MediQ: Elixir to Medical Management

AIIMS Delhi, March 31, 2012 11:30AM, NRD and I were looking at multiple gigantic queues -- Queues to get appointments to doctors of their concerns, or to get some sort of medical help. What even more surprising was, that some of these guys were queued for more than 8 hrs – since 3AM!

Varanasi, Dr Hatwal, known expert of Thyroid related problems. He has a unique system. Patients write their name on a paper and put it under the brick. A Friggin Brick! The brick is not guarded by anyone. On a windy day, an innocuous lift of brick, to put one’s paper-slip, can just literally blow everyone else’s application. Come on doctor, you can do better. He wouldn’t hear, or at least pretended not to.

Saraswati Heart Care, Allahabad. I call in from Varanasi to get an appointment, three days in advance. I can’t. I will have to come to the hospital – be physically present there in the morning to get the appointment; which, the receptionist says, wouldn’t be much trouble as everyone does that. I, be assured, will get the appointment for the day.

In India, we are use to of queues. Starting from our college days – queues for fee deposit, queues for admission, queues for food, queues for enquiry, queues for deity, and queues for shitting – literally. While some queues are cut short by advent of information technology (IT), most of them are not. The queues – that are solved by IT, are mostly profitable entities for upper/medium upper classes – movie tickets, club tickets, air tickets, train tickets… off the top of my head.

Why can we not have a universal queuing system for medical/doctors’ appointment and patients’ history keeping? Let’s call it MediQ (yeah, I have googled and this domain name is not available and already owned as a firm’s registered name.)

The Story: I like to think in stories. So, let me tell you a story of a Mr. Hardbody. Hardbody did not have a healthy life as most stories’ protagonists do; but he is a smart person. For last three days, he had this chronic pain in his eyes. So he requested an appointment to his eye doctor from his smart phone which turned out to be a week ahead. He thought he could wait. But suddenly the next day, he had so excruciating pain that he just looked into MediQ for the nearest available eye doctor with closest open appointment, reserved it. It was in next 30 min, a 7 min drive from his home. The doctor made some temporary relief to Hardbody but suggested a surgery as soon as possible. Hardbody called his insurance agent who sympathetically declined that the particular procedure was not covered in the insurance, sorry. Hardbody will certainly loose a major fortune if he paid for the bills. So, he searched for the lowest cost surgery over MediQ. It turned out to be a doctor in India. He looked at the recommendations for that doctor, and talked to the patients who had recently undergone through the surgery by him. It was a good deal, affordable including flight costs and little tourism. He requested the doctor in India to look for his case, over MediQ. Doctor promptly replied, since all the reports from pathology and previous doctor were automatically available to the doctor. Hardbody packed his stuffs and left. He had gone through surgery successfully. The doctor, looking at previous history of Hardbody on MediQ, figured out that some medicine’s causes him acidity, so he prescribed the alternatives. MediQ analyzed the post-surgery medicines were available in stores in nearby Hardbody’s house. Hardbody came back home happy. Posted a review of the surgery and provided his rating for the doctor over MediQ. He can be found in MediQ discussion groups with people having similar issues. And his history is updated in MediQ.

Fundamental Requirements: These features are the core of the idea. It can’t be compromised. MediQ must

1. reliably manage appointments
2. be free on the patients’ end

Functions:

1. People can make appointment to doctors via internet, via smart phones, or via SMS
2. There is going to be only one appointment list. So, any appointment made by calling the doctor, or by going physically to the clinic, or by any means that is not mentioned in #1, has to be entered in the MediQ by the operator/receptionist.
3. On unavailability of slots on request date and time, MediQ should automatically suggest the closest available appointment schedule.
4. MediQ should also manage cancellation of appointment by the doctor or by the patient.
5. MediQ should manage doctors’ schedule, so that it does not allot appointments on the doctor’s day off.
6. MediQ should be able to make two way communications between doctors and their patients so that patients can be communicated about the upcoming appointment X hours ahead, or a sudden cancellation by a patient should push the candidates behind, one slot ahead, or an emergency request shot up to top priority irrespective of its position in the queue.

Roadblocks:

1. Like any new system, doctors – specially, the government hospitals, the biggies, would not embrace MediQ with open arms. So, we need some ground work done beforehand, in convincing people.
2. Awareness – people should be aware of the system so that they can request appointments by themselves; ask for appointment number when appointment made by physically going in or over phone call.
3. Funding is a minor roadblock, but it is as real as it gets.

Nice to have:

1. Medical History: MediQ should manage patients’ history.
   
2. e - Clinic: Things that do not require patients to be physically present to doctors can be taken care over MediQ. This includes upload of reports, and suggestions by doctors.
   
3. Integratability: This is revolutionizing. An integrated system which is hooked with pathology labs, emergency systems, medical stores, various doctors and research centers, and with people having same form of illness.
   
4. Sociable: MediQ creates a society of people connected over internet. People can talk with others with same symptoms; doctors will have millions of case studies to go through.
   
5. Location tied – Location Free: A search will get you to nearest available doctors and closest available appointment slots to them. You can get medical expenses that might cost for a surgery anywhere on the globe. So, if you find that your insurance does not cover laser eye surgery, and it costs a fortune to you in USA, while the same treatment with equally good doctor in India is much cheaper (including your air ticket) – just make an appointment. 

Tipping Point 2: The Unusual

Tipping Point Part 2: The Unusual
This story runs into two parts. Click here for part 1.

My Plate – Your Plate: I noticed this before reading Tipping Point. There is this hotel next to our office where tables are full with working people during lunch hours and a common food ordered by everyone – Mini Meals. I am not the biggest fan of monotony. The tipping takes place like this.

All the tables are cramped with hungry, sweat drenched, Axe-laden males and rare females. They are really not in love with the sultry weather – neither the super-tired fan (ceiling fans!). They want to fill their bellies and run back to their air conditioned offices, they do not have time to be creative but a quick suggestion will do. When waiter comes, you need to shout at the top of your voice to get his attention. Everyone shouts – what else – “Mini Meals”. I try twice but the waiter does not find me a subject for mercy and moves away. He is now far away (still in the hotel) from me… I feel embarrassed, and I shout like a guy who is embarrassed, “Hey waiter! One Masala Dosa (another type of food), please” and it tips.

I feel happy to find early adopters by the time my order comes and by the time I leave, I can see a mature market for Masala Dosa.

I am cold. Me too! This phenomenon is same as the lunch tipping, the difference here is, that the people are constrained by the thinking that they might be contradicting other people’s wish. I am talking about night train journeys in sleeper class at in mild cold season when most of the people feel cold while fan is running but they do not take any step to switch the fan off thinking that they are the only who is inconvenienced by the fan.

I noticed this many times. What happens is as soon as I start feeling cold, I ask the person closest to switch to fan-switch to turn it off… It involves shouting and repeating the intention. In following minutes I hear people asking the same in neighboring compartments… and it is successive enough to feel like triggering chain reaction.

Fire Walk: Recently, I went to a seminar where organizers claimed that they will make people (ordinarily available bipedal human being) walk on broken glass and flaming fire. I thought it is doable, but did think that they will pump a lot of funda, boosting talk and some technique. But they did not. I went there thinking a long session of platonic talk to divert our brain from concentrating on the real danger of burning and cutting, but all they did is, they placed a seven feet bed of coal, poured gasoline heavily, flamed it and said casually, “walk!”

I got crazy. 30 seconds of burning fire, no one walked, and all were cold feet [he he … this phrase does not suit here]. Now, the coals has become real red rubies and I, for a split second, though to just run through and finish this drama but consciousness was on denial. And, I guess everyone had this surge of thought to go through in a quick movement and end it (and be the burnt feet hero).

45 seconds. And one of them got surge and could not hold… ran through. There was no need of organizer to encourage, it had already been tipped. People went through in succession. They added more and more gasoline (when I walked the first time, flames were coming up to my lap) but once tipped the suppressant like this did not work. The same thing happened with ‘walk on broken glass’ and ‘stand on nail bed’ events.

This story runs into two parts. Here is part 1 >>

Tipping Point 1: Usual Tipping

Tipping Point Part 1: Usual Tipping
This story runs into two parts. Click Here for part 2.

Marla Singer. I, once again, got reminded of Marla Singer. But I resisted playing Marla this time. I was standing opposite to Bangalore City railway station and I needed to cross the road to make it to the station. In less than two minutes, more than twenty people gathered at either sides of the road and they were in the same mindset – “jump cross the road as soon as rush of speedy vehicles gets a break.” And it never happened.

Few more moments of wait and someone decided to commit suicide and started walking casually – well, the suggestion worked, everyone joined him and it tipped –a momentary halt in racing vehicle as if there was a red signal.

Power of Suggestion makes it possible to tip an event – Tipping Point says so. I have some non-utterly-boring incidences where I think I can relate what I read in the book, Tipping point. They all point to power of suggestion part of the book.

Uncontrolled Traffic: There are quite a few very deadly crossroads on Poonamallee High Road, Chennai with overloaded traffic, self-assumed-smart vehicle drivers and thinking-over-smart pedestrians and this phenomena tip almost in every 4 of 10 red signals.

Red signal is yet at 35 second in down timer, at this moment there was a momentary slack in orthogonal traffic and a daring self-assumed-smart bike rider zips through it – A suggestion. Now tipping point, every one joins the bike rider and crisscross, honk-honk, shout-shout…

The same thing happens at 09:50 onward at night but with one difference, the suggestion is a commonly known fact that traffic lights will be in yellow-mode (that means see-and-cross, decision is yours) at 10 o’clock. And 09:50 PM is the tipping time for all non-major traffic signals.

Real Boring Habit can Tip: I lived 10 months dwindling in different private hostels in Chennai. The arrangement is like this, the hostel is nothing but a 2 bedroom, one hall, one kitchen (basically all except restrooms are converted to bedroom) apartment which is so strategically situated that no one wants to buy this or accept as rent. People who stay have one of the two main reasons to accept this. One, they do not have money and two, they have one or more attributes like they are ultimate lazy, totally unplanned, short stay or have no friends in Chennai.

No matter what the reason is, once in hostel they realize that they have been paying more for less, feel cheated. So, how to recover? Simple, utilize resources to the maximum – watch TV 24 hours, take bath two times (well, that’s a requirement sometimes), over eat et-cetera.

I read book occasionally. Reading anything was assumed to be most miserable thing to do in hostels – people become sympathetic to you. The other activity that we used to do, when not wasting resources, was, to talk – and we talk a lot. During one of the discussions, I kept on quoting different books wherever required. For some unknown reasons, people really liked it. And within a week, TV hours reduced, people started going to Landmark (bookshop) with me, borrowing books and most of them started a book. Phenomena tipped. The readers in the hostel had shot from one occasional reader to one occasional reader plus five enthusiasts, from 12.5% market share to 75% market share.

The reverse happened as well. Enthusiast dropped as quickly as they adopted. It happened something like this. I paused reading for one very busy month. I could see no one’s bookmark had shifted a page. I, finally, shifted to a new place and whenever I go back to the hostel – the bookmark still stays where it was, when I left the place.

This story runs into two parts. Part 2 >>

KFC Earns

How Much does KFC Make out of your hunger?

• 1USD = 44.20 Indian Rupees (INR)

• Rs. Implies INR in all discussion below.

• 10 grams Gold worth Rs. 9728 in India

• Per capita income in India = USD 705

• Rs. 100, 000 can buy a YEAR of decent living, children education and basic entertainment in an average Indian family of four members.

In KFC (Kentucky Fried Chicken) one fine evening, in Kolkata February 24, 2007 Saturday I had a light dinner and made a guestimate* of how much the owner of one of such store can earn.

Data:

Location: City Center, Kolkata

Min. Priced food: Rs. 75
(Only two items in this category, most of them lie in a range of Rs. 100 to Rs. 200.)

Floor Area: 30 x 30 Square Feet.

Employees: 12 (5 waiters, 2 Counter Boys, 1 welcome girl, Assuming 4 cook)

Average Number of customer at any instance: 40

Assumptions:

1. One customer spends one hour in the restaurant which is a far long time because usually people come in group of 3 in average.
   Which makes 20 minutes per customer but here we are calculating worst case income.
   
   
2. Employees are paid Rs. 10,000 per month for 5 hr/day 7 days a week.
   
   
3. Total cost on food includes cost of raw material, storage cost, cost of cooking aids (Gas, water, power etc.) and depreciation cost of cooking aids.
   It is assumed 50% of sale price of food.
   
   
4. Operation hours: 5 hrs/ day 30 days a month.
   
   
5. Rental, security, insurance, advertisement, public relation cost: Rs. 125, 000.
   
   
6. verage money spent per person per visit: Rs. 100.
   
   

Calculations (per month):

Total Revenue:

Total customers x Average order price = 50x5x30 x 100 = Rs.750, 000.

Total Income after removing cost incurred in converting raw material into edible food:

Total Revenue x (1- fraction of food cost) = 750, 000 – (1- 0.5) = Rs. 375, 000

Total Profit:

Total Income – Salary Payment – Rental etc. cost

= 375, 000 – 120, 000 – 125, 000

= Rs.130, 000 per month

Worst case profit:

Yet the calculation itself was made too tight to leave a space for any further deduction, in worst case the profit is assumed to be 75% of calculated profit.

0.75 x 130, 000 = Rs. 97, 500 per month

Best Case Profit:

1.50 x 130, 000 = Rs. 195, 000 per month

* Guestimate = Guess + Estimate.

In guestimate I observe and try to calculate some facts in a rough manner. This process includes basic observation, rough idea of processes involved in final estimation and nano amount of common sense to keep things in-bound.

There is absolutely zero reliability of this information, please don’t start putting this data as a fact but if you do so please be ready to logically explain each assumptions that are being made in calculation.

Genre: Guestimate
Type: Personal View
Language: English
Category: For ALL age group
Place and Time: IIT Kharagpur. February 27, 2007. 02:01 in afternoon.