- Email: [email protected]
THE WAITING OUT-PATIENT
31 abnormalities noted can account for only a fraction of all cases of Meniere’s syndrome. Moreover it is difficult to understand how a congenital abnormality can of itself suddenly produce symptoms in a person previously healthy, and how a static condition can cause paroxysms separated by intervals of normal health. To explain these features one might assume some periodic alteration in the shape or calibre of the artery that is in contact with the nerve. A similar mechanism is held by some neurologists to be a likely explanation for ophthalmoplegic migraine. But whether stimulation of the eighth nerve can take place in this manner is doubtful, for tests usually indicate that both cophlear and vestibular sensibility are diminished. The direction of the nystagmus and of the sensation of rotation which occur in an attack does not provide consistent information as to whether the suspected nerve is the origin of abnormal stimuli or whether it is
temporarily paralysed. THE WAITING OUT-PATIENT
THE
out-patient arrangements
committee of
King
Edward’s Hospital Fund for London has performed a useful public service by the issue of a memorandum on "Time-saving Methods in Connection with Arrival and Registration of Out-patients, with Notes on Other Early Items of Procedure."1 In this pamphlet of 35 pages the committee, of which Dr. H. Morley Fletcher is chairman, sets out clearly some practical for shortening the interval between the time when patients arrive at the hospital and the time when they see the doctor. That this interval can be materially reduced by simple and inexpensive means has been proved by the experience of certain hospitals where special attention is given to this branch of administrative technique. Like any other kind of technique, it must be learnt, and this memorandum should do much to teach it. Probably the most important of the committee’s suggestions is that there should be centralised supervision of the whole out-patient department, preferably by the secretary or other chief executive officer of the hospital, who should be personally responsible, and report periodically to a standing out-patient committee and to the medical staff. The appointment of such a committee would, it is thought, have the advantage of ensuring that some members of the governing body would become familiar with the detailed working of the out-patient department. Essential importance is attached to an efficient system of record-keeping, which should not only be accurate but include all the information that is necessary and none that is not, and facilitate the rapid entry of particulars of new patients and the rapid finding of papers relating to old patients. A modern system should, it is said, provide that the original registration forms should easily be supplemented by the records of special departments ; that the patients should have no opportunity of reading their case-sheets ; that the original forms should give each department all the personal information needed, and so make it unnecessary to ask a patient the same questions more than once ; and that each patient should have a serial number on all his papers. To promote discussion of this important subject, the committee has drawn up a model scheme of records, which is explained in the memorandum. ’The forms recommended are of three kinds : (1) an identification-card to be kept by the patient ; (2) a
suggestions
1 Published for King Edward’s Hospital Fund for London by Geo. Barber and Sons, Ltd., Furnival-street, London, E.C.4. Price 1 1/2d., post free.
case-sheet, a prescription-card, and a folder, all to be used during visits and returned to the registry ; and (3) an index-card to be kept in the registry for reference. The importance of record-keeping is perhaps less appreciated by hospital administrators here than in the United States, where in some hospitals the problem of transporting case-sheets from the registry to the departments concerned has been solved by installing a pneumatic-tube system. To European visitors, however, American methods occasionally seem too elaborate, and they have led native humorists to suggest that diagnosis and treatment may be carried out by study of documents rather than by examination of patients. The memorandum discusses various methods, apart from registration, for reducing the waitingtime in out-patient departments, especially by approximating the time of arrival of the first patient to that of the doctor, by shortening the preliminary processes, and by giving different times of arrival to .certain classes of patients-e.g., male and female, adults and children, old patients and new patients, patients with doctors’ letters and those without. The growth of hospital contributory schemes has increased the number of patients exempt from all almoner’s inquiries other than those relating to aftercare, and time is saved by sorting out these patients before they reach the almoner’s room. It may be noted also that the bringing of doctors’ letters has among its many advantages that of reducing the time spent by the patient before examination. The memorandum, though primarily intended for hospital administrators, may profitably be studied
by private practitioners, especially those with large practices in industrial areas. Prolonged suspense in a doctor’s waiting-room is good neither for the patient nor the practice, and it can only be avoided by taking thought. OPHTHALMIC BENEFIT: THE SORE POINT AN open letter from the Minister of Health to
Sir Francis Fremantle emphasises the fact that an insured person cannot obtain ophthalmic benefit until he has, as a first step, been examined by his own insurance doctor. Moreover, the new regulations provide that every person claiming ophthalmic benefit shall be informed of his right to go to a medical eye specialist, if he so desires, whether that is the normal arrangement made by his approved society or not. Sir Kingsley Wood emphasises these points as he feels that they have not been generally understood. He omits however to say, what the medical secretary of the British Medical Association knows to be a fact, that little or no encouragement is given to the insured person to seek the advice of a doctor about his eyes ; unless the right is exercised at the time of application for ophthalmic benefit the insured person has to follow the instructions of his society, which generally means that he will be examined by a sight-testing optician. Sir Kingsley adds that the object of the list of opticians to be drawn up by the new committee is to enable approved societies to have a list of persons to whom members The can go for the purpose of obtaining glasses. list will, in fact, be described as " A list of opticians recognised by the committee for the purpose of the supply of optical appliances to insured persons." But the value of this description is marred by the alteration of the first draft of the regulations to include a reference to services rendered by an optician incidental to the provision of an optical appliance. This implies the recognition by the Minister of sight-testing by opticians, and an admission
temporarily paralysed. THE WAITING OUT-PATIENT
THE
out-patient arrangements
committee of
King
Edward’s Hospital Fund for London has performed a useful public service by the issue of a memorandum on "Time-saving Methods in Connection with Arrival and Registration of Out-patients, with Notes on Other Early Items of Procedure."1 In this pamphlet of 35 pages the committee, of which Dr. H. Morley Fletcher is chairman, sets out clearly some practical for shortening the interval between the time when patients arrive at the hospital and the time when they see the doctor. That this interval can be materially reduced by simple and inexpensive means has been proved by the experience of certain hospitals where special attention is given to this branch of administrative technique. Like any other kind of technique, it must be learnt, and this memorandum should do much to teach it. Probably the most important of the committee’s suggestions is that there should be centralised supervision of the whole out-patient department, preferably by the secretary or other chief executive officer of the hospital, who should be personally responsible, and report periodically to a standing out-patient committee and to the medical staff. The appointment of such a committee would, it is thought, have the advantage of ensuring that some members of the governing body would become familiar with the detailed working of the out-patient department. Essential importance is attached to an efficient system of record-keeping, which should not only be accurate but include all the information that is necessary and none that is not, and facilitate the rapid entry of particulars of new patients and the rapid finding of papers relating to old patients. A modern system should, it is said, provide that the original registration forms should easily be supplemented by the records of special departments ; that the patients should have no opportunity of reading their case-sheets ; that the original forms should give each department all the personal information needed, and so make it unnecessary to ask a patient the same questions more than once ; and that each patient should have a serial number on all his papers. To promote discussion of this important subject, the committee has drawn up a model scheme of records, which is explained in the memorandum. ’The forms recommended are of three kinds : (1) an identification-card to be kept by the patient ; (2) a
suggestions
1 Published for King Edward’s Hospital Fund for London by Geo. Barber and Sons, Ltd., Furnival-street, London, E.C.4. Price 1 1/2d., post free.
case-sheet, a prescription-card, and a folder, all to be used during visits and returned to the registry ; and (3) an index-card to be kept in the registry for reference. The importance of record-keeping is perhaps less appreciated by hospital administrators here than in the United States, where in some hospitals the problem of transporting case-sheets from the registry to the departments concerned has been solved by installing a pneumatic-tube system. To European visitors, however, American methods occasionally seem too elaborate, and they have led native humorists to suggest that diagnosis and treatment may be carried out by study of documents rather than by examination of patients. The memorandum discusses various methods, apart from registration, for reducing the waitingtime in out-patient departments, especially by approximating the time of arrival of the first patient to that of the doctor, by shortening the preliminary processes, and by giving different times of arrival to .certain classes of patients-e.g., male and female, adults and children, old patients and new patients, patients with doctors’ letters and those without. The growth of hospital contributory schemes has increased the number of patients exempt from all almoner’s inquiries other than those relating to aftercare, and time is saved by sorting out these patients before they reach the almoner’s room. It may be noted also that the bringing of doctors’ letters has among its many advantages that of reducing the time spent by the patient before examination. The memorandum, though primarily intended for hospital administrators, may profitably be studied
by private practitioners, especially those with large practices in industrial areas. Prolonged suspense in a doctor’s waiting-room is good neither for the patient nor the practice, and it can only be avoided by taking thought. OPHTHALMIC BENEFIT: THE SORE POINT AN open letter from the Minister of Health to
Sir Francis Fremantle emphasises the fact that an insured person cannot obtain ophthalmic benefit until he has, as a first step, been examined by his own insurance doctor. Moreover, the new regulations provide that every person claiming ophthalmic benefit shall be informed of his right to go to a medical eye specialist, if he so desires, whether that is the normal arrangement made by his approved society or not. Sir Kingsley Wood emphasises these points as he feels that they have not been generally understood. He omits however to say, what the medical secretary of the British Medical Association knows to be a fact, that little or no encouragement is given to the insured person to seek the advice of a doctor about his eyes ; unless the right is exercised at the time of application for ophthalmic benefit the insured person has to follow the instructions of his society, which generally means that he will be examined by a sight-testing optician. Sir Kingsley adds that the object of the list of opticians to be drawn up by the new committee is to enable approved societies to have a list of persons to whom members The can go for the purpose of obtaining glasses. list will, in fact, be described as " A list of opticians recognised by the committee for the purpose of the supply of optical appliances to insured persons." But the value of this description is marred by the alteration of the first draft of the regulations to include a reference to services rendered by an optician incidental to the provision of an optical appliance. This implies the recognition by the Minister of sight-testing by opticians, and an admission