Lexiamma’s Lexigyaan: Honest Thoughts – Healthcare in USA v/s India

Dr. Anjali Mediboina

Curious about the healthcare experience in the USA and how it differs from India? Well, let Lexiamma give her two cents!

1. Dear Lexiamma, I’m curious about the experiences in the USA and Indian healthcare systems. What, according to you, are some of the key differences you observed in patient care approaches between the two countries?

A: Patient-doctor interaction is definitely a key difference between the two countries! In the USA, there is much emphasis on how a doctor speaks to their patients. From the moment a doctor enters the room, they should be mindful of the things they say, from the way they address the patient, to the tone they use, and even the words spoken [1]. In English, especially in America, there is a lot of racial prejudice, with many patients of color, especially Black patients, describing instances of being denied healthcare services, such as pain medication [2]. I feel in India, we have more neutral terms such as “aap” in Hindi, which allows us to refer to a patient in a more respectful way. However, I do believe that some doctors in India are unnecessarily rude to their patients; it would be good if such respectfulness was emphasized in India as well.

2. Lexiamma, how should one adapt their communication style when interacting with patients in the USA compared to India? Would it be difficult?

A: It’s always a bit difficult to get used to new places; the best way to do it is by listening and watching your colleagues and doctors. Listen to how they speak to their patients, what words they use to describe the diseases/health conditions and watch their mannerisms… you’ll pick up in no time! Be interested to learn, and ask questions. It’s also always helpful to ask your seniors for feedback, as well; they’ll be more than happy to let you know if there’s any way you can improve!

3. Dear Lexiamma, I’ve heard about the concept of HIPAA in the US healthcare system. Can you explain how it works and whether you think it could be implemented effectively in India?

A: HIPAA is a law in the USA which ensures the security of their medical information. It sets standards for the electronic exchange, privacy, and security of health information. For example, if a doctor asks the intern to send updates of lab investigations on their private WhatsApp chat – this technically would be a violation of HIPAA.  However, I believe that in India, while we do have the Information Technology Act 2000, which protects health information to an extent, there are potential loopholes in the law[3]. The government has proposed DISHA (Digital Information and Security in Healthcare Act), and while this seems to be a good move, the sheer volume of patients has to be considered, and maintenance of digital records all over India has yet to be implemented. We’ll have to wait and see!

4. Dear Lexiamma, do you believe there are aspects of patient care from the US that could be beneficially implemented in India? If so, which ones and why?

A: I think mainly, a streamlined workflow. Each person has a role to play, and this ensures that the burden does not fall on one person. In India, Interns and PGs do a lot of the work – from ensuring medications have arrived and been administered, to worrying about the insurance plans, it’s a lot of burden, and leads to physician burnout and mental health conditions. Ensuring proper teamwork and proper distribution of workload would make a monumental difference. I’ve also heard of unions for residents and doctors in the USA; they ensure the salaries are paid on time, provide legal help, ensure proper holidays and enforce strict limits to working hours – I think something like this in India would surely help, especially in terms of working hours and minimizing mistreatment of doctors by superiors and patients.

5. Do you think one healthcare system is better than the other, Lexiamma?

A: Absolutely not. Every system has its pros and cons. I always say that being a doctor is better in the USA, but being a patient is better in India! While it’s true that the USA has better facilities and lower patient burden, healthcare is extremely expensive, and you need insurance in order to afford it. In India, at least access to government hospitals is an option. Not to mention, in most places in the US, there is no such thing as “walk-in” appointments; for any emergency, patients have to go to the ER – and due to the heavy burden on the ER, many patients have to wait for hours before getting seen by a doctor.

References:

1. Hagiwara N, Slatcher RB, Eggly S, Penner LA. Physician racial bias and word use during racially discordant medical interactions. Health communication. 2017 Apr 3;32(4):401-8.

2. King CJ, Redwood Y. The health care institution, population health and Black lives. Journal of the National Medical Association. 2016 Jun 1;108(2):131-6.

3. Kaushik A. Is India Lacking Healthcare Data and Security Guidelines? ETHealthWorld [Online]. 2022 Jan 16. Available from: https://health.economictimes.indiatimes.com/news/industry/is-india-lacking-healthcare-data-security-guidelines/88931122

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