Tuesday 3 January 2017

Component of a simple consultation

Dr K K Aggarwal
National President IMA and Dr Vijay Agarwal




ACTIVITY
Actions Required
Charges INR
Registering a patient
  1. Capturing demographic details
  2. Noting allergies
  3. Noting other alerts
  4. Storing of data for 3 years (MCI) / 7 Years (Income Tax)
  5. Electronic health record keeping (CEA Rule 9)


Consultation

Professional conduct, Etiquette and Bioethics

A: Acknowledge patient and introducing yourself
L: Patient listening
E: Detailed explanation
R: Revision in patients own words
T: Thanking the patient

History taking
Detailed history taking
Making a summary of past voluminous records


Examination
Ensuring privacy & confidentiality;
Undressing and examination;
Hand washing before and after examination.

Investigations
Planning, Counseling and Documenting

Treatment
Making provisional diagnosis;
Writing detailed prescription as per MCI code of ethics.
Treatment counseling

Counseling
Diet
Mental
Fitness
Pharmacy
Sexual Health
Vaccination


Rehabilitation
Exercise
Job
Vacations

Notification
Notifiable Diseases
Communicable Diseases
Adverse Reactions
Medico Legal Cases
Sentinel Events
Antimicrobial Resistance
Drugs/Devices/Vaccines/ Herbs/Blood reactions  

Certificates
Leave, fitness, rest etc.

Consent
Consent
Informed refusal
Video Consent


Skilled Maneuvers
Physical
Mental
1, BP in all four limbs
2. Tourniquets test
3. Carotid massage test
4. Epley maneuver
5. Cold pressor test
6. Valsalva test
7. Fundus examination
8. Brain stem reflexes
9. Cognitive functions
10. Risk stratifications
11. Filament neuropathy check
12. Per rectal exam
13. Per vaginal exam
14. Pap Smear
15. FNAC
16. Oral smear
17. Potency testing
18. torch tests for hydrocele
19. Stethoscope test for conductive deafness
20. PAPA. CHACHA, KAKA test

Skilled Procedure
Physical Mental
Dressing ( Small, Medium, Large, Special)
Removing Foreign Body
Gastric Suction
Pharyngeal/ Laryngeal Suction


Point of Care Investigations
ECG
Blood Sugar
SPO2
PEFR
Pocket Spirometry
Noise Pollution Check
PM 1, 2.5, 10 levels
CO Monitoring
Autonomic functions
Driving fitness testing
Hb
Urine spot test
Point of care blood tests ( dengue, malaria, typhoid, chikungunya)
Bence jones protein screening test


Observation / Monitoring  if Required (hours)
  1. First dose of drug
  2. Syncope
  3. Breathlessness
  4. Hypotension
  5. Allergy reaction
  6. After injections


First Aid
Oxygen ( per hour)
Nebulization
CPR
Other first aids
Injection
Cast
Plaster
Sling
Foreign Body removal



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