The “Amar Uchala” Way

When I was in college almost 20 years ago, we had a popular Hindi newspaper called Amar Ujala. This was well-circulated in western UP and was a staple amongst students at the ubiquitous ‘dhabas’, which ringed the campus of the Aligarh Muslim University, Aligarh. We all loved to read its over the top reporting, brazen twisting of facts and its economy with the truth. Affectionately the newspaper was called ”Amar Uchala”.

Those were the days of innocent fun and we hardly realized that how insidious and damaging this kind of reporting can be. It struck home to me when I came across this piece of reporting on its pages recently.

Amar Ujala report

Let us look at this report from the Amar Ujala. The headline says that in Gurgaon 11 people die every day in private hospitals. The report cites the response of the Municipal Corporation of Gurgaon (MCG) to an application under the Right to Information Act filed by one Mohit Khatana. The entire story is based on this RTI response and paints an extremely negative image of some of the most well-known hospitals in Gurgaon.

The report without any comparative basis, claims that these hospitals have very high mortality rates and publishes data on the number of death certificates issued by MCG on the request of various hospitals in Gurgaon. It claims that the data shows that the mortality in these hospitals is very high. It also makes wild allegations against private hospitals claiming that the hospitals admit very sick patients knowing fully well that these patients are unlikely to survive and in the process, they make a lot of money.

It also quotes Mohit Khatana claiming that it seems that the larger the hospital, more are the number of deaths.(I don’t know how can it be otherwise!!!) The report also claims some unknown experts saying that mortality is far worse in these hospitals as the numbers cited do not include those who are sent LAMA (Left Against Medical Advice) and die at their homes.The report, of course, does not present any point of view from the affected hospitals.

Now let us examine facts.

Medanta is the largest private sector hospital in Gurgaon with over 1000 operational beds. It is also a referral centre for tertiary and quaternary care and receives patients from all over the country. It is a major hub for medical value travel with sick patients flocking to its doors from all parts of the world. With such a large number of very sick patients coming to Medanta, it is only natural for it to report the maximum number of deaths to the Municipal Corporation of Gurgaon (MCG). How can this be a point of contention is beyond comprehension.

Let us look at some other facts. The MCG records deaths reported by various hospitals. The data includes those who are brought dead to the hospital ER, those who die in the ER before they could be admitted for treatment, stillborn babies and even those who are certified dead at their homes by doctors of these hospitals. All these deaths are reported to MCG by the respective hospitals and a death certificate is issued by the MCG basis this information. These are not mortality figures of the hospitals.

I happen to have the data for Max Hospital in Gurgaon. The hospital reported 73 deaths out of 7609 patients that were admitted to the hospital in the period of Jan 01 2017 to Nov 30th, 2017, which makes the mortality rate under 1%. I am sure other hospitals too will be maintaining their mortality data and with a little bit of effort, the journalist from Amar Ujala should have been able to access this information. In the finest tradition of his newspaper, he never bothered.

To make matters even worse, the mortality data from these hospitals are not even comparable. The mortality in any hospital is a function of the number of patients handled as well as the service mix of the hospital. Thus, a large hospital, attracting a greater number of patients and providing advanced services such as cancer care, high-end cardiac care, and transplants will have a higher mortality than let us say a secondary care hospitals with a lesser number of beds. Thus, one fails to understand how can one compare mortality at Max Hospital, Gurgaon which is an under 100-bed secondary care facility with Medanta Hospital, which is quaternary care hospital with over 1000 beds.

Finally, the conclusions drawn are just as ridiculous and mendacious. Even if one was to assume that this data is comparable and accurate (which it most certainly isn’t), how does it indicate that hospitals are admitting and keeping sick patients who have no chances of survival?

Pray, what else is a hospital supposed to do – turn away the very sick and admit the relatively healthy? If Medanta Hospital is admitting the very sick knocking at its doors and trying its best to save their lives, what is wrong with that?

This kind of perverted reporting, completely one-sided and meant to only cause discord between patients and their clinicians and hospitals is lamentable. The journalist is not only ignorant of facts, sadly he doesn’t seem to be interested in the truth either. He has to find a ”sensational” story to file and this seems juicy enough, the facts be damned.

Amar Uchala, too hasn’t changed much in these 20 years.

The views expressed are personal

Advertisements

A Complete Abdication of Responsibility

The private healthcare sector in India is now increasingly being looked upon as a sector that should focus on doing good rather than being run as a responsible business enterprise. The government wants the private hospitals to be good Samaritans and treat patients at such low prices that the business itself becomes unviable!!!

Essentially, the government wants its duties to be discharged by the private sector.

This is a complete abdication of responsibility on the part of the government and totally unfair to the private sector players and their investors. It is a well-known fact that public healthcare expenditure in India remains abysmally low at under 1.4% of the GDP. This compares poorly even with countries in sub-Saharan Africa. According to the WHO World Health Statistics 2015, the public sector in India spent 1.16% on health as a percentage of the GDP, ranking 187th among 194 countries. A recent report in The Wire says ”global evidence on health spending shows that unless a country spends at least 5-6% of its GDP on health, basic healthcare needs are seldom met”.

Another recent report in The Mint pointed out ”The World Health Organization estimates that India spent about $267 per capita on health care in PPP adjusted terms in 2014—China spent three times that amount, Brazil five times, European nations 10 times and the US 20 times” 

To make matters far worse is the fact that much of the funds allocated to the sector remain unutilized. This is nothing less than criminal negligence. Sample these facts reported in The Hindustan Times in August 2017.

”More recently, in a performance audit of the Reproductive and Child Health scheme under the National Rural Health Mission (NRHM) tabled in the Parliament last month, CAG said the cumulative unspent amount in 27 states increased from Rs. 7,375 crore in 2011-12 to Rs. 9,509 crore in 2015-16.”

Since the government allocates a minuscule amount for public health and even spends less, the out-of-pocket (OOP) expenditure in India remains high. In the year 2014-15, 62.42% of health spending was borne by the citizens themselves. Unexpected medical expenditure remains the single largest cause of individual families being pushed below the poverty line. The National Health Policy Draft of 2015 estimated that ”nearly 6.3 crore people are faced with poverty every year because they do not have financial protection for their healthcare needs“.With the OOP remaining high, there is a sense of anger and frustration amongst the consumers and the politicians have been cleverly channeling this palpable anger towards private healthcare providers by painting them as uncaring, profiteering and worse.

Now compare this with what is happening in the private healthcare space in India. A recent report (August 2017) in The Scroll cites a PwC study saying that private health spending in India was more than double the government’s expenditure, at 3.3% of the GDP in 2014. The private sector consisting of individual doctors, clinics, nursing homes, diagnostic chains, trust hospitals and corporate hospitals provide care to more than 80% of our people. A report by the India Brand Equity Foundation (IBEF)  published last month points out that healthcare sector in India is the largest employer in the country. The sector is expected to record a CAGR of 16.5% between 2008-2020 and the industry size is expected to grow to USD 280 bn.

The same report quotes Department of Industrial Policy and Promotion (DIPP) ”The hospital and diagnostic centers attracted Foreign Direct Investment (FDI) worth US$ 4.34 billion between April 2000 and March 2017.”

A mere glance at this data indicates that while the government has wantonly abandoned its duty of providing good quality healthcare to the citizens of the country, the private healthcare sector continues to make significant investments. Private investments are by definition ”for profit” investments and are made in the rightful expectation of a reasonable return on the capital employed.

Instead of spending scarce public funds on building new infrastructure, decongest government hospitals, ensuring efficient and smooth management of these hospitals and providing greater access to the citizens to public healthcare, the government is busy pandering to the masses through populist measures and what may even be called as bullying.

Populist policy announcements, which are not even clearly thought through are being made every day. It has been announced yesterday that any citizen in the city of Delhi who fails to get timely medical attention in a Delhi government hospital can approach a private healthcare institution and avail of cash-less services, which will be reimbursed to the hospital by the government later at rates, which are very low. The private hospital has no choice but to accept the patient and treat him at government-mandated pricing.

This kind of policy-making, akin to shooting from the hip must stop.

The government should define its own role in the healthcare sector in the country.

It must be said, even though it may sound harsh that the responsibility of providing good quality healthcare to those who cannot afford private healthcare squarely lies with the government.This is a responsibility, which it must not attempt to shirk or palm off to the private sector.

The views expressed are personal

 

 

The Winds of Change

With the trust levels between clinicians in private practice and their patients plummeting to what many would call an all-time low, many clinicians have been wondering what they need to do to regain the lost trust.

In a recent interaction with some senior clinicians, I found that many are reflecting deeply on things that they perhaps need to do differently and maybe unlearn some of what they learned early on in their careers. The new skills they felt they needed to acquire lie not in the domain of medicine but in the areas of patient communication, documentation and even bed-side manners.

The clinicians are increasingly realizing that treating patients and saving lives is much more than just wielding the knife or taking life and death decisions based on their clinical acumen and skills. The clinicians feel that they need to engage with their patients in multiple ways to earn the patient’s trust once again.

The good news is that they are more than willing to do so.

The new age clinicians are learning lessons in patient communication (pun intended) as they deal with Google strengthened patients, who have dozens of questions on their differential diagnosis, tests needed, treatment plans and even backup plans if things go wrong.  The patients are asking questions on drug reactions, likely side-effects and how would one cope with them if God forbid, they occur. They want to know why a particular implant is being recommended, what are the chances of an allergic reaction from the metal used in the implant and what can be done about it!!! From the clinician’s point of view, this is many worlds’ away from the time when they were treated like demigods and their pronouncements considered to be almost divine.

The clinicians are getting used to the new reality and many are keen to be trained in being able to address these questions adequately and in a manner that the patients understand. The clinicians are trying hard to learn the language of their patients. Many do not shy away from passing on patient literature developed by hospitals, especially for this purpose. Many are equipped with videos of past patients, which they happily handout to their new patients. Some, direct the patients to check out authoritative resources on the web and satisfy their thirst for knowledge. Clinicians are writing blogs and creating web content for patients to read and understand their conditions better before they decide on surgery.

In India, very few clinicians are as digital media savvy as say their colleagues in management. I reckon this is primarily because many senior clinicians are still from a generation when they never had social media when they were growing up or training in medical schools. They became professionally busy well before the advent of the smartphone and the 24×7 assault of the Facebooks, the Linked-Ins, and Twitters of the world. Thus, they hardly had time to get used to the tremendous power these digital tools wield in engaging with consumers today.  This too is now changing. Many clinicians are now harnessing the power of these social media platforms to engage with their patients. That the mediums allow for a continuous engagement, which is way beyond the episodic nature of a surgery or hospitalization is an added advantage. Many clinicians in a sincere effort to shed the old world aura of being  Gods are also sharing snippets of their personal lives, hobbies, family pictures and vacations to connect better with their patients.

The doctors are also trying to be nicer to their patients and are even considering sartorial changes to make them look smarter and more approachable. It is now quite usual to see smartly attired,  doctors welcoming patients in their OPD chambers. Some are even spending time in the gym, making them look fitter and healthier. They are certainly willing to spend more time with the patients and their attendants. The clinicians are also realizing that patients admitted to the hospital under their care look forward to seeing and hearing from them at least once a day. Many now hold conversations with their patients on their medical rounds, which are far more reassuring than in the past. Some clinicians are also sharing their phone numbers so that patients can WhatsApp if they need to reach out for anything.

These are all welcome developments.

However, the biggest change, which appears to be happening is in the area of documentation. Unfortunately, medical education and training in India, which is still largely in government-run institutions does not equip doctors with the meticulous documentation needed, while working in large corporate hospitals. The clinicians need to learn to work on HIS systems of various degrees of complexity, put in orders in the system, prescription have to be recorded in electronic formats and the smallest of thing needs to be properly documented. The days of the clinician’s iconic scrawl are well and truly over. Verbal orders barked to nurses no longer suffice. The culture of documentation and the use of technology allows for significant reduction in medication and other errors. It leads to far greater patient safety and protects everyone from doctors to nurses to hospitals from disputes and legal action.

These are welcome changes. That the clinicians are thinking about ushering in these changes to help reach out to their patients better is indeed reassuring. I am sure these will go a long way in bridging the gulf that now divides patients and their doctors.

The Myth of Overcharging in Private Corporate Hospitals in India

Why is it so easy for us to believe that corporate hospitals ‘overcharge’?

If one was to poll educated, middle-class Indians, mostly professionals and smart and rational people, most would unhesitatingly aver that private corporate hospitals in India inflate their bills and take patients for a ride. If one was to ask them the same question with respect to a five star hotel, a dinner at a fancy restaurant or even an airline, where fares vary on a daily (and sometimes on an hourly basis), the answer would usually be that, yes they are expensive, but than they do offer certain comforts. I am yet to hear someone moan about a luxury hotel, overcharging.

One of the reasons for this perhaps is because expenditure on healthcare is almost always a forced expenditure. No one goes to a hospital to enjoy a few days of surgery, rest and recuperation. We spend in a hospital only because we do not have a choice. This expenditure is also usually unplanned, which means that it is an unwelcome drain on one’s savings. Thus, we hate to spend in a hospital, anyways.

To make matters far worse, the expenses in a hospital are also uncertain. They also do not guarantee the desired outcome. Thus, it is possible that in a hospital we may end up paying far more than what was initially indicated and we may also end up not fully regaining good health. Sometimes, we may end up paying an obscene amount and also lose a loved one. In these situations, it is almost certain that we will blame the hospital for ‘overcharging’ and not providing proper care.

Then there is the old inherited belief that healthcare is a noble profession and the providers of healthcare services should aim to serve the society rather than try and make some profits for their shareholders. This belief is so ingrained in our psyche, right from our childhood, that it is impossible to reconcile to the present day reality of private healthcare is as much a business as any other. An entrepreneur invests a very large sum of money upfront in creating infrastructure, buying state of the art equipment, hiring highly skilled and experienced clinicians and sustaining cash losses for many long years before he makes a profit. Yet we grudge him this and believe that since he has chosen to invest in healthcare, he must continue to serve humanity without expecting a reasonable return on his investment.

This sadly is the perceptual reality of private healthcare even amongst the well-educated, well to do people in our contemporary society.

Juxtapose this with the reality of high-end quality tertiary care in India being the cheapest in the world. Thousands of people travel from all across the world to avail of India’s high standards of healthcare at prices, which by global standards are almost unbelievable. Yet, in India, private healthcare institutions are reviled as expensive, profiteering and seen as overcharging. I remember meeting a CEO of a private insurance company in the US. The meeting happened at a global conference on medical value travel.

‘So, where are you folk, from’?

‘We are from New Delhi, India’.

‘Aha, India, so tell me something about your hospital’

The usual spiel about the hospital followed. I talked about some great work we were doing in Cardiac Surgery.

‘So do you guys do ‘bypass surgery’

‘Yes, we do. In fact a lot of it’

‘In a month, how many cases, would you be doing in your hospital?’

To keep things simple, I told him that in just one hospital we do about 10 surgeries a day. The gentleman clearly thought I had no idea of what I was talking about.

‘That seems a lot, how much does a bypass surgery cost?’

I thought, I should not tell him the real cost of USD 4500, lest he thinks that I was completely unaware of the cost of a bypass surgery.

‘Sir, we charge USD 10000 for the surgery’.

‘Well, that is impossible, it is humanly not possible to perform successful bypass surgeries for USD 10000 anywhere in the world’.

‘So what is your success rate?’

‘Well, it is close to 99%’.

‘That is simply impossible, we don’t have these kinds of numbers even in the US’.

I hesitatingly asked him, what in his opinion, would be a reasonable estimate for a bypass surgery in the US.

‘Well, I would say anything below USD 100000, would be difficult’.

‘But, you just can’t do this for USD 10000, there must be a catch somewhere’

By now, I was becoming a little hot under the collar. I told the gentleman, that we would be delighted to host him at our hospital in India and show him how the impossible is done. He would still not believe me.

Finally, I told him that just as he doesn’t understand, how the surgery can be done for USD 10000, I fail to understand, how does it cost upwards of USD 100000 in the US.

The gentleman never did accept my invitation to travel to Delhi to see how we worked. This is a true incident, and I narrate it only to underscore the point that while the world wonders at how private healthcare in India is able to deliver high-quality medical care at such low prices, patients in India, believe that the same healthcare services at even lower price points are obscenely expensive.

Private healthcare costs, though rising, still remain one of the lowest in the world. Large corporate hospitals have well-defined billing policies and most of the bills are generated through a sophisticated HIS system. After having worked for over 15 years in large private corporate hospitals in India, I am yet to come across a stated (or even unstated) policy, which says that let us overcharge for our services from our patients. The pricing is usually based on a cost-plus model and the ceiling is determined by the competitive situation in a particular market. Finally, the consumers always have a choice. If they find a particular hospital expensive, they can choose to go to the one that they believe is rightly priced.

Private corporate hospitals in India usually provide world-class care, medical outcomes comparable with the best in the world, highest possible service levels and at prices lower than anywhere else in the world.

By clamoring for more, let us not destroy that we should all be rightfully proud of.

A Time for Reflection

The last week of December is usually a time for reflection.

And the private healthcare industry in India has a lot to think about. The last two months have been those of turmoil for the industry. The crisis related to the implementation of a draconian Clinical Establishment’s Act in Karnataka led to angry protests by the medical community in Bangalore, while in Delhi two cases of alleged overcharging and medical negligence at the two leading hospital chains caused an unprecedented furor. Much has been said about these cases, I won’t add more, however, we must reflect upon what lies behind these flair-ups.

These cases must not be considered as an isolated outbreak of public anger with the media and the politicians blowing up the issues. While that did happen, we must look at them as a trigger for a far deeper malaise.

For a long time, private healthcare in India is increasingly being viewed by patients with a great deal of distrust. With the public healthcare in tatters, the consumers continue to flock to the private establishments, where the care and services are of high quality, however, they no longer trust their doctors and hospitals. This is an extremely worrying sign because the only thing that binds patients and clinicians is trust, an implicit faith in the system that the hospitals and the clinicians will always act in the interest of the patient.

We must ponder over what has led to this catastrophic erosion of trust.

Private healthcare systems are being increasingly looked upon as businesses with commercial interests, which far out-weigh patient’s interests. The media has been peddling this narrative for a while, highlighting cases of ‘wrong billing’ without diving into the arcane of what exactly is wrongly billed. Selective charges of profiteering on things like syringes and gloves are bandied about causing more damage. Somehow, the real narrative of hospital profitability measured in terms of financial parameters such as Return on Capital Employed (ROCE) do not find any mention in these stories. The fact that most private healthcare companies are barely profitable just doesn’t seem to register. Private Healthcare systems need to address this urgently. They must get together and build a counter-narrative, which highlights their often precarious finances and the enormous risks they have taken to build a healthcare system, which actually takes care of the needs of the majority of the people of our country.

While this needs to happen on the external front a lot of house cleaning must also happen internally. The hospitals must review their pricing structures and make them more transparent. The patients today are educated and if the components of a hospital bill are explained to them in detail, I am sure many will understand and appreciate.

The other big issue that destroys trust is the difference that the patients find in the estimates given at the time of admission and the final bill that they end up with. Medicine is at best an inexact science and in many cases, it is hard to predict a patient’s course during hospitalization. However, large private chains do have the data and technology to be able to predict estimates with a reasonable level of accuracy in a high number of cases. Thus a system can analyze bills of say, the last 500 patients who underwent a bypass grafting, exclude the outliers and predict the probability of the bill is a certain amount. This can be shared with the patients transparently. Even if hospitals do this for cases of planned and routine surgeries, I am sure the trust levels will increase.

The real trust builder is, of course, ensuring proper engagement and communication with the patients. Large hospitals, with hundreds of patients, often forget to pay enough attention to individuals leading to a sense of isolation and abandonment. The hospitals need to establish protocols for patient communication. The clinicians must sit down with the patients and their caregivers and explain how the patients are doing in the hospital, the challenges that they foresee and the prognosis. My view is that even if the prognosis is grave, it should be shared transparently with the caregivers. This should be done with great sensitivity and empathy and in a language which is shorn of all the jargon.

Finally, the biggest builder of trust is the time that a clinician spends with the patient and their caregivers. In busy hospitals, clinicians often just do not have enough time to spend with their patients. The out-patient consultations are frequently cursory and fleeting, often leaving the patient wondering whether their doctor has even understood their medical condition or not. While admitted to the hospital, sometimes patients don’t even see their surgeons even when they are being wheeled into the OT’s. Why can’t we have a system, where the operating clinician would himself visit the patient either in their rooms or in the pre-op area, reassure them once just before they face the knife. There can be many such processes that can be established, which gives greater comfort to the patients.

The media noise of profiteering resonates with patients and caregivers only because they find their hospital experiences sterile and scary. As the healthcare costs mount, the patients will need better experiences for them to trust their hospitals and care providers.

My belief is that the time has come for private healthcare providers in the country to walk the talk on patient-centric care. No amount of external regulation will help build the lost trust. It is only actions, which build trust in patients and their caregivers, which will help regain the lost ground.

And once we regain our patient’s trust, they will not find us profiteering nor will the media’s false charges stick.

Here is wishing all my readers a Merry Christmas and a very Happy New Year.

The views expressed are personal

 

The Aftermath

While the slug-fest between the government of Delhi and private healthcare providers, the Indian Medical Association/Delhi Medical Association and a completely partisan media continues, one is left wondering about the possible aftermath of this ugly episode. The media will soon move on to other stories and the government having scored some brownie points and having successfully demonstrated its ‘might’ will look at another vote-catching device, only the citizens of Delhi will be stuck with a much worse healthcare system.

Let us look at some of the reasons for this.

With the kind of sheer hostility that is being shown by the consumers towards private healthcare and individual doctors, many are already talking about not accepting seriously sick patients. Their fear is that if the patient dies in the hospital, they will be blamed for the death and they run the very real risk of being publicly abused by vicious and ignorant television anchors, beaten up by patient attendants and may be sacked from their jobs. In an environment where the media and the patients believe that it is the doctor’s job to get them well and that he is fair game if the outcome is not the desired one, we are clearly telling our doctors not to treat patients where there is a risk of failure. This will indeed be very sad because as patients we must give our doctors the confidence and the strength to fight the good fight to the best of their skills and ability. That trust is the very basis of the practice of medicine.

The advent of private healthcare had also seen some of the best and the brightest Indian doctors returning to India to work in these corporate hospitals. The world over, Indian doctors and nurses are recognized for their skills and diligence. There is much demand for them all over the world. The prevailing atmosphere of distrust and antipathy is already making many of them uneasy. Many have started regretting their decision to return and work in India. Many who were contemplating to return would now prefer to stay put. Many who had plans to go abroad for training, would now look at ways to bring their plans forward and try to stay abroad longer. One can hardly blame them.

Private hospitals are beginning to realize that it is far more important to have paperwork and video recordings of their patient interactions rather than a caring system, where people are encouraged to go the extra mile to help a patient. Since, the hospitals are not sure when they may be facing a media or a court trial, they will ensure that they are well protected at all times. This will further push up the cost of private healthcare. The undue activism visible today will end up defeating its own purpose.

Setting up and running hospitals is an expensive proposition. Only investors with very deep pockets can build the required infrastructure and sustain operations till they see profits, which happen years later and are meager in any case. If the local governments pandering to their vote-bases arbitrarily decide to shut down hospitals, why would investors put in money to build healthcare infrastructure in the country? The government spends on healthcare are in any case minuscule and compare poorly even with sub-Saharan Africa. The government hospitals are already over-crowded, mismanaged, filthy and without much accountability. If the private investors decide that investing in healthcare is not well worth the risk, where will the people like you and me go for our healthcare needs? If I was planning to set up a hospital in Delhi today, I would certainly think twice.

Working for some of the leading ”corporate” hospitals in India in the last 15 years, I have had the opportunity to travel the world. Everywhere that I have traveled, I have been uniformly asked one question, which is, how has Indian private healthcare system evolved so well. Considering the country’s other developmental parameters, private healthcare, which attracts patients from all over the world (Max Healthcare received patients from 80 countries across the world this year) stands out. Not only is the quality of health care compares well with the world’s best, the costs are the lowest. Ironically, instead of taking pride in our achievements, we are trying our best to run down our hospitals and the people who work in them.

Private healthcare players in Delhi are quite dumb-founded by the political grandstanding, the unwarranted hostility of an ignorant media and worse of all the support of ordinary citizens to this madness. Are we, the citizens of Delhi willing to pay this kind of steep price just because we believe the half-truths being peddled by self-serving politicians and a biased, unprincipled media?

PS: Might be a good idea to find out where these same politicians and media warriors and their families go to when they need serious healthcare. No prizes for guessing though.

The views expressed are personal.

The Destruction of Trust – A Media Trial and a Witch-Hunt

The last couple of weeks have been a difficult time for the healthcare services providers in the NCR of Delhi. The media have been busy reporting about how Fortis and Max Healthcare ill-treat their patients and how the only thing they care about is profits. Having worked in both the hospitals, I can only say that this is completely wrong. The media-houses in their zeal to sensationalise and chase TRP’s are doing a great dis-service to these hospitals and the the medical profession in the country. The reporting is biased, short on facts and the conclusions drawn are completely unwarranted even bordering on fantasy.

The stories pertain to two cases, one at Fortis Hospital, Gurgaon where a 7-year-old child died of complications related to Dengue and the hospital is accused of over-charging and being callous. The other pertains to Max Healthcare, which is charged with negligence as one of the twins born at 23 weeks gestation was wrongly declared dead at Max Hospital, Shalimar Bagh, Delhi. The false narrative being spun is that the hospital chains are negligent, money- making machines and do not care for their patients. The outrage is completely manufactured and the stories falsely amplified and one-sided.

To make matters infinitely worse the politicians too have jumped in. They clearly want to be seen as championing the poor masses, who mostly cannot afford the services of these hospitals. The hospitals are being subject to multiple enquiries and the police has been called in to investigate the ‘murders’. The hospitals are being threatened with the cancellation of their licenses. (Strangely, a few months ago when scores of children died at a government owned hospital in Gorakhpur because the hospital ran out of oxygen supplies, no one thought of cancelling the license of that hospital)

Lest, we forget, both these hospital chains are amongst the top 5 private healthcare services providers in India. Between them they run more than 40 hospitals, treating thousands of patients every day. They are amongst the most well equipped hospitals in the country, boasting of the highest levels of technology, processes and systems and have patient outcomes comparable to the best in the world. They employ the finest of clinical talent available in the country and provide them an environment to excel. The hospitals attract thousands of patients from all over the world, who travel from across the globe seeking treatment for the most complex of diseases. Having worked in both the organisations, I can confidently say, that while there are many differences between the two institutions, both are thoroughly committed to the highest standards of patient care.

In-spite of all this, the hospitals are not infallible. No hospital in the world is. They can only aspire to do better, keep improving themselves and always try to do the best they can.We need to ponder, how these centre of clinical excellence have suddenly become pariahs overnight basis two cases, where there have been lapses. Like in any other profession or sphere of human endeavour, errors are inevitable. Tight processes, technology support and intent to weed these errors out is far more important than the errors themselves. On these, I can say without any hesitation that the hospitals compare favourably  with the very best that we have in the country.

The line between genuine errors and negligence is very thin. Doctors, while racing to save lives are required to make split second decisions, which may mean the difference between life and death to their patients. Sometimes not taking a particular decision may prove fatal and at others taking a particular decision may lead to complications. We have to trust our doctors to take the right decisions based on their experience and judgement. We also have to accept the fact that their decisions might turn out to be wrong and that these decisions can have horrendous consequences. This is just the nature of medicine. An adverse outcome doesn’t mean that the surgeon or the hospital messed up. It mostly means that they tried their best and yet didn’t succeed.

This is something very fundamental to healthcare. As patients or care-givers, we must support the doctors as best as we can. We can question, we can ask but let us not blame, at least, not every time something goes wrong. If we believe that there is a case of genuine negligence, as consumers we do have options. We can lodge a complaint with the Indian Medical Council, approach the consumer courts or go to the police. We must use these options judiciously.

Getting back to the baby, who was born at 23 weeks of gestation at Max Hospital, Shalimar Bagh. It has now been established that the decision, not to resuscitate the child was medically correct as he had a very slim chance of survival. The prognosis in case of survival too was also very poor. The decision to declare the child lifeless, without fully ascertaining the fact of death was wrong. Failure to properly communicate this tragedy to the parents too was an error. Was this negligence? Was their any malafide intent of causing harm to the child or undue pain to his parents? In my view this certainly wasn’t the case. I am not an expert in these matters and various eminent clinicians are conducting an enquiry about what happened. My view as a layman is that someone made a mistake, it was a bad mistake to make, hopefully some lessons too would have been learned and this would never be repeated again.

Does this mean that the hospital, the doctors and the administrators be called vultures, cheats and murderers and have rampaging mobs running amok in the hospitals baying for their blood?

The views expressed are personal.