A different way of thinking

Medtech Business - A different way of thinking

Read my blog published in Medtech business journal in UK--  Recently, during a patient data visualisation discussion with a DW/BI engineer, I realised the vast difference in thought processes between engineers and doctors. He was displaying the hospital data as trend lines, whereas I wanted coloured and vivid representation. It was so difficult for him to understand my perspective. We didn’t end up in an argument only because we have a very high respect and regard for each other.

The main challenge stems from differences between the thought processes of nurses/doctors and engineers. Engineering education is by numbers, graphs and grids, whereas medical education is all by colours, pictures, shapes and impressions. Clinicians think in terms of lists and rule out one by one to reach a decision: intuition tempered with experience plays a vital role in decision making.

I am reminded of my early days in medical school, when my professor showed me pink, reddish-pink, red, maroon, purple-red and purple colours during surgery. Each of these colours meant a different diagnosis and corresponding treatment plan. But all I could see was RED-PINK! It took years of training for my brain to understand and appreciate the fine differences between pink, reddish-pink, red, maroon, purple-red and purple.

Early in medical school we are taught that human biology is unpredictable. So 2 + 2 in medicine is not necessarily 4: many times it could be <3 [unresponsive] or 5 [synergistic] or >5 [exacerbated]. Therefore we were always taught that medical technology is an aid, but clinical judgement is supreme. Now imagine the challenge if someone wants to derive a mathematical model out of that!

Processes in a hospital are dynamic and change at the drop of a hat. In an emergency, doctors need to take over everything outside the system and then the systems have to catch up post facto. Process dynamism is a requirement of the process itself rather than an external factor. It is an extremely subjective and dynamic environment.

All industries, apart from a few such as outer space exploration, deal with things made by people – whereas in healthcare you are dealing with a system made by God. The variation is by design, not by error – it’s called evolution!

Engineers build medical software technology, so they design it to work with numbers, graphs and grids. The technology has yet to develop to a point where it can mimic the clinician’s brain, which naturally thinks in terms of colours, pictures, shapes and impressions.

Healthcare vertical is not as easy as it might seem. IT companies need to bridge the gap by investing in consultants who understand healthcare, management and IT.

Healthcare and IT knowledge need to exist in the same brain and need to be processed together by the same human processor. The idea of putting a domain expert with an IT team doesn’t work in healthcare. There are enough failures to prove this point, and the writing is on the wall.

GIS for Public Health

India has very good Satellite Images and Geospatial Data for GIS. For public health the need is to layer the disease prevalence and disease trends on to the satellite images. ISRO, PHFI and a IT company with GIS and DW/BI capability should join hands in a PPP model to build the online Epidemiology model for India. CDC has tried to do this in US but the relevant medical data is scarce due to data privacy and business interests. Whereas in India the GOI and Stat Govt own the healthcare data. Also the private sector can be forced to share the medical data for epidemiological analytics. The need is for someone to take a lead. In my mind the lead has to be taken by the Govt.

Comprehensive Health Insurance required in India

In India about 157 million households [62% of population] live with < 1 lac per year household income. The economics of these people works very different from that we can imagine. I recently saw a household maid suffering from uro-genital infection. She could have been easily treated by high-end antibiotics; total cost of treatment in private sector would be about INR 2000 whereas her monthly income is about the same. She has the option of going to a Govt run hospital, but there the cost of lost wages due to long waiting and lack of easy access to medication deter her from getting treated. There is an urgent need of a comprehensive and unifying health insurance system for the whole population, not just RSBY for BPL. This comprehensive and unifying health insurance system probably can be a PPP model between the Govt and Private sector insurance.


Currently private health insurance penetration is only about 2% in India. That too it is targeting the upper crust of 200 million population. There are no viable economic insurance solutions for the rest of the 800 million in India. What are we doing by aping the west? We need our own models.