We spent yesterday morning shadowing consultants (or attendings) at Sir Ramachandra’s outpatient department (OPD). This particular OPD resides in the public hospital (SRMC also has a private hospital on its campus), and it serves patients from near and far who do not have the ability to pay more than the minimum out-of-pocket expenses for healthcare. It costs 10 rupees (roughly 1/6 of $1 USD) to see a doctor, and medications and lab tests are heavily subsidized for patients. For example, a combination pill of simvastatin, aspirin and clopidogrel is available to patients and costs a mere fraction of what the three medications would cost on their own.
There are no appointments; rather patients line up for hours in the heat for the chance at seeing a doctor. The OPD sees on average anywhere from 800 to 1200 patients a day (!!!). It is quite something to watch the system unfold. Once a patient registers at the front desk, they are given a little blue book, which serves as their medical record and is the only means of providing continuity of care from one visit to the next. Then it’s a waiting game. Some semblance of a line is formed and patients are finally ushered into the consultants’ room once their time has come. Because there are so many patients to be seen, time with a provider is short. There is little time for greetings or chit chat; the doctor scans the blue book, asks some targeted questions regarding the chief compliant, decides whether further testing is indicated and, if not, the patient is sent home with some scripts. Because demand is so high, most patients are seen in under 5 minutes (!!!).
But I found myself in awe of how much can seemingly be done in such little time. A man with a tongue lesion was triaged to Oral Surgery just moments after sitting down at the consultant’s desk. A woman with palpitations was ordered for an ECG and then returned to the front of the line with her ECG strip a short while later. After a quick eyeballing, an elderly male with dyspnea and productive cough for two weeks was sent up to the inpatient ward. Physicians here are expert diagnosticians with impressive gestalt. Since time is a limited commodity, and patient demand is endless, physicians must be sharp and decisive in their thinking.
I have some work to do in my Shapiro clinic…