Coping with Swine Flu in India

Swine flu has finally arrived in India.

So far 4 people have died and 782 people are confirmed to be infected with the virus and are undergoing treatment in designated government hospitals. The deaths have been in Pune, Mumbai and Ahmedabad, while Pune seems to be the worst hit. Strangely, school children appear to be seriously affected and many schools have shut down for a week or more.

Last week when I was in Mumbai a colleague called up in the evening. His 8 years old daughter was having a high fever and flu like symptoms. He had taken her to Max Hospital in Saket in New Delhi and he had been referred by the paediatrician to a government owned facility in Malviya Nagar for suspected swine flu. ‘The doctor did not even touch her, heard us while we explained the symptoms and promptly referred us to the government hospitals for tests. The government hospital admitted her for observation and now we do not know what to do. I fear even if my kid does not have swine flu, she is likely to catch it in the hospital’  explained my colleague Vijay Jain.

Another colleague in Mumbai, who was coughing and sneezing, had a bad throat and a fever decided not to come to work for a few days.  He felt that it wasn’t right for him to put others in office at risk.

These are tough calls. It is difficult for doctors to diagnose Swine Flu from the symptoms a patient presents. If the flu like symptoms are a little severe thay have no choice but to refer patients to the designated hospitals for tests, which means a patient has to visit a hospital, which has confirmed cases of Swine Flu and is therefore exposed to the disease. It is really a catch 22 situation.

In this situation the best thing to do would be to avoid going to busy public places, which are closed, particularly malls, airports, cinema theatres and yes offices and schools.

It would also help not to panic if one develops flu like symptoms. Afterall flu, that is the normal flu is a lot more prevalent than the swine flu and kills many more people every year. Mortality rate due to swine flu is still quite low, less than 7 per thousand. Statistically this is not a big cause of concern.

The government on its part must involve some private hospitals in combating the epidemic. It would help if a few private hospitals were allowed to test blood samples for the disease and admit patients in secluded wards. Large private hospitals are certainly more than capable of maintaining the records, treating the patients and ensuring that the disease remains in check. Additional testing and treatment centres will also help in instilling greater confidence in the public.

The government must also embark on a public awareness campaign. It must use mass media to educate the public about the disease, its symptoms, diagnostic procedure, treatment and prognosis. While I have noticed some advertising, it is hardly adequate.

Finally, the media must behave responsibly. In a situation like this it is indeed easy to create panic and cause mayhem by irresponsible journalism. It is the duty of all journalists to report objectively without resorting to unnecessary sensationalism and devoting too much media space to stories related to the spread of the disease.

Last but not the least, let us spare a thought for folks in the medical profession. They are at great personal risk in handling infectious patients. However, this is part and parcel of their calling. They must take all possible precautions, while providing succor and care to all those who seek their helHospital,p.

At the end of the day all of us are at risk. It is really up to us to exercise caution and help in whatever small way we can to fight the disease.

Pic courtesy www.flickr.com

Some names have been changed to protect privacy

An OPD Experience

The other day my wife had an appointment with her doctor at one of the well known hospitals in town. We were to see her at 8PM, but what with under construction Metro line collapsing and the resultant traffic snarls bringing the city to a halt, we were running late. Hoping against hope of catching the doctor, we reached the hospital 20 mins late.

Luckily for us, as we arrived the doctor was finishing with her last patient of the day and agreed to see my wife immediately. She indicated that some tests were needed and while she went about doing those, I might run along and pay the bills as the billing counter would be closing. She scribbled the tests on a medical form and off I went to do the needful.  

CT scan at Rs. 1500!!!

On May 31st, which happened to be the World No Tobacco Day, I was holidaying in Kashmir, when I received a strange sms. Since I had decided not to carry my mobile phone on my vacation, I saw it only once I returned to Delhi.

The message, which I reproduce verbatim said ‘On the occasion of the World No Tobacco Day Artemis offers Lung CT at Rs. 1500 only. Offer valid only for My 31 2009 only. For registrations, please call’.

Needless to say that I was quite shocked. This is exactly the kind of lazy and insensitive marketing communication that puts off consumers from hospitals and makes them extremely suspicious of hospital communications.  

Why we do not need ‘Claim Ref’?

A few days ago The Hindustan Times in New Delhi reported that the global acturial company Milliman has ‘launched ‘claims processing guidelines’ that enables a third party administrator (TPA) or insurer to determine the severity of a patient’s condition and identify if the length of hospital stay investigations, consumables and treatment procedures are more than what is typically required’. 

The product reportedly called ‘Claim Ref’ can apparently be linked to a software, which allows it to compare a claim made by a hospital, with a ‘typically’ similar case taken out from a database containing information about 125 procedures gathered from Indian hospitals. This simply means that the insurance companies can hold back payments to the hospitals if the claim amount is in excess of what ‘Claim Ref’ indicates.

I am hugely skeptical of such arithmetic modelling for the following reasons.  

Hospitals and Luxury Hotels

Yesterday I came across a piece in The Hindustan Times, which talked about the ‘luxury’ that a hospital now offers. The piece had snaps of fancy chefs offering a choice of cuisine to patients, nurses ‘requesting’ young patients, mostly kids to have their medication and the pretty front office executive (with her ‘May I help you badge’ in place)making ‘guests’ welcome.

This made me remember my grandmother, who is all of 104 years old narrating to me her escapades in hospitals run by the British in colonial India. She had great admiration for the no nonsense English doctors, the stern nurses, who followed orders and paid little attention to patient grievances. She remembers these episodes with a mixture of nostalgia and respect for the efficiency that this system stood for. The food was always what the doctor ordered, the medicines were given like clockwork and chores like sponging were a must-the patient had little choice in the matter.  

Incubating New Ideas in a Hospital

New Product and service lines always provide an opportunity for healthcare marketers to reconnect with their customers. A good marketer must always be on his toes looking for opportunities to connecct and communicate with his customers. Sometimes in the course of the evolution of the hospital’s services such opportunities present themselves, often the marketer has to create and then sustain them.

A new hospital keeps adding new services in the first few years and these provide the opportunities for the marketers to talk about them. For example Artemis Health Institute in Gurgaon opened a ultra modern blood bank a year after its formal launch and added a Lasik in the Ophthalmology service. These are occasions for the healthcare marketer to communicate with its customers. As the hospital matures and grows older, the addition of new services slackens and thus the marketers need to create these for continuous engagement with its customers.  

Homeopathy in a Modern Hospital

A few days ago I received an sms from Artemis Hospital exhorting me to check out their Homeopathy services! This seemed strange as Artemis Hospital is one of the most advanced centres of medical care in North India and boasts of the highest level of medical advancement. It has invested tonnes of money on advanced imaging equipment such as a 3T MR, a 64 slice CT scanner, a PET CT and a 4D Doppler amongst other fancy stuff.

Artemis has highly experienced doctors and surgeons who literally operate on the cutting edge of technology. Amongst all this Homeopathy seems to be a little out of place.

Ask any doctor worth his salt about homeopathy and other alternate systems of medicine common in India and he will be downright derisive or at best will say that he is not sure of their efficacy. Doctors are trained in the science of medicine and surgery and rely on scientific evidence proven in laboratories and tested on animals and humans in scientifically designed and executed clinical trials. For them to accept homeopathy, ayurveda or the yunani system of medicine as effective treatment is difficult. Yet we have a modern hospital offering the services of a homeopath. I am intrigued.

Now, I have nothing against any system of medicine. I am sure the practitioners of any of these alternate systems of medicine have their own methods of diagnosing and treating people and I would also concede that there are enough people who believe in them. However I do know that God forbid, if I ever need serious medical attention I would head straight to a doctor qualified and experienced in the western system of medicine.  To me that is a straightforward choice.

I am also against mixing the modern western medicine with the likes of homoepathy and ayurveda. They just do not mix well. I would think twice about referring a friend to a modern hospital, which also offers homeopathy and ayurveda. Somehow, it appears that the hospital and the medical folks do not have enough faith in their own system of medicine. It seems like a tacit admission of the fact that these ancient alternative systems of medicines have something to offer even when modern medicine has failed. This I personally find hard to believe.

Arguments about offering a choice of medical systems to patients are also common place. This to my mind is bunkum. The patient wants a cure for whatever ails him. He wants it fast,with minimal pain and with a certain degree of reliability. He cares two hoots about the choice of medical system. If he walks into a hospital, he has already professed his faith in the western system of medicine. Offering anything else to him is downright foolhardy.

Why would Artemis hire the services of a homeopath and than go about promoting it? I can only say that if they are serious about homeopathy, they can always consider launching a homeopathy institute and call it something appropriate. After all Artemis Homeopathy Institute does sound weird. 

Pic courtesy www.flickr.com

 

 

The PR Story

As I wearily settled into the cramped seat of a Spicejet flight to Mumbai this morning, I pulled out the Metro Nation a tabloid format newspaper and started flipping through the pages. Suddenly an image of my former colleague Dr. Deep Goel, the head of Laparoscopic and Bariatric Surgery at Artemis Health Institute, Gurgaon caught my attention. Dr. Goel was featured in the story along with a 200 kg Canadian patient, whom he had successfully operated upon (performing sleeve gastrectomy) and discharged from the hospital with in 24 hours. The story albeit poorly written (the journalist appears to be totally ignorant about medicine, medical procedures, surgeries et al), did manage to inform the readers about Dr. Goel’s superlative skills and about the Bariatric Surgery at Artemis.

Last week I had come across the story of a successful heart transplant in Chennai, when the donor was in Bangalore a team of surgeons from Chennai successfully harvested a heart in Bangaloreand transplanted it in a policeman in Chennai. Stories about Pakistani children being successfully treated for congenital heart diseases at Narayan Hridyalaya in Bangalore and undergoing liver transplants at Apollo Hospital in Delhi have routinely appeared in national media. Celebrities being treated at Leelawati and Breach Candy hospitals in Mumbai are also commonplace.  

Why Hospitals are not Transparent?

As a consumer of healthcare services and also as a keen observer of the drama that unfolds in a hospital everyday, I have often wondered at the extent of opacity that I see around me. A hospital is usually as transparent as a black hole. Ironically most hospital swear by the maxim of ‘complete transparency’. This is rarely true.

Try getting a straight answer from a hospital executive or a doctor and you will straightaway run into a wall.  They are just not programmed to answer straight. Many a times, I would accept that it may not be feasible or advisable for a doctor to be completely transparent. However, there are times when a doctor must look the patient in the eye and say as it is.

Delivering bad news is never easy. It takes a lot of character and compassion to tell another individual that he is terminally sick. However, not telling or beating around the bush, while doing so is far worse. Than there is the matter of giving hope to those diagnosed with a rare condition, telling them that, while they are gravely ill, they need to put up a fight and the doctors, the hospital and everybody else responsible for their care will walk with them every step of the way.  I would like to believe that the ability to communicate and connect with the patients is a wonderful gift to have and it makes for some very happy patients.  

The Evergreen Mantras for Failure!

 If you are a surgeon and a  CEO of a yet to be launched/recently launched hospital, with a great vision about creating a truly world class hospital, here are some useful tips on how to fail!. If any of you dear readers, find any resemblance to any individual, hospital or real life situation let me assure you that it is just your imagination working overtime.

 

1. Select a set of promoters who know nothing about healthcare, do not know the difference between a CT and an MRI and between an orthopaedician and a paediatrician (sounds the same eh!). 
2. Bedazzle them with your medical knowledge by constantly sprouting jargon. Display high levels of energy and commitment, while never compromising on golfing holidays.
3. Commit an impossible deadline for starting the hospital operations and than as the deadline approaches, keep telling the promoters that the hospital will start on time. On the appointed day do tell everyone that you are ready to start except the damn hospital is not ready and everyone involved in its construction has really taken you for a ride.
4. Blame all cost and time over runs on executives from the promoter’s parent company meddling around in the hospital’s affairs.
5. Hire a bunch of doctors, who are medical school buddies and friends.  
6. Also hire a set of professionals, brighter than yourself, give them the freedom to perform and if they do better than yourself, ensure that they get the sack.
7. Compromise on everything that you professed to believe in. While you go about doing this do tell all and sundry that these are things you are being forced to do by the promoters, who in any case know nothing about medicine.
8. Hire a Chief Operating Officer, whose wattage is 1/100th of yourself and ensure that he is always there to take the rap for everything that goes wrong.
9. Have your own surgical outcomes comparable to the worst surgeon in the hospital, however never forget to have a weekly lecture on all things under the sun including medical outcomes.
10. Always have a sidekick and confidant along, to perform the surgeries and also to provide a handy shoulder in these difficult and sorrowful times.
11. When the going gets really tough, get going, er bolt.

Pic courtesy www. flickr.com