Date: 18th October 2010
Author: Dr. Aniruddha Malpani
About: Medical Director, Malpani Infertility Clinic (www.drmalpani.com)
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 !