In a recent article, Dr Aakash Ganju argued that the empowered healthcare consumer is rising and will accelerate the shift in the healthcare experience over the next few decades. There is a perception that, like in other industries, this consumerism will take years to percolate from the affluent (and the digitally empowered) to the underserved health consumers who have limited choices. Nothing could be further from the truth and Ramesh’s (name changed) story should illustrate that the empowered, savvy health consumers are all around us, amongst the well-off as well as amongst the less affluent.
Ramesh came to Mumbai as a 13 year old migrant from a village in Uttar Pradesh in 1997. He spent many years doing odd jobs till eventually settling into a permanent profession. His single income household supports his wife, two young children and when he can, his family back in his village.
A few years back, Ramesh came to me for help with a family problem. His father was suffering from an advanced case of piles, a medical condition that can cause immense discomfort and pain during bowel movements. Ramesh’s father had come to Mumbai looking for treatment. I suggested to Ramesh that he consult a surgeon at one of Mumbai’s leading government hospitals. I warned him that the waiting time would be long, but the quality of the consult would be amongst the best he could have access to. I called a few friends and made an appointment for Ramesh’s father at the surgery OPD of this hospital.
I forgot about this as I as travelling extensively for the next few weeks. On my return, I asked Ramesh how the appointment was. He said it was okay, they were made to wait a lot and they didn’t like the experience. I was a little amused that Ramesh was complaining about the wait times when he was able to consult with the finest surgeons in the country. Nevertheless, I asked him what he wanted and then wrote out a reference to a friend of a friend, who had a busy private practice in low income community of Mumbai. Checking back again after a few weeks, I heard the lament that the patient crowd wasn’t “good” at this private clinic. Now, I was at wit’s end and didn’t know what to do. So, I asked him to see another doctor in private practice and rope me in for any support. I didn’t want to call in any favors until I understood what Ramesh was looking for.
After avoiding the subject for a couple of months, I asked Ramesh if his father had improved. He said his father had gone back to his village and had decided to avoid surgery. I thought this was a silly choice to make, but nevertheless asked how they had arrived at the decision. Here’s what Ramesh told me – his father consulted with several doctors, including the one in the government hospitals, the low-income community private practice, the more affluent private practice and the doctor back in his village (I suspect there may have been a few more). He also spoke to several other patients with a similar condition and could distill his choice to the following options.
Option 1: Undergo surgery and run the risk of losing control over his bowel movements
Option 2: Spend considerably more money to undergo a special type of surgical procedure
Option 3: Manage his discomfort with medical treatment but have control over his bowel movements
Now this reflection is not about the quality of medical options offered to the patient. It’s unlikely that any of the doctors he met spent more than two minutes talking to him. So, the options he pieced together was a combination of what he gleaned from the discussion and the conversations with other patients. What amazed me was that this wasn’t some patient rights advocate researching his treatment options on the internet, this was a poor, rural farmer of limited formal literacy, who could understand and articulate the choices he had so clearly. The three options listed above are not my understanding and refining of the conversation I had with Ramesh. They are exactly, to the word, the options that were conveyed to me, in their glorious brevity!
I was chastened by this experience. In hindsight, I was perhaps a bit presumptuous of the experience that I thought Ramesh sought for his father. Yes, he had limited means and did not have health insurance, but in this case, he was willing to mobilise additional resources. He was particular about the kind of experience he wanted. He was not willing to submit to what he perceived as undignified wait times and the patronizing attitude of a government hospital doctor. When unclear about the choices, he went out to talk to other patients (in an offline world). In doing that, he was able to discern, with remarkable sophistication, the trade-offs he’d have to make between the pros, cons and the cost of the diverse treatment options.
A few years later, Ramesh’s father underwent a rubber band ligation procedure (option 2 above), when he was ready for it, and when the benefits outweighed the cons for him. It doesn’t matter that he had piles in this case. He could have had any other medical condition, but the process of gathering information and matching that with his own priorities, to make an intelligent, informed decision would have remained the same.
The last two decades have seen a shift in the dynamics of doctors’ consultation rooms. Patients are seeking information from doctors, families, social media, social networks, other patients and whatever sources they may find. Informed patients have begun to push away from the patronising “I know best for you” doctors and started making more informed choices (I wish more informed was always better informed, though that’s perhaps a topic to mull over next time).
Online consumers and millennials will undoubtedly accelerate the pace of healthcare consumerism. But it’s worth celebrating that patients like Ramesh’s father, part of the billions underserved globally, will fully participate in and benefit from the transformation of the healthcare experience.
Dr Aakash Ganju is a healthcare consultant and entrepreneur, focused on increasing transparency, access, and convenience to health providers and consumers. He is the CEO of Avegen and lives in Mumbai, India.
Also published on Medium.