Scope of Private Practice in INDIA
This was the article published in Bombay Hospital Journal
Scope of Private Practice in Mumbai
Everyone lives by selling something
Health Care Organizations the world over have been going through a lot of churning due to developments in many fields, the rapid growth of knowledge in medicine & other sciences, tremendous developments in technology, increasing trends of specialization have brought in changes in the pattern of delivery of health care. Dermographic transition, epidemiological shift, increasing consumer expectations and their changing preferences, rapid growth of private sector in health care have influenced the health care immensely. Emergence of evidence based medicine, health insurance and increasing demand for accountability for health care quality are some of the factors which have changed the paradigm in health care today.
Meeting the challenges of operating in today’s health care environment requires a complete health care reforms and how hospitals & health care organizations are managed. A commitment to quality enhancement throughout a health care system involving all professional and service groups is essential to ensure a high quality of health care delivery.
Quality has to be planned and not left to chance occurrence or to individual institution. Time for managing the change is running out but it is well known that a crisis period is the best time for change. Health care providers, planners, managers and others responsible for the redirection of the industry have urgently addressed the issue of quality health care at least in some parts of our country, but still lots have to be done.
Mumbai a vibrant, financial capital of India has all sorts of health care providers, institutions, private and public… The scope for medical practice is enormous, in every field of medicine. Not only allopathy practitioners but also Ayurveda, Homeopathy, Unani and other alternative medicine practitioners flourish here…Mumbai is facing unprecedented challenges in magnitude, diversity and complexity of health care and its delivery to Mumbaiites..
The Challenges in Health Care in the 21st century would include population explosion, growing disparity between resources and demand, impact of HIV/AIDS, Increased cases of Diabetes, Ishcaemic Heart Diseases, Alzheimer’s, Infectious Diseases etc and the changing demographics in the society. At the micro level one has to think of changing role of hospitals and hospital care,, primary care physicians, altered spectrum of disease and increased emphasis on Gerontology and Geriatric medicine. Also one has to change a mindset from curative health care to preventive aspects and to rehabilitation.
The most striking feature in todays health care industry is use of computers..
Are they problem or the Solution ?
Is there dehumanization of patient care ?
The message is clear….
We are entering an era of computer controlled therapy that will drive a wedge between clinicians and patients, offering potentially competent but sterile, impersonal and dehumanizing care.
Despite the fact that there are array of gadgets that could allow medical practice with minimal laying on of hands, yet the portrayal of physicians and others is that they must talk to their patients, hold their hands and provide that unique touch which would give the precise comfort and support that we envision which were widely available when family doctors made house calls few decades ago..
Inspite of over two decades of explosive growth of computerization very few physicians personally use the computers in providing critical care.. They mainly use this for office management, accounts , correspondences and may be some for their clinical software…For those physicians who did not grew up in the computer age, this sense of mystery breeds mistrust and even fear. How can I possibly learn about these devises ? How will I use them , or failure to use them, affect the way in which I am perceived by my colleagues or more importantly by my patients ? Will the nature of my work be changed over time by this machine ? Is there a threat to the traditional role of care giver or a physician ? No computers can replace physicians, but there is a gnawing concern that these machines may possibly affect their practice..It is ultimately the sense of control over the technology, rather than by the technology that will allow practitioners to feel adopting computer based tools for record keeping, and other uses..
Mere existence of the computers as tools for physicians and other health care workers need not be a threat to our goal of human care, with close relationships developing between the patients and care givers, the greatest threat , as to these ideals in our current world are the fiscal, organizational and time pressures that can prevent even the most well-meaning clinicians from finding the time to sit with their patients, to listen and teach and to demonstrate the kind of concern and caring that was ironically probably one of the reasons that they entered the health care field, as the computers recede into the environment, but increasingly help the physicians find information quickly and easily, the result may be the release of time that will be available for building precisely the patient doctor relationship.
Mumbai has all the necessary resources to get all whatever a physician needs to be present in his clinic, which include, gadgets, for diagnosis, computers etc…One has to learn to market his practice… Traditionally the most acceptable marketing tool which was allowed was “word of mouth”, e.g saibaba etc.. but today threre are several mantras which can be adopted to promote the physician ethically. Most of these are time tested and shall prove greatly rewarding to all… Follow up your patients with a phone call, write a column in news papers, journals, magazines, being on the advisory board of your own community, getting media attention during inauguration of a newly bought laser machine or a gadget with some patients treated talk about the same. Providing public lectures in their own language on common forums like Lions, Rotary, Giants etc, Join a charitable clinic,. Make some pockets of communities near your practice and be in constant touch with them who can refer you patients for ever..
One more important aspect of increasing scope of private practice is Mediclaim… My advice to all is that get all your patients under mediclaim and see the rewards of your practice flourishing…The advantages are that most of the private hospitals are empanelled by the TPA’s and this system will be very useful for the patients to avail the best services at reasonable cost without wasting time on individually finding of facts , which is very difficult to find. And the patients will go to the right place without loosing time and without any tension in mind about the availability of the treatment..
Private Practice can boom to sky if one is consistent, committed,
Brilliant in his work, and develops a brand for himself by getting some media coverage etc after treating some VIP etc …Your scope of practice also increases if one gets a attachment in a five star hospital or a public hospital where interdepartmental references form a major referral ..
One more field which is virgin in Mumbai still and has a tremendous scope is telemedicine….The patient at Virar or Alibaug or in the interiors of Maharashtra can be seen, interacted, xrays ECGs and scans can be seen, and treatment discussed and of course charged, this is a reality and this can save the time of patient and cost incurred by him to reach at the tertiary care hospital in Mumbai… And the doctor in Mumbai can get a fixed charge for seeing this patients live… This is a reality, and now patients from remote hilly areas in the north of India e.g. areas like Kargil are being consulted for and even treated by Doctors at AIIMS in New Delhi and even Apollo Hospitals in Chennai through telemedicine…which has one of the highest scopes of medical practice..
One more field which has a tremendous scope is cosmetic surgery,
With the increasing number of Tv channels and Tv serials lots and lots of glamour struck crowd comes for treatment and for them the looks are more than anything and they are good paymasters..
In the past few years there is so much influx of patients who come from abroad for treatment here, these are patients from Gulf, UK, Malaysia, Africa, and so many neighboring countries…for obvious reasons .This is because one thing is a fact that ,India though a developing nation has one of the finest crafty medical personnel who do a fantastic job when provided with a good infrastructure and all the facilities…The cost of health care delivery specially for certain procedures like angiography,
Angioplasty, surgical treatment like CABG, stereotaxic surgeries, complex tumor surgeries, etc are at least 10 to 15 times cheaper than any other developed country with equal or better results..
We must capitalize on this fact that we do have good private hospitals here in Mumbai and also we should develop our clinics for quality care , make our clinics more patient friendly, get accreditations and be a favorite spot for foreigners who seek to acquire quality health care. and every family physician can play a major role in boosting his practice and contribute a lot to our country by way of providing foreign exchange for the quality health care which can be provided to all the foreigners who seek their help…Mumbai can be one of the best centers of medical tourism for the continent in near future., and one must positively think of continued improvement in health care delivery and get their clinics accreditated by ISO or ICHA etc which are quality assurance certifying bodies universally accepted..
A family Physician or a Primary Care Physician in a busy clinic in the metropolis of Mumbai plays a vital role in providing a quality health care to his patients by upgrading his clinic, making it more patient friendly, by adding at least simple things like clean drinking water, good clean toilet facility, a comfortable place to sit for the patients, a good examination table, which is not there in public hospitals including in Mumbai, they should have all the records of their patients, update himself with all the academic updates by attending regular CME’s workshops etc and acquire some special skills of Basic Life Support, Advance Cardiac life support, trauma life support, Cosmetology, Counseling for Diabetic patients, Mental Health counseling etc..and have facility for some common pathological tests like routine CBC, Urine etc..X ray & Sonography facility etc.
Private Practice in summary has a great scope provided every practitioner gives a quality health care to patients which is mandatory and “raison de etre” for the medical profession and I emphasize that it needs 3 ingredients for improvement WILL, IDEAS and EXECUTION One must not forget the fact that we earn, learn and depend on our patients illnesses, pain, discomfort and hence it should be our moral duty towards our own conscious to give our patients more than they ask for…. And this mindset once adopted the scope is infinite and there shall never be a dry or a slack day….
Dr Deepak K Jumani
