By Syamala Ariyanchira
October 10, 2014
The nightmare began sometime in mid-September when my husband, who was on a business trip in USA, ended up in a hospital emergency room. What was presumed to be some food poison has now turned into a medical puzzle. As the situation became worse, I flew to the US, and soon after I reached there, he was rushed to the emergency ward for the third time in a span of two weeks.
My job involves analysis of various matters related to healthcare, which often requires comparison of the practices in developed markets with those in various emerging markets. This work exposure, however, was inadequate to understand some of the basic differences with respect to the medical approaches in the West and India.
Some of the striking differences I noticed are as below. It could be an obvious list for those who are familiar with both the worlds. On the other hand, I will not be surprised if someone totally disagrees with me as well.
The most striking experience for me was the process efficiency- particularly in the ER. The process is so well laid out that no one wasted a single minute in confusion or to figure out what has to be done for a patient. Professionalism was evident at all levels – from specialists and nurses to techs and even the reception desk clerks.
In my part of the world, public hospitals often lack this level of efficiency. On the other end of the spectrum, India has reputed private hospitals, which are driving health tourism industry in the country. These hospitals manage to get the crème of healthcare professionals by offering competent pay packets and state-of-the-art work environments.
Sadly, the quality of health care one can get in India depends upon the affordability of a person.
Respect for all Human Life
Respect for human life, disregarding the social status, age, race, or stage of illness of the patients, is evident. From the reception desk clerk at the ER to the highly qualified specialists do not show any preferences of differential treatment to patients.
During a friendly chat, one Indian American doctor mentioned that the treatment we are receiving in the ER is the same that even President Obama would receive. Or, a homeless man would get. The payment part is considered as another matter, and is not a measure of what care one would receive.
As per the law of the state, nobody coming to the hospital can be turned back without having treated – Something that is lacking in my part of the world.
It was a great feeling to watch this team literally practicing the philosophy of equality of healthcare in the ER.
Tests getting priority over listening to patient symptoms!
Another major difference in the approaches is the emphasis on tests. In India, probably since they do not have great facilities, a doctor is keen to get as much disease history as possible from the patient. Hence, each and every detail the patient shares is generally considered important. Doctors have the patience to listen, since that is their main resource for diagnosis.
Here, on the other hand, the doctors seemed to be in a rush to conduct tests, scans, or invasive procedures, based on which they can decide treatment strategy. Impatience was often evident as we tried to explain the symptoms. We were asked to hurry, since they have to see many other patients. Though a valid reason, I feel symptoms could have given valuable clues. For example, his mentioning of excessive night sweats immediately received attention of the Indian doctors we got in touch over phone for second opinion.
Finally, we prepared a disease summary report that detailed the entire symptoms in chronological order and gave a print out of the report with the doctors, hoping they would read it in their leisure time and note down if any symptoms ring a bell.
For a tourist travelling on basic travel insurance, the healthcare cost is the first thing to worry about, if he falls sick in USA. Americans pay the highest price for each diagnostic test, each pill, each IV fluid bag, and emergency care.
It is highly complex how costs of these tests are determined since the cost for the same test can differ from one patient to another, in the same hospital. There was no way to compare costs and choose one that we could afford.
While digging deep to understand the cost range, I came across with an article dealing with the same topic. The article indicates the range for an upper back MRI to be $614 to $1,800, based on a search using “Now I Know” tool of Harvard Pilgrim.
As an Indian, my brain understands out-of-pocket payments better. For some of us, who have the luxury of medical insurance through employer, healthcare cost is not a big concern. However, if it involves major issues and several expensive tests, we try to stay within the limits.
Doctors are also careful before recommending tests and medications. Though affordability decides the quality of healthcare, things are slowly changing in India – thanks to the NGOs assisting poor communities and innovative insurance packages being introduced by various companies addressing the needs of lower middle class population.
The doctors and nurses in the US seemed to be much more cautious than their counter parts in India. Treatments are not usually started until the diagnosis is conclusive. My husband spent valuable two weeks staying in a hotel, taking pain reliefs and an antibiotic while waiting for results of diagnostic tests. Did he lose some critical time during the early stages of some illness? I am not sure since our medical puzzle is still not solved.
Of course, US is a litigious society and doctors have to be extremely cautious.
In comparison, I remembered the experience of my friend in India, who had TB meningitis. After eliminating the chances of some suspected diseases, the doctors started the treatment for TB meningitis straight away, without waiting for test results. That saved my friend’s life, and the culture tests confirmed the disease three weeks later. I am not sure if that would have been possible, had he been in USA.
In India, we are used to doctors taking chances starting treatments for certain conditions based on their intuition. Often, their intuition turns out right. Probably the experience gained in third world countries is helpful.
The doctors in India definitely have an advantage over their counter parts in the US. They are treated like God and possibly they can get away with many things. However, this trend is changing in India.
We are packing our bags as my husband feels slightly better. We do not have any infrastructure or the financial resources required to continue the diagnosis and treatment in USA. Back home, hope the doctors will be able to move forward from the point where the USA team left off. Also hope that the puzzle will be solved sooner rather than later, definitely at lower costs.