What are Great Doctors Doing?

The Nova Scotia Physician Achievement Review (NSPAR) Program provides physicians detailed and confidential feedback about their practices based on confidential assessments from their peers, co-workers and patients.

NSPAR regularly interviews physicians who have achieved the highest assessment scores. This research helps to identify qualities and behaviours that characterize physicians who are rated most highly by their patients, peers, and colleagues. We call these findings practice pearls -- useful tips that physicians can use to improve their medical practices.

The following list of practice pearls is updated regularly. Please check back often.

Appropriately transferring patient care
Physicians who take appropriate responsibility for the transfer of patient care receive high marks from their medical colleagues. Before ending a shift or going on vacation, physicians should take special care to familiarize colleagues with patient histories and identify patients who may need particular attention in their absence.

Providing clear and necessary information in patient referrals
When referring patients to specialists or consultants, physicians should clearly describe the clinical question and provide other necessary information, which includes basic investigation results, patient history and possible diagnoses. Specialists and consultants should be made aware of exactly why the patient is being referred, the expectations of the referring physician, and what has already been done to reach a diagnosis or treatment.

Managing schedules and appointments to better serve patients
According to NSPAR Program findings, long waiting times in physicians’ offices are a significant issue for many patients. High-performing physicians tend to pay close attention to how schedules and appointments are managed in their offices. This can increase the efficiency of their practices, provide faster access for patients, and reduce wait times.

Recognizing the importance of patients’ families
Assisting families who wish to be involved in the care of a loved one often lessens the burdens faced by patients. Highly rated physicians tend to recognize that a patient’s illness can affect an entire family. With the patient’s consent, these physicians tend to communicate actively with family members in ways that support patient care.

Taking time to review medications with patients
Physicians who take time to discuss medications with patients tend to receive high marks from patients and colleagues. While pharmacists also play an important role in this area, physicians should nevertheless discuss and answer patients’ questions about such as drug interactions, side-effects, and probable benefits. These physicians also routinely review the list of prescribed and non-prescribed medications that their patients are taking.

Dealing with stress
According to the College’s NSPAR Program, a significant number of Nova Scotia physicians report that they face above-average personal and/or professional stress. While stress is common in medical practice, too much unmanaged stress can lead to professional dissatisfaction, illness, and substance abuse. High-performing physicians tend to find balance in their professional and personal lives, with an emphasis on exercise, proper eating, and pursuit of non-medical interests.

Avoiding isolation in medical practice
For a number of reasons, some practicing physicians have relatively little direct contact with other physicians. Although practicing in isolation is generally not ideal, it is sometimes unavoidable, particularly in rural areas with small populations. For physicians, regular contact with medical colleagues facilitates patient referrals, enhances professional knowledge, and is a source of interpersonal support. Physicians commended by the NSPAR Program often make a point of maintaining formal and informal contact with other physicians through continuing medical education sessions, small learning groups, and joint social activities.

Maintaining good medical records
High-performing physicians maintain good medical records. Features of a good medical record include: Legibility; a comprehensive family history; functional inquiry, and past history (including significant positive and negative observations); records of all referrals and correspondence from consultants; and a cumulative patient profile (or similar document). The College’s Guidelines for Medical Record-Keeping contain a medical record self-evaluation that physicians are encouraged to review.

Considering the needs of patients during sensitive examinations
Intimate physical examinations can be physically and emotionally uncomfortable for patients. Commended physicians are attentive to the needs of patients when conducting these examinations. Essential steps include informing patients that they are entitled to have a friend or family member present during examinations, providing adequate privacy and draping for patients, and seeking the patient’s explicit consent if third parties such as nurses or medical students will be present during the examination.

Undertaking regular continuing medical education
Physicians commended by the College’s NSPAR Program participate in regular continuing medical education (CME) or continuing professional development (CPD). In fact, many physicians use the results of their NSPAR review to focus on specific professional development activities. These can include journal review groups, academic conferences and seminars, small-group discussions, online education, and hospital-based case reviews.

Making ongoing improvements medical practice
Physicians commended by the College’s NSPAR Program tend to be curious and interested in making ongoing improvements to their practices . They interact with others, learn from how other physicians to address specific practice issues, and explore how things are done in other communities. The Physician Guidelines and Policy section of the College website is a good source of practical ideas for improving medical practice in areas such as doctor-patient communication, practice administration, and coordination of patient care.

Communicating with patients about ongoing care
As our system of health care grows more complex, it often results in fragmented care for patients, who value cohesion and certainty.  Patients deserve to know who has the main responsibility for providing continuous care on their behalf.  Great physicians work to ensure that patients understand who has the overall responsibility for the ongoing care they receive, including what follow-up is going to take place, what the next step in care will be, and who is responsible to ensure that these things happen.

Engaging in Collaborative Practice
Feedback to the College's NSPAR Program confirms that patients and colleagues praise physicians who appropriately refer to allied health professionals such as physiotherapists, nutritionists, and diabetes educators. This practice makes the best use of physicians’ time and optimizes patient care.  The global move toward collaborative health care is well-founded: Doctors and patients particularly value physicians who are integrated into a team of health care providers.