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Interview with Dr Neeraj, GP in Bangalore, India

Dr Neeraj, 44 years old, owns a small private clinic in Bangalore. He is a family physician. He did his bachelor in medicine MBBS and then when into building medical software for a while, before become a GP again and opening his own clinic. Dr Neeraj was one of the few advocates we spoke to of prescribing antibiotics with a lot of caution.

He sees around 40 patients per day which is pretty high compared to other middle class clinics.

Top Quotes

“Antibiotics are not used here, they are abused.”
“Most patients when they come they have antibiotics in their hand, saying they have been taking these”

On the difference between lower and middle income patients:

"The low income need a remedy now, they need immediate relief. My primary intention is to give them maximum support. They need their wages the next day - their livelihood depends on it. Middle income have sick leave, they can afford to stay home."

On why patients trust him:

"I avoid unnecessary prescriptions of medicine and unnecessary tests. That’s why my patients trust me”

On prescription of antibiotics:

“People think antibiotics are magic pills that will cure them faster. If you don’t give them any they can get angry - they’re asking for them very often.”
"Here we use a very limited prescription of AB’s. Many of my patients leave with 'plain prescriptions' - just advice to rest. Some of them have hesitation, they are leaving without something. I can only do this with my close patients."

On educating patients

“Most of my time goes on educating patients, otherwise i’d see 150 patients a day.”

On AMR:

“50% of my patients are resistant to some antibiotic”

On diagnosis and certainty:

“I can ask 1000 questions regarding the patients cough to see whether antibiotics are necessary. (Sometimes you can tell even without tests)"
“I might not know what bacteria is causing the infection, that level of uncertainty will be there, but i will know there is a bacterial infection”

On pharmacies in India

“For them (pharmacies) it just business, they don’t care about the long term consequences on the life of that particular patient (when giving antibiotics without prescription).”

Prototype Feedback

Visual Aids
“I would prefer using something like this (to explain to patients about antibiotics) - its a visual aid and visual impact is important."

“It’s like candy popping antibiotics round here. This would be good to remind them”


On the visual with the chainsaw cutting a flower

“The one with the chainsaw is wrong. Some people might think antibiotics are very powerful and will ask for them. It’s like a saying here: 'you don’t need a sledgehammer to kill an fly', but it still kills the fly. Same thing, you don't require a chainsaw to kill a flower, but it still cuts.”

Serious Stories
“Lack of awareness in patients (around antibiotics) makes our practice hell”

On educating patients:

“I don’t have much time to give a whole lecture (to each patient around AMR), but I try my best. Also I don't want patients to think I am lecturing them, like their dad. I tell them only what is necessary”

"Need to be careful with messaging. A campaing will have a positive effect but should not make people be scared of antibiotics (just cautious), so they can still take them when they actually need them."

"(Such messaging) might make people go towards alternative routes like Ayurvedic medicine.”

Smart Prescriptions
Dr Neeraj trying out the smart prescription prototype.
“If i was typing the symptoms of my patients on a computer, the patients might interpret that as not knowing. (ie the system is telling them what to diagnose).”

On the systems giving suggestions from guidelines

“As a private practitioner I don't think the warning is helpful - if it was a suggestion it would be ok.”
"I would like to have red flags for potential bad interactions of medicine and allergies."
"This should be helpful. Too much information can be overwhelming and I would override it.”

On the system recommending no need of antibiotics (according to guidelines):

“Other doctors would worry about losing patients. If they don’t prescribe antibiotics the patient will go to another doctor”

On the system giving clear (automated) instructions to the patient:

"This information is awesome. It will be a delight for the patient.:"
"The benefits are that patients will have knowledge of the diseases and will be more religious in taking their medications."

On phsycial vs digital prescriptions:

“There’s a huge impact of the physical prescription. Psychologically patients feel like they are not cured if they don’t receive (a physical) one”

On follow ups

“This service is fantastic but I am not sure whether patients will go through the effort of replying. If they feel their symptoms worsen they will come running to the clinic.”
“People will feel personally more attention, that I am putting in effort to do this”
“Patients will be delighted as I am taking personal interest in them”
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