# Referral visit

Referral out to another PHC

# Chapter summary

Simran accompanies Birender to Nanauta PHC, where they meet a formidable doctor who investigates in greater depth.

# This chapter

Upon arrival at Nanauta PHC, Simran and Birender informed the Staff Nurse, Mumtaz, that they had been referred by Dr. Sood at Tikroul PHC. Mumtaz opened up the app, and confirmed that there was an inbound referral note. She added them to the queue, asked them to take a seat. Another nurse checked Birender's height, weight and blood pressure.

If the patient's medical history can be summarized by Agni, then the referral "note" can involve less typing, and more tapping on the phone screen. The physician to whom the patient has been referred (the "destination") should have the same level of information as the referring physician (the "source").

Finally, referral requires bidirectional flow of data: from the source to the destination, and vice versa. Referrals are loops.

After a short wait, Simran and Birender went over to see the elderly, stern-faced Dr. Bhargava. She gave Simran an almost-smile, nodded at Birendra, and gestured at the examination table.

Dr. Bhargava did a detailed clinical examination, and asked Birender for his recent prescriptions. Birender pulled out his phone, and found the message with details of his last prescription. Dr. Bhargava scowled at him, then at his phone. She jotted down his last two prescriptions in her notepad, and added her own observations.

Finally, she turned to them both. "Anamika was right to refer you here. We need to check your kidney function, and this is the only PHC in this sub-division with the necessary equipment. The other option would be to send you to Saharanpur."

It took a moment for Birender to remember that Anamika was Dr. Sood's first name. He nodded.

Simran asked, "Is my father's condition serious, Dr. Bhargava?"

"His diabetes was undiagnosed for a long time. We have to make sure that there are no long-term consequences."

Dr. Bhargava went on to explain the progression of the disease, and the link between renal function and diabetes.

The consultation concluded with a prescription for lab tests. Simran and Birender went back to Mumtaz, who directed them to Kiran, the lab technician. Kiran took a urine sample and a blood sample, and informed Birender that the results would be available in an hour.

Simran and Birender both decided to wait. They stepped out of the PHC for a cup of tea. "Please make some fresh tea," said Simran to the shop owner, "and no sugar!". Birender sighed. His days of strong, well-sweetened tea seemed to be disappearing like clouds in the summer sky.

On their return to the PHC, Simran enquired about the next steps. Mumtaz explained that Dr. Bhargava would review the lab results, and then give a final prescription. She also explained the what the two tests—Albumin-to-creatinine ratio, and blood urea nitrogen (BUN)—measured.

By noon, Birender was getting restless. The lab tests were in, but there was a long queue to see Dr. Bhargava. Finally, it was his turn. Dr. Bhargava reviewed a paper printout of the lab test report, and wrote out a prescription.

"Your kidneys are ok, but you need to take care of your glucose levels," she said, "Reduce your consumption of rice and rotis, and stay away from sugar. You have to strictly regulate what you eat." Dr. Bhargava paused, and glanced at Simran, who nodded.

"Take this prescription over to Mumtaz before you leave. She will help you. And come see me next month." She turned a baleful eye at Simran. "Not next year."

Simran got to Mumtaz's desk first. "Dr. Sood asked us to give you this prescription, and see her in a month."

Mumtaz smiled. "Just a minute. I'll add her prescription to your medical records. Dr. Bhargava is not too keen on using digital tools." With quick, efficient movements, she took a photo of the prescription, and added a follow-up date using the app.

Physicians who have been lifelong paper users are less likely to adopt a system like Agni. Agni should provides features that allow for capturing handwritten notes—once an image has been acquired, structured information can be extracted from it—manually or automatically.

Birender had just returned home when his phone rang. It was Gayatri. "Dr. Sood asked me to call. What did Dr. Bhargava say?"

"She asked me to see her in a month."

Technology can only enable care delivery. There is no substitute for human touch.

# Next Chapter

None (yet)