On our second day of the rotation, we had the pleasure of going to City Heart Hospital founded by Dr. Sanjay Gandhi for an evening clinic. Now, I want you to stop and take a moment to consider the mental image conjured by that previous statement. What did you picture? A small-moderate sized hospital with multiple wards, an ED, a lobby, a nice designated clinic space, a board of directors, students/residents, swarms of doctors/nurses, and a nice portrait of Dr. Gandhi on the wall commemorating his role as founder? If so, I can’t blame you…. but it is time to think again.
Dr. Gupta is a cardiologist by training and a generalist in practice. City Heart hospital began as a single rented room out of which he started his clinic 15 years ago. Slowly, he has single handedly built up his one-room clinic into a hospital with up to 30 beds. These beds are scattered across 5 disjointed rooms some with 2 beds and others with 8. Around the side of the building and up a giant ramp is the “ICU” (and you must remove your shoes before entering….. you can only begin to imagine our disgust with this if you have ever seen what goes on in an ICU) with another 5 beds. It is nearly impossible to tell who is who as all the employees are wearing normal street clothes with no identification. There is even a resident who is completing her training as a generalist and a fully functioning OR staffed by a variety of on call surgeons. On site imaging includes an X-ray and ultrasound. If a patient needs a CT or MRI all they have to do is walk (on their own…… even when having a stroke……) across the street to one of the numerous private imaging companies and then bring back their images.
Clinic is still conducted in the same room where it all began. Dr. Gahndi’s office is equipped with his desk, an exam table, a chair for the patient, a couch for guests, and walls covered in degrees, picture, and awards. He ushers us into his office and has the four of us students sit on the couch to observe clinic. Patients are brought in one by one and sit down in front of all of us plus Dr. Gandhi as he works his magic. If they need an EKG, a “tech” will come in and do one in the room as we all watch. A patient encounter can last between 30 seconds and 5 minutes but hardly ever any longer. Sometimes it seems that if I blink I’ll miss an entire patient encounter. We asked him about the speed with which he sees patients and he laughed while telling us that this was slow because we are in the “healthy season.” If this is slow I would hate to see what busy is…. as far as I could tell there were almost always 3-5 people in the waiting room at any given time.
Next was time for making rounds at the hospital. As I mentioned before, he has space for 30 patients, but because of “healthy season” and demonetization he is hovering around 12 admitted patients. First we go up to the ICU to check on a man with respiratory distress on BiPAP and his neighbor who had just had a STEMI treated with TPA. Downstairs we round on a septic patient, a man with pneumonia, a gentleman with fatigue and a new lung mass, and then a man with possible Tb. The breadth of illness as well as the range of acuity was impressive, to say the least. The rounds were rather surreal – the patients we lying on shabby beds with dust and dirt on the ground, monitors that were 15 years outdated, and overall conditions way worse than any hospital back home and yet they were receiving first world care with modern drugs, guided by advanced imaging and 21st century practice guidelines. Simply put, the juxtaposition was striking. It really makes you wonder about what truly is essential to providing good healthcare. Are all of our fancy rooms and technologies necessary? Or are they simply luxuries with little added benefit? Do we really need all the bells and whistles or should we maybe do a better job of practicing clinical medicine and actually talking to and working with the patient. I think Dr. Gandhi said it very precisely when he described medical practice in India as much more “clinically based” rather than “investigative medicine” as we practice in the U.S.
Although we only had a few days to spend at City Heart Center, they were a great introduction to medicine in India. We saw how invested a physician becomes in his office, hospital, and patients. We saw some incredibly sick patients receiving top notch care. And we saw medicine practiced in a way quite different from what we are used to.
As a fun aside, I have to say that it did feel pretty cool to be reading the chest X-rays on old-school plastic films rather than a computer monitor like back home. For all of the perks computers have to offer, it is so much more satisfying to hold up a chest film to the light and have a good look at it.