explained through counseling to patients making a purchase. Drugs are dispensed securely and with great care. Prescriptions are documented and kept on record, and physicians or their nurses are routinely called in cases of doubt. While this may seem routine, it is of sad notice that the Philippine Pharmaceutical Industry, at this point in time, may benefit from adopting some of the practices noted here in the US (because currently, for instance, antibiotics and certain restricted drugs can still be easily acquired without a prescription from Philippine pharmacies).

On the matter of drugs, it can be viewed either positively or with disdain that the US healthcare system is heavily influenced by marketing. Whether it be the general tendency of physicians to use brand names in prescribing drugs or the aggressive strategies employed by pharmaceutical representatives in getting physicians to write out prescriptions for advertised drugs, marketing dominates. It was explained however that sometimes it is better to tell patients about drugs using brand names, because using both the brand and the generic name may cause confusion. It must be remembered however that later on, when healthcare insurance is called upon to answer for the expenses of the prescribed medications, there is a tendency for the generic brand of less cost to be filled by the Pharmacist.

Next: To Choose, not just to Consent

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