SEGMENTING INDIAN PATIENTS

                                                                   SEGMENTING INDIAN PATIENTS

GOOD HEALTH IS VANITY

REGULAR HABIT IS SANITY

PREVENTIVE MEDICAL CHECK UP IS REALITY

 Only metaphor than comes to mind for describing Indian as a patient is- chameleon. The way he changes colors during sickness/illness (Journey from person to patient and back to recovery) is worth watching and is interesting. Fact that fear of death makes him vulnerable, emotionally unstable is beyond doubt; problem is - for minor illness, also Indian behaves in an erratic manner.

Scenario changes when doctor comes in picture to diagnose and treat a patient. Here reference is made to practicing doctors and family doctor and not to private medical hospitals run by N G Os or by corporate. Lot of changes is occurring in medical field. Medical engineering is slowly replacing individual judgment of doctor. Newer diseases such as cancer and AIDS are frightening while the earlier dreaded diseases such as cholera and tuberculosis are today curable.

However problem with an Indian is – on many occasions patient very casually /grossly blames medical profession in general and doctor in particular. Mockery is that he again goes to same doctor on slightest doubt about health. As if this is not enough, he also in some cases asks for false medical certificate or fake medical bill.

Segmentation of patients in following categories might be of some help to doctors while dealing with them. A note of caution. Patient in this discussion is not terminally ill patient but a normal patient visiting doctor for diagnosis, treatment and recovery.

1-Google Gyani: - This is most dangerous category of patients. Dangerous in sense he/she gives lot of Gyan to doctor also while getting himself diagnosed. He is an avid reader of magazines such as Arogya Patriaka, Aarogya Darpan, health related columns in newspapers and is Google searcher. He talks on Ebola virus with authority. The issue further gets complicated if he gives dosages of this half-cooked knowledge to normal persons. In exceptional cases, he gives valuable information also. He advises friends and relatives not to buy ear buds from roadside vendor because he has read an article on how these spurious ear buds are made from already used  cotton and can be harmful. He is fond of using technical terms such as TLC/DLC, systolic/diastolic, LVEF (left ventricle ejection factor), creatinine and so on. He confirms that by clapping a dozen times in morning, one can eliminate risk of heart attack. He advises person suffering from dysentery to consume Norflox TZ, which is prescribed drug. He has instruments to check blood pressure and sugar level at his home. This gives him another opportunity to discuss issues related to health. Member of two daughters club falls in this category because he wants to be physically fit for longer time. He consumes vitamin B3 and D12 either on doctor’s advice or on his own. He eats valuable time of doctor which is earmarked for other patients. 

2-Perpetual Pessimist:- Many Indian patients fall in this category. The pendulum shift makes him vulnerable due to pessimist nature.  He thinks of extreme negativity. He is always ready for getting himself thoroughly examined and is ready to undergo many tests to remove doubt. While in dispensary waiting for his turn, he has feeling that doctor is giving lot of time to patients before him. He also seeks second opinion which is now a days fashion with upper class Indians. He insists on speedy recovery and may use medicines from Homeopathy or Ayurvedic also without permission from his regular Allopathic doctor. Patient falling in this category may also ask doctor to give tablets and capsules and avoid injections. Family members are in trouble because of his erratic behavior pattern. Keeping him meaningfully occupied is only solution. In some cases, vacuum created by empty nest (sons/daughters in other countries) is main reason for psychological problem, which then cause physical illness. Yet another problem with him is he inquires about symptoms of others and frightens them. With/without knowledge of family members, he also visits palmist or astrologer to check longevity of life and is ready to perform any ritual. He checks weekly forecast( both sun sign and moon sign) and believes the one which is depressing. After getting copy of various reports from pathology lab, he does not have patience to consult his doctor. He asks the lab assistant immediately if the report is normal or not. Obituary column in newspaper is often read on priority by this category. He also asks for an emergency kit to be carried during the tour either within India or abroad.

3-Jolly Jumbo:- He is one who believes in present moment and a strong believer in quote- JITNI CHAVI BHARI RAM NE UTNA CHALE KHILAONA! As a result, he does worry much about seriousness of disease and is ready to face consequences. It is interesting to note that in extreme cases, perpetual pessimist also may face shift in paradigm and may move to this category, once he realizes stark truth of certainty of death. Normally patient falling in this category does not follow advice on dietary restrictions wherein he may be regular on taking medicines. It is job of doctor to make him aware of seriousness of disease, if any, so that he can plan for future accordingly. He cites examples of those who died without any vices such as tobacco or liquor. He may be having instrument to check blood pressure at home but hardly uses it. For him, Yoga and pranayam are fads. He believes in break down maintenance and is of opinion that if medical reports are normal; money is wasted. He is a foodie and does not worry about cholesterol and is not fussy about calorie and fiber information. Because of strong physique and no previous medical problem history, this category sounds very confident in their behavior and approach to life. The positive side is- his enthusiasm is infectious and can help perpetual pessimist to come out of nervousness. He believes in naturopathy also and may not take any medicine, if suffering from flu.

4-Doctor Dependent:-  He/she is desirable category who fully believes doctor and does not try to show any lack of confidence in him. He obeys instructions of doctor, not only related to medicines but diet restrictions also. He believes in philosophy- Do not displease two categories- God and Doctor; if you displease God; you have to go to Doctor and if you displease Doctor, you have to go to the God! He keeps all health related records with utmost care. If pharmacist suggest an alternative or substitute drug if prescribed one is out of stock; he will change pharmacist. If doctor advises two days rest, he will add one from his side. If the patient is a woman, she will check if preventive medical check up for breast cancer is to be done or not. Even if curious, this category respect the valuable time of doctor and does not ask may questions. However, patient is elaborate on symptoms description. He also takes due precaution during season change. He carries onion in pocket if traveling in summer and consumes teaspoonful of brandy in winter. If suffering from cardiac problem, he can be seen standing in a corner during funeral of his relative or friend. He has blood and urine tests done only through the pathology lab suggested by his doctor. He counts number of sweets consumed by his doctor if both meet in a public function.

It is pertinent to note here that patient is not going to be falling in particular category permanently. Depending upon age, health cycle, eruption of health related issues, he moves from one category to other. Understanding psyche of patient helps doctor in handling his customer (patient) in a better way.

Milind Fadnavis is Associate Professor at Institute of Management Technology- Nagpur India and can be reached at milind.fadnavis@gmail.com