At VGKK hospital or for that matter any primary care setting, clinical decision-making is assumed not to be a problem. There are by now a myriad guidelines ranging from the WHO to NHSRC who enjoin a certain clinical decision-making appraoch for primary care health workers.
But in my experience, hardly any of these are in practice, often due to the difficulty in locating these at the time of making a decision. Patrick Kolstern, who taught us nutrition during my MPH at ITM Antwerp used to share how the best time for the most impactful health-related educational messaging - the so-called IEC or BCC bandied about by health workers as some kind of panacea for all those intractable health problems in community health - was the clinical encounter, and often NOT for malnutrition or for anything nutrition. Patrick’s point distilled from robust experimental evidence was that the mother’s attention on the health workers gyaan was highest when they were seeking care as opposed to when we the system wanted to deliver care at their homes…when they were not possibly seeking it.
So, clinical engagements in primary health care are indeed important arenas for wellness and positive health exchanges, but also for apprpropriate (hopefully evidence-based) inputs. My own Hosa Jeevana addiction clinic experience and in general mental health clinical work shows that having good quality access to decision-making during my practice is very helpful. And thanks to Ariadne Labs which gives UPTODATE subscription for eligible individuals practicing in non-profit settings which allows me to greatly ground my decision-making in current evidence.
But it is sometimes deeply disheartening to see younger colleagues, typically medical interns posted for their training from Chamarajanagar Institute of Medical Sciences liberally prescribing antibiotics for first-time URTI presentations. And upon discussing with them, I find that the distinction of practicing in primary care is not particularly evident to them - the fact that patients can often return and that we are much closer to their homes than they might have been in tertiary care settings. But, that’s not all; in general, much like the climate crisis is given a short shrift in routine settings, AMR too in my opinion, gets the Ostrich head in the sand treatment from healthcare professionals. “Yes, we know how serious it is, but come on…what else can we do? URTIs just dont go away, and moreover, how can we send back patients without antibiotics”
Could a console help? Perhaps something that runs on Ras-PI with a touch screen tablet?
{How do I now link this to a common location where multiple such notes that generate an implementable idea can be laundry-listed - tags?}
Can a tool like simple.org be implemented in remote/rural hospital settings? Needs to be explored. Seems like an open-source offshoot of IHCI.
Last updated: 2025-12-30 16:03