Specifics vs general: Ask for specific test and not the complete panel of tests to reduce treatment costs

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Evidence-based medicine has become the norm today. Laboratory tests are now greatly relied upon in the diagnosis of a condition, its treatment and follow up.

Most often, we ask for liver function tests (LFTs), kidney function tests (KFTs) or a lipid profile as a whole, for instance, without mentioning the specific test/s in the panel. This is the general practice and it is done quite possibly to avoid legal consequences

In lipid profile, total cholesterol or high-density lipoprotein (HDL) cholesterol may be the only tests required. If HDL is low, then triglyceride (TG) level is high. High TGs indicate serum lipemia.

A good peripheral smear should be able to tell you about the white cell count (total and differential), platelets, types of anemia, parasites, sepsis, etc.

In non-alcoholic steatohepatitis (NASH), serum glutamic-pyruvic transaminase (SGPT), now called alanine aminotransferase (ALT), may be the screening LFT required.

In suspected hypothyroidism, thyroid-stimulating Hormone (TSH) is the only screening test required.

Urine routine and microscopic gives information about diabetes mellitus, renal disease or urinary tract infection (UTI).

Good clinical examination supported by peripheral smear, urine analysis should be able to give a diagnosis in most cases. A third test that can be done in chronic fever is ESR.

All these 3 tests can be done in a clinical side lab. Further investigations can be done in a stepwise manner.

When a patient seeks health care, he/she looks for availability, affordability and quality. The issue of affordability is very significant in India as it has one of the highest out of expenditures on health in the world, which is over 60%. This contributes to poverty due to exorbitant health expenses resulting in further inequity in health services.

Universal health coverage is the answer to affordable healthcare of quality in the developing countries of the world including India.

Universal healthcare provides Affordable, Adequate, Accessible, Available, Appropriate and Accountable quality and safe healthcare to the public.

As per the WHO, “universal health coverage implies that all people have access, without discrimination, to nationally determined sets of the needed promotive, preventive, curative and rehabilitative basic health services and essential, safe, affordable, effective and quality medicines, while ensuring that the use of these services does not expose the users to financial hardship, with a special emphasis on the poor, vulnerable and marginalized segments of the population.”

As part of the Choosing Wisely Campaign, clinical societies like the American Society of Anesthesiologists, the American Society for Clinical Pathology and the Canadian Association of Pathologists recommend that routine preoperative laboratory testing, including, CBC, coagulation studies, and metabolic panels for low risk surgeries without a clinical indication should be avoided.

By asking for specific test and not the entire panel of tests, it is possible to reduce treatment costs for a patient.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Lower doctor-to-patient ratio is a major cause for burnout among healthcare professionals

Health Care, Heart Care Foundation of India, Medicine Comments Off

Deficit of 6 lakh doctors in India is alarming

New Delhi, 16 April 2019: India has a shortage of an estimated 600,000 doctors and 2 million nurses, say scientists who found that the lack of staff who are properly trained in administering antibiotics is preventing patients from accessing live-saving drugs. Even when antibiotics are available, patients are often unable to afford them. High out-of-pocket medical costs to the patient are compounded by limited government spending for health services, according to the report by the U.S.-based Center for Disease Dynamics, Economics & Policy (CDDEP).

There is 1 government doctor for every 10,189 people (WHO recommends a ratio of 1:1000), or there is a deficit of 600,000 doctors, and the nurse-to-patient ratio is 1:483, implying a shortage of two million nurses.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “In India, there still exists a huge disparity between the number of patients and the primary care physicians. As a result, patients get less time with the doctors. Overcrowded OPDs means doctors end up attending to two or three patients at the same time. This can compromise the quality of care given and a loss of faith in the doctors as well. Indians also have a peculiar notion about who a good doctor is. There is a belief here that the best doctor is one who charges a lesser amount but is also available round the clock, which is not practical. Then there are also doctors who charge less in the hope of getting more patients. All of this leads to a shorter consultation time, because a doctor cannot keep working endlessly.”

Burnout among doctors due to factors such as these is an important issue in healthcare and affects both the doctor and patients adversely. A doctor suffering this condition may lack empathy towards the patients or even have an impaired judgement.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “The cases of burnout are likely higher in female doctors due to the demands at both work and home. The number of specialists is limited, and hence they are subjected to more working hours and the nature of the jobs is demanding. With such a punishing workload, they may also end up taking the blame if something goes wrong or even become frustrated with the changing work culture. Addressing the doctor-patient ratio in India is, therefore, an urgent need of the hour.”

Here are some tips for doctors to avoid a possible burnout.

  • Practice smart work scheduling
  • Start a hobby which will help you distract yourself from the regular workload
  • Make time for relaxing techniques such as yoga and meditation, as these will prove to be stressbusters.
  • Make time for family and friends
  • Delegate tasks and try to manage your time effectively.