Re-Energizing the General Physician

The Customer Experience Company

Re-energising the GPNamrata Rana and Sunil Mehra

Health Care delivery is largely a localized business. Consumers prefer convenience if they feel the facility meets their needs.

Healthcare delivery

A consumer uses different providers for different purposes. Having a network of providers within commuting distance is value to a consumer which today is not being met. With the corporatization of healthcare with large private hospitals the consumer is increasingly moving towards centralized locations.

In the last 20 years,the GP stands marginalized from being cornerstone of medical practice to mere fringe player.

Marginalization of GP

The GP is today undermined, undervalued, underpaid and barely understood despite the critical function he / she performs as part of overall treatment cycle.

Insurance is not sold as a health maintenance system

Insurance for Hospitalization

The general tendency is to take good health for granted, particularly amongst the younger age groups. Even with widespread illness and disease around, the ‘it won’t happen to me’ is a commonly held notion. This perception also stems from the fact that Health Insurance is sold almost entirely as a hospitalization benefit which is rare and not as a health maintenance system which is an everyday need.

A growing number of corporations are willing to provide high end health care benefits to their employees

Corporate Reimbursement

This is leading to some dramatic changes - over burdening of the large hospitals, excessive testing of executives who may be perfectly healthy and a rise in healthcare costs. Sometimes, this is also leading to needless over medication and over treatment.

Further, as an unintended consequence of insurance linkages, more and more people go for even the first line of examination to a tertiary hospital.

High Cost of Health care

The role of GP’s and primary centers is hence getting diminished. Thus the consumers are gravitating to high cost delivery centers leading to all round cost escalation and unnecessary pressures on tertiary hospitals. The unnecessary pressure translates into inadequate attention to patients which in turn leads to high levels of customer dissatisfaction which is completely avoidable.

Customer dissatisfactionAll these trends are leading to the rising cost of medical treatment. Conversely unwarranted pressure on medical facilities is translating into unacceptable high level of customer dissatisfaction.

Role of the GPLets examine the

in the context of these healthcare trends

GP’s - Is a rethink needed?1. There's a significant rethink among patients, doctors and corporates on this subject viz the virtual disappearance of the GP from the corporate mainstream hospitals. 2, The concept of the Family GP who knew individual/family quirks/allergies/histories/propensities is being looked at with new respect as an important provider in the healthcare system. There is an attempt to restore the GP’s position at the centre rather than margins of medical practice 3. Superspecialists are swamped with patients. Fallout? Shabby medical care. Patient dissatisfaction with med services provided is at an all time high. Model of specialist referring patient to another specialist is just not working. Very evocative of 6 blind men trying to describe an elephant.

By definition, a generalist takes a general interest in all parts of the body and mind. This enables the proficient generalist to act, where required, as the first point of medical contact for the patient, to deal with both acute and chronic health problems and, critically, to manage illness that presents in an undifferentiated way at an early stage of development

It is part of the GP’s special skill and ability to map the patient physiologically as well as psychologically. It is one exchange where the classic bedside manner is critical to both the healing and the reassuring process. This translates into the enduring trust / loyalty relationship between doctor and client.

Who is a GP?

..because 70% of the maladies we report with to any medical outlet, fall in the generalist category, requiring no hospitalization or anything beyond routine testing. The specialist / battery of tests trajectory is a poor modern day EXPENSIVE substitute that makes a patient out of the client with its negative fallout on the clients morale and trust quotient.

It is many times the GP that separates chaff from the grain and is best qualified to make onward referrals strictly when required.

Why is the role of the GP significant?

Woman with acute abdominal pain and back pain visits GP. The GP well aware of the psychological context and its physical fallout upon the patient discerns immediately that the recurrent in-law / marital problem has resurfaced and the symptoms exhibited are physical manifestations of the same. Accordingly, he puts on his best bedside manner, calms down the patient, prescribes for immediate symptoms and send patient home.

Juxtapose the above example with same woman patient trying to find a remedy at a large hospital. At the hospital she is sent to a gastro specialist as well as to an ortho. She is prescribed an ultrasound and an Xray, maybe even an MRI of the back to get the full facts before the doctors begin diagnosis. This is because in the absence of any history with the patient it is the most bona fide option to exercise.

A ‘Telling Example’

Specialist vs GP

Moral of the story.....

GP’s personal contextual care of the patient is increasingly being replaced by an assembly line, knee jerk system of tests, pills and procedures...

to the detriment of the patient, not to mention the expense, as opposed to which treatment and diagnosis might have been ridiculously simple. More significantly the patient acquires a ‘BIG DISEASE” label with the attendant fallout on his / her mental state and morale.

Visit to specialist

Battery of tests

Over-treatment

High ExpenseUnwarranted prescription

If the role of the GP is so obvious, why is the system so loaded against them?

Patient illiteracy in the current Spend First, Think Later context.

If its a backache, it must be arthritis, if its a headache, visit a neurologist, if its a cough, it must be asthma, if its heartburn, it must be cardio...........and the list goes on

Patient illiteracy

If the role of the GP is so obvious, why is the system so loaded against them? 1

Corporate funded employee health packages are ensuring that a battery of tests are being performed on some perfectly healthy people, who think nothing of visiting a specialist for a minor ailment.

In a manner of shooting a mosquito with a gun. They do it because they can. Logic - ‘My company is paying for it’

Corporate Reimbursement


A person staying in a posh colony, finds it appropriate and the ‘done thing’ to call up the specialist with the snob quotient who ‘treats everyone’ rather than visit the humble GP in a clinic 5 steps away in the colony market.

I don’t want to be considered downmarket by visiting a humble medical establishment.

Reflexive Class Assertion


Everyone is awash with information from newspaper health supplements, magazines and the internet. Everyone seems to think they know more than the physician and therefore rush to the specialist who they think knows more.

The ‘I know more than you’ syndrome. Everybody has done his / her MBBS on the internet these days!

Patients as Media Victims


The halo around the specialist increases if he / she has a long queue and charges the earth. Patients are impressed if a battery of tests is prescribed by the specialist regardless of their irrelevance to the ailment.

The laundry list of tests prescribed they feel, is in inverse proportion to the profound medical knowledge of the specialist! The down to earth GP, with his ready reckoner solutions feels like a lesser light in comparison.

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Who is the

Loser?

The patient is the primary loser, who could easily sidestep and avoid being sucked into medical quicksand, if he were to divest himself of notions about the doctors competence and need for multiple gratuitous testing.

Which translates into huge mental trauma and fiscal loss - FOR THE PATIENT.

While it is unfair to tar everyone with the same brush doctors and patients in urban Indian cities today have become used to the test - treat, test- treat cycle of overmedication and over treatment. A complex mixture of commerce, commonsense and self defense are factored into arbitrary test prescriptions by doctors.

Value is garnered through testing rather than the lives that are impacted positively through sensible diagnostics and relevant treatment.

The Patient is the Loser

Reasons for the Eclipse of the GP1. Prevalent social ethos - for majority of patients, treatment is not about prescription but procedure.

2. Presence of large corporate hospitals in metros - large scale corporatization of private medical care in metros.

3. The bull run on specialists - to the exclusion of the GPs. Specialists revenue translate into 4 / 5 figures. GP’s revenues stay in the 3 /seldom 4 figure category.

Also.....

The GP operates in a crowded landscape

Specialists

Ayurvedic doctors

Homeopathic doctors

Gp’s

The GP competes at multiple levels - With specialists in large Govt and Private hospitals - with the Unani / Ayurvedic / Homeopathic practitioners - with the RMP (registered medical practitioners) - with the local pharmacist who prescribes OTC medicines

Pharmacists

Reasons for the eclipse of the GP

RMP

Benefits of Empowering the GPA strong GP network working independently ensures objectivity, better attention, low cost care and a feeder network into specialized secondary and tertiary centres.

Ensures value based competition - Healthcare providers compete on specialization rather than on owning the customer. GP provides entry level healthcare while hospitals focus on high level interventions. GP intervention leads to patient ownership which may lead to specialist care and translates into both patient trust and loyalty with very obvious dividends.

Maximizing wellness needs to be the focus of our national health policy. By its very nature each tertiary case is specialized towards disease management while GP’s provide initial diagnosis and post disease care. A strong GP network assisted by Govt. Policies and Health Plans can provide holistic wellness. This will also ensure that Total Cost of Care over the lifetime of a patient stays low. (NHS-UK / Canada vs American Healthcare)

Can we develop an INNOVATIVE FRAMEWORK that creates genuine value for the GP?

Can the GP take Centerstage?

A framework for the new GPWhile there is a significant felt need amongst doctors and patients to solve this problem, no one really seems to know how to address it. If this is done, both patients and doctors would benefit.

However, the GP as a cornerstone of medical practice cannot be resurrected with out making a framework that is financially viable and keeps the ethos of the GP in mind.

What does the GP need to have to ensure a stream of customers?

ValueThe GP needs to provide significant unmatched value that comes from personalized service, easy access, high quality reputation underlined by peer endorsement and a promise of wellness.

of the research

Personalized service

Easy access

High quality reputation

Promise of wellness

Knows my medical history and that of my family, remembers me

How does the GP build customer loyalty?

Close to my home, easy access to appointments, easy to visit for me, elderly, children - not very expensive

Does not overmedicate / prescribe unnecessary tests, has my best interests at heart. Believes in LESS IS MORE philosophy of medication.

Overall he / she focuses on wellness and wellbeing rather than constant medication.

Requirements for Empowering the GPThe GP network however cannot be allowed to function in isolation. Recognizing the importance of the GP certain actions need to be taken that can ensure empowerment and customer trust. ✓Centralised rating system of GP’s ✓Knowledge Development of GP’s ✓Patient feedback system ✓GP code of practice

Other than the above providing Additional Transparent service networks such as - Organ Banks, Blood Banks, Pharma networks etc. will be helpful

Addressing Customer Needs

To make the GP centre stage, we need to look at addressing customer needs at various levels. Here is a segregation of customer needs.

My Health

My Family

My Lifestyle

My Work

My Fitness

Emergencies

•Sees me in the context of my situation;

•Helps me to stay healthy and develops with me a plan for me to manage as

much of my care as is possible myself, or with support from a carer;

•Understands and is able to identify the causes of any illness I have;

•Helps me to get the care I want and need;

•Gives me care, but knows when to refer me to someone else;

•Helps me access appropriate care, advice and support to cope from a variety

of sources and helps me co-ordinate my care; and

•Arranges for someone appropriate, with key details of my condition, to be

available when I need care, advice and support.

A patient‟s view of a GP is a doctor who:

Care PathwaysPatients view health episodes as a series of questions at each stage of decision making. At each stage the GP needs to have the connect with the patient to provide them with required care. If the ‘Care pathway’ is disrupted someone else can take control of the patient lifecycle.

Me and My family

Does it need basic care and OTC meds?

Does it need a doctor visit?

Does it need emergency services?

Cold and cough

Persistent Cold and cough

Breathing difficulty

Dr. Visit

Tests are needed

Test can be done by Dr.

Test can be done in my

neighborhood

Do I need to visit a specialist

centre?

Report collected /

Dr. met

Patient decides to visit same or different Dr.

Report collected

FrameworkA Viable GP

Ready

AccessibleGPReputed

Customer and Service framework

Minor ailments

Vaccinations

Post surgery treatment

Handling emergencies

Record of patient history

Record of family history

The GP Framework

Consultations

In GP clinic

At patients home

In corp offices where GP is empaneled

Diagnostics

Treatment

ECG machine

Basics - steth,

pulse, wt

Partnerships - Network

Tie up with Imaging CentreTie up with Path Labs

Referral network - Hospitals - Nursing homes

Portable equipment*

Men - Women

Children

Geriatric care

Special care requirements

DialysisCardiac

defibrillator* *

Vaccinations

Do you think India is facing a GP crisis?India still suffers an acute shortage of about 6,00,000 doctors, one million nurses, 200,000 dental surgeons and large numbers of paramedical staff. India is the biggest exporter of doctors in the world. With an overseas workforce equal to almost 10 percent of the Physicians in India, it is quite a contributor.

India is the biggest exporter of doctors in the world. With an overseas workforce equal to almost 10 percent of the Physicians in India, it is quite a contributor. The reason is obvious – a huge backlog of medical graduates waiting to get into a post-graduate course! With the increasing public awareness about healthcare issues and the demand for specialists and super-specialists, there is an increasing need for more post-graduate institutes that can cater to the backlog.

One out of every 10 practicing physicians in Canada have Indian origin.40,000 Indian doctors in the UK treat approximately half of its population.50,000 physicians and approximately 15,000 residents and students in the US are Indians. 20% of doctors in Australia have Indian roots

ConclusionThe time is right for a viable GP practice network. It would certainly be a viable revenue model.

By its very definition it would remain low margin, high volume, so economies of scale would be vital.

Considering the volumes at hand the business possibilities are immense and the promise of ethical profitability would be fulfilled.

Futurescape, Delhi

Level 4, Rectangle 1, Commercial Complex D4Saket, Behind Sheraton, DelhiNew Delhi – 110017, INDIA

Futurescape, Mumbai

Level 2, Raheja Centre Point 294 CST RoadNear Mumbai UniversityOff Bandra–Kurla Complex, Santacruz (E)Mumbai – 400098, INDIA

Telephone: +91 9910201783

+91 (11) 6654 4196

Email: [email protected]

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Re-Energizing the General Physician