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Why do Indian doctors continue practising in exactly the same way their seniors did 40 years ago ?

A major lacuna is the poor quality of medical records which most doctors keep. The medical record is the heart of clinical care - and yet it's extremely poorly maintained in Indian clinics today. The majority of doctors do not even bother to store and keep their patient's medical records - they just write down their opinion on their letterhead and hand it over to the patient. Usually, this is just a laundry list of tests the patients needs to do and a hand written illegible scrawled prescription - without even a mention made of the clinical findings or what the diagnostic impression is ! While it's good that the patient owns his own records, what happens if the patient forgets to get his records for the next visit ? This creates a lot of frustration for the doctor, who berates the patient for his carelessness - but the damage is done ! Wouldn't it make much more sense to keep a copy - and give one to the patient if he wants it ? Is this a lot of hard work ? Not anymore ! In the old days, one would have to make carbon paper copies or provide xeroxes, but using electronic medical records, this is now very easy to do !

Clinical care protocols are very similar in the US and in India. This is hardly surprising - after all, patients are the same the world over , and most will need the same kind of treatment. However, while most Indian doctors will provide exactly the same standard of medical care a doctor in the US does, why is there such a big difference in the way they keep medical records ?

In the US, every medical encounter is carefully documented ! Perhaps this was originally done for protecting against lawsuits for medical negligence; but today, the US government is making it compulsory for all US doctors to use EMRs - not just to improve the quality of care, but also to reduce costs ! Why don't Indian doctors use exactly the same approach to documenting their clinical care ? Are they too busy to do so ? too lazy ? or do they feel it's not important enough ?

Why do most doctors in India not bother to document their clinical encounters well ? Why is medical record keeping still shoddy and badly done in most practises ?

If Indian doctors understand the clinical importance of keeping good quality medical records, then why are they so reluctant to use EMRs ( electronic medical records ) ? In the past, it was true that PCs were very expensive; and that few doctors would afford them. Also, many older doctors were not very computer -literate; and the software programs which were available for medical record keeping were very doctor-unfriendly ! A combination of computer-unfriendly doctors and doctor-unfriendly software meant that most doctors were quite disillusioned with EMRs and were not willing to use them.

The good news is that things have changed dramatically ! Technology has improved; computers have improved; and Indian medical software companies such as Plus91 ( in which I am an angel investor) are realising the importance of mapping the doctor's clinical processes and respecting his work-flow so they are now making EMRs which are doctor-friendly and which enhance his productivity !

So why aren't Indian doctors rushing out to buy these , given the fact that they are inexpensive and can help them to improve the care they provide to their patients ?

Partly, this is because of the unhappy experiences doctors have had with Indian medical software in the past. It was the computer-savvy early adopters who were the first to lump on the IT bandwagon 10 years ago, to try to use computers to improve clinical care. Unfortunately, they burnt their fingers, which is why they are reluctant to try again.

As a consequence, most doctors do not know any one else who is using EMRs; and because they have little exposure to practise management skills during their training, they still do not understand the value an EMR can provide to their life.

Another major problem is that Indian doctors are not willing to pay for this. This is because they have been completely spoilt by the pharma companies . Because they are so used to getting everything free from pharmas, they are not willing to pay for anything at all ! This means EMR companies find it hard to sell their products - but if they do not generate revenue, how will they be able to produce good software ?

Please remember that your patients form the heart of your practise - and your patient's medical records are worth their weight in gold. If you keep them carefully; update them religiously; and share them with him, you can show your patient that you have all his medical details on your fingertips. This will help to inspire confidence in your clinical skills . Patients will rave about how well-organised you are - and this word of mouth marketing will help you get more patients, as it differentiates you from other doctors.

Also, by keeping your patient's records, you are creating a lot of patient loyalty and "stickiness" . If your patient is confident you know all about him because you have all his medical details, he is going to be very reluctant to switch doctors - after all, who wants all the hassle of explaining his medical history all over again to a new doctor ?

However , if you do not keep your patient's records; and the patient has to start explaining everything which has happened to him every time he sees you, be is likely to lose confidence in you very quickly ! ( That doctor does not even remember my name - forget about my medical problems !)

Hospitals in India have started documenting medical care electronically; and boutique medical clinics and chains have also started doing so. This is very heartening progress - and doctors who do not start doing so soon are going to find they will start losing their patients to computer-savvy doctors ! You need to move with the times - or you will get left behind !

Indian doctors have an excellent reputation for their clinical skills and patients all over the world look upto them . Because of their exposure to a large number of patients during their training in medical college, they have a lot of clinical experience; excellent diagnostic acumen; and are technically proficient. They are quite conscientious and are willing to work long hours for the sake of their patients.

However, most doctors in India still do not use technology intelligently. The majority do not bother to store and keep their patient's medical records ; or if they do, it's done in an extremely disorganised fashion. Most prescriptions are hand written illegible scrawls - and most doctors still manage their clinics very poorly . The doctor is often rushing from clinic to clinic , while his patients are made to wait for ever and ever. Phone calls are poorly handled, because doctors do not realise the importance of running their practise as a small business.

The major problem is that while doctors in India are taught to be good clinicians during their training, they are never taught how to run their practise. They have poor practise management skills, and are so focussed on the clinical care they provide , that they lose sight of the overall big picture as regards the services they provide to their patients.

Remember that when a patient comes to your clinic, the amount of time he spends with you is only a few minutes. Most of it is spent waiting; filling up forms; paying money; or talking to your staff. While many doctors feel that all these activities are administrative paraphernalia which are below their dignity, the fact remains that all these do contribute significantly to the experience your patient has in your clinic ! However, if you do not spend time and energy in training your clinic staff; or if you treat your front office staff badly, they are likely to treat your patients badly as well - causing a lot of unhappiness and grief for everyone !

Unfortunately, because doctors ignore and neglect these aspects of their practise, they do a bad job with delivering services to their patients. Many do not learn to use assistants efficiently to leverage their time; while others would rather do everything themselves, because they have never learnt to delegate well.

Even worse, though that have a lot of clinical experience and expertise, they do not share this efficiently, because they do not publish medical papers or articles. The only reason US doctors are more prolific in their writing skills is because they use the time and expertise of secretaries and editors to hone their publishing skills. India has so much untapped non-clinical talent which doctors can easily use to provide better services to their patients - and a higher profile for themselves !

Sadly, most doctors are not entrepreneurial enough and have poor practise management skills because they do not learn how to handle staff; and to delegate non-core non-clinical activities to others. Unless Indian doctors learn to maximise their productivity and efficiency using technology and other people's time, they will never be able to grow to their maximum potential !

The good news is that there are now many clever young entrepreneurs ( who are not doctors) , who are entering the Indian market. They realise that the way doctors provide medical care leaves a lot to be desired - and have come up with clever new solutions to address patients' pain points. They understand that healthcare is a service business - and while the doctor has an important role to play, there are lots of ancillary services which need to be provided around the doctor, both to improve his productivity; and to make the patient experience more pleasant.

As these businesses grow and flourish, hopefully all doctors will realise the importance of paying attention to how critically important it is to focus on the complete patient experience in their clinic - not just on the clinical care they provide ! The good news is that it's easy to fix these problems - we just need to pay attention to them !

This is a guest post from Mr Aditya Patkar, Marketing Director, Plus91.

Patient Safety is a vital aspect of healthcare. Medical errors can lead to deaths and medical tragedies which are preventable , leading to heartburn and losses for all doctors and patients . In any industry, software is used to improve efficiency and accuracy. I am going to highlight some basic examples as to how medical software ( electronic medical records, EMR and practice management software, PMS) can be used to improve patient safety.

1. Prescriptions and Medications: The commonest errors occur when doctors write prescriptions on paper and the patient or the chemist misreads the prescription. This is a common occurrence and a printed prescription generated from software with prepopulated Drug Data is the safest bet against such a mishap. Other errors which can be prevented include: mistakes made by doctors in writing the dosage or strength( which intelligent software can automatically prevent) ; and the inadvertent prescription of a combination of drugs which can cause harmful drug interactions. These features are already present in the Plus91 clinic package , Clinkare. This ensures standardized prescriptions, reducing the possibility of error and confusion !
Another neat feature is sending reminders to the patient to take their medication at the correct time via SMS. This ensures high patient compliance , because missed dosages could lead to major problems in treatment. This feature is available in ClinION , the hospital management solution from Plus91 Technologies.

2. Patient History: If doctors are in a hurry, and if a patient comes without his old case papers , the doctor may end up prescribing the wrong treatment ! Not having easy access to the past medical records is a major pain point for all doctors ! EMRs allow storage and instant retrieval of the patient’s medical records, allowing doctors to make better medical decisions , thus ensuring patient safety. This feature ensures that the doctor no longer needs to rely on his error-prone human memory ! Intelligent EMRs also have built-in Clinical Decision Support systems , to help the doctor practice evidence-based medicine.


3. Patient Data Entry: As we know, GIGO holds true – garbage in, garbage out ! Accurate entry of patient data in the system can be ensured by various validation measures and checks in the software. A simple example is the use of validated fields , which accept only values within a pre-defined range. Thus, if the value for hemoglobin is entered as 100, this will be automatically rejected !

4. Check for Informed Consent: A patient must know what procedure they are undergoing – what the risks are; and the important dos and don’ts, to help ensure a good outcome . A software program can ensure that the consent forms are filled in using a reminder / validation system , to ensure that all the patients queries have been answered. It’s also possible to use a video/presentation format , with a consent thumbprint or electronic signature taken at the end. This is helpful for risk management, because it documents that informed consent was obtained. It also ensures that the patient follows all the key preoperative instructions ( such as coming on an empty stomach before surgery . )

5. Check lists: A checklist ( as described in Dr. Gawande’s new book “The Checklist Manifesto”) is the doctor’s most trusted friend. Clinic software programs come with check lists which need to be marked as complete before the next set of tasks ( on the next screen) can be accessed. This ensures that all important steps are carried out in order.


6. Alerts and reminders. SMS or Email alerts can be automatically sent by the software, when there is a problem. For example, if a key lab value falls out of a particular range , the doctor can be automatically alerted, so he can take the needed corrective action !