Introduction to IPD care
Getting admitted in hospital is not a pleasant idea for any individual. A person gets admitted in hospital because he needs services/ help which he cannot get at his residence.
The services he needs are support, i.e. to support or save life in critical moments, medical and surgical interventions (e.g. Operations), Investigations (to gain more knowledge about illness), specials treatment modules ( I/v antibiotics, I/v chemotherapy) Isolation, Nursing care, Physical support (Rehabilitation ) and Emotional support etc.
We have to understand that most of these patients are dependent on us for receiving these services as we have the technical knowledge and infra structure to offer these services. When we offer them good services and alleviate their sufferings they remain grateful to us.
What is our attitude towards a person who is dependent on us for support & help will determine our attitude towards patient getting admitted to seek our services. While most of us would want to help the dependent person, the Doctor patient relationship and in fact relationship of the hospital and staff with patient will be determined this very outlook of ours.
Every person who has to heal himself from illness requires being cared for. To provide medical care is a science and art. If rapid, gentle and permanent care of the illness is our mission!!! then to care for the sick should be our prime objective.
Learning to CARE for sick
To train students to care for the sick individuals from birth to death should be our prime objective. ‘Care needs to taught’ and a student has to be nurtured so that he learns to care from his heart & soul.
Although patient care is universal to all the systems of medicine, Human Care is more relevant to homeopathic system of medicine than to any other system of medicine being practiced.
IPD building and training allows us to systematized this art in variety of situations. From critical moments of life, to acute distress, to life threatening trauma, we care in a scientific way through technological, administrative and human “Systems”
Component of ‘Medical Care’ in IPD
In-patient care requires that a doctor is trained to look at his patient in hospital from eight different perspectives.
1. Clinical care
2. Human care
3. Economic care
4. Legal care
5. Social care
6. Care of ethics
7. System care
8. Care of the team
IPD CARE TEAM WORK
The unhappy man who got admitted has to leave satisfied & happy. If you have achieved this in a case you have won the day. One has to be consistent in achieving this goal. It if one has to be consistent then system and teamwork is the key. Hence it is important that a homeopathic physician learns to become a team man.
Systems:
It is a complex whole. A set of connected things organized in such away so as to work together. It demands methodical work as per plan.
Ø Systems of admission (OPD & Casualty)
Ø Systems of Clinical care (while patient is admitted)
Ø Systems of Dispensing
Ø System of Operations & Procedure
Ø Systems Rehabilitation/ Recovery
Ø System of Billing
Ø System of Discharging the patient.
There are standard systems and there are systems, which can be customized as per our needs.
The student has to be taught about these systems. Their experiences of following or not following systems and their implications have to be tapped.
Learning the system will help him to become a team man. Against past (mis)understanding, a hospital is not run only on basis the doctors but on the result given by team of care-givers that include medical consultants, medical officers, nursing staff, paramedical personal, hygiene workers & administrative staff, etc.
Only when the entire team works in a cohesive way, a positive patient experience is generated. The positive patient experience is crucial for growth of hospitals and institutions.
Team Work
1) Working in team requires “Patience”, “Tolerance” and sensitivity to see other person’s perspective.
2) To make an emotion free objective decision in the interest of the patient and in the interest of science and abiding to it as a team.
3) Co—ordination, clear communication written and oral with colleagues, subordinates, nursing and administration.
4) Open to new clinical feed back, and flexibility to change and alter the therapeutic plan.
5) Co-ordination with allopathic consultants on equal grounds and terms to understand their view and capitalize on their experience. We can utilize their expertise for patient benefit and growth of science by expanding the application of homeopathy in newer and unexplored clinical conditions.
At the same time it is an opportunity for us to demonstrate our results to other professional colleagues. Needless to say 1 good result speaks more than few good words.
Each team should have a team leader, built up our students. The homeopathic physician should lead or should be on equal terms with other leaders which will generate professional respect from doctors, colleagues, subordinates. The respect can only be had by being competent in ones field and profession. To develop competency one has to undergo training.
Training of homeopathic Students
Our students are raw talent who need to be shaped up so that their energy and enthusiasm can be directed in the constructive way.
Ø History taking especially in-patient who is in pain ,or in life saving emergency ,the skill and power of observation, at the same time sensitively perceiving human mind when in acute distress.
Ø Examination skills General and systemic examination with Interpretation of abnormal findings.
Ø Procedures their indications, contraindication, method, instruments, complications and skills should be taught and demonstrated. – Ward procedures – Minor surgical procedures – Life saving procedures
– Medico legal procedures
Ø Investigations
– Indication
– Utility
– Contraindication
– Risk
– Preparation
– Cost
– Principals of the technology used.
– Interpretation of reports
– Reading of investigation
Ø Documentation of case
Case record designed for homeopathic Ipd purpose
Ø Processing of the case
1. The process of arriving at diagnosis and its homeopathic implication homeopathic classification of disease
2. Processing of mental state of the patient.
3. Clinico – pathological co-relations with susceptibility and miasm & symptomatology
4. Homeopathic therapeutics of condition & therapeutic approach (acute, chronic acute followed by Intercurrent Etc)
5. Application of susceptibly in selecting Posology plan (selection of potency and repetitions).
6. Use of reportorial method & keynote method IPD practice.
7. Follow up Documentation & criteria of follow up (Herrings law of cure).
8. Remedy Response analysis (kents twelve observation)
9. Ancillary measure. (Fluid replacement, oxygen, temperature regulation etc.)
10. Life saving skills to handle conditions Mentioned under suspended animation & Idiosyncrasies.
11. Sensitivity and sensibility training to balance between brain and heart so that emotional prejudices are made aware of and objectivity is maintained.
Action plan for training
Ø Introduction to IPD
Ø History of Inpatient care in Homeopathy (lectures)
Ø Tapping students past experience in IPD (Interactive session )
Ø Work shop with Demonstration on
a) Case taking emergency
b) Work shop on examination skills
c) Work shop on reading investigations
Ø Stimulatory experience clinical & Homeopathic (Interactive session)
Ø Homeopathic cases Treated in IPD to be discussed in sessions
Ø Bed side training (ward rounds)
Ø Ward work to develop hands on experience and skills (e.g. Intravenous line, blood collection, dressings, endotracheal intubations etc.)
Ø Experts in put on Following Subjects
1. Homeopathic postoperative care
2. Homeopathy and Anesthesia
3. Homeopathy in life saving conditions.
4. Ethics, code of conduct and legal inputs for homeopathic doctors
5. Inter personal skills and team work (work shop)
6. Documentation & maintaining register
Case presentation and scientific paper presentation
IPD Development (Action Plan)
Ø Appoint separate full time individuals to build up IPD. (Responsible for clinical care, Administrative Systems, legal care, Nursing, Instrumentation and Infrastructure development)
Ø Form clinical units (Department Development)
1) Headed by consultants homeopathy
2) Appoint clinical consultants from various specialties.
3) Each unit should have senior medical officer or lecture. (Primarily responsible for homeopathic IPD case)
4) Appoint Register & Houseman to carryout day-to-day clinical and academic work.
Ø Build up Diagnostic wing (x-ray, sonography, clinical laboratory. Etc)
Ø Appoint Nursing staff in charge & Administrative in charge and give them teams.
Ø Define each persons roles, responsibly and accountability
Ø Set targets to be achieved long term and short term goals. – Draw action plans
Ø Review meetings to see that targets are in focus and action plans followed
Ø Train doctors to have steady flow of IPD trained doctors
The final product
Post training PG students can become:
a) Clinical expert
b) Master in applied homeopathy
c) Sensitive Human being
d) Focused task master
e) A team man
f) Clinical administrator
g) A PG teacher
Conclusion
Ø Homeopathic IPD care is more than just prescribing a homeopathic medicine to the admitted patient. It is a complete system of caring for individual in homeopathic way
Ø Homeopathic IPD care is in nascent stages and hence it is of advantage to decide its direction, and we can plan its shape and structure.
Ø Homeopathic IPD care is essentially team work
Homeopathic clinicians, teachers, administrators and head of the institution will have to come together to from team
Ø Specialized training of PG students in areas relevant IPD care is necessary (clinical, homeopathic, human care)
IPD care will help us train our students to become sensitive tough & efficient individuals with better self-esteem. They can be better clinicians and masters of applied homeopathy. For PG students it will open up more job opportunities and also in future add to source of earning for hospitals over all a positive growth of students as physician and as personality.
Ø Homeopathy can be applied in newer clinical conditions and hence scope of homeopathy can be expanded from conventional to unconventional areas thus allowing homeopathy to move towards its goal of becoming main stream medicine from its current status of alternative medicine.
——————————————–
Dr. Navin Pawaskar
M.D. (HOM) Practice of Medicine
Consulting Homoeopathic Physician
Member Institute of Clinical Research
Director Clinical Services, Dr. M. L. Dhawale Memorial Trust’s
Rural Homoeopathic Hospital, Palghar, Thane District
Reader Department of Medicine, MLDMHI Mumbai
