Optimizing Effectiveness in Medical Practice: It’s all in the Details

Optimizing Effectiveness in Medical Practice: It’s all in the Details
Dushyant Viswanathan Internist Elkridge, MD

Dushyant Viswanathan, MD, works at the Columbia Center for Integrative Medicine in Elkridge, Maryland. Interested in yoga, meditation, and integrative medicine since age 15, he became a physical trainer and places emphasis on nutrition in his practice. He is certified in integrative medicine, including hormone balancing... more

From a physician’s perspective, the ultimate purpose of the encounter with the patient is to formulate an assessment that leads to a plan of action, the execution of which leads to resolution of complaints and symptoms which necessitated the encounter in the first place.    

As an internist specializing in integrative medicine, my goal is to strictly, even religiously, adhere to this principle: resolution of symptoms, optimization of health, and high quality of life are my pre-eminent clinical goals. This philosophical framework and the workflow required to make this happen in day-to-day reality of our medical practice help ensure success and excellent patient outcomes. The specific aspects of this workflow will be the subjects of several articles I will write on the topic of Optimizing Effectiveness in Clinical Practice.    

Of utmost importance to our medical practice is our practice to spend a lot of time with patients and be extremely detail oriented. The more information I have about a patient, the more likely I can be of service. How does one obtain such details? In comprehensive encounters, often taking 34 hours in length. At CCIM, a physician on a busy day will see 4-5 patients in a 12 hour day, to allow for plenty of unrushed time for each encounter. A new patient typically will spend 2-4 hours with the physician and staff; every detail about their health and concerns will be addressed and included in this comprehensive assessment.   

While it is important to have a comprehensive encounter, it is vitally important to obtain a detailed life history and perform complete physical examination. There are so many clues in a person’s medical history which suggest possible underlying physiological imbalances that require iteration. I take an extraordinarily detailed history, often going chronologically from early memories of childhood. Slowly over the course of the encounter, a holistic picture comprising physiology, emotional body, and psychospiritual being begins to emerge.    

We get to know every detail about our patients--their relationships, their eating habits, their psychosocial issues, and their emotional history. We take time to make sure that we are on the same page when it comes to our goals. Eventually, lab testing is typically warranted, results of which are placed in context of the assessment and clinical picture to further its completeness. What eventually emerges is a holistic picture of patterns of behavior, physiology, and perceptions which are the ultimate causes of symptoms. Our customized treatment programs take all of this into account and are designed to resolve imbalanced patterns. When physiological and psychospiritual cycles and patterns are optimized as a result of the customized treatment patterns (this is measurable), symptoms dissolve, and patients feel better.   

When people feel better, they realize they are capable of joy, high quality of life, and healthier relationships, and as a consequence their spirituality and interest in proactive life and health choices typically burgeon. We have programs customized for people focused on longevity and wellness; they are no longer sick, and want to stay happy, healthy, and well into their elder years. These people have given us opportunities to serve them, and as a result of our work with these patients, we have been invited to speak at the Age Management Medicine Group Conference in Las Vegas in November of this year www.agemed.org/November2015/tabid/1342/language/en-US/Default.aspx   

What is extraordinary for me as a physician is to participate in each patient’s healing trajectory, observe them become well and proactively stay well while optimizing their quality of experience.