On Tuesday we met with some patients at their home in Bangalore. We asked two sisters - Radha, Sushmita aged 44 and 45, and Reshma Radha's daughter, 22, to tell us about how they manage their health, how they use antibiotics, and to give us feedback on our prototype ideas.
Here's some of the key learnings:
They don't trust allopathic healthcare providers, but still do what they say
“As soon as we went for my son's cough, they listed 3-4 antibiotics, so that he would feel 'hale and hearty' in a few days, but in a month we’re sick again”
“The doctor will continuously give us antibiotics, overloading us. They would never tell us to get rest”
“It’s easy to go there (to pharmacies). Why go to a doctor and wait in a queue if you know what to buy? But we don’t really trust them, they are not qualified to tell us what's wrong.”
When we probed, what about changing doctors or asking them why they're offering so many AB prescriptions?
“We don’t question the doctor. We are just taking medication blindly"
It's really interesting how even though they can see doctors and pharmacists are motivated by providing them with quick relief, and not looking after their long term health, they continue to visit them. We also found this with our patient in Kenya - after 18 months of recurring stomach infections and AB's, he was not considering changing doctors. They're talking about being 'bombarded, loaded, and overdosed' with drugs that they may not need, and are open about the idea of taking more control and learning more. The issue is - how? They can't imagine who would support this or invite them to learn, because their medical professionals already benefit from the system the way it is, and don't expect to have to answer questions about what they're doing.
However they have started to explore alternative medicines for certain conditions.
“You have to be much more patient with Ayurvedic preparations - they do work but they take a long time. They are good for things like back ache, acne, hair loss”
Reacting to 'Serious Stories' concept:
“That’s really scary, I would definitely look this up”
“They (the doctor) will never tell us this. Who will go to them if they do?"
They had never heard of a superbug or AMR, despite being educated and upper middle class. They speak the language of 'side effects', as many of the other patients we've met do - noticing that if they take too many drugs they will feel ill, or get sick again next month. If we position resistance as a 'side effect' of overuse of antibiotics, it might help patients understand. They also found the idea that a doctor might warn them of AMR nonsensical.
Reacting to Visual Aids concept:
“He (the doctor) is educating us, speaking the truth. Making sure we’re educated about medicines”
“We can understand better if there’s an image, laymen like us can’t understand verbally”
They preferred the petrol in a diesel engine card out of all of them. They appreciated the idea that - using this tool - doctors are helping them to get to the truth about when you should and should not be using medicines.
Reacting to Smart Prescriptions concept:
“This is good because it would mean we can read the prescription. We don’t understand what the doctor has written. It’s more handy.”
We're repeatedly hearing that a key benefit of smart prescription is in translating a doctors writing and language into something that 'normal' people can understand and act on.
“It feels like someone is caring about you. Right now, when you’re out of the clinic, you’re out”
Again, the idea of follow ups showing a caring touch was really appealing for patients - extending the doctor's presence outside of the short consultation. They would prefer the communication to be 'real' than automated