On Monday morning in Bangalore we went to meet and co-create with Dr Sachit who is GP in a private clinic. The clinic is owned by a Christian organisation and focuses on lifestyle illnesses such as hypertension, diabetes and addiction, treating people with a holistic approach - combining allopathic practices with things like hydrotherapy and natural remedies. However, they also act as a local GP service too. He will see 10 patients a day and spends 20 minutes with each one, charging 300 rupees (Approx £3). Most patients are middle class/income, educated and have smartphones.
Here are the key learnings:
Antibiotics are commonly requested and prescribed without tests for bacterial infections, even though tests are available on site and fast - with an average turnaround time of 30 mins:
“Most patients want quick relief and don’t want to pay for the tests. “If it’s necessary I’ll insist on lab tests, but if I am clinically sure of what they have,I will prescribe."
“Diarrhoea patients just want quick relief - they are hesitant to take stool tests because they’re uncomfortable doing that.”
“I would say 4 or 5 patients out of 10 per day are getting antibiotics here”
Patient loyalty (or fear of losing patients) motivates him to prescribe:
“Patients will insist on antibiotics. We don’t want them to leave unhappy, they might start rumours. This might affect the reputation of the clinic - we might just give them what they ask for”
“If the patient needs it clinically i will give it anyway, if it’s not possible to do a urine test”
It was interesting that Dr Sachit felt that examining a patient and listening to their symptoms (without testing) could enable him to clinically be certain that antibiotics were needed.
On asking, what do you wish patients knew about antibiotics?
Dr Sachit clearly knows that there are dangers around misuse of AB's but tensions around how to communicate this to patients are likely to be pressuring him into overprescribing.
Smart prescription service feedback:
“Patients will feel that the doctor is taking a personal interest in their recovery”
“With reminders, patients will be on time with their meds. They will also know better what’s happening with them and be able to identify side effects”
Dr Sachit also linked this last point to loyalty - saying that often when patients do not understand an illness/aren't guided through recovery, they can be tempted to switch doctors, thinking that because they're not feeling better instantly, the doctor must have given them the wrong medication.
“I will spend time describing why I'm prescribing medication - so paracetamol for fever and body pain, antihistamine for sneezing, etc”
It was interesting that because Dr Sachit can spend 20 mins with each patient, he feels a lot of the education piece is taken care of by him already. However he really liked the idea of this app creating digital patient records and allowing him to formalise/organise follow ups rather than just recommending that patients return.
Top Doc feedback:
“Every day new things develop, you do forget what you learn. This mini test would be good to revise your knowledge”
Doctors can't help but forget elements of what they learned, simply because medicine is such a vast topic and changes all the time - with new best practices or discoveries. We've heard this multiple times and it's a great rationale for positioning this learning tool - staying on top not because you're behind, but because that mindset comes with the territory of being a doctor.