OUTPATIENT DEPARTMENT, POLYCLINICS The outpatient department refers to the entire activity when connected with a hospital, and the specific subdivisions are referred to as clinics. A clinic (or outpatient clinic or ambulatory care clinic) is a health care facility that is primarily devoted to the care of outpatients. Clinics can be privately operated or publicly managed and funded, and typically cover the primary health care needs of populations in local communities, in contrast to larger hospitals which offer specialised treatments and admit inpatients for overnight stays. Some clinics grow to be institutions as large as major hospitals, or become associated with a hospital or medical school, while retaining the name “clinic." The word derives from the Greek klinein meaning to slope, lean or recline. Hence kline is a couch or bed, klinikos is sloping or reclining and Latin is clinicus. Clinics are often associated with a general medical practice, run by one or several general practitioners or clinics are usually operated by physiotherapists and psychology clinics by clinical psychologists, and so on for each health profession. Some clinics are operated in-house by employers, government organizations or hospitals and some clinical services are outsourced to private corporations, specialising in provision of health services. In China, for example, owners of those clinics do not have formal medical education. There were 659,596 village clinics in China in 2011. Health care in India, China, Russia and Africa is provided to vast rural areas by mobile health clinics or roadside dispensaries, some of which integrate traditional health practices. In India these traditional clinics provide ayurvedic medicine and unani herbal medical practice. In each of these countries traditional medicine tends to be a hereditary practice. Ayurvedic practices include the use of herbal medicines, mineral or metal supplementation (rasa shastra), surgical techniques, opium, and application of oil by massages The function of clinics will differ from country to country. For instance, a local general practice run by a single general practitioner will provide primary health care, and will usually be run as a for-profit business by the owner whereas a government specialist clinic may provide subsidised specialised health care. Some clinics function as a place for people with injuries or illnesses to come and be seen by triage nurse or other health worker. In these clinics, the injury or illness may not be serious enough to warrant a visit to an emergency room, but the person can be moved to one if required. Treatment at these clinics is often less expensive than it would be at a casualty department. They sometimes have access to diagnostic equipment such as X-ray machines, especially if the clinic is part of a larger facility. Doctors at such clinics can often refer patients to specialists if the need arises. A polyclinic (or policlinic), is a place where a wide range of health care services (including diagnostics) can be obtained without the need for an overnight stay. Polyclinics are sometimes co-located with a hospital. A typical polyclinic is an outpatient facility that houses general medical practitioners (GPs) such as doctors and nurses to provide ambulatory care and some acute care services but lacks the major surgical and pre- and post-operative care facilities commonly associated with hospitals. Besides GPs a polyclinic can house outpatient departments of some medical specialties i.e. gynecology, dermatology, ophthalmology, ENT, neurology, pulmonology, cardiology, endocrinology etc. Ambulatory care is a personal health care consultation, treatment, or intervention using advanced medical technology or procedures delivered on an outpatient basis. Many Medical Investigations and treatments for acute illness and preventive health care can be performed on an ambulatory basis, including minor surgical and medical procedures, most types of dental services, dermatology services, and many types of diagnostic procedures (e.g. blood tests, X-rays, endoscopy and biopsy procedures of superficial organs). Other types of ambulatory care services include emergency visits, rehabilitation visits, and in some cases telephone consultations. Such diseases as diabetes or chronic obstructive pulmonary disease can be treated under ambulatory care sensitive conditions (ACSC) Ambulatory care services represent the most significant contributor to increasing hospital expenditures and to the performance of the health care system in most countries, including most developing countries. Acute care is a branch of secondary health care where a patient receives active but short-term treatment for a severe injury or episode of illness, an urgent medical condition, or during recovery from surgery. In medical terms, care for acute health conditions is the opposite from chronic care, or longer term care. Acute care services are generally delivered by teams of health care professionals from a range of medical and surgical specialties. Acute care may require a stay in a hospital emergency department, ambulatory surgery center, urgent care centre or other short-term stay facility, along with the assistance of diagnostic services, surgery, or follow-up outpatient care in the community. Hospital-based acute inpatient care typically has the goal of discharging patients as soon as they are deemed healthy and stable. Acute care settings include but are not limited to: emergency department, intensive care, coronary care, cardiology, neonatal intensive care, and many general areas where the patient could become acutely unwell and require stabilization and transfer to another higher dependency unit for further treatment. The doctor-patient relationship has sometimes been characterized as silencing the voice of patients. It is now widely agreed that putting patients at the centre of healthcare, by trying to provide a consistent, informative and respectful service to patients, will improve both outcomes and patient satisfaction. When patients are not at the centre of healthcare, when institutional procedures and targets eclipse local concerns, then patient neglect is possible. Scandals have shown the dangers of silencing the voice of patients, recommending that the health service puts patient experience at the heart of what it does, and especially, that the voice of patients is heard loud and clear within the health services. There are many reasons for why health services should listen more to patients. Patients spend more time in health care services than any regulators or quality controllers. Patients can recognize problems such as service delays, poor hygiene, and poor conduct. Patients are particularly good at identifying soft problems, such as attitudes, communication, and 'caring neglect', that are difficult to capture with institutional monitoring. One important way in which patients can be put at the centre of healthcare is for health services to be more open about patient complaints. Each year many hundreds of thousands of patients complain about the care they have received, and these complaints contain valuable information for any health services which want to learn and improve patient experience. Patients' satisfaction with an encounter with health care service is mainly dependent on the duration and efficiency of care, and how empathetic and communicative the health care providers are. It is favored by a good doctor-patient relationship in a clinical encounter. Explanatory notes: Triage (/ˈtriːɑːʒ/ or /triːˈɑːʒ/) is the process of determining the priority of patients' treatments based on the severity of their condition. X-radiation (composed of X-rays) is a form of electromagnetic radiation. Röntgen radiation, after Wilhelm Röntgen who is usually credited as its discoverer, and who had named it X-radiation to signify an unknown type of radiation. Spelling of X-ray(s) in the English language includes the variants x-ray(s), xray(s) and X ray(s). A general practitioner (GP) is a medical doctor who treats acute and chronic illnesses and provides preventive care and health education to patients Clinical psychology is an integration of the science, theory and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective and behavioural well-being and personal development.[ Ayurvedic medicine /ˌaɪ.ərˈveɪdə/) is a system of Hindu traditional medicine native to the Indian subcontinent. Practices derived from Ayurvedic traditions are a type of alternative medicine Ayurvedic practices include the use of herbal medicines, mineral or metal supplementation surgical techniques, opium, and application of oil by massages. Unani Medicine also spelled Yunani Medicine (/juːˈnɑːni/; is a form of traditional medicine practiced in middle-east & south-Asian countries. It refers to a tradition of Graeco-Arabic medicine, which is based on the teachings of Greek physicians Hippocrates and Galen, and developed into an elaborate medical system in middle age era by Arabian and Persian physicians, such as Rhazes (al-Razi), Avicenna (Ibn Sena), Al-Zahrawi, and Ibn Nafis. Traditional medicine (also known as indigenous or folk medicine) comprises knowledge systems that developed over generations within various societies before the era of modern medicine. Traditional medicine is the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness. I. 1. 2. 3. 4. Answer the following questions: What does the outpatient department refer to? What are clinics associated with? What is acute care? How is doctor-patient relationship sometimes characterized? 5. What can improve patient’s satisfaction in a clinic?