Understanding the Indian Health care needs

Ever since I started my journey (I don't mean years of experience, but a mindful understanding) in medical services and health care, I found it hard to to accept the fact that health care industry can not be disrupted by technology or path breaking innovations. So, I started with self questioning - " Is health care industry already in self sufficient and doing great, where it can no further be disrupted?" My answer would be "No" based on global prospective, but also "yes" when I started thinking in the Indian context.

Yes, in Indian context health care industry is self sufficient and doing well. Here is my explanation - Almost in all the major cities and towns, there is adequate availability of medical services from qualified medical doctors. Though it's a matter of fact that doctor to patient falls below or on the border of WHO prescribed ratio. It's not a serious problem to dig on. Yes because, in India Doctors are super heroes, they visit 60-65 patients per Day and number can for to end less some times and they can diagnose and prescribe each patient in just a span of less than 2 mins on average. Wow and this amazingly solved to doctor- patient ratio problem for India. So, for my next question: are we doing great? and in Indian context I said yes - because in a low-middle income country like India, keep the health care costs low is the biggest problem. In India we have consultation fees- starting from $1 per consultation going upto $10 per consultation. It's almost one tenth of consultation cost in USA where minimum consultation cost on average is $100 per consultation. Hence, we are quite successful in keeping the health care costs low and affordable. International community finds this as a good sign of affordable health care, and even I am happy with this 1$ in Indian context. But, how we achieved this affordability? yes the answer is same more number of consultations in an hour, poor facilities, hiring non qualified para-medics (Nursing and pharmacy), not spending on technology, and quality. How ever 1$ in confined to small clinics, small to medium scale hospitals, clinics, nursing homes charge around Rs. 300 ($ 4.5) - Rs.500 ($ 7) per consultation and medium to large scale hospitals charging Rs 700 ($10) to Rs 1200 ($15) per consultation.

After understanding these numbers we can understand that with few problems health care in India is accessible, and affordable. But, the answer is still "No" in the global context. The major problem involved is neither understood nor solved. Yes, the major problem is though there is availability of qualified medical doctors, and health care costs are affordable, there is a lack of vigilance over the quality and patient inconvenience. Lets start from our solutions, doctor visiting higher than 60 patients a day is making him spend less than 5 mins on a patient, it is not their mistake. For, suppose if you are sitting in clinic and your token is number 3, you would pray for doctor to complete his first two consultations faster, but the doctor understand the pain of person sitting with a token 40 and with the limited time he try his best to serve every last person in the waiting hall. Due, to this the duration of each consultation falls less than 5 mins. Read this, I started thinking of one major problem- patient pain with waiting time in short patient waiting time (PWT). There are many start-ups that tried to addressed this problem with their appointment booking software applications. But, many of them have gone through a same problem:- Not all physicians ready to accept such applications particularly busy, old and experienced consultants refused to use it. The lack of punctuality is another major problem. This dose not mean lack of punctuality this is typically due to getting stuck with a surgery or a patient at another hospitals or simply getting stuck in traffic. After all in a long busy day physicians are not finding time for them selfs, so they are not the one to be blamed. It can neither be blamed on patient for choosing an over crowded doctor, by believing that higher the crowd better the doctor is :) .

Any way coming back to our discussion, the over crowdedness led to situation where, time spent on each consultation is low, most patient reported dis-satisfaction on issues such as - physician incomplete listening to patient problem, in-complete physical examination. Educated patients who are medically literate with google have reported problem such as in-complete diagnosis or no any diagnosis, symptomatic treatment for chronic problems. These misunderstanding between the patient and doctor or patient dis-satisfaction do exist at larger rate do to lack of collective decision making and/or due to poor communication of doctor with the patient which could be due to time constraint of the doctors. However, patient tendency in India to compromise, accept their helplessly and go back to the same clinic/hospital with their dis-satisfaction is a great opportunity to keep business going. :) In India patient neither denied a payment due to his/her dis-satisfaction nor they complain about their treatment.

This seems to be simple, but the basic ethics of health care are lost when the patient consent rights are denied. Coming to next biggest problem - quality. There is no monitoring over - prescriptions (What is Prescribed, why it is prescribed, is the prescription legally acceptable). We are taking about monitoring the quality, but when there is no valid documentation, How can you monitor. The hand written prescription, these are some times written on a letter head, but some time confined to white paper or a more simple tissue paper. This poor documentation of medical records and prescriptions has led to lack of accountability for any kind of adverse effects faced by the patient. When there is no importance given to patient consent, when the provider or a pharmaceutical manufacturer has no accountability, when patient are illiterate to understand their rights, what we provide is not the health care.

The ideal health system require proper doctor- patient communication, efficient medical examination, accurate diagnosis, anti-biotic stewardship, patient centric treatment choice, patient understanding about his own treatment is needed, respecting his consent, proper documentation, quality assessment, medication therapy monitoring and management, last but not the least there is need for accountability.

With hope we see a ethical, patient centric, evidence based health care system in India soon,

signing off

Thank you for reading