Doctor's visit

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A doctor meeting with her patient in Egypt. Doctors develop a close relationship with their patients in order to build trust and better diagnose and treat disease. Meet My Doctor.jpg
A doctor meeting with her patient in Egypt. Doctors develop a close relationship with their patients in order to build trust and better diagnose and treat disease.

A doctor's visit, also known as a physician office visit or a consultation, or a ward round in an inpatient care context, is a meeting between a patient with a physician to get health advice or treatment plan for a symptom or condition, most often at a professional health facility such as a doctor's office, clinic or hospital. According to a survey in the United States, a physician typically sees between 50 and 100 patients per week, but it may vary with medical specialty, but differs only little by community size such as metropolitan versus rural areas. [1]

Contents

Procedure

The four great cornerstones of diagnostic medicine are anatomy (structure: what is there), physiology (how the structure/s work), pathology (what goes wrong with the anatomy and physiology), and psychology (mind and behavior). In addition, the physician should consider the patient in their 'well' context rather than simply as a walking medical condition. This means the socio-political context of the patient (family, work, stress, beliefs) should be assessed as it often offers vital clues to the patient's condition and further management.

A patient typically presents a set of complaints (the symptoms) to the physician, who then performs a diagnostic procedure, which generally includes obtaining further information about the patient's symptoms, previous state of health, living conditions, and so forth. The physician then makes a review of systems (ROS) or systems inquiry, which is a set of ordered questions about each major body system in order: general (such as weight loss), endocrine, cardio-respiratory, etc. Next comes the actual physical examination and other medical tests; the findings are recorded, leading to a list of possible diagnoses. These will be investigated in order of probability.

Jan Steen's The Doctor's Visit, c. 1663 Steen Doctor and His Patient.jpg
Jan Steen's The Doctor's Visit, c. 1663

The next task is to enlist the patient's agreement to a management plan, which will include treatment as well as plans for follow-up. Importantly, during this process the healthcare provider educates the patient about the causes, progression, outcomes, and possible treatments of his ailments, as well as often providing advice for maintaining health.

The physician's expertise comes from his knowledge of what is healthy and normal contrasted with knowledge and experience of other people who have had similar symptoms (unhealthy and abnormal), and the proven ability to relieve it with medicines (pharmacology) or other therapies about which the patient may initially have little knowledge.

Duration

Time that doctors spend with a patient. Time that doctors spend with a patient, OWID.svg
Time that doctors spend with a patient.

A survey in the United States came to the result that, overall, a physician sees each patient for 13 to 16 minutes. [1] Anesthesiologists, neurologists, and radiologists spend more time with each patient, with 25 minutes or more. [1] On the other hand, primary care physicians spend a median of 13 to 16 minutes per patient, whereas dermatologists and ophthalmologists spend the least time, with a median of 9 to 12 minutes per patient. [1] Overall, female physicians spend more time with each patient than do male physicians. [1]

For the patient, the time spent at the hospital can be substantially longer due to various waiting times, administrative steps or additional care from other health personnel. Regarding wait time, patients that are well informed of the necessary procedures in a clinical encounter, and the time it is expected to take, are generally more satisfied even if there is a longer waiting time. [3]

Web-based health care

With increasing access to computers and published online medical articles, the internet has increased the ability to perform self-diagnosis instead of going to a professional health care provider. Doctors may be fearful of misleading information and being inundated by emails from patients which take time to read and respond to (time for which they are not paid). [4] About three-quarters of the U.S. population reports having a primary care physician, but the Primary Care Assessment Survey found "a significant erosion" in the quality of primary care from 1996 to 2000, most notably in the interpersonal treatment and thoroughness of physical examinations. [5]

Research and development

Analysis

A study systematically assessed advice given by professional general practitioners, typically in the form of verbal-only consultation, for weight-loss to obese patients. They found it rarely included effective methods, was mostly generic, and was rarely tailored to patients' existing knowledge and behaviours. [6] [7]

The National Institute on Aging has produced a list of "Tips for Talking With Your Doctor" that includes asking "if your doctor has any brochures, fact sheets, DVDs, CDs, cassettes, or videotapes about your health conditions or treatments" – for example if a patient's blood pressure was found to be high, the patient could get "brochures explaining what causes high blood pressure and what [the person] can do about it". [8]

Virtual doctor's visit

This section is an excerpt from Telehealth.[ edit ]
Telehealth Doctor attending by teleconsultation.jpg
Telehealth

Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. [9] It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions. [10] [11] Telemedicine is sometimes used as a synonym, or is used in a more limited sense to describe remote clinical services, such as diagnosis and monitoring. When rural settings, lack of transport, a lack of mobility, conditions due to outbreaks, epidemics or pandemics, decreased funding, or a lack of staff restrict access to care, telehealth may bridge the gap [12]

as well as provide distance-learning; meetings, supervision, and presentations between practitioners; online information and health data management and healthcare system integration. [13] Telehealth could include two clinicians discussing a case over video conference; a robotic surgery occurring through remote access; physical therapy done via digital monitoring instruments, live feed and application combinations; tests being forwarded between facilities for interpretation by a higher specialist; home monitoring through continuous sending of patient health data; client to practitioner online conference; or even videophone interpretation during a consult. [9] [10] [13]

A scientific review indicates that, in general, outcomes of telemedicine are or can be as good as in-person care with health care use staying similar. [14]

Telemedicine as predicted in 1925 Diagnosis By Radio, 1925 (telemedicine).webp
Telemedicine as predicted in 1925
Advantages of the nonexclusive adoption of already existing telemedicine technologies such as smartphone videotelephony may include reduced infection risks, [16] increased control of disease during epidemic conditions, [17] improved access to care, [18] reduced stress and exposure to other pathogens [19] [20] during illness for better recovery, reduced time [21] and labor costs, efficient more accessible matching of patients with particular symptoms and clinicians who are experts for such, and reduced travel while disadvantages may include privacy breaches (e.g. due to software backdoors and vulnerabilities or sale of data), dependability on Internet access [16] and, depending on various factors, increased health care use.

Software and health records

This section is an excerpt from Electronic health record § Use in research and development.[ edit ]

Electronic medical records could also be studied to quantify disease burdens – such as the number of deaths from antimicrobial resistance [22] – or help identify causes of, factors of, links between [23] [24] and contributors to diseases, [25] [26] [27] especially when combined with genome-wide association studies. [28] [29]

This may enable increased flexibility, improved disease surveillance, better medical product safety surveillance, [30] better public health monitoring (such as for evaluation of health policy effectiveness), [31] [32] increased quality of care (via guidelines [33] and improved medical history sharing [34] [35] ), and novel life-saving treatments.

See also

Related Research Articles

Internal medicine, also known as general internal medicine in Commonwealth nations, is a medical specialty for medical doctors focused on the prevention, diagnosis, and treatment of internal diseases in adults. Medical practitioners of internal medicine are referred to as internists, or physicians in Commonwealth nations. Internists possess specialized skills in managing patients with undifferentiated or multi-system disease processes. They provide care to both hospitalized (inpatient) and ambulatory (outpatient) patients and often contribute significantly to teaching and research. Internists are qualified physicians who have undergone postgraduate training in internal medicine, and should not be confused with "interns", a term commonly used for a medical doctor who has obtained a medical degree but does not yet have a license to practice medicine unsupervised.

<span class="mw-page-title-main">Ambulatory care</span> Medical care provided for outpatients

Ambulatory care or outpatient care is medical care provided on an outpatient basis, including diagnosis, observation, consultation, treatment, intervention, and rehabilitation services. This care can include advanced medical technology and procedures even when provided outside of hospitals.

Terminal illness or end-stage disease is a disease that cannot be cured or adequately treated and is expected to result in the death of the patient. This term is more commonly used for progressive diseases such as cancer, dementia or advanced heart disease than for injury. In popular use, it indicates a disease that will progress until death with near absolute certainty, regardless of treatment. A patient who has such an illness may be referred to as a terminal patient, terminally ill or simply as being terminal. There is no standardized life expectancy for a patient to be considered terminal, although it is generally months or less. Life expectancy for terminal patients is a rough estimate given by the physician based on previous data and does not always reflect true longevity. An illness which is lifelong but not fatal is a chronic condition.

<span class="mw-page-title-main">Electronic health record</span> Digital collection of patient and population electronically stored health information

An electronic health record (EHR) is the systematized collection of patient and population electronically stored health information in a digital format. These records can be shared across different health care settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information.

<span class="mw-page-title-main">Telehealth</span> Health care by telecommunication

Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions. Telemedicine is sometimes used as a synonym, or is used in a more limited sense to describe remote clinical services, such as diagnosis and monitoring. When rural settings, lack of transport, a lack of mobility, conditions due to outbreaks, epidemics or pandemics, decreased funding, or a lack of staff restrict access to care, telehealth may bridge the gap as well as provide distance-learning; meetings, supervision, and presentations between practitioners; online information and health data management and healthcare system integration. Telehealth could include two clinicians discussing a case over video conference; a robotic surgery occurring through remote access; physical therapy done via digital monitoring instruments, live feed and application combinations; tests being forwarded between facilities for interpretation by a higher specialist; home monitoring through continuous sending of patient health data; client to practitioner online conference; or even videophone interpretation during a consult.

eHealth describes healthcare services which are supported by digital processes, communication or technology such as electronic prescribing, Telehealth, or Electronic Health Records (EHRs). The use of electronic processes in healthcare dated back to at least the 1990s. Usage of the term varies as it covers not just "Internet medicine" as it was conceived during that time, but also "virtually everything related to computers and medicine". A study in 2005 found 51 unique definitions. Some argue that it is interchangeable with health informatics with a broad definition covering electronic/digital processes in health while others use it in the narrower sense of healthcare practice using the Internet. It can also include health applications and links on mobile phones, referred to as mHealth or m-Health. Key components of eHealth include electronic health records (EHRs), telemedicine, health information exchange, mobile health applications, wearable devices, and online health information. These technologies enable healthcare providers, patients, and other stakeholders to access, manage, and exchange health information more effectively, leading to improved communication, decision-making, and overall healthcare outcomes.

<span class="mw-page-title-main">Telenursing</span>

Telenursing refers to the use of information technology in the provision of nursing services whenever physical distance exists between patient and nurse, or between any number of nurses. As a field, it is part of telemedicine, and has many points of contacts with other medical and non-medical applications, such as telediagnosis, teleconsultation, and telemonitoring. The field, however, is still being developed as the information on telenursing isn't comprehensive enough.

<span class="mw-page-title-main">Telerehabilitation</span> Delivery of rehabilitation services over the internet

Telerehabilitation (or e-rehabilitation is the delivery of rehabilitation services over telecommunication networks and the internet. Telerehabilitation allows patients to interact with providers remotely and can be used both to assess patients and to deliver therapy. Fields of medicine that utilize telerehabilitation include: physical therapy, occupational therapy, speech-language pathology, audiology, and psychology. Therapy sessions can be individual or community-based. Types of therapy available include motor training exercises, speech therapy, virtual reality, robotic therapy, goal setting, and group exercise.

<span class="mw-page-title-main">Telepsychiatry</span> Mental-health care by telecommunication

Telepsychiatry or telemental health refers to the use of telecommunications technology to deliver psychiatric care remotely for people with mental health conditions. It is a branch of telemedicine.

<span class="mw-page-title-main">Rural health</span> Interdisciplinary study of health and health care delivery in rural environments

In medicine, rural health or rural medicine is the interdisciplinary study of health and health care delivery in rural environments. The concept of rural health incorporates many fields, including wilderness medicine, geography, midwifery, nursing, sociology, economics, and telehealth or telemedicine.

Home automation for the elderly and disabled focuses on making it possible for older adults and people with disabilities to remain at home, safe and comfortable. Home automation is becoming a viable option for older adults and people with disabilities who would prefer to stay in the comfort of their homes rather than move to a healthcare facility. This field uses much of the same technology and equipment as home automation for security, entertainment, and energy conservation but tailors it towards old people and people with disabilities.

The doctor–patient relationship is a central part of health care and the practice of medicine. A doctor–patient relationship is formed when a doctor attends to a patient's medical needs and is usually through consent. This relationship is built on trust, respect, communication, and a common understanding of both the doctor and patients' sides. The trust aspect of this relationship goes is mutual: the doctor trusts the patient to reveal any information that may be relevant to the case, and in turn, the patient trusts the doctor to respect their privacy and not disclose this information to outside parties.

<span class="mw-page-title-main">Health 2.0</span>

"Health 2.0" is a term introduced in the mid-2000s, as the subset of health care technologies mirroring the wider Web 2.0 movement. It has been defined variously as including social media, user-generated content, and cloud-based and mobile technologies. Some Health 2.0 proponents see these technologies as empowering patients to have greater control over their own health care and diminishing medical paternalism. Critics of the technologies have expressed concerns about possible misinformation and violations of patient privacy.

Teledermatology is a subspecialty in the medical field of dermatology and probably one of the most common applications of telemedicine and e-health. In teledermatology, telecommunication technologies are used to exchange medical information over a distance using audio, visual, and data communication. Applications comprise health care management such as diagnoses, consultation, and treatment as well as (continuous) education.

Connected health is a socio-technical model for healthcare management and delivery by using technology to provide healthcare services remotely. Connected health, also known as technology enabled care (TEC) aims to maximize healthcare resources and provide increased, flexible opportunities for consumers to engage with clinicians and better self-manage their care. It uses readily available consumer technologies to deliver patient care outside of the hospital or doctor's office. Connected health encompasses programs in telehealth, remote care and disease and lifestyle management, often leverages existing technologies such as connected devices using cellular networks and is associated with efforts to improve chronic care. However, there is an increasing blur between software capabilities and healthcare needs whereby technologists are now providing the solutions to support consumer wellness and provide the connectivity between patient data, information and decisions. This calls for new techniques to guide Connected Health solutions such as "design thinking" to support software developers in clearly identifying healthcare requirements, and extend and enrich traditional software requirements gathering techniques.

<span class="mw-page-title-main">Remote patient monitoring</span> Technology to monitor patients outside of conventional clinical settings

Remote patient monitoring (RPM) is a technology to enable monitoring of patients outside of conventional clinical settings, such as in the home or in a remote area, which may increase access to care and decrease healthcare delivery costs. RPM involves the constant remote care of patients by their physicians, often to track physical symptoms, chronic conditions, or post-hospitalization rehab.

Digital health is a discipline that includes digital care programs, technologies with health, healthcare, living, and society to enhance the efficiency of healthcare delivery and to make medicine more personalized and precise. It uses information and communication technologies to facilitate understanding of health problems and challenges faced by people receiving medical treatment and social prescribing in more personalised and precise ways. The definitions of digital health and its remits overlap in many ways with those of health and medical informatics.

<span class="mw-page-title-main">Teleophthalmology</span>

Teleophthalmology is a branch of telemedicine that delivers eye care through digital medical equipment and telecommunications technology. Today, applications of teleophthalmology encompass access to eye specialists for patients in remote areas, ophthalmic disease screening, diagnosis and monitoring; as well as distant learning.

<span class="mw-page-title-main">OpenNotes</span> American healthcare research initiative

OpenNotes is a research initiative and international movement located at Beth Israel Deaconess Medical Center.

<span class="mw-page-title-main">Artificial intelligence in healthcare</span> Overview of the use of artificial intelligence in healthcare

Artificial intelligence in healthcare is a term used to describe the use of machine-learning algorithms and software, or artificial intelligence (AI), to copy human cognition in the analysis, presentation, and understanding of complex medical and health care data, or to exceed human capabilities by providing new ways to diagnose, treat, or prevent disease. Specifically, AI is the ability of computer algorithms to arrive at approximate conclusions based solely on input data.

References

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  3. ↑ Simple Tips to Improve Patient Satisfaction By Michael Pulia. American Academy of Emergency Medicine. 2011;18(1):18-19.
  4. ↑ ECRI. Special Article: Internet Influence on Doctor/Patient Relationship Archived February 6, 2007, at the Wayback Machine . Health Technology Trends. June, 2006.
  5. ↑ Safran DG (February 2003). "Defining the future of primary care: what can we learn from patients?". Ann. Intern. Med. 138 (3): 248–55. doi:10.7326/0003-4819-138-3-200302040-00033. PMID   12558375. S2CID   1336772.
  6. ↑ "People may not always get helpful weight loss advice from their doctors, study finds". ABC News. Retrieved 17 January 2023.
  7. ↑ Tremblett, Madeleine; Poon, Annabel Y X; Aveyard, Paul; Albury, Charlotte (13 December 2022). "What advice do general practitioners give to people living with obesity to lose weight? A qualitative content analysis of recorded interactions". Family Practice. 40 (5–6): 789–795. doi: 10.1093/fampra/cmac137 . PMC   10745272 . PMID   36510443.
  8. ↑ "Tips for Talking With Your Doctor" (PDF). National Institute on Aging. May 2014. Retrieved 3 February 2023.
  9. 1 2 "What is TeleHealth?". Office for the Advancement of Telehealth. The Health Resources and Services Administration. March 2022. Retrieved 12 January 2024.
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  17. ↑ Monaghesh E, Hajizadeh A (August 2020). "The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence". BMC Public Health. 20 (1): 1193. doi: 10.1186/s12889-020-09301-4 . PMC   7395209 . PMID   32738884.
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  19. ↑ Portnoy J, Waller M, Elliott T (May 2020). "Telemedicine in the Era of COVID-19". The Journal of Allergy and Clinical Immunology. In Practice. 8 (5): 1489–1491. doi:10.1016/j.jaip.2020.03.008. PMC   7104202 . PMID   32220575.
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  30. ↑ Desai, Rishi J.; Matheny, Michael E.; Johnson, Kevin; Marsolo, Keith; Curtis, Lesley H.; Nelson, Jennifer C.; Heagerty, Patrick J.; Maro, Judith; Brown, Jeffery; Toh, Sengwee; Nguyen, Michael; Ball, Robert; Dal Pan, Gerald; Wang, Shirley V.; Gagne, Joshua J.; Schneeweiss, Sebastian (20 December 2021). "Broadening the reach of the FDA Sentinel system: A roadmap for integrating electronic health record data in a causal analysis framework". npj Digital Medicine. 4 (1): 170. doi:10.1038/s41746-021-00542-0. ISSN   2398-6352. PMC   8688411 . PMID   34931012.
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