PERIPHERALIA

The page number in the footer is not for bibliographic referencingwww.tandfonline.com/ojfp 72

I started general practice the wrong way around. I designed 

what was the most ideal practice setting for me, and I have 

been trying to get back there ever since. I started in rooms 

in a shopping centre, and only employed one nursing sister. 

Her name was Sister Zurlinski and she was made in heaven.

Between us, we devised a system that would facilitate the 

most time-efficient way for me to see patients. The floor 

area of the rooms was not that large, but we designed it 

to accommodate two small examining rooms, as well as a 

consulting room or office with just a desk and chairs.  

Sister Zurlinski would sit at reception, which was in the small 

waiting room, and when the patients came in she would 

enquire politely what they had come in to see me about so 

that she could prepare them for the consultation.  She had 

grown up in the area and knew the social background of the 

community.

She would then weigh the patients, take their blood pressure, 

record the relevant vital signs and test the urine if indicated 

by the history. Children would have their temperature taken, 

and she would write a few words of short history on one or 

two lines.

She would prepare the older patients over the phone when 

they were making their appointments, so that they would  

bring in their medication. When they arrived, she would 

empty their handbags, go through the list with them and 

write down exactly what they were taking in the file. I think 

this was the most time-saving exercise that she performed 

for me.

We devised different systems for different conditions. If 

patients came in for a Papanicoloau smear, she would show 

them into one of the examining rooms, test their urine, and 

tactfully ask if she needed to test it for pregnancy, record 

their vital signs, measure the haemoglobin, and ask them 

to undress. She would place a clean sheet over them. We 

designed, between us, crude prototypes that are now used 

by nurse practitioners, which enabled me to walk in and 

consult with the prepared patient.

It sounds a bit like conveyor belt medicine, but everyone 

was reassured by the efficiency of the system and the 

thoroughness of the approach. An electrocardiogram was 

carried out for patients with chest pains, and the appropriate 

tray laid out for lacerations or cysts requiring removal. Sister 

Zurlinski spoilt me for the rest of my practice life.

I have never been able to organise such a system again. 

Looking back, a large part of my practice life has been 

spent taking measurements and vital signs, and gathering 

information that could have been performed by a nursing 

assistant. Most of us work in a similar, inherited way of seeing 

patients inefficiently. To consult with a prepared patient, 

the staff ratios within the system and how the information 

is gathered, stored and retrieved would need to change.  

A fundamental alteration to the flow systems for our rooms 

or outpatients would also be needed.

If we instituted this concept of the prepared patient and 

the designs that accompany it, we would only need half 

the doctors that we now have to run the health services.  

So please do not tell anyone about this.

Chris Ellis, Family Physician, Pietermaritzburg, KwaZulu-Natal 

e-mail: cristobalellis@gmail.com

The prepared patient