DE-BRIEFING OF THE GP

VISIT AND IMPACT OF

SOCIAL ISSUES
Ruthven
Medical Centre
4 Ruthven Road,
Kingston 10
Type of Practice
▶ The practice is a Group practice with a mix of family physicians
and specialists.

▶ The types of doctors on the team are general practitioners,

surgeons (general, pediatric and urologist). There’s also a
dermatologist, obstetrician and gynaecologist and a
pediatrician

▶ Model of teamwork adopted is a

parallel practice.
Size of Practice
The practice is a medium-sized practice. The centre sees
an average of 60 patients daily.
Management Style
The practice is owned by Dr. Lenworth Jackson who bought
it in 2005. but it is managed by the lead administrative
officer.

Reporting Relationship
Problems are reported to the lead admin. officer and then
to Dr. Jackson.
 The Team
The team comprises of 8 doctors:

2 General practitioners

Dr. Lenworth Jackson Dr. Shane Alexis

● Obstetrician and Gynaecologist ● Dermatologist

Dr Michael Abrahams Dr. Frances Berry

● Pediatrician Urologist

Dr. Maolynne Miller Dr. Gareth Reid

● General Surgeon Pediatric Surgeon

Dr. Patrick Bhoorasingh Dr. Simone Dundas

The team also consists of a registered nurse, a practical
nurse, an administrative staff of six (including a lead
administrative officer) and two filing clerks.

There are also six auxiliary staff, a security guard and a

night caretaker.
Financing the visit
A general check up with the family physicians start at $4000 and $6500
for the specialists.
Contracts with Sagicor and Medicus Insurance companies.

Doctor Remuneration
Ruthven Medical Centre is an Expense Sharing physician practice.
All doctors that rent full-time pay $52,500 JMD per month which is all
inclusive (covers rent, maintenance, janitorial services, water, electricity,
internet, receptionist services, administrative services and security.)

The lead admin officer is also responsible for generating income

analysis sheets daily and presenting each doctor with their respective
earnings based on respective patients seen.
Interaction with MOH
● The center reports to the Ministry of Health on the
vaccines that are administered each month. They also
report to the M.O.H. if there’s an outbreak of any
disease.
● MOH sends info on new medications, health policy
changes and info on diseases..
Dr. Patient Consultation
● Mutual Dr.-Patient relationship

● Adept communication skills , however through comfort with

patients, some formalities were overlooked .

● Close ended questions to avoid patients going off on

tangents. Due to their comfortability, patients tended to
disclose concerns.

● Empathy shown where necessary. Therapeutic relationship

sustained. Effective listening and overall high communication
competency.
Patient Examination
● The average duration of the patient visits was 20
minutes.

● Dr. Jackson had a patient-centred interview style

rather than clinician-centre.

● He emphasised the importance of using focused

history taking and examinations. This allows to
pick up details that might otherwise be missed
and enables clinicians to correctly diagnose
patients.
Incidents of interest
● Dr. Jackson showed a patient who suffered from multiple
sclerosis and as a result had dizziness and vision
impairment.
● In this scenario a detailed family history would be
necessary as family history of MS is a strong indication,
along with a thorough examination of all systems due to
the delicacy of the case. The patient later on had an
aggressive head tremor and on MRI exam, a
glioblastoma. In this scenario, a focused history and
examination is of utmost importance.
Incident of interest cont’d

● The patient was on interferon injections every

other day and the monthly supply of this drug
could cost her roughly 160 thousand dollars.
Approach to Chronic Non-Communicable
Diseases
● Chronic patients often don't have good compliance, refuse to
go to the hospital and lack funding.

● Sustained follow up - ensures early detection of adverse effects

of drugs, tackles problems in compliance, failure to respond to
treatment etc. Patients with disease at a severe stage are
followed up more often. e.g. severe diabetics

● To deal with compliance, long- term medication e.g. monthly

injections are opted for. (done for arthritis patients

● To monitor chronically ill patients more effectively, more

advanced equipment/ methods are used e.g. E.C.G. for
hypertensive patients and Patients that can are advised to get a
machine to monitor their illness.
● Dietary approach also taken (done for hypertensive and
diabetic patients. Glycosylated Hb also used for diabetics.
Impact of Economic Issues
● Socioeconomic status- Many chronically ill patients
lack the funds needed to properly maintain their
health so they miss follow up visits or skip out on
buying the prescribed medications. Some may not
have access to healthcare services e.g. health
insurance.

● Use cheaper generic drugs

● Offer fee waivers e.g. office visit fee
● Opt for longer term treatment to avoid them having
to buy different medications.
 Referrals

● No rule to referring.
Refer to whoever
might be able to help.

● A simple referral form

is used.
Cultural, Legal & Ethical Issues
● Legal- This relates to persons injured from accidents.
They’re followed for a time and if their case gets worse
and they wish to pursue the legal aspect, they’re
referred to another physician or specialist.

● Cultural- This pertains to religious persons e.g. rastafarians

wanting to falsify immunizations for school records due to
them being against immunizations. They’re counseled on
the safety and benefits of immunization.

● Ethical- This pertains to abortions. The FP is pro-choice but

how involved he is in supporting the act is uncertain.
C.I.S.O.C.A
The Centre for the Investigation of Sexual
Offences and Child Abuse (CISOCA)
Mission/Aim:
To investigate allegations of sexual offences and child abuse.
Through..
● creating an atmosphere which will urge victims of child abuse
and sexual offences to report incidents.
● investigating all reported cases of sexual offences.
● investigating allegations in an efficient and proficient manner.
● enhancing victim rehabilitation through counselling and
therapy
● conducting public education campaigns through various
means and media.
● Victims under the mandate of CISOCA are
underage persons who suffer incest, grievous
sexual assault, buggery, rape, underage sex, sexual
touching or interference, sexual grooming.
 Contact and Referrals
● Contact can be made via phone or by
visiting their any of their offices
isandwide.

● Referrals should be made anytime

anyone suspects that a child is being
abused or personally knows of the
abuse.
 EMPATHY
The capacity to understand or feel what another person is
experiencing from within their frame of reference,
During a patient- physician interaction, understanding, respect
and support are key. Empathy takes us to another level of
understanding. Understanding is something most of us crave
and being misunderstood can be one of the most frustrating
things for a patient. During our GP visit we were able to
experience a display of empathy first-hand.
 ● One example of Dr. Jackson’s empathy was how he
waived the doctor’s fee when a patient told him they
would not be able to afford the medication he had
prescribed.

● Another example was how Dr Jackson printed out some

information on lumbar compression for a patient who
could not understand the cause of her back pains.

When a patient feels comfortable with a

doctor, they are more likely to be open and
honest. A lack of empathy may lead to a
patient withholding information pertaining
to their diagnosis or not following up with
their doctor.
 AGEING & INTERVENTIONS
● The quality life of an aged person can correlate with their
socioeconomic status in terms of being able to afford quality health
care. In cases where the elderly patients couldn’t afford the care,
they’d be managed with generic or long-term treatment.

● The chronic disease of aged persons should be continually

managed and should override acute care in elderly patients. Acute
elderly care can cause decreased life quality and increased
deaths.

● In the visit we saw where Dr. Jackson actively and sustainably

managed elderly patients and promoted
continuous chronic disease management.
● One issue that arose was the notion from patients
that they’re already old and death is imminent. That
doesn’t have to be the case as with proper care,
they can have a longer fulfilling quality ife. In this
case, Dr. Jackson persuaded them to take the further
steps to manage their illness e.g. encouraging
patients to go to the hospital for surgery.
SUMMARY

This experience has further cemented the need to always

be well-informed and attentive to quality patient care.
The experience was a good one.
REFERENCES

https://japarliament.gov.jm/attachments/article/339/Submission%20-
%20Centre%20For%20Investigation%20Of%20Sexual%20Offences%20and%20Child%2
0Abuse%20(CISOCA).pdf

http://jamaica-gleaner.com/article/lead-stories/20170827/we-will-be-coming-get-you-new-
cisoca-head-vows-track-down-those

https://jis.gov.jm/report-sexual-abuse-children-cisoca/