One of the lessons I have learned during my stay in Belgium was the opportunity to undergo in providing a first line health care system. I was assigned by the campus to visit one of the districts in the west of Belgium, precisely in Zelzate, a small town nearly an hour away by bus from Gent. Zelzate is directly adjacent to the Netherlands, thus made this little district culturally similar to its neighbor. I was assigned to a GVHV clinic, Geneeskunde voor Het Volks, which means healthcare for the community. The concept of this facility is almost the same as the concept of Puskesmas as BPJS service provider in Indonesia, namely using per capita system as their payment gateway. This healthcare financial system is a somewhat minority within health care system in Belgium although with this per-capita system the clients do not have to pay anything. Reasonably this is because public participation on health financing is sufficiently high, hence made people do not feel the reluctance to use direct insurance or to share cost on medical expenses. I had the opportunity to accompany Dr. Karl Segers in the examination of patients either in the clinic or outside the facility. In this writing, I will be reviewing further on the home visit. This topic is quite interesting to discuss because in general, a primary health care physician in Belgium spends roughly 20-30% of his clinical activities to conduct home visit services.
Early in the morning before we visited the patient, Dr. Karl gave me a briefing on what cases to visit. When doing the home visit, the doctor equipped with a stack of medical records and a laptop that has direct internet access with patient database server at the clinic. Although hard copy is not widely used, it is useful primarily for elderly patients whose medical records have existed since before the era of digitalization of the medical records. Therefore in the home visit, doctors will be more arranging patient data input through the laptop. The process of filling the medical records was conducted not for long, maximum only five minutes per patient. The average time of home visit per patient is approximately 45 minutes to one hour, depending on the weight of the problem encountered. Not only computers but doctors equipped with facilities like a mobile clinic. For example, the doctor can immediately draw the patient’s blood sample when needed and can directly send to the laboratory.
The essential message of the home visit system is THE HEALING EFFECT. Most patients visited are chronic cases that require long-term care, such as diabetes, hypertension and in some cases malignancy. The presence of doctors in the patient’s home not only gives a positive effect on the doctor-patient relationship but also provides a sense of trust that will unconsciously contribute positively to the healing process of the patient. Doctors who do home visit will also be able to approach the environment and family, which is often the primary factor concerning the occurrence of a disease.
In chronic or palliative cases, patients or doctors commonly do not have excessive expectations of healing or improving an individual’s health status. But doctors are still expected to conduct an assessment based on ICE principles, namely accepting the Idea, Concern, and Expectation of patients. This ICE principle alongside applied when assessing the patient additionally employed in the decision making done by the doctor. Often the idea, concerns, and expectations of the patients do not correspond within the doctors perspective. Thus made the importance of excellent communication, and the healthcare system believes home visit can hugely facilitate and bridge the conversation, especially in balancing the expectation between doctors and patients. An approach of patients with high expectations and irrational complaint is very efficient when using communication strategy as mentioned earlier. In many cases, doctors moreover will not set upper expectations of patients in the high expectation condition, solely flow like water. Doctor as the medical provider is not possible to solve all the patient’s problems, for unreasonable notions are strongly recommended to keep the counseling in progress. Dr. Karl told me “Did you know Bagus, doctors are one of seven ART professions in the world. Therefore being a doctor is like being an ARTIST”. The art of proceeding patient examination, art in counseling and essentially art in treating for the suffering.
Reflecting back in Indonesia, where the doctor usually has provided a parking lot which signed “Tempat Parkir Dokter”. However in Belgium signing in the parking lot for doctors only “ART”. This means parking for an artist.