# Consultation

# Previous chapter

# Chapter summary

Dr. Sood confirms her provisional diagnosis of diabetes, and writes a prescription that covers both diabetes and hypertension.

# This chapter

As Birender walked over to the PHC for the third day in a row, he wondered how long this would continue. All this WhatsApp business, but no simple way to talk to the doctor! Someone should fix this. Making an old man walk around, he thought.

Then he remembered Dr. Sood's injunction to walk at least two kilometers every day. Well, the walk to the PHC and back is two-and-a-half kilometers! I can tell that to Dr. Sood, if she asks.

In communities where mobile internet is affordable and reliable, tele-consultation services via mobile app can help reduce patient effort. While Agni is being designed for environments with poor connectivity, the scope for tele-consultation integration should be kept in mind.

His appointment was for 9 am, but Birender reached a few minutes late. After a stern glare from Gayatri, he was informed that he is 3rd in the queue—"because you are late". Birender settled down to wait. He pulled out his phone, and looked through photos of Rajat that Simran has shared last night.

His reverie was interrupted by Gayatri's strident voice "Birender! Birender Singh!". Birender started to raise his hand, but stops halfway. "She may be the principal, but I am not a student," he thought.

Dr. Sood was looking through some papers when Birender walked into her office. On closer examination, Birender saw his name, and "Lab test report" written on top. Dr. Sood smiled and greeted him, then her face resumed its customary seriousness. She said, "Birender ji, your blood glucose levels are quite high. You have diabetes—and have probably had it for some time now. I will change your medicines."

To create a new prescription, Dr. Sood first looked over Birender's prior prescription. Then, she changed the dosage of Amlodipine tablets from 5 to 7.5 mg a day, and added Metformin tablets, 500 mg once daily, with supper. Both medicines were prescribed for 30 days.

The starting point for a new prescription is often the previous one, especially in the case of noncommunicable diseases (NCDs), where doctors need to titrate dosage, or swap out one active ingredient for another. Therefore, Agni should enable doctors to use the last prescription as a starting point.

In a public health setting, there is often a mandate to prescribe formulations rather than brands¹. Agni should follow a formulation-first approach.

She went on to explain what Diabetes was, and the precautions Birender had to observe. Birender understood the need to watch his sugar, but eye checkups? What did that have to do with diabetes? And his feet? They felt perfectly fine, thank you very much.

Dr. Sood noticed his confusion, and said, "Do you have a smartphone? If I send you a few videos, will you be able to watch them?"

In response, Birender pulled out his phone and gently waved it.

Treatment extends well beyond medicines and surgical interventions. Agni should make it easy to share education content that helps patients make lifestyle changes.

"Come back for a checkup in a month," said Dr Sood.

It was now her turn to wave her phone. "Please go to the Pharmacy. They should have received your new prescription by now."

As soon as the doctor prescribes medicines, the pharmacist should be notified.

A formulation provides the chemical composition, dosage, and form of a drug. A brand name refers to it by the seller's name. For example, the formulation Cetirizine Hydrochloride 10 mg tablets is offered under various brand names, such as Cetiriz, Cetzine, and Alerid—each sold by a different firm. The term generic is also used as a synonym; however, this label is better applied to low-cost alternatives to drugs that are no longer protected by patents.↩