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Ragama Hospital armed to face the future with its Family Physicians to the fore
A patient with ankle oedema which was diagnosed as congestive heart failure in a ‘remote’ consultation is later treated in hospital.
The new coronavirus (SARS-CoV-2) and all the dangers posed by it are here to stay.
The North Colombo (Ragama) Teaching Hospital had a system in place which moved smoothly soon after the COVID-19 crisis hit, which enabled its staff to look after the patients already under its care while gathering more under this health umbrella.
Driving this engine was none other than Family Medicine Specialists. This is a model that could be followed across the country.
Prof. Kumara Mendis, Chair Professor of Family Medicine of the Faculty of Medicine, University of Kelaniya says that while making a workable guideline (now on the Epidemiology Unit website) for doctors dealing with patients at the primary care level, this is how they set about being an example at the Ragama Hospital.
“We have to be one step ahead and can’t keep the public inside their homes while they are ill. How should we re-define our work to meet the public need,” he asks, pointing out that face-to-face consultations, as they used to be, will not happen in the next six months.
Being the first from Sri Lanka to qualify in medical informatics in 2000, after his MD in Family Medicine, Prof. Mendis and his team just downloaded an open-source and “little by little” transformed all the paper data on about 1,300 patients into computer data by 2018.
This was the electronic medical record system that is cloud-based that came in handy when the new coronavirus hit the country.
“We got five SIM cards and put this on the web page of our faculty website and asked our students to man the phones and direct any queries from patients to one of the five Family Physicians of the Department of Family Medicine who would respond promptly,” he says.
Knowing fully well that COVID-19 hits the elderly and those with co-morbidities, the team identified about 300 people who fell into this category from their list, divided these numbers among the Family Physicians who called each patient within the first three days, told them not to panic and assured them that they could call the doctors at any time.
If the patients complained of symptoms such as swelling of the feet, they requested them to WhatsApp a picture of their feet. They also directed them to other specialists at the Ragama Hospital such as surgeons and psychiatrists if the need arose.
“We have also got admissions for our patients when the necessity arose through these specialists. If they needed medicines on diagnosis, we sent them a WhatsApp prescription or sent the prescription to Osu Sala where they could collect their medicines,” says Prof. Mendis.
With adequate proof of the success of the system coming from the patients themselves who have introduced others to this system and from whom the Family Unit gets at least 15 calls per day, Prof. Mendis is sure Ragama is ready to face the future.
What he is hoping for is to get others such as GPs on board, for as he says “remote consultation” will be the norm in the future.
Meanwhile, the Assistant Registrar of the Sri Lanka Medical Council (SLMC), Dr. Chandana Atapattu says that with tele-medicine forming a vital niche in our lives, the SLMC is preparing a Code of Ethics on such remote consultations to ensure the safety of patients and professional ethics among doctors.