Kolkata: Dr. Madhukar Reddy Kasarla has brought in pioneering changes to the practice of medicine, especially in relation to healthcare delivery in the hospital settings. Dr. Kasarla’s entire focus is on admitted patients in the hospital. Dr. Kasarla is considered as a global leader in healthcare communications: his publications have dealt with some of the most outstanding issues in hospital medicine. For example, Dr. Kasarla is a strong advocate of dedicated discussions on end of life care issues with patient families. Sreerupa Patronobis of Kolkata 24x 7 recently caught up with Dr. Kasarla.
SP: Welcome Dr. Kasarla
MRK: Thank you
SP: Is hospital medicine a new field in India?
MRK: Not really. In India, a physician team often performs both outpatient consults, as well as care for patients admitted on the floor. In the United States, Bob Wachter created a revolution by delineating a special field of hospital medicine.
SP: Do you practice hospital medicine?
MRK: Yes, at the Parkview Surgical and Cardiovascular Hospital, I care for patient who undergone complex surgeries.
SP: What are the challenges in hospital medicine?
MRK: The challenges in hospital are manifold, involving both the patients and their families. I have special interests in health literacy, which significantly improve patient outcomes.
SP: Please give an example.
MRK: in the recent publication in the Physician’s Weekly, I outlined the significance of communication with patient families regarding end of life care issue. Say, a very sick patient are in ventilator. The patient’s family may still think that a miracle can happen, reversing the life threatening event. Discussing the option of taking the patient off the ventilator is an important aspect of the clinical management. Though it is often a difficult decision, an empathetic approach along with discussion of available evidence can help the families derive at acceptable decisions. Many physicians miss the opportunities, leading to confusion, increasing healthcare costs, and escalation of medical waste.
SP: This is an important aspect in Indian hospital as well.
MRK: Sure, there are published reports, say in The Lancet, of patient dissatisfaction and physician abuse from populated countries like China and USA. In the western countries, there are reports of litigations. Patient-physician relationship has been long been trusted through history, is a cornerstone of the highest quality of healthcare, and effective communication has been key to establish this.
SP: You have special interests in health care communication and served on the medical advisory board of innovative computer applications that improve health care communication.
MRK: Yes, that is true. I serve on the board of Talk2All Inc., which is an app which translate several languages in real time. Patient or their families, with defects in communication, are tremendously benefiting from this app. I have advised to use this app in Hmong population, who are from Laos. Here are clusters of Hmong people in USA, in California and Michigan. Hmong people almost cannot speak English. They have tremendous difficulty in communicating in English. Hmong populations are amongst the highest level of Hepatitis B affected in the United States. Because of the universal acceptance of use of cell phone, this app Talk2All has been revolutionary in improving health literacy.
SP: What is your opinion in improving healthcare communication in India?
MRK: Healthcare communication literacy should be imparted to the students and ancillary staff early in the career and should be actively present. Sometimes, the pressure of population can be overwhelming but effective dealing strategies with enhanced communication can bring success. The PMSY (Pradhan Mantri Swasth Suraksha Yojana) is already doing this in the newly instituted All India Institute of Medical Sciences (AIIMS) across the country. Several other institutes like Indian Institutes of Management (IIM) are offering guidance and courses on this very important subject.
SP: Thank you Dr. Kasarla for your candid discussion.
MRK: Thank you again