emoji from docs & coming home (delhi summer illness 3)

 One of the most interesting things i have noticed over this illness episode, though it’s been present throughout my three years in Delhi, is how accessible doctors are expected to be here – and how easy it is to fall into a habit of WhatsApp-ing (now officially a verb?) with your doctor (and sometimes getting a ‘thumbs up’ emoji in reply, which is oddly validating after you report that your fever has broken or some other milestone has been reached — even when you know your doc may not actually know with which patient s/he is communicating, something i learned later!).

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To begin this potential relationship, you receive (at least one of) his/her mobile number on the paper you get with the notes on your consult as well as the prescription (one of the many pieces of paper one accumulates).

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i am hardly alone in availing the doctor’s number, as evidenced in part by the number of calls or texts a doctor might take during your 10-minubte appointment slot: clarifying prescriptions, checking whether a clinic visit is necessary for certain symptoms — and so on. This disruption is compounded by nurses, patients and others coming in and out of the consult room. A closed door has very little meaning — or at least not the meaning i expect it to have. (The curtain around the examination table is, mercifully, more sacred.)

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As indicated, i now WhatsApp fairly regularly with one of my doctors, which was quite comforting when, a day after one of my appointments, i woke up from a nap with a fever and a full-body rash. i was able to text her and received a response to send a picture of the rash. this raised some new and interesting questions:

  • Is it easy to operate a camera/phone when your fingers are arthritic? (answer:no)
  • What is the best lighting to capture a good picture of a rash? (answer: still unclear. all my pictures looked like everything was red, which was only partially true)
  • Is there a good way to get a picture of a full-back rash without ending up with something risque to send to your doctor? (answer: i couldn’t do it successfully, so these pictures did not go)

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These more informal chats also facilitate meeting outside the corporate private hospital. From studying health systems, i know that these sort of evening and weekend visits at small, private clinics are in many places a common feature of the public health system (government doctor by day, private practitioner by night). This was my first experience of big-private by day, small-private on the weekends. There were several pluses to seeing my doctor at her family’s imaging center rather than in the big hospital — lower consult fees, longer appointment time, more flexible appointment time (i.e. the morning after the rash broke out), less crowded. Mixed in with some guilt of being in a waiting room mostly of expectant mothers awaiting ultrasounds while i am blatantly feverish.

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As a small vignette from this particular visit to the imaging center, at about the lowest point of the illness (limited mobility + fever) there was a gap between when the doctor finished her consult and when i could get a particular needed scan done. The doctor let me nap on the exam table (no curtain) while she preceded with another consult in the same room. No one else seemed fazed and i certainly didn’t care by that point.

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Another manifestation of this tendency towards convenience and connection is the wide availability of diagnostic services that ‘come home’ (or ‘come to office’). In any case, diagnostic and imaging centers are quite often standalone entities, separate from the doctor’s practice (which also means you can walk in and ask for pretty much any test you want). Now of the big chains have set up mobile services. i have yet to avail this as someone pointed out that i may not want be a(n ill) woman home alone and invite someone in to my house to take my bodily fluids — but everyone who has tried this seems to find the service quite professional as well as convenient.

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When at a pharmacy last week for my ever-changing cocktail of painkillers, i noticed a sign alerting me that they can come home to do full cancer screens for the whole family. Which, (a) some things still feel like they should happen in a clinical setting — but perhaps i am old-fashioned? and (b) what a dreadful family bonding activity.

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In terms of communications with doctors and getting clinical services outside the clinic, i presume in Delhi, i am witnessing both the past and the future. There is still a tradition/expectation (among the middle- and upper-classes, in any case) of a family doctor who lives near by, who is also a family friend and might come over for chai and check-up and is available by phone when needed. So (working hypothesis) the past is setting present expectations and practices around access to some extent. But, if diagnostics can be untethered not just from the clinic but from brick-and-mortar in general (at least for collections, and then reports emailed to you), i suspect we might start to see this become a far more common practice globally.

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