“Problems are not stop signs, they are guidelines. Robert H. Schuller”
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The maintenance of strict glucose control is unassailable in diabetes, but hypoglycaemia (low blood sugar) is one of the major limiting factors on account of its morbidity and mortality. Though it is regarded as more common in Type I Diabetes, its occurrence in Type II Diabetes is often underestimated for a number of reasons, predominant of which is underreporting? Contemporary research, clinical experience and speaking to people with diabetes in non-clinical settings show that it occurs with much higher frequency than previously thought or reported. This has far reaching implications for safe management in the community and healthcare professionals and people alike sometime chose a guarded option and higher blood glucose levels are maintained which predispose people to more vascular complications.
In the UK hypoglycaemia means blood sugar levels less than 4 mmol/l. When this can be managed by the person themselves, it is regarded as mild and when third party intervention is needed it is regarded as serious. Though more common in people on insulin, it is also frequently associated with intake of sulphopnylureas (such as glibenclamide, gliclazide, glipizide, glimepiride, tolbutamide.With increasing use of insulin for Type II diabetes, the problem is likely to escalate. Though analog insulins do offer better protection, it is by no means absolute.

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The brain is extremely vulnerable to falling blood sugar levels as it neither has the ability to synthesise nor store glucose. When blood sugar falls, counterregulatory hormones of which glucagon and epinephrine (adrenaline) are the most potent are secreted and cognitive, physiological, and symptomatic changes occur. The recognition of symptoms is fundamental to self-management of hypoglycaemia. If (even mild) hypoglycaemia episodes recur often over time (e.g., once a day), symptoms are produced at a much lower blood sugar level. This is dangerous because symptoms are produced when the blood sugar level is precipitously low. In turn, failure to sense symptoms of hypoglycaemia (hypoglycaemia unawareness) increases the risk of prolonging duration and increasing frequency of hypoglycaemia. These events lead to a vicious circle leading to an increase in severe hypoglycaemia with brain dysfunction. Well-known risk factors for the development of hypoglycaemia include exercise, alcohol, older age, renal dysfunction, infection, decreased intake of energy, and mental health issues, including dementia, depression, and psychiatric illnesses. Though there is no conclusive evidence for long term deleterious impact of recurrent moderate hypoglycaemia on brain function, this is probably relevant for simple tasks, but may perhaps lead to impairment at times of performing complex tasks like driving. 

The challenge is to lower blood glucose to near normal values in order to lower the risk for long-term complications, but at the same time minimize hypoglycemia- and hypoglycemia- associated morbidity and mortality. The goal is also to manage most people with diabetes in the community. Continuous glucose monitoring is one of the methods used, which is constantly being evolved to be more accurate. In addition to this is the ability to transmit blood sugar readings from glucometers to the healthcare providers by using the internet (cloud services) via mobile devices in real time. This also has the ability to analyse and prepare trends which are useful for decision making. In addition to this, digital health has the ability to establish a two way communication between healthcare providers and people for providing advice by using multiple platforms like video link, text chat and messaging.

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An episode of hypoglycemia maybe quite miserable and have far reaching consequences. Often these people try to conceal these symptoms as these have social and economic implications. Thus they need both support regarding their lifestyles and emotional support. It is vital that they have lifestyle and mental health trained professionals to speak to and interact with for them to be further educated to make the necessary adjustments that are needed. Most importantly, it is important to win the confidence of these people that they live in a supportive community and there is help and correct guidance at hand. This can also be done remotely by using mobile health services and in the comfort of the person`s choice of place.
 
 
 
 

“To care for those who once cared for us is one of the highest honours.” -Tia Walker

One of the most difficult decisions is to know when to offer care to an elderly loved one. This is most often misconstrued as, if nothing else, a loss of independence, dignity and privacy. One needs to maintain a high level of tact and understanding to overcome any kind of resistance that will inevitably be encountered. Any offering needs to be thought out and discussed in detail and the loved one should understand that loss of independence isn't a personal failing.

The usual options are to place the elderly with relatives or in care homes. But every effort must be made to keep them in the comfort of their own homes and environment to help them lead productive lives. The focus should shift to prevention and proactive care. Rapid support close to home in times of crisis, good acute hospital care when needed, good discharge planning and post-discharge support. good rehabilitation and re-ablement after acute illness or injury, high-quality nursing and residential care for those who need it, choice, control and support towards the end of life and integration to provide person-centred co-ordinated care are key components. 

As our population gets progressively older, by 2030, one in five people in England will be over 65. However, as people age, they are progressively more likely to live with complex co-morbidities, disability and frailty. People over 65 account for 51 per cent of gross local authority spending on adult social care and two-thirds of the primary care prescribing budget, while 70 per cent of health and social care spend is on people with long-term conditions. This data further makes a case to find technological solutions to elderly care, motivated by a need both to improve services and to save costs. Most of the technology will be in monitoring and surveillance using telecare, telehealth and mobile health and the other in assistive technologies to help people for mobility needs.

Increased adoption of mobile technology by the elderly and favourable results from the “Three Million Lives” campaign has stimulated efforts in finding solutions using technology and remote care especially in chronic diseases like diabetes.

As diabetics get older, they have more comorbidities, mobility becomes restricted, suffer more mental health problems and self-care becomes more difficult. Blood sugar control becomes a problem, they develop foot problems, pain, nutritional problems, have falls, find it difficult to exercise and need more acute hospital admissions. It becomes more difficult for people to keep appointments. Telehealth and telecare by remote monitoring and intervention by appropriate personnel is able to more efficiently deliver care and prevent neglect, which is clinical and financial implications.

However, as the diabetic moves on in the journey, when they are completely unable to cope, they may need to be shifted to a care home. Residents with diabetes within institutional settings appear to be highly vulnerable, neglected group of subjects, and have more complications, nutritional impairment, increased hospitalisation rates and high levels of physical and cognitive disability. Diabetes is often unrecognised especially in those with mental health needs. There is often a lack of specialised diabetes care and lack of proper planning leading to poor results in this setting. Such barriers can be broken with the help of Mobile Health, where the residents may be linked with specialised diabetes care, nutritionists, mental health experts and appropriate blood sugar monitoring and intervention done whenever needed. This would necessitate a well-designed, individualised, and implementable care plan, implementation of which would become easier.

​The scope of digital health in the elderly care is immense, but extreme care must be taken so that it is not overzealous and imposed, so that this does not come across as being intrusive, which will lead to increased resistance of adoption. It is indeed tricky to build a simple, easy to use system, which will be adopted widely, but does not sacrifice independence. The reason for use of mobile technology is that it is increasingly being viewed as being part of one`s life by the elderly. The bottom line here is to develop solutions with maximum client delight and not awe. This will require cultural shift that maybe achieved by design thinking, leadership, development of skills and working practises and security and management of data.

“Christmas is doing a little something extra for someone”. Charles M. Schulz
The New Year always brings worries in Diabetic clinics; when numbers - namely blood sugar and cholesterol go in the red. Research has shown that in a majority, this is transient and most New Year resolutions are effective in handling them before even they start wavering. Reams of literature and even social media still hasn`t been able to decide on the appropriate etiquette for the diabetic and the pre-diabetic. But there are extremely useful guides, whether it is recipes or suggestions on various kinds of exercise and even travel and holidays. This is up to the individual but we believe this is a time to enjoy, connect and liberate oneself and bond with friends, family and the greater community.

It is vitally important that not just the person but the people around need to be aware and educated so as to help people make this season extremely memorable. However, this should not lead to intrusion and policing, which will be counterproductive. 

In today’s world of digital health, remote monitoring with wearables, use of cloud services in monitoring blood sugars and use of telemedicine can enable people to enjoy themselves because people are always `connected` and help is always at hand. Digital health has emancipated the individual from the inconvenience of travel and restrictions of time and space and continuous help is available much before disaster strikes. However, a sense of self responsibility needs to be inculcated year long, so that the festive indulgence is tolerable.
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Though the holidays are a time for festive cheer, for some it is a bit of stress and loneliness. Family issues, bereavement, monetary and employment setbacks along with negative reflective thoughts often dominate leading to depression and alcoholic binges. This could spell doom for diabetics. Help is needed, sometimes proactively. Though a fair amount is being done in this field, remote assistance with use of telemedicine by personnel trained in mental health could provide tremendous support in this field. Santa now has more things to pack in his sack.

“To eat is a necessity, but to eat intelligently is an art.” – La Rochefoucald

One of the most difficult decisions that anyone needs to make is to decide upon the best diet that satisfies both the body and the mind. Despite the information explosion regarding nutrition and myriad apps, confusion still remains as to what or what not to eat. Though details of diet is not the aim of this discussion, the goal of any diabetes diet plan is to improve blood glucose, blood pressure, and cholesterol numbers and keep weight on track. This along with exercise reduces diabetes complications like heart disease and stroke. Though personal judgement is paramount, professional help from a nutritionist is desirable.

The diagnosis of an inappropriate blood sugar is quite daunting and sometimes nothing short of bereavement and the rule book in the form of do`s and don’ts stare in their faces. Motivational interviewing and better psychological and nutrition techniques may need to be used to ensure long-term adherence and good results.
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Eating disorders occur more frequently in diabetics and need to be managed diligently for better blood sugar control and thus prevention of further complications.

In the UK, 76% of adults use mobiles and collectively, UK consumers check their smartphones over a billion times a day. The widespread use of this technology and the level of engagement have the potential of changing the way clients engage with their healthcare providers leading to more involvement in their self-care. At the American Heart Association’s annual Scientific Session 2015, data was presented demonstrating that wearables to track diet and activity behaviors – in combination with remote “coaching” from a health care professional – they actually made better choices and adopted healthier lifestyles. Specifically, the study showed that those patients who were engaged via mobile devices actually increased fruit and vegetable intake, decreased sedentary screen time and decreased their saturated fat intake. In addition, engaged patients appeared to have increased moderate-to-vigorous physical activity. This shows a clear trend towards adoption of healthier lifestyles with the use of mobile technology.
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Though futurism is an imperfect science, mobile technology has the potential of becoming the constant companion in life`s journey. The journey is just beginning. 

“Physical fitness is not only one of the most important keys to a healthy body; it is the basis of dynamic and creative intellectual activity.” John F Kennedy

The growing number of diabetics and the disconcerting number of projected prediabetics are now making us look at behaviour and lifestyle modification including exercise as an important preventive and therapeutic strategy.

Exercise is very important in maintaining the energy balance for long term weight loss, which would need unrealistic dietary calorie restrictions on its own. In the UK,
66 per cent of men and 56 per cent of women over the age of 19 meet the guidelines for participation in at least moderate intensity activity. Along with a 44% increase in gym spending in the last year, mainly due the availability of budget gyms, there is an increase in activities such as cycling, park runs and open water swimming. Running is now the fastest-growing sport in the country. Sport England revealed that 35.5% of people participated in at least one sport once a week, with swimming and running being the most common. 


What is driving these numbers is the adoption of technology such as high-tech sports gear as well as wearables and mobile applications that track and monitor results,providing feedback and even mentor fitness enthusiasts. This group is 45% more likely than the average Internet user to download free apps once a fortnight and they are 35% more likely download paid apps two to three times per week. They are 33% more likely than the average British adult to own a smartphone and 52% more likely to own a tablet. 46% of this group access the Internet more than once a day on their mobile device. In the past four weeks, they have spent an average time of 685 minutes on Facebook, 73 minutes on Twitter and 36 minutes on Pinterest.

One of the issues with the wearables adoption is that the people most likely to use wearables are those who need them least. A survey found 48 percent of users are younger than 35, affluent and highly motivated. A further evolution of technology is required to increase affordability, ease of use and ultimately to increase adoption of wearable health promoting devices.
 
Unfortunately, the adoption of exercise as a consistent lifestyle behaviour is hindered by psychological barriers which include low fitness, pain, boredom, lack of stimuli, comparison with other individuals, body image dissatisfaction, time and weather constraints. Cognitive strategies by motivational and mental health professionals may help to make physical exercise enjoyable, personalised and sustained. If needed other enjoyable forms of exercise may need to be adopted. Such an endeavour can be done using telehealth and mobile technology so as to suit the time and place of both the provider and the client.  

“The true secret of happiness lies in taking a genuine interest in all the details of daily life.”-William Morris

​Even though it was widely expected, it is still quite disheartening to know that a recent big Dutch study says that almost half of 45-year-olds will develop so-called prediabetes, an elevated blood sugar level that often precedes diabetes, 30 percent would develop full blown diabetes and nine percent would start taking insulin. This means that one in three healthy 45-year-olds will develop diabetes in his or her lifetime. Though this population sample is mainly white and Caucasian, the results in the UK could probably be worse as there is a significant ethnic minority population. Type 2 diabetes is known to occur 6 times more likely in people of South Asian descent and 3 times more likely in African and Afro-Caribbean people.

To the already overburdened healthcare system, this is a huge burden that needs to be tackled. Currently, the people with pre-diabetes would qualify for an intensive lifestyle prevention programme in the form of education, diet and exercise management. Though successful in scientific studies, these results are not replicated in the real world. The problem is that these people do not show any symptoms and the prevention of harm is not well appreciated. The management is challenging which needs a lifetime commitment and thus calls for a change in behaviour.

The UK has an excellent programme of structured diabetes education which is free. This is key and can be life changing. Most people who attend these have reported definite benefits. Diabetes education helps people to stay healthy, live well, and avoid expensive and life threatening complications. Though there is commitment to improve access to diabetes education, statistics show otherwise. For example in England, just 3.8% of newly diagnosed diabetics attend diabetes education. Not attending a course is wasteful, not only in terms of finance, but also a lost opportunity for people with diabetes. 

The problems are manifold. There is uncertainty amongst healthcare professionals about the value of this education and inadequate data as to who is attending. For pateints the issues are - location and timing of courses, long waiting times, some do not appreciate the term “structured” education. Along with this, there is also the difficulty in getting paid time off from work.
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Considering the importance of education in self-empowering and self-management of these people, it’s now time for some novel approach. There is a need of making this education easily accessible with the use of mobile technology, so that people can access these at a place and time of their choice. Use of online tools and telemedicine will facilitate healthcare and education. The mobile coverage of this age group is close to 100% and this has potential to transform this issue 

"Aging is not lost youth but a new stage of opportunity and strength." --Betty Friedan

There are more than 3 billion internet users in the world today. In the UK 80% of adults have broadband connection, 61% use a mobile handset to access the internet, 72% of online adults use social networking and 66% of adults use a smartphone. There has been an increase in those aged 65+ ever going online (42% vs. 33% in 2012) and tablet use by 65-74s has trebled; from 5% to 17%. Almost all of those aged 55+ who don't have access to the internet at home (20% for 55-64s, 37% for 65-74s and 65% for over-75s) do not intend to get it in the next 12 months (15%, 30% and 59% respectively). The bottom-line therefore is that overall there has been a widespread uptake of the internet, mobile and social networking ​mainly amongst the younger population, but there have been significant gains in the elderly population, previously thought to be internet naive.  

This has laid the foundation of the digital health revolution. The social network revolution has enabled people to reach beyond their conventional groups and world, people whom we may not know and may never meet but can build safe, effective networks and communities and share experiences and practises with. 

Mobile technology and the internet revolution have dramatically changed the ways in which people communicate and access information. This has also liberated mankind from the confines of geography and space. Today an internet-enabled mobile device is one of the bare essentials that we carry with us along with our house keys. 

This has given rise to the e-patient, who is able to gather information about his condition and is empowered to self-care responsibly. The e-Patient has driven a change in the doctor/patient relationship, which was once driven by paternalism, to one of collaboration. 

​​Digital health has emancipated information from the confines of consultation and difficult to maintain and transfer records to more dynamic forms like self-tracking devices to sensors capturing various biometric data which can be transferred using cloud services to the healthcare professionals’ office and may help avoid potentially unnecessary visits to clincs and hospitals. All the health data can be entered into Electronic Health Records which can be shared with ease to facilitate continuity of care. Telemedicine, either by video, audio or text methods can facilitate a two-way communication system between the client and the provider avoiding unnecessary visits. Given the ubiquitous use and change in behaviour of the population, the question is not of whether; rather it is how we can use technology to effect change that will be efficacious, safe and cost effective. 

Currently one of the biggest priority for NHS is community-based care of the elderly, who consume 70% of the NHS budget. Elderly people generally are extremely wary of their loss of independence and digital healthcare will empower them to self-mange more effectively and conveniently.. Additionally the digital healthcare has potential to be more cost effective for the NHS as compared with the current conventional model of heathcare system.

Digital healthcare will enable resources to be diverted to more needy areas. However, for people who are not able to access digital healthcare for any reason, a robust traditional health delivery backup has to be present.
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Any new system is generally subject to enhanced scrutiny and for digital healthcare - effective, efficient and safe healthcare delivery will be key criteria  for  success.

“A good scalpel makes a better surgeon. Good communication makes a better doctor.” – Josh Umbehr, MD

Last week was dominated with tales of tragedy, apprehension, despair yet hope. One thing that vicious events do is to bring people together and evoke conversation of a more personal variety. In the middle of all this contemplation and grief, I (DB) was asked by a middle aged well placed lady “I wish to have liposuction, what do you think”? 

She had educated herself over the net and had a formal consultation as well. At first it appeared that she was looking for a second/third opinion but on further refection it was apparent that she was expressing a failure of lifestyle interventions in the form of diet, nutrition and exercise, she had done to shed those pounds and make herself what she thought would be more attractive.She followed a strict regimental lifestyle and a multitude of fitness tracker apps to achieve her weight loss goals. Her body did not respond as well as she would like and multiple times over the last year, she changed diets as well as exercise routines. This simply did not work. She felt that she was doing something wrong but could not put a finger on it. Sometimes, she would get a bit disheartened and take a break from her own lifestyle. 

She was very well educated and was well aware about all the chronic diseases like diabetes and arthritis that could affect her due to overweight. Even though the yearly blood tests were still clear, a fear still lurked inside her about these conditions. This fear was not enough to sustain motivation to lose weight over prolonged period of time.

The health benefits of exercise and nutrition are well known, but the question is the body perception and a positive feeling about oneself, which is very important in any kind of preventive medicine. In addition to taking care of our bodies, it is vitally important to deal with the complexities of our mind. 

As much as we need medical personnel for disease related support, lifestyle personnel in the form of nutritionists and exercise specialists, we also need people who are trained in the matters of the mind to support the person in preventive care, especially to build confidence and motivate continuously, to reduce the risk of failure.

Support from trained psychologists which can be accessed from a place of the patient`s own comfort may be extremely helpful. Communication today, courtesy of the internet and the mobile revolution is not just ubiquitous, but has improved in quality. It has broken geographic barriers and liberated the constraints of space. There is no better way than mobile internet to integrate all the arms of the support system to empower the person to self-care, which is the best way to prevent and manage the chronic diseases. 

“Now you`ve upset me. I won`t speak to you anymore”. I (DB) have known Peter for a few years now; he is a good friend, a bit temperamental yet fun loving, a loving husband and a very doting father. Although we did enjoy a laugh, I had got used to such abrupt comments once in a while. Knowing that any comments from my side would only worsen matters, I went back to my office, gathered my stuff and lazed my way down to the pub, which was the last ritual before we hit the weekend.

This time it was different. As I walked in I found Peter stomping out and glaring at me with bloodshot eyes. Taken aback, I walked over to the table where the others sat in silence staring at me very disapprovingly. Angela broke the silence. “Peter says that you have been rude to him. He does not approve of your sense of humour.” John took over and began lecturing me about humour pushing the boundaries of offensiveness. I was a bit irked, because Peter always bragged about being `the funny guy`, but something had changed somewhere. Vikram brought in a bit of a management conspiracy theory and was immediately shot down and sanity was restored. 

For the next two weeks, I kept my distance from Peter and when he called in sick, I seized the opportunity and rang him to find out how he was. “I`m better, but will be out of action for the next two days”. Peter had been a Type I diabetic since he was 10 years old, had travelled the world, always carried his sandwiches and we all had got used to him falling ill very frequently. Of late, his sugars were all over the place and he was trying hard to get an insulin pump. Due to his frequent eating, he was now putting on the pounds. 

​The following Monday, he returned and on the pretext that I wished to know more about the project that he was on, I sat down and asked him how he was doing. Over the last few days, he had become more and more irritable, he was having frequent arguments at home with his wife, he had lost money on an ill-advised investment for which he was now in a lot of financial difficulty, he was struggling to pay his rent and was probably not going to be able to go on his family holiday.

He described that these days, with the increased fluctuation of his blood sugars, he was having more episodes of feeling hypoglycaemic and was having to eat more of his ham sandwiches that he carried with him. He described that during each such episode, he got more irritable, angry, anxious and his whole personality would change. We had noticed that during formal meetings, disagreements were a norm, but Peter would vacillate between being meek and being militant. Increasingly, he was losing the ability to see the middle path and was seen to be adopting more a path of confrontation than discussion. He was a talented chap, but was slowly getting labelled as being unreliable. Though most people understood the reasons for his absences, it was his frequent change of personalities which was getting him into situations, where his credibility had begun to be questioned. 

We are now closer to Peter and he does discuss his frequent vacillations in moods with us. We support him by appreciating that he has different emotional needs and not to judge him by how he behaved sometimes as this just might be his diabetes speaking. He does need help, but everyone is unsure from whom. 

Of course, we haven`t discussed the pub incident. This and many more will have to be forgotten.

​(This is a true story and the names have been changed to protect the innocent parties)

Our travels now took us to a newly qualified GP, in the first six months of her practice. A brilliant student in her times, a wife and mum to a boy, she juggled family and professional life with great aplomb. Always positive about life, it was always very difficult to get any criticism out of her, unless things were completely unbearable.
After a few brief pleasantries, the conversation shifted to her experience as a new GP and as expected she said that her life could not have been better and finally, she was on course to fulfilling her dream.

The conversation meandered on and after a few pit stops like work-like balance and sharing responsibilities at home it came down to her experience in managing chronic diseases specifically diabetes. It was quite amazing to see her grasp and knowledge of the subject, the thoroughness of her approach and the pains and great effort that she took to give the best possible care for the ones that she was responsible for. We felt extremely reassured and proud of the British medical training and healthcare systems that we are in safe hands. “Then why is it that the National Audit Office is so critical about diabetes management in the UK? And why is it that the problem does not seem to abate?” Then the penny dropped.

It is extremely difficult to put a finger on what the problem is and even more difficult to find what the solution is. All newly diagnosed diabetics are put on a structured education programme and people who have attended it report that this is an excellent programme. But most people don`t attend and “people with jobs simply don`t”. In a climate where jobs are not particularly easy to come by and leave to attend these is discretionary subject to the employer`s altruism, nobody wants to fall behind in the race. There is also a perception of the patient`s apathy, the cause for which is individual and not easy to ascertain. All people who do not attend clinic appointments or miss blood tests are sent reminders and sometimes, she herself pays home visits. “Even then they do not come”. Nobody admits to not taking medicines, but in a lot of cases, test results show otherwise. This creates a bigger problem, because on the one hand there is a suspicion of under dosing, if the person were to be believed and needs dose escalation and on the other hand if the person is not being truthful, any intervention could be disastrous. There is no objective way to decide either way, but the results of both are far from ideal. Unfortunately, this is the norm rather than the exception.

This is a situation that all health care professionals are prepared for and everyone vows to tackle in a different way, but the reality is that what it leads to is despondency and frustration in the healthcare team and thus results are far from optimal. Despite all the healthcare professional`s best possible intentions and efforts, some people don`t bother with anything and are sometimes skeptical and cynical and continue in their merry ways.
A time comes when enough is enough and these people are ​`lost to the system`, `non-adherent` or simply vanish from attention. Some of them resurface as medical or even surgical emergencies in secondary or tertiary care and their lives are changed for ever.

At these moment, we paused to look at the National Audit Office`s statistics and paused to think, whether there was any solution to what is being termed as apathy or non-adherence. The problems may be extremely individual, something that we are not aware about. We are probably trying to solve a problem, when we do not know what the real reasons are. We do not know what happens between a blood test and an appointment or even a missed one. A 10 minute appointment is grossly inadequate to know someone. A letter from the surgery probably intimidates the person more than helps him or her. And as the vicious cycle of summons and absences continues, maybe we are distancing ourselves from the people we set out to serve. Maybe they are reticent in telling us what their real issues are, maybe they find us too intrusive, maybe a trust deficit and overall.

We are not particularly sure whether the current healthcare set up actually provides a great client experience.

We probably need to take the healthcare to the person, instead of the patient coming to healthcare. It is probably no longer enough to say that the person does not listen. It is time to take responsibility and improve the client experience. Maybe it is time to engage people in their places of comfort, unless it is absolutely necessary to drag them to healthcare facilities. There is no point in having an excellent education programme and people not going to it. More resources are spent in tracing and chasing people than actually treating them. And when everything fails, resources and lives are lost once people have complications and admitted to hospital.

The current budget deficit is clamouring loudly for bringing healthcare closer to people, understanding and managing the person as a whole with emotional support and behavioural intervention along with the present extremely erudite system. What we can do is take responsibility and improve the overall client experience, which motivates patients in such a way that they understand and embrace their problems and lead a life of fulfilment. The best possible way is to give people the opportunity of interacting with healthcare from places where they are comfortable like homes and places of work.