TOO MANY PATIENTS,NOT ENOUGH DOCTORS- HOWTECHNOLOGY CAN PLAYAROLE IN ADDRESSING THIS GAP?

Too manypatients,not enough doctors-How technologycan playa role in addressing this gap?

Dr Rohit Sharma,Founder and CEO,Zini.ai highlights the role of technology in addressing the doctor-patient gap

Healthcare is a topic that has long been neglected by everyone. Reason being, as long as you are healthy, you don't care what is going on in hospitals. As long as everyone you know is doing fine, why worry about the situation of those you don't even know, right? But the pandemic has been an eye opener for most people.

The pandemic has evidently presented the demand and supply gap in the Indian healthcare system. From shortage of beds to shortage of oxygen, shortage of doctors to shortage of medicines, we realised that the foundation of our healthcare system stands on a shaky ground. For instance, when the second wave was at its peak, we saw examples of the everyday struggles people had to go through to access medical facilities. In top notch government hospitals in Delhi, we could see thousands of people waiting for their turn to be able to see a doctor. Waiting times in most OPDs were 10 to 30 days and the shortage of beds was such that patients had to wait for anywhere between 15-30 days to get a bed. But don't for a moment think that things were fine before the pandemic. The healthcare system is and has been neglected for years now.

The current doctor patient ratio in India

As per a WHO study, on an average a doctor is able to give approximately 2 minutes and 20 seconds per patient in India. And that is on average. This means that many patients get less than 2 minutes of a doctor's time when they finally get to meet him/her. Ideally this time should be 15 minutes including a thorough history taking, evaluation, prescription, guidance and counseling of the patient. The average doctor patient ratio claimed by India is 1:1400 but that is when you add up all kinds of doctors, like allopathic, ayurvedic, homeopathic and other alternative medicines. The ratio of only allopathic doctors to patients is still a staggering 1:10,000. According to official reports by the government of India, 57.3% of medical practitioners in India do not have a medical degree. Many of them are not even college graduates.

How can we expect anyone to get good quality healthcare in such a scenario? The pandemic did not overwhelm the healthcare ecosystem of India. It just brought the already overwhelmed system into the limelight. It just turned a very bad situation into the worst imaginable nightmare. And who is to blame for this?

If you see any hospital today, doctors are overwhelmed with work. They live the most stressful lives of all professions. Many junior doctors work 12 to 14 hours a day taking rounds in OPDs, wards, OT and admin departments. In my own experience while interning in my medical school, I have firsthand experienced the chaos that patients undergo. A patient who comes from 100s of kilometers away has to wait in line and get pushed around by other patients. Each patient gets barely a few minutes with no time for extra questions or detailed counselling. This is because the doctor has to attend to 100+ patients within a few hours. There are too many patients; too little doctors and both of them are suffering here. Doctors are doing their best, but there is only so much a human can do in 24 hours. Patients are struggling of course, and if they are old and illiterate then their health is only in god's hands. The situation is sadder than it looks.

How do we fill this gap between the demand and supply of medical guidance? Well, either make doctors at a massive pace, or use what the whole world is using, and that is "Technology".

Talking about the former, even if governments start aggressive actions today, it would take almost 10 to 30 years to fill this gap of adding new doctors to the workforce. It takes almost 10+ years and millions of dollars of infrastructure investment just to add 1 new doctor to the workforce. And I am sure that is not a feasible option for India right now. What our country should focus on aggressively right now is tapping into the potential of all the genius minds of our country and taking help from their innovations.

Utilising the power of technology

We all know that no one can replace doctors and the knowledge they come with. We need to find a way to use this knowledge and technology such as AI to address the demand and supply gap in healthcare. One of the ways is to use AI-powered, medical conversational AIs that have the ability to interact and talk with a patient just like a human doctor. These AI-powered multilingual virtual physicians are extensively trained on medical data.

As per studies, as high as 25% of the patients who need primary care do not need to visit a hospital and do not need any further investigations. They can be easily managed by these AIs and it would reduce a massive burden from the healthcare system making room for more serious patients. Even those who need to be seen by human doctors would be 'triaged' and referred better by these virtual agents.

As a first step towards creating access, the virtual physician can interview the patient thoroughly, discuss their complaints, understand their symptoms and health issues and guide them accordingly in a matter of minutes, all by using a smartphone. Once the initial process is completed, the virtual physician can guide the patient to the nearest medical care facility available if required. This can work well especially in rural areas where there is a scarcity of doctors.

There are a few handful companies like ADA health and ZINI.ai that offer AI powered virtual physicians. Using natural language processing technology, these "Virtual Physicians'' can talk to patients in their native language and guide them locally. Imagine a scenario in 10 years when a virtual Physician is available in every village, urban society, island, or spaceship. While it takes 10 years to add 1 human doctor to the workforce, these virtual GPs can be scaled in a matter of months.

Many people expected telemedicine to be the wonderpill that will solve all problems of a skewed doctor patient ratio. But that is not true. Telemedicine does not fix the doctor patient ratio; it only shifts the same ratio from offline to online. There is still the same shortage of doctors. Yes, it has its merits in improving access to many areas and people, but the doctor still has a limited set of hours he/she can work for and telemedicine cannot increase that. The manhours of medical guidance available on the supply side are still the same and distributed through a separate channel only. Telemedicine does not increase the resource availability but these virtual physicians can do that.

Can tech help in automating the 5 steps of the patient care process?

There are 5 main steps in the patient care process-History taking (interview and discussion), general physical examination (measuring pulse, BP etc), systemic physical examination, investigations (lab reports and scans) and lastly, treatment advice. Today there is technology to remotely measure or automate at least some of these steps. AI Virtual physicians can automate

Continued on Page 32