Paramedical professionals: The driving force of any healthcare institute
24 Apr, 2017

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Dr Clive Fernandes, Group Clinical Director,Wockhardt Group Hospitals Consultant,highlights that healthcare delivery has become more complex with the emphasis on multidisciplinary teams and holistic care

If I were to ask you which  organ is more important in the body, the heart or the brain it would be very unfair for me to expect any one answer as they both have vital roles to play in the body for effective functioning.

In healthcare too we face a similar paradox. Healthcare has always been synonymous with the doctor and rightly so as they are the key drivers but there are many other professionals whose role is equally important

if the desired healthcare outcomes are to be achieved.

Healthcare delivery today has become more complex with the emphasis on multidisciplinary teams and holistic care falling into place and for all the right reasons. However, before I begin, I would like to reiterate that at no point I am saying that the physician’s role is not important, they are the drivers of healthcare but they are supported by many paramedical departments which contribute in achieving the desired outcomes of care.

Though I would like to share in detail about each department,I am going to highlight just a few departments and they are not necessarily in the order of importance.

Nursing – This quote describes nursing perfectly,“Save one life and you are ahero, save hundred lives and you are a nurse.” For a patient the most reassuring sight is to see a healthcare provider available 24*7 and this provider is none other than the nurse who takes care of the patient’s needs while in the hospital.

The term 'Nurse’ is synonymous with compassion – many expect less but get much more. Nursing professionals face challenges daily, from staffing

and job responsibilities to the many tasks that they are accountable for. Depending on which unit/ward they are based in, there are guidelines

outlining the number of patients a nurse should take care of but these ratios are more for reference rather than statutory. Also, there are no defined

JD’s for a nurse hence the nurse patient ratio and the workload depends on the type of institution the nurse is working in. A nurse should ideally spend a significant amount of time at the patient’s bedside but again depending on the type of institution, a nurse spends nearly 30 to 40 percent of time in documentation of records, ordering labs, indenting medications, patient handovers, arranging the records and coordinating the patient admission and discharge leaving very little time for actual patient care. If something

happens to the patient, the first person to be blamed or held responsible is the nurse just by virtue of them being there 24*7. How often have nurses been commended when patients go home completely fit after a debilitating illness or a complex surgery? Are the many men and women in the nursing profession getting the recognition and remuneration that they so rightly deserve?

Pharmacy associates and the Clinical Pharmacist- This is another very important department as nearly every patient admitted and more than 50 to 60 percent of out-patients need medications – enter the pharmacy. Many mistakenly think that a pharmacist’s role is limited to dispensing what the physician has prescribed. The pharmacist’s role goes way beyond that – managing all statutory regulations, ensuring supply chain integrity from the manufacturer and distributor to the consumer. There are medications that need the cold chain to be maintained to be effective.Then there are narcotics that statutorily need specific storage and prescribing compliances, purchasing quality generic medications thatare as effective and much cheaper for the patients. These are just a few key functions that this department silently performs. The IOM report in 1998 ‘To err is human’ and the subsequent awareness towards medication errors has created a new category of para medical professionals in the last decade the ‘Clinical Pharmacist’ whose main role is to ensure that the patient receives the right medication in the right dose, route and frequency and there are no drug interactions when multiple drugs are prescribed by multiple physicians. These paramedical professionals have become a part of the team and join the doctor on patient rounds advising on drug doses, interactions and dilutions that could be missed at times. Ward rounds by the clinical pharmacists, on the spot checks and pill counts have helped in identifying and preventing many medication errors. The healthcare industry has started appreciating the contribution of the pharmacy and clinical pharmacists in making healthcare delivery - especially medication management more safe and we need to do the same at our institutions.

Dieticians – When it comes to the patient’s diet, every healthcare administrator knows that no matter the quality of food provided, the patient feedback form at discharge always says that the food was tasteless and the quality of food needs improvement. No prizes for guessing

why! A dietician’s role is very important - apart from medication, diet is of paramount importance, as we all understand the nuances of providing a diabetic and hypertensive patient with a normal diet. Calculating dietary requirements in terms of calories and BMI i.e. body mass index may not be the first thing we normally do at home but we all understand the need to do so in the context of a hospitalized patient. In addition, the dietician needs to ensure that no food drug interaction occurs. There are certain foods to be avoided if a patient is on certain medications and the dietician physician combination would be able to guide the patient.

Physiotherapists - Not all aches and pains require the patient  to be put under the surgeon’s knife and then there are times after surgery a proper rehabilitation programme with exercises and muscle strengthening over a period of time holds the key to achieving the desired outcomes. A physiotherapist’s role is to ensure exactly this and like the other paramedical associates mentioned, they go about doing their job silently but hold the key to a successful outcome.

Many times surgical interventions have been avoided due to physiotherapy and that itself is a testimony of the importance this group plays in healthcare.

Technicians- This is another very important group of paramedical professionals present in the OT, Cath lab, dialysis department,

radiology and lab services who silently go about doing their bit to ensure that our patients have excellent clinical outcomes.

Healthcare is evolving and the concept of multidisciplinary teamwork is being recognised. Just like most sports teams have a captain, in the world of medicine the physician is the captain but each member of the team has their role defined. No role is small or big and each is equally important. It’s time we recognise the importance of paramedical associates in healthcare and appreciate and applaud their efforts.

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