PRIMARY SKILLS IN PATIENT CARE Dr.T.V.Rao MD BASIC CARE AT PRIMARY HEALTH ESTABLISHMENTS

PRIMARY SKILLS IN PATIENT CARE

Dr.T.V.Rao MD

BASIC CARE AT PRIMARY HEALTH ESTABLISHMENTS

I was a part of a Medical system for more than 4 decades. When I was a medical student my teachers were keen that I must learn, and perform clinical skills in examination of the patients in an organized fashion, at the end of the posting in the clinical specialty. The golden words as taught by my teachers still stands good today in whatever rank you are working as said “Hospitals should do the sick no harm.” So wrote Florence Nightingale, the founder of modern nursing, 150 years ago. We were made to perform a minimal examination of the patients, and be able to come to some decision to treat the patients with our little newly learned skills, my teachers were always asking us take history of the patient, my learned teachers used tell us the real knowledge and museum of Medicine is in the patients, every finding is there, however we were failing to use our 5 senses, like listening to the patients suffering, his appearance and many times feeling inhibited to touch, and I was working with a British surgeon he used to tell me the best Doctor, nurse, or health care worker gives a tender, loving , care, to his patients, Rest of the acts are all forgotten by patients, Our curriculum emphasizes more of learning than of practice so we many of us are becoming less performing or badly performing doctors, which has put many patients at risk with problems they are suffering, never forget simple problems gets complicated with loss in the Golden hour of the patients, as in accidents Many clinical cases are complicated in the early stages beyond the capabilities of the specialists and the advanced technologies, as every disease has a humble beginning, only after repeated missing by many primary care physicians, or junior Doctors gets complicated. I think if I were a Medical student today I practice more of the human touch than the advanced technologies, This means you’ll have lots of opportunities to observe your patients to monitor how they’re progressing and to spot any problems early. Today we pay little attention to basic matters. Understanding how to, for instance, assess patients breathing, pulse rate, blood pressure and body temperature, and what your assessments mean for the patient’s welfare, are key skills you’ll acquire. While we often refer to these observations as ‘fundamental’, that doesn’t mean they’re unimportant; in fact, it’s often more helpful to think about these observations by another name you might hear – vital signs. The young Medicos should do self-appraisal so it’s also vital that you know the why, when, how, what and where of clinical observations: Why you’re doing an observation. When to do it, How to do it, what your findings might mean for the patient. Where to report and record your findings as most of the very few senior Doctors are available in the critical hour of the patients. Today the society is inflicted by litigation than by appreciation of many dedicated professionals, Every junior physicians should be taught on keeping the documents of the patient’s condition when he reaches the causality and his journey through the rest of the medical care there are many reasons for keeping records in health care, but two stand out above all others: to compile a complete record of the patient’s progress through services. Many credited hospitals and famous Professionals went into litigation's with primary negligence and in desired documentation when the events turn to be difficult to solve legally. Different means of record-keeping are used in health care settings. Some workplaces use hand-written records, others have moved to computer-based systems, and many use a combination of both. You’ll be expected to be able to comply with whatever requirements your employer sets for record-keeping, be it hand-written or electronic. That means you’ll need to: know how to use the information systems and tools in your workplace protect, and do not share with anyone, any passwords given to you to enable you to access systems. Make sure written records are not left in public places where unauthorized people might see them, as in the case of finding a patient with HIV positivity, and that any electronic system is protected before you sign out. To enable continuity of care for the patient/client both within and between services. The records we keep in health care need to be clear, accurate, honest and timely (meaning they should be written as near as possible to the actual time of occurrence of the events they describe). But before we begin to explore these principles, we should be aware that apart from being clear, accurate, honest and timely about what we write, we also need to be careful. This means we have to ensure that nothing we write is, or could be interpreted as being: insulting prejudiced, ageist or discriminatory in any way. Being a Microbiologist I am always interested to emphasize the spread of infections in the primary care, Infections, particularly those known as ‘health care acquired infections’ (HCAIs) (which means that patients acquire the infection while accessing health services), are one of the biggest challenges facing health services throughout the world. There are many kinds of infections that patients can acquire while accessing health care services. You may have heard, for instance, of ‘MRSA’ and Health care associated infections – these are typical of the kinds of microbes patients can pick up in health care settings and which can cause serious – sometimes fatal – infections. Our job as health care workers is to do everything we can to reduce passing (or ‘transmitting’) infection to patients, and from one patient to another. Central to this is hand hygiene. Never forget the timely and appropriate hand washing at many stages of patient care, It sounds very simple, but there’s no doubt that learning how to perform hand hygiene and making sure you wash your hands ‘as you should, when you should’ are the most important things you can do to combat HCAI. Protecting vulnerable people from harm is a big part of your job. In fact, it’s a big part of the jobs of everyone in health care – nurses, health care assistants, chief executives, cleaners, doctors and porters all have the chance to do things to make patients journeys through health care safer. So it’s everyone’s responsibility. It was good in many British hospitals the first contact of patient in a Hospital is a Medical assistance who are trained with scientific sprit, and the patients are primarily observed and matters will be kept on better track than with is happening in our country. I Wish that many upcoming medical Institutes should follow the quote from EDGE HILL UNIVERSITY About the Clinical Skills and Simulation Centre, As their Vision remain…. to develop a centre of excellence to provide the teaching and learning of skills within a safe environment to enable students to develop and maintain competence in all aspects of clinical skills. In line with the Faculty’s strategies for teaching, learning assessment and research, the Centres will develop research in practice learning, skills acquisition and simulation. The rapid privatization and expansion of Medical colleges, takes back seat in clinical training and skills to our Medical students, producing unskilled younger doctors, putting the role of Medical Teachers in question? And many challenges await solutions?

Dr.T.V.Rao MD Professor of Microbiology Freelance writer.

Former Medical Officer in Republic of Zambia