As medicine pushes the frontiers of care delivery, disease detection, management and rehabilitation strategies emerge in the form of specialized clinics

-Team@CMHF

• Tucked in a quiet corner on the 10th floor of PD Hinduja National Hospital and Medical Research Centre, Mumbai, is a cluster of consulting rooms.
1. What strikes you as odd is that Nina Madnani, a dermatologist, sits next to Ashwini Bhalerao-Gandhi, a gynecologist.
2. Wouldn’t a paediatrician sitting next to a gynecologist make more sense?
3. Walk to the nurse’s booth and browse through the brochures on the desk and you realize where you are—at PD Hinduja’s Vulvar Clinic.
• At Fortis Flight Lieutenant Rajan Dhall Hospital, New Delhi, a chest specialist, pulmonologist, respiratory therapist and special nurse come together in a room near the pulmonary function lab thrice a week.
1. An unlikely gathering of people, but they collaborate to run the Infectious Disease Clinic.
• At Mumbai’s Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, the centre for rehabilitation has an entire wing dedicated to sports-related injuries.
1. The clinic brings together not just orthopaedics, sports-injury specialists and physiotherapists, but also has a six-camera Gait and Motion Analysis Lab and rehabilitation room.

Multidiscipline advice

• From dedicated floor space to makeshift clinics, from combined consultation rooms to disease-specific diagnostic labs, from multidiscipline treatment to early detection—India’s specialty hospitals are leaving no stone unturned to provide world-class healthcare.
• While most hospitals already have specific medical services and departments, they are now pushing the frontier in healthcare with specialized multidiscipline clinics.
• The doctors running these clinics say most patients are referred to them by colleagues, but there are some cases where the patients stumble upon the clinics after extensive online research about their ailment and treatment options.
• There are certain diseases like Systemic lupus erythematosus (SLE) that require multidiscipline attention
• SLE is an autoimmune disease, which means the body’s immune system attacks healthy tissues.
• SLE can lead to long-term (chronic) inflammation in joints and kidney problems—requiring both the attention of a Nephrologist and Rheumatologist
• The idea is to create a space were we can provide patients specific care.
• Combined consultancy in a common space helps patients clear their doubts and the doctors too can consult each other and work as a team according to the patients’ requirements.
• Started two years ago, the SLE clinic functions at the hospital premises once a week.
• SLE can have a deep emotional impact on an individual’s life, especially with some women unable to conceive.
• PD Hinduja hospital’s Diabetic Foot Clinic is another example of a multidisciplinary care centre.
• In the long term, diabetes can affect the heart, kidney, eyes and feet. While most people keep a check on the first three, the feet are often neglected. Hence the foot clinic, says Arun Bal, a general surgeon who initiated the Diabetic Foot Clinic.
• Dr Bal works in close association with an orthopaedic, a doctor from neuropathy and vasculopathy and qualified paramedics.

Patient-specific delivery

• The idea behind these clinics is to make healthcare delivery patient-specific
• A patient doesn’t need to run from one place to another to meet doctors or to have tests done and everything is provided for them in one space.
• The Diabetic Foot Clinic at Kokilaben D Ambani Hospital has a fixed space with a foot scanner (which scans the nerves, bones and muscular atrophy in the foot), a biothesiometer (to check sensation) and a Vascular Doppler with a diabetic educator.
• Their Travel Clinic is held once a week by Tanu Singhal, who has been trained in travel medicine at the London School of Hygiene and Tropical Medicine.
• The Travel Clinic is a one-stop-shop on the vaccinations, injections and precautions to be taken before leaving for another country.
• The clinic also provides almost all the vaccinations.
• Having a specific clinic means the patient doesn’t have to go to three-four doctors and then reach his/her diagnosis
• Sometimes, patients can end up paying the fee for just one consultation while two or more doctors actually work on their case.

Creating awareness

• Having such clinics can also help create awareness about the disease, as it has for the Vulvar Clinic at the PD Hinduja hospital.
• Most women think if they have an itch, a swelling, a rash or a boil ‘down there’, they must go see a gynecologist but the truth is its all skin, which needs as much care as the skin anywhere else on our body
• Dr Madnani conducted a study of 70 women (at her clinic in Mumbai and the hospital) and found that most either had lichen simplex, lichen planus or lichen psoriasis—all skin-related infections—and hence should have been examined by a dermatologist.
• Slated to start in a couple of months, the Fortis hospital’s Incontinence Clinic will be the first of its kind in India.
• Incontinence is a disease where the muscles around the woman’s urethra weaken and the urine leaks out involuntarily.
• Women often are embarrassed to talk about it or get diagnosed and making some a social recluse, says Urologist Dr Anshuman Agarwal.
• Statistics shows that the age affected by it is coming down and even those in their 50s have incontinence—over 25% of post-menopausal women suffer from incontinence in India.
• The world over, the problem with incontinence is late diagnosis due to lack of awareness or embarrassment in approaching a doctor.
• Creating a space where women with similar problems come together helps as they feel reassured that incontinence is common and can be resolved, says Dr Agarwal, adding that he will work in consultation with a gynecologist.

From life-saving to life-enhancing

• The Infectious Disease Clinic at Fortis hospital, Delhi, is another such success story not just for patients but also for doctors.
• Conducted thrice a week for 2-3 hours, the Infectious Disease Clinic looks at a host of diseases: typhoid, dengue, malaria, tuberculosis, viral infections and HIV.
• The medical team comprises a chest physician, pulmonologist and specialized paramedics, among others.
• This is one of the best ways to treat a disease from both the patients’ and doctors’ perspective, says Vinod Nangia, an infectious diseases specialist at Fortis.

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