Patients are opting for healthcare à la carte

  • Sanchita Sharma & Apoorva Dutt, Hindustan Times
  • Updated: May 01, 2016 11:55 IST
Doctors Harsh Mahajan and Sonia Rawat prepare a patient for an MRI at Mahajan Imaging in New Delhi. (Saumya Khandelwal/HT Photo)

Preventive health check-up have morphed from being comprehensive physicals meant to red flag both existing and potential diseases to a mechanical assembly-line examinations, where patients allege that doctors miss out more than they detect.

Irrespective of how much you’ve paid, you’re sent off for a standardised set of tests, many of which are not needed. The only time the doctors or nursing staff, usually the least experienced in the hospital’s medical hierarchy, ask for your name and age is to make a patient card and bill. Their attitude says they don’t really want to know.

You come away feeling like a rodent being screened for an irrelevant scientific experiment that no one cares about.

“The one-size-fits-all screening model doesn’t work as each individuals health profile varies widely, as do the diagnostic tests, medication, advice and treatment they need,” says Dr Harsh Mahajan, the founder chairman of Mahajan Imaging, where he is redefining preventive care by providing hyper-personalised check-ups that are crafted after an extensive review of the patient’s age, medical history, gender, lifestyle and family history of disorders and diseases.

Read: Doctors are over-reliant on medical tests and patients pay the price

“Family physicians have been replaced by specialists and super-specialists who often don’t talk to each other, which sometimes results in symptoms being missed. There’s a growing demand for internists who spend time to study and understand your holistic health needs before prescribing diagnostic tests you actually need,” says Dr Mahajan, who now offers a bouquet of customised tests, which include gene tests for discerning patients.

”We provide diagnosis and advice, but not treatment or referral. Armed with test results, patients can go back to a doctor, clinic or hospital of their choice for treatment,” says Dr Mahajan. The formula works because patients don’t feel they are being pushed to go for unnecessary tests, interventions and surgeries. And more often than not, spending an hour with a general physician before and after the tests leads to underlying disorders being diagnosed.

Read: Overkill: An avalanche of unnecessary medical care is harming patients physically and financially

Madhuri Sinha, 65, found out she had clinical depression, which is not screened for in a routine preventive examination. “She had undergone a double mastectomy a decade ago after she was found to carry a BRCA1 mutation that raised her breast cancer risk. Even now, though she was healthy, she was unnaturally worried about her health and had disturbed sleep, so I tested her on the depression scoring scale, which showed high anxiety and depression,” says Dr Sonia Rawat, the UK-trained physician and cardiologist who head the preventive health programme.

“What most doctors don’t have is time and that’s something I insist on giving each person who’s getting screened. I don’t meet more than three to four patients a day, and spend 45-90 minutes with each patient before and after the tests to ensure symptoms are not overlooked,” says Dr Rawat.

With a battery of information available online, patients too have started to do their own research before seeking medical advice. For Fatema Surti, a public relations professional living in Jogeshwari, factors in her age and family history in how she deals with her health. “Three years ago, I had trouble sleeping, skin issues, hair loss and I was underweight,” says the 26-year-old. “Each time I went to a doctor, they would administer the same round of tests -- vitamin tests, lipid tests, thyroid, and so on. With just one vitamin test costing Rs 2,000, I realised it would be quicker and more cost-effective to customise a series of tests for myself.”

Under the supervision of her family physician, Surti isolated her symptoms, ruling out thyroid and Vitamin B deficiency as possible factors. “Now, I focus on getting my calcium levels and cholesterol, since my weight and high cholesterol for my age make these imperative,” she says. “I’ve removed blood sugar and several vitamin tests, which has made tracking my health a more efficient process.”

Over the past two years, people asking for personalised health tests have gone up by 30%, says Dr Altaf Patel, the director of medicine at Mumbai’s Jaslok hospital. “There used to be standard battery tests, such as blood sugar, lipase and amylase tests,” he says. “Two factors have changed this. One, with diseases creeping in earlier than ever, the age demographic of the people getting tested came down. Second, awareness is higher, both of diseases as well as of the role family histories play in a person’s health.” Dr Patel recommends personalised health tests based on three parameters -- age, family history and critical findings.

Read: Despite guidelines, too many medical tests are performed before low-risk procedures

Many specialists in corporate hospitals, too, prefer people getting need-based tests from reliable clinics. “I prefer that my patients go for selective tests to measure their cardiovascular health parameters instead of going for the routine TMT (treadmill test), which can throw up false-positive and false-negative results, especially in women,” says a senior cardiologist at a leading hospital in Delhi.

A diabetic who was diagnosed with high cholesterol two years ago, Delhi-resident Sunil Khatri*, 40, was one such person who benefitted when he discovered it was high cholesterol medication and not diabetes or nerve and muscle dystrophy that made his leg muscles weak, painful and stiff.

“I run regularly, so I initially thought that running was the cause of the pain, and over the past year, I went to several specialists, including neurologists, orthopaedists and sports medicine specialists to get checked. I was told there was nothing wrong,” says Khatri, who works for a multinational in Gurgaon.

Dr Rawat finally diagnosed his muscle pain as a rare side effect of the use of statins, the blood cholesterol-lowering wonder drugs. “Statins caused proximal muscle weakness and raised levels of creatine kinase (CPK). I tested him for CPK, which was high. I switched his medication, and the muscle pain vanished,” says Dr Rawat.

Experts sound a note of caution, however. The overload of information online has made people “hyper-aware” and fearful, sometimes unwilling to leave the diagnosis to the doctors. “People need to be careful to not waste time and money getting tests they don’t need just because of an imagined fear,” Dr Patel says.

(* Name changed on request)

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