Fresh Off the Boat: An International Doctor's Initial Insight Into Contrasting Health Care Worlds

COMMENTARY

The journey of an international doctor gaining insight into psychiatry in the United States has been both enlightening and humorous, revealing striking disparities between the American and Indian health care systems.

While I have only spent a little under a month gaining insight into the United States and a little over a year working in India, it has been an enlightening odyssey akin to transitioning from a Bollywood dance number to a Broadway show—both captivating but in entirely different ways. In this article, I will delve into the intricacies of these systems, highlighting their unique merits and quirks.

Health Care in India: A Mosaic of Challenges

Health care in India is a tapestry woven with challenges and triumphs. Holistically and statistically speaking, it is almost a game of hide and seek—with metropolitan areas boasting of world-class medical facilities and rural regions bearing the brunt of health care shortages. To address this disparity, the Indian government has sanctioned the promotion of Ayurveda, a traditional system of medicine. While Ayurveda offers benefits for certain non-life-threatening conditions, its scientific foundation remains questionable. Treating a broken bone with a turmeric poultice may hold cultural significance, but it lacks the scientific rigor expected in modern medicine.

Mental health awareness in India is unfortunately still a rare gem hidden in plain sight. Despite the pressing need, stigma and misconceptions surround mental health. During my tenure in India, I frequently encountered patients seeking quick fixes, resulting in an overreliance on electroconvulsive therapy. While its efficacy is highly regarded by scientific and plebeian communities alike, this does lead to viewing medication and therapy with a negative lens. Anything time consuming is viewed as tedious and the economic concerns surrounding long term treatments are a major push factor causing a lack of interest in and adherence to these treatments. In urban India, there is an undeniable trend to destigmatize mental health treatments, influenced by the West. However, this comes with a double-edged sword: the unintended glorification of mental health problems in certain segments of society. It is a cultural phenomenon with significant drawbacks that extend beyond just India.

The frenetic pace of Indian health care demands that doctors see upwards of 40 to 50 patients daily. It is a high-stakes race, akin to Formula 1 pit crews, where we strive to provide the best care possible within limited time frames. Interestingly, psychosis and schizophrenia are sometimes revered in rural India, with individuals being hailed as possessing divine elements, a phenomenon referred to as "Devta aa gaya hai.” This leads to communities not seeking treatment for what can be severely debilitating conditions and instead viewing suffering as enlightenment.

Of course, generalizing would be mighty foolish of me. As the quote goes: “Whatever you say of India, the opposite also holds true.” All I am offering is an anecdotal take reflective of my own (limited) experience in health care.

The Art of the Patient History

In the United States, doctors wield a formidable tool in their diagnostic arsenal—the patient's history. Here, practitioners are committed to unearthing the minutiae of a patient's medical journey. They take the time to listen, to dig deep, to connect the dots, and to find the elusive diagnosis. It is a need in the truest sense, a meticulous approach to health care that is, in many ways, a luxury in India.

In India, the bustling pace of health care often necessitates quicker assessments. While this may seem like a drawback, it is a testament to the resourcefulness and adaptability of Indian health care professionals who work tirelessly to provide care in a resource-constrained environment.

In the United States, my experience within the Rady's Children’s Hospital System shed light on a different paradigm when I encountered a seamless integration of therapists within psychiatric practices. This collaborative approach resembles Batman and Robin working in tandem. Psychiatrists focus on medical management, while therapists provide invaluable talk therapy, creating a holistic approach to mental health care. While private institutions do have these in India, government hospitals that cater to the masses are still a far shout from incorporating therapy at a larger scale.

One of the noteworthy merits of the American society is its emphasis on mental health awareness. The public, even generations preceding Gen Z, seem far more receptive to psychiatric intervention than the average Indian household. While I have not yet studied the data on how this correlates with patient outcomes, it does bring forth the topic of mental health to the dinner table—a feat India is still pursuing.

Having said that, the American health care system is not without its complexities. Insurance coverage, while widespread, often entails navigating a labyrinthine bureaucracy. Affordability is another concern, with the cost of health care occasionally straining budgets. Yet, the system's commitment to providing cutting-edge treatments and a wide range of options is commendable.

Cultural Context and Paradoxes

India's culture is fairly nuanced when it comes to mental health. On one hand, it promotes inclusivity and fosters a sense of community that often leads to happiness despite adversity. The support systems and extended families provide a safety net that can be invaluable in times of crisis.

Yet, there are paradoxes. A lack of awareness about conditions like posttraumatic stress disorder, combined with cultural norms, can interestingly lead to fewer cases than one might expect. Corporal punishment, for example, is widespread in India, but it is often viewed through a cultural lens. While it may be a concern, it does not always carry the same traumatic weight as it might in cultures where such practices are less common. This does not, however, diminish the importance of addressing such issues; it simply underscores the complexity of cultural influences on mental health.

A Word of Praise for India

Let's not forget to celebrate India's strengths. Despite the challenges, India's health care system showcases resilience and adaptability. The sense of community, the rich tapestry of traditions, and the ability to find joy amidst adversity are all part of India's unique charm. It is a nation where the spirit of togetherness prevails, where laughter and shared meals are potent antidotes to life's trials. Credit where credit is due. India is not all snake charmers and magic potions. The affordability and ease of accessing health care in urban India is a major plus, even if it comes with a side of stigma. Seeing a doctor will not bankrupt you nor will it take you months to see a specialist and you can often skip the bureaucratic hurdles of the American system.

Celebrating American Health Care

In conclusion, my journey from India's health care landscape to the American system has been an enlightening experience. It is akin to navigating 2 different chapters of a thrilling novel, each with its own narrative and nuances. While I appreciate the meticulous approach to diagnosis and the prioritization of mental health in the United States, I also hold deep admiration for the resilience and strength of India's health care professionals and their commitment towards fighting a battle they are numerically not quite equipped to tackle.

As I continue my medical sojourn, I am reminded that the world of health care is as diverse as the patients it serves. It is a journey filled with laughter, challenges, and moments of profound insight. In the end, it is not just about the contrasts but the beautiful tapestry they create, showcasing the richness of human experience and the infinite ways we strive to heal and find happiness, no matter where we are in the world.

Acknowledgment: I would like to extend my gratitude towards Dr Shawn Sidhu and Dr Tyler Morrison for all their help in facilitating this article and guiding me to publish for the first time in the Western Hemisphere—hopefully the first of many!

Dr Ahuja is an international medical graduate from India currently enrolled in the Accelerated Clinical Experience Program at UC San Diego, where he is rotating in multiple Child and Adolescent outpatient and inpatient units across the Rady's Children's Hospital Network.