While growing up, there was nothing I dreaded more than visits to the eye doctor. The tears that sprung to my eyes when I learned I needed glasses at the early age of six flowed into rivers each time I received a report that my eyesight had worsened. My prescription steadily climbed in my elementary school years, and after each visit, my mother would scold and blame me for neglecting my eyes. Desperate for a magic bullet and ignorant that my myopia was largely genetic, I resorted to eating carrots and fish eyeballs, wearing my grandma’s enormous reading glasses, and spending fifteen minutes every night doing the eye exercises taught to my parents during their Chinese communist schooling. With my childhood memories of the eye doctor marked with such negative emotions, I’ll admit that the last thing I wanted from this internship was to be inspired to pursue a career in ophthalmology.
I spent the entire last year convincing myself I did not want to go into medicine. During my freshman year, I fulfilled premed requirements with the mindset that I would merely keep the door open for medical school. I hardly knew anything about medicine, and had never been in a hospital since I was born. The summer after freshman year, I shadowed at a hospital in Baltimore and it was there that I learned about the myriad subspecialties that exist in medicine and how much they vary in nature. I had the valuable opportunity to shadow many different types of doctors, but because most of it was in the hospital, I wasn’t smitten since I find that I prefer outpatient medicine. I came out of the experience with better knowledge of what the field of medicine encompasses, and a greater sense of uncertainty towards my conviction to pursue that career path. With no real commitment to the long and arduous road it would require, I decided against it, telling myself I needed to explore other careers in the field of healthcare that was not necessarily being a doctor. I hoped that working at Aravind would expose me to and ignite in me a passion for other aspects of healthcare such as management or public health.
However, instead, working in close proximity to doctors at Aravind has caused my medical school dialogue to resurface. Due to my newfound fixation with ophthalmology, discussions I’ve had with visiting doctors who have successfully molded their careers to fit their own passions and needs, and a clearer understanding of myself and how I feel most fulfilled, I have found myself seriously rethinking my career goals. I plan to do a lot more shadowing here before I ultimately decide to open that door once again, but by the end of the summer, it’s possible I may discover that commitment I previously lacked.
While I’m amazed by the inspiring work of this institution, at the same time, the care I see at Aravind often rubs me the wrong way. The Aravind model emphasizes patient-centered care at a high volume, but I’m not totally convinced the care is patient-centered in the sense that I understand it. I place tremendous value in the doctor-patient relationship, and the time and effort it takes to cultivate trust and comfort. Here, doctors speak to patients for about two to three minutes, after which they are shuttled off to a young counselor around my age to explain to them their diagnosis and options for treatment. The fellows in the retina clinic were lectured the other day for failing to see a high enough number of patients. I have seen the fellows with patients, and I have observed the sensitivity and kindness with which they administer their care. I understand that they are at Aravind to be trained in high-volume care, but it upsets me that the quality of their care goes by unnoticed because the quantity isn’t as high as it should be. Aravind focuses so much on increasing its number of patients without an equivalent increase in capacity that the system puts doctors and sisters under extreme stress to dispose patients as quickly as possible. In the ideal Aravind model, sisters are expected to provide the compassionate face-time to patients so that doctors can focus more on their area of expertise, but the overwhelming amount of patient inquiries makes this difficult for them to do on a day-to-day basis.
A big question on my mind when I came here was whether or not the Aravind model could be transferred to other places, including the U.S. Aravind works here because Indians bear extreme trust in the medical institution and do not necessarily take ownership of their own health—to me, Aravind seems to ride on that wave, taking advantage of that trust to minimize the amount of interface time patients receive in order to increase volume. Americans would never accept such short interactions with doctors and explanations of serious surgeries from a young counselor without a medical degree. Americans are likely overly uptight and distrustful, but is it right for Aravind to focus so much on figures at the expense of patient empowerment and quality interface time? One fellow I spoke to made it seem as if, as doctors in India, they have no other choice but to learn how to administer efficient care at a high-volume because that’s what the population requires and so they must cater to that need. If that’s the case, is my inherent understanding of what it means to be a doctor unsound? Or perhaps, the key is to strike the right balance between efficiency and quality, finding innovative ways to make those two minutes as valuable as possible.
After spending so much time in the busiest clinic in the hospital as an outsider, it’s easy for me to grow critical. Luckily, I have Sindhu to remind me to look at the faces of the patients packed into the waiting room, to remember that many of these patients would never receive care otherwise, and that because of the Aravind model, they are able to have their vision—and their livelihoods—restored.