PERSPECTIVES ANZJSurg.com
Medicine in small doses Re-engineering the surgeon–patient interface: the futuristic consultation Surgeons are now facing increasing challenges to find the balance between results of diagnostic imaging, clinical and financial targets, pressure from the media and what patients may glean from the Internet, and may become distracted from their core role as a caring surgeon in human interactions. The General Medical Council (GMC), in April 2013, published a guide to help patients get the best outcome from the interaction with their doctor (What to expect from your doctor: a guide for patients, http://www.gmc-uk.org/guidance/patients.asp), explains to patients how to create a better partnership with their doctor and is based on the GMC’s ‘Good Medical Practice’ (Lancet 2013; 381: 1432). I am indebted to Abigail Zuger (JAMA 2013; 309: 2384–5), a New York Physician and fellow medical writer, for coining the phrase ‘re-engineering the clinical experience’ to aptly describe how our surgeons in the future will be communicating with their patients across the spectrum of interactions during a consultation, responding to their patients’ needs and modifying their practice management. Engineering is the application of scientific, economic, social and practical knowledge to design, build and maintain structures, systems and processes (http://www.en.wikipedia.org/wki/ Engineering), so re-engineering in our context is re-designing and re-building the framework around the different ways the surgeon– patient interaction may change across these application domains in the future. The first is the psychological interaction that plays out in the consulting room, where diplomacy has become the norm possibly driven by the bullying and harassment policies that have changed the way we speak with our patients, avoiding the tendency of talking down to them. The exchange of knowledge should be on an equal footing. The patient needs to leave the consultation with ‘some idea’ rather than ‘no idea’ about what transpired over the previous 10–30 min. The patient should be comfortable enough to ask the questions rather than being too embarrassed to break the ‘white-coat silence’ (Judson et al., JAMA 2013; 309: 2325–6). The second is the role computers and e-health may play and ‘play’ may well be the ‘key’ word. The surgeon and patient playing ‘computer games’, each having equal input to what is on the screen, providing a unique digital dialogue (White & Danis, JAMA 2013; 309: 2327–8). The patient may well have an active role in what is added to their Patient Controlled Electronic Medical Record (PCEHR) – e-Health medical record, this information being provided with their full consent and input and combined with information either from the internet or from the most recent ‘application’ (App.) on the subject. ANZ J Surg 83 (2013) 706
Although the role out of the PCEHR in Australia has been slow, surgeons should be encouraged to develop a greater understanding of eHealth and how this can help communications not only with their patients but with all health-care professionals. A better understanding of e-health is provided through the National E-Health Transition Authority (NEHTA: http://www .nehta.org) and the various clinical leads sponsored by NEHTA who spread the word. Surgeons should encourage their patients to register as Individual Healthcare Identifiers (IH-I), and set an example by registering themselves as individuals, register as a practitioner – Healthcare Provider Identifier-Individual (HPI-I) and support their practice manager registering the practice as a Healthcare Provider Identifier-Organisation (HPI-O). The Medicare Local in your region will have an e-Health advisory committee that can help you with this process. For the e-health consultation to be more interactive will require re-designing of the consulting room. The tradition large mahogany leather topped desk separating the surgeon from the patient will be replaced by a much more interactive design so patient and surgeon can sit next to each other looking at the same screen, which may either be imbedded in the desktop or sitting at a slight angle as we do using the iPad screens. As the Australian Council of Healthcare Standards (ACHS) has developed new national standards with an emphasis on the importance of consumer input in all levels of clinical governance (http:// www.achs.org.au/achs-nsqhs-standards/), so may our patients have a greater influence on how we re-engineer our practices and the subjects and content of some of the research projects we undertake (Timetti and Bach, JAMA 2013; 309: 2331–2). While on the topic of accreditation, it is likely that surgical practices in the future will need to take a lead from General Practice with the need to satisfy an accreditation processes (http://www .health.vic.gov.au/pch/gpp/accreditation.htm), a tool to measure ongoing practice and business development as well as providing enhanced patient care, increased professional satisfaction and risk management. Hence, we may need to re-engineer the way we establish and manage our practices which will have significant input from consumers. So the futuristic surgeon may need to develop a whole new range of communication skills, re-engineered to satisfy the needs of our patients to enhance the surgeon–patient interaction. Bruce P. Waxman, FRACS Academic Surgical Unit, Monash University, Melbourne, Victoria, Australia doi: 10.1111/ans.12352
© 2013 Royal Australasian College of Surgeons
Medicine in small doses Re-engineering the surgeon–patient interface: the futuristic consultation Surgeons are now facing increasing challenges to find the balance between results of diagnostic imaging, clinical and financial targets, pressure from the media and what patients may glean from the Internet, and may become distracted from their core role as a caring surgeon in human interactions. The General Medical Council (GMC), in April 2013, published a guide to help patients get the best outcome from the interaction with their doctor (What to expect from your doctor: a guide for patients, http://www.gmc-uk.org/guidance/patients.asp), explains to patients how to create a better partnership with their doctor and is based on the GMC’s ‘Good Medical Practice’ (Lancet 2013; 381: 1432). I am indebted to Abigail Zuger (JAMA 2013; 309: 2384–5), a New York Physician and fellow medical writer, for coining the phrase ‘re-engineering the clinical experience’ to aptly describe how our surgeons in the future will be communicating with their patients across the spectrum of interactions during a consultation, responding to their patients’ needs and modifying their practice management. Engineering is the application of scientific, economic, social and practical knowledge to design, build and maintain structures, systems and processes (http://www.en.wikipedia.org/wki/ Engineering), so re-engineering in our context is re-designing and re-building the framework around the different ways the surgeon– patient interaction may change across these application domains in the future. The first is the psychological interaction that plays out in the consulting room, where diplomacy has become the norm possibly driven by the bullying and harassment policies that have changed the way we speak with our patients, avoiding the tendency of talking down to them. The exchange of knowledge should be on an equal footing. The patient needs to leave the consultation with ‘some idea’ rather than ‘no idea’ about what transpired over the previous 10–30 min. The patient should be comfortable enough to ask the questions rather than being too embarrassed to break the ‘white-coat silence’ (Judson et al., JAMA 2013; 309: 2325–6). The second is the role computers and e-health may play and ‘play’ may well be the ‘key’ word. The surgeon and patient playing ‘computer games’, each having equal input to what is on the screen, providing a unique digital dialogue (White & Danis, JAMA 2013; 309: 2327–8). The patient may well have an active role in what is added to their Patient Controlled Electronic Medical Record (PCEHR) – e-Health medical record, this information being provided with their full consent and input and combined with information either from the internet or from the most recent ‘application’ (App.) on the subject. ANZ J Surg 83 (2013) 706
Although the role out of the PCEHR in Australia has been slow, surgeons should be encouraged to develop a greater understanding of eHealth and how this can help communications not only with their patients but with all health-care professionals. A better understanding of e-health is provided through the National E-Health Transition Authority (NEHTA: http://www .nehta.org) and the various clinical leads sponsored by NEHTA who spread the word. Surgeons should encourage their patients to register as Individual Healthcare Identifiers (IH-I), and set an example by registering themselves as individuals, register as a practitioner – Healthcare Provider Identifier-Individual (HPI-I) and support their practice manager registering the practice as a Healthcare Provider Identifier-Organisation (HPI-O). The Medicare Local in your region will have an e-Health advisory committee that can help you with this process. For the e-health consultation to be more interactive will require re-designing of the consulting room. The tradition large mahogany leather topped desk separating the surgeon from the patient will be replaced by a much more interactive design so patient and surgeon can sit next to each other looking at the same screen, which may either be imbedded in the desktop or sitting at a slight angle as we do using the iPad screens. As the Australian Council of Healthcare Standards (ACHS) has developed new national standards with an emphasis on the importance of consumer input in all levels of clinical governance (http:// www.achs.org.au/achs-nsqhs-standards/), so may our patients have a greater influence on how we re-engineer our practices and the subjects and content of some of the research projects we undertake (Timetti and Bach, JAMA 2013; 309: 2331–2). While on the topic of accreditation, it is likely that surgical practices in the future will need to take a lead from General Practice with the need to satisfy an accreditation processes (http://www .health.vic.gov.au/pch/gpp/accreditation.htm), a tool to measure ongoing practice and business development as well as providing enhanced patient care, increased professional satisfaction and risk management. Hence, we may need to re-engineer the way we establish and manage our practices which will have significant input from consumers. So the futuristic surgeon may need to develop a whole new range of communication skills, re-engineered to satisfy the needs of our patients to enhance the surgeon–patient interaction. Bruce P. Waxman, FRACS Academic Surgical Unit, Monash University, Melbourne, Victoria, Australia doi: 10.1111/ans.12352
© 2013 Royal Australasian College of Surgeons
