Rheumatology in India and beyond (UK)

Shabina Habibi DM (Rheumatology), MRCP (London)
Consultant Rheumatology, Queens Hospital, Barking Havering and Redbridge University Trust, Romford, United Kingdom

What are the main differences and similarities in rheumatology practice between India and the UK, and how do these affect patient care?

In the UK, healthcare through the NHS offers free services, but patients with rheumatological conditions may experience delays in specialist consultations, except through fast-track paths like EIA clinics. In India, private healthcare allows direct specialist access with larger patient numbers per clinic. Documentation methods vary, with the UK utilizing electronic systems. Socio-economic factors lead to increased patient involvement in the UK. The prevalence of conditions differs, with common issues managed in primary care. UK rheumatology practice emphasizes teamwork, involving various specialists and multidisciplinary teams, contrasting with India’s consultant-driven approach. Despite variations, both countries face significant patient waitlists for rheumatologists.

How has transitioning from India to the UK impacted your practice, and what challenges and opportunities have arisen as a result?

Moving from India to the UK, I encountered stark differences in medical practice. In the UK, doctors undergo a comprehensive 2-3 day induction, covering diverse topics like fire safety, equality, healthcare waste management, etc. This training, unlike in India, emphasizes aspects crucial to daily practice. Effective communication is paramount in the UK, involving writing letters to patients and colleagues, a practice uncommon in India. Seeking advice through email, learning to ask for help, and understanding the importance of consent were adjustments I made. Handling complaints is formalized in the UK, with a focus on reflecting and preventing recurrence. Leadership and management training, integral to medical practice, have been part of my ongoing learning experience.

What disparities have you noticed in research and technology advancements in rheumatology between India and the UK, and how do they affect patient outcomes?

In the UK, research is meticulously conducted with rigorous training in GMC good practice and trial-specific requirements. The team, led by a consultant, includes a research manager, specialized nurses, and admin staff. Results are expected to be published and often influence NICE and BSR guidelines. Every hospital conducts audits and service improvements, shaping local guidelines. Electronic accessibility to patient information enhances overall outcomes. Attending IRACON 2023, I observed the quality of research in India, signaling positive strides in the field.

How do cultural and socioeconomic factors shape your approach to rheumatology practice in both countries, and how do you address these in patient care?

Despite differences in the prevalence and natural history of conditions across ethnicities, social and economic factors remain similar. In the UK, healthcare through the NHS ensures equitable access regardless of social status. The ability to prescribe expensive medications, like biologics, is based on clinical need rather than affordability, and hence eliminates cost concerns. This enhances compliance and leads to better long-term outcomes. However, stringent guidelines may limit certain treatments initially. Smoking is prevalent, especially in the elderly, impacting prognosis. Patients in the UK, requiring more detailed explanations, may reflect varying education levels. Robust documentation and consent practices are crucial due to a higher incidence of complaints and litigation.

In terms of continuity of care, what differences exist in patient relationships between India and the UK, and how do you establish lasting patient-provider connections in both places?

While waiting times to see a specialist can be lengthy, once in secondary care, a patient is exclusively managed by one rheumatologist, fostering a close doctor-patient relationship. Excellent compliance with medication and regular attendance for clinic appointments is observed. Clinic letters and calls reinforce attendance, and discharges are rare. Responsibility for DMARDs is shared with primary care at most centres. Specialist nurses operate dedicated helplines for patient queries, ensuring prompt communication with consultants. Free NHS healthcare significantly contributes to good compliance with potentially toxic medications, ultimately leading to improved outcomes in chronic conditions.