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Observation and Interview with Dr Guarav

Dr Gaurav is a senior doctor at a large public hospital in Banaglore

*NB he requested to remain anonymous, hence there are no photographs of him and we have changed his name. 

He has 26 years of experience as a practising doctor, and holds both public and private clinics. On Mondays he has an Outpatient Clinic (OPC) which we sat in on, to make some observations over a few hours, followed by an interview. Here's a few key learnings

He had a traditional mindset towards patient care - a ‘doctor knows best’ attitude

In reaction to 'Patient Stories' concept - 

“I tell my patients about how to take the drugs, on the prescription, and I find no problem with compliance. I would not need this.”

He didn't feel that there was a need to 'go deeper' and help patients understand the WHY as well as the WHAT when it comes to taking medicines. Given that he only spends 3-5 minutes with each patient, this may also be a contributing factor. It was quite surprising for us to learn that Dr Guarav didn't acknowledge gaps in patient understanding - it felt as though he didn't really need them to understand, as long as they followed the prescription. As far as he knows, giving the right prescription is the best mode of care.

Family members waiting outside the clinic

Was very confident in his own consultation and prescribing practices as they are:

In reaction to 'Compare Me' concept: 

“this comparison would not matter to me. I prescribe what is appropriate according to the guidelines”

Interesting that he felt the guidelines are ‘king’ and he needs no support in assessing his performance - even though he sees upwards of 50 patients each day. He was keen on the idea of continuous medical education, (CME) - but that is quite 'external' - learning about new theories and discoveries from journals. 

HMW encourage someone like him to be hungry for more insight into his own practice and performance? HMW help even experienced doctors feel that they have something to improve on?

Felt concepts about blending everyday practices with medicine were unappealing

In response to Recovery Kit concept - 

“No, I would not tell someone to take honey and ginger. That’s for your grandmother to do. I would prescribe them paracetamol.”

Interesting that in India it would be counter intuitive for a doctor of his stature to talk to people in everyday terms about what else they could try, as Dr Tayla does successfully in USA. We learned later in the week about how blending two approaches to medicine, for example herbal/Ayurvedic with Allopathic, would be considered very radical here. It felt too that this approach would be seen by him as undermining his quality and stature of care.

And those which use technology...

In response to Machine Learning Stethoscope - 

“I make a diagnosis with my stethoscope but also my examination and the patient history. This alone could not tell you if it was bacterial”

Interesting that he did not feel technology could ever be a match for his years of experience, or be better than the tools he currently uses. A bit concerning that he perhaps would not be open to these types of developments for his more junior doctors to adopt in the future. 

Thought the problem of AMR was more prevalent in primary care (lowest level) not tertiary or private, where he works:

“You might find these issues in rural areas or in primary care facilities, but not here”

He didn’t feel this was an issue for him to worry about or intervene within.

Jenny and Baneen, our fixer, leaving the session

Overall these reactions made us think about the level of resistance we might encounter in India when developing an intervention to be used by experienced doctors, versus a Community Health Worker, for example who is very open to learning new ways of working. It also made us think a lot about designing interventions that are not just adopted but really embraced by the people we prototype with, for best results.