A VISIT TO THE DOCTOR'S CLINIC ( AN OFFICE CONSULTATION) PAST, PRESENT,AND FUTURE

     I have very fond memories of  patients visiting my father's clinic for an outpatient consultation in  late 60 s and 70 s. The atmosphere was one of happiness and joy. There was  a high degree of respect given to the doctor. The consultation began with the exchange of pleasantries. An enquiry about a close family member son / grandson / father / grandfather was the opening sentence. This was followed by the usual questions and a clinical examination.  A chest X Ray, and a few basic blood tests were done if really required. Urine sugar helped to pick up diabetes which was then investigated in a laboratory. The consultation ended with a sound advice and a reassurance. The patient was invariably accompanied by many family members wife, sister, mother in law, children and others. This was a sort of a day out for them. Most were coming from out station places like Kasargod, Hassan, Coorg and this was an outing. The consultation was followed by a lunch at a restaurant, and then a movie followed again by some shopping. Then they went home usually by the last train / bus. No wonder therefore the patients liked the visit to the doctor's office and looked forward to it. Obviously an "experience based socially laced medicine" was being practiced much to the satisfaction of the patients. I remember one particular patient of mine, a lady, whom I saw at an institution that I was working at that time. Her son would bring her every month by train for a chronic backache. I would see her and she would go away by noon. On one particular day, I found her waiting for me in the evening - I was really surprised to see her waiting. On asking her why she had waited, she simply said  "Doctor, you did not pat me on the back and reassure  me as you always do!" I then realized the importance of this one simple gesture!
     Then came the changes. There were more investigations available. The whole process became customised and standardised. Less time was being spent with the patients. Slowly the emphasis was shifting from "reassurance" to "cautious observation" and a specific and accurate diagnosis . This probably reduced the satisfaction and trust in the doctors. Consumer courts started and slowly "defensive medicine" started taking over from "experience based medicine". The doctors did not see the writing on the wall.
     I  remember an interesting episode which happened to a senior surgeon of Mangalore. On account of an MS Surgery examination, the doctor who was an examiner for the examination, reached his clinic only by 6 PM though he was to reach by 12 noon. A patient who considered himself important was visibly agitated and gave a vent to his feelings. He rudely said to the doctor "Where were you doctor? I waited for you for 6 hours!" The doctor was naturally a witty one. He coolly said "I waited for you for 30 years. Where were You?"  The patient was speechless!
     In 1990 s, the "evidence based medicine" started taking over. The wit, humor, wisdom, social interaction and trust were slowly replaced by arroganace, cut and dry approach, mistrust, a feeling that the things were being done for a "gain" by the doctor. The distance between the doctor and the patient increased. Doctor shopping began. This was the time when Corporate entities  made an entry into the hitherto sacred and  private space of doctor patient  interaction. Health was converted into a "product" and the doctor, a "service giver"- just like any other service for gain! Naturally the respect of the  patients vanished and doctors were merely performers and service providers for a fee! This trend increased the patient expectations tremendously and a good result was always expected. The costs naturally went up and the satisfaction levels plummeted. We are currently experiencing this.
     What will be the future of the patient's office visit? A survey by doctors at the US showed that the patients did not like to wait for 1 hour for a 7 minute long consultation.Dr. Eric Topol feels that the  Smartphones will have an important role to play in the whole process in future - Eye examination, ENT examination, transmission of metrics like BP, Heart rhythm, respiratory rate, oxygen saturation can be conveniently and easily done using a smart phone without the patient's presence in the doctor's office. Dr. Topol even  expects the hospital visits to happen in a completely different way in 5 years from now. Video links with transmission of data in real time or in advance - a form of virtual office visit may replace most of the  conventional office visits.
     Do not ask me whether the payment for the virtual consultation will be real or virtual  an image of a high denomination currency sent with a thank you note to the doctor bu the patient using WhatsApp! I really cannot tell!