Indicator 5: Timing Is Everything: Why Consultation Hours Must Be on the Wall

Series: Understanding MSDS | Post 8 of 52
Standard 1 (ROM-1) | Indicator 5 | Category: RED (100% required)

The Evening the Doctor Was Not There

Dr. Shoaib Akhtar ran a busy family practice in Gujranwala. Patients liked him. He was known in the neighbourhood as the doctor who would see you at eleven at night if you needed him.

His hours, however, followed his life rather than a schedule. Some days he opened at ten in the morning, some days at four in the evening. On Fridays, it depended on the traffic from the hospital where he also worked a morning shift.

His patients had adjusted. They would call the receptionist, Imran, and ask, “Is Doctor sahib coming today?” Imran usually knew. Sometimes he guessed.

On a Tuesday at half past five, the PHC assessor arrived. Seven patients were already waiting. The dispenser, Waqas, was checking blood pressures and had given syrup paracetamol to a feverish child “until Doctor sahib comes.”

The assessor looked at the outer wall. The signboard carried the clinic name and PM&DC number, but no timings. Inside, the wall above reception held a pharmaceutical calendar and a framed verse. No timings there either.

“When does the doctor sit?” the assessor asked.

Imran hesitated. “Usually evening, sir. He is on the way.”

Dr. Shoaib arrived forty minutes later, apologetic and out of breath. By then two observations had already been written: consultation hours were not displayed, and the clinic was functioning in the absence of the doctor.

Indicator 5 is a RED indicator. It was scored as not met.

What Indicator 5 Requires

The indicator reads: Consultation hours are displayed.

The MSDS Reference Manual requires the timings of the physical availability of the doctor to be clearly displayed at a prominent place outside and inside the clinic, and to be observed accordingly. The clinic should function only when the doctor is available.

Three things are therefore assessed, not one:

• Hours displayed outside the clinic
• Hours displayed inside the clinic
• Hours actually followed, with the doctor physically present whenever the clinic is open

How It Is Scored

There is no partial credit on a RED indicator.

If the timings are displayed and followed, the indicator is scored as fully met. If the timings are not displayed, it is scored as not met. A neatly painted board does not rescue a clinic that opens its doors while the doctor is elsewhere.

Why the Commission Cares

The manual states the reason plainly. Displayed hours are for the convenience of patients, but the deeper purpose is to discourage clinics from functioning beyond the practice time of a legitimate practitioner, to build patient confidence, and to limit quackery.

When the doctor is absent, someone else starts seeing patients. Waqas meant well. In the eyes of the assessor, however, an unqualified person was providing care inside a clinic that carried a doctor’s name. That is precisely the pattern the PHC was created to stop.

What Dr. Shoaib Changed

The fix took one evening.

He fixed his hours: Monday to Saturday, 5:00 pm to 10:00 pm. Sunday closed. The morning hospital shift was left off the board entirely, because the board is a promise to patients and he could not keep a morning promise.

The timings were added as a line on the main signboard, and a small printed board was placed above reception. The same timings went onto the third line of his door plate, so all three matched.

Then came the harder change. Staff were told that no patient would be examined or given any medicine before the doctor arrived. If he was running late, Imran would inform waiting patients, not treat them.

The total cost was a few hundred rupees. At reassessment, Indicator 5 was fully met.

“I thought flexible hours were a kindness,” Dr. Shoaib later told a colleague. “In reality, they confused my patients, my staff, and finally the assessor.”

A Quick Self-Check

• Are your consultation hours visible from outside the clinic?
• Are they displayed again inside, in the waiting or reception area?
• Do the timings on the signboard, door plate and inside board match each other?
• Do you actually keep them?
• Does anyone see, examine or medicate a patient when you are not physically present?

If the answer to the last question is yes, the problem is larger than a board.

Series so far: Post 1, The Inspector | Post 2, 18 Standards, 47 Indicators | Post 3, Red, Yellow and the Score | Post 4, Signboard | Post 5, Easy Access | Post 6, PHC License | Post 7, Door Plate | Post 8, Consultation Hours

About this series: Educational content on MSDS compliance for clinics under the Punjab Healthcare Commission, based on the PHC MSDS Reference Manual 2017.