One of the happiest memories of my younger days was watching M*A*S*H on TV. The show was based on the experiences of the doctors and nurses of a Mobile Army Surgical Hospital during the American military involvement in Korea. While it was mainly a humorous show focussed on a rebellious young doctor who hated the war and being forcibly conscripted to be a part of it, it also shone a light on the tragedies that form a part of every armed conflict.
It was here that I first heard the term “triage”. A term that our overburdened health infrastructure had to use during the second wave of the Covid pandemic. Simply put, triage is done when medical facilities are overwhelmed by a huge number of patients like it happened immediately after a session of hostilities between the American and Korean forces in M*A*S*H. Doctors had to prioritize who would be treated first – those with life-threatening but treatable injuries were chosen ahead of those with less critical injuries, or those with mortal injuries and could not be saved.
As per a statement made in Parliament in September last year, we have around 12.5 lakh doctors for a population of around 135 crores – or roughly one doctor for one thousand citizens. While this meets the WHO recommendation of 1:1000 ratio, the problem lies in the distribution. Most of these doctors practice in urban areas, whereas the bulk of our population is rural.
There is another even more severe problem – we have only around 3.7 lakh specialists, which comes to around 1:3700 doctor-patient ratio. When we factor in the fact that an even greater percentage of these doctors are in cities, the shortfall in patient care for the common Indian becomes even more stark.
Not that patient care in cities is something to talk about. According to a report in The Economist titled “The importance Of Primary Care” (April 26, 2018), the average time spent by a physician with a patient to diagnose her ailment in India is 180 seconds – 3 minutes. While this is better than the 90 seconds spent by doctors in China, this is the primary reason why the success rate of diagnosis is just 30%. This is not because of carelessness by the doctor but due to the sheer patient load.
This shortage of trained medical personnel is why Dr Devi Shetty suggested that even medical students could be conscripted for patient care during the second wave. While this may be an acceptable solution during these extraordinary times, given the complexity of modern treatment techniques, this is definitely not a sustainable solution.
Given the amount of time, experience and skills that are needed before a doctor can become a good physician, it is very difficult to quickly improve the doctor-patient ratio in our country.
What is possible, however, is to help optimize the use of the doctors time so that within the same amount of time, more patients can be treated, without compromising the quality of care by simultaneously increasing the success rate of diagnosis.
The good news is that now, technology makes this possible.
While tele and online doctor consultation have become acceptable due to the growth of medical intermediaries like Practo, medline etc, and home diagnostics for blood sugar, SPO2, blood pressure are already quite prevalent, a number of homegrown startups have come up, which leverage Artificial Intelligence, Machine Learning as well as Internet of Things and specialized sensors to identify potential health hazards as well as diagnose and provide low cost non-traditional diagnostic tools.
Take Fedo.ai, a Bengaluru-based startup that uses the patient’s phone to capture a video of his face and within a few minutes, using advanced AI and ML, generate a Fedo score that indicates his health level. While this has aroused great interest in insurance companies as a tool for processing policies, it can also be used by individuals too for a quick and simple health check.
Similarly, Salcit Technologies, a Hyderabad-based company has created an app called Swasa that uses the cough sound recorded through the patient’s mobile phone to test for the presence of various lung-related ailments.
We even have an Odisha-based startup EzeeRx that has developed an instrument that can check for a number of parameters like blood sugar, creatinine levels etc without even a blood sample.
These are but a few examples of the ways technology can be used to allow doctors to triage patients and through accurate, quick, inexpensive and easily accessible diagnostics, help them successfully diagnose and treat their patients. Hopefully, by optimizing the utilization of the doctor’s time, affordable and good healthcare will soon become a reality for every citizen – rural or urban.