Connecting Better with Patients Works Wonders

Hospital_bedside_caring2

Most doctors I know are reticent with their patients. Curiously the better they are at the work they do, the greater the reticence. They will walk over to the patient’s bed, look at the charts, confer with their colleagues, instruct the nurses, maybe inquire from the patient about how they are doing, mumble a few reassurances and then they are gone. The patient is often left pining for more information and hoping that their doctor would spend a little more time with them, maybe even share a light-hearted moment to lighten a grim day or just hold their hand for a while.

While medical outcomes do matter in the end, a doctor’s ability to connect with his patients is what matters during their stay in the hospital. I recall how Dr. Harsha Hegde a former colleague and a orthopaedics and spine surgeon would interact with his patients on his rounds. I have seen him checking on his patients, while chatting up with them on all manner of things. He would walk into a room, chat up with the patient about anything under the sun, engage with the patients as a friend, assure them that they will be out of the bed soon, crack a joke or two and in the same breath pass on the necessary instructions to the nurses or other colleagues. I even recall on many occasions, he would invite a patient out for dinner in the evening, particularly the day before the patient would be ready for discharge from the hospital!!!

Once we had a patient from the US, a school inspector if I recall correctly. He had come in pain and required a two level cervical disc replacement surgery. Dr. Hegde, duly operated on him and one evening as I was heading home, I saw him in the hospital lobby with the patient. Apparently, Dr. Hegde was taking him out for dinner !!! The patient too appeared to be in a state of shock, saying that he could hardly believe his luck. Three days back he had arrived from the US suffering from excruciating pain, and here he was heading out for a dinner with his doctor, who already seemed to have wrought a miracle.

While, what Dr. Hegde does is exceptional, most patients would be happy with a lot less. When the doctors start connecting with their patients, the patients also tend to be a lot more forgiving. A nagging unexplained pain, a sudden unexpected turn for the worse, a longer than planned stay in the hospital, and even a bigger bill are forgiven if the patient believes that their doctor was nice to them.

These patients than start spreading the good word around. They often exaggerate their experiences, the doctor turns into that wonderful knight in shining armour, who came riding on a mythical horse and saved them from the jaws of death. The doctor becomes a true saviour, capable of doing nothing wrong and the hospital too acquires a nice and warm halo. These patients are truly a healthcare marketer’s delight, they are the ones who do all the marketing and the doctor’s reputation and the number of patient’s queuing up outside their door goes up exponentially. The doctor loves it, the hospital loves it and of course the patients love it as well.

On the other hand, a very good surgeon with excellent outcomes, but with a grumpy, matter of fact style, would always be a lesser surgeon in the eyes of the patient. While, the patients would be happy with the excellent outcomes, they would always add a line saying that the doctor is rather ‘difficult’. And, here not surprisingly the patients would find many things wrong with the hospital as well. For some strange reason they will find that the nurses do not respond on time, that the food served is rather cold and bland, the pain relief offered to the patient is poor and the hospital overcharges for everything !

Life in a hospital is such. However, I do have a hunch, doctors, who connect with their patients better, also help in faster healing. The patients probably recover quicker and better, they return homes in a better and happier frame of mind and ultimately, that is really what truly matters.

Advertisements

Hiring Right Makes a Hospital Special

Hiring right, is at the best of times a tricky proposition, more so if one is attempting to hire people to work in a hospitals. This becomes even more difficult if one is hiring people in managerial roles in non-medical areas, folks such as the Front Office Executives, Case Managers, Service Line Managers or Sales Managers.

This is primarily because healthcare services are unlike any other service industry. The customers here are both patients and customers, they are unwell, they don’t want to be there but circumstances have forced them to seek the services of the hospital and the expenses incurred unlike say that of a restaurant or an amusement park are an unforeseen burden. Many a times, they have been compelled to travel far away from home and they are alone amongst strangers, who will have an immense amount of power over them. And to make things a lot worse is the lingering uncertainty about the medical outcomes, indeed about life and death.

People working in hospitals must understand these factors well. Medical folks because of the virtue of their training and  knowledge comprehend these facts instinctively. However service personnel, who have moved to healthcare services from say the hospitality sector are often caught by surprise and are left wondering about the interplay between patients, customers and hospital staff.

Thus, a hospital must be very careful in hiring the right people and then training them in handling customers and patients. Here is a small checklist of what I look for when hiring people in a hospital.

Empathy:

This is the single most important characteristic that I look for in an individual. It is absolutely essential that those who work in hospitals have empathy for patients and their attendants. Many years ago I heard a doctor say that she always tries to remember that it is not a tumour that she is treating, but a human being. Anyone who works in the hospital would do well to remember that. In a hospital I would like to hire people, who can connect with those in distress and interact with a measure of understanding and compassion.They must treat every patient and his problems as the only one that they have to handle that day.

Patience and Maturity:

It is imperative that a hospital hires mature people with loads of patience. This will help in managing patients, who are generally impatient-to see the doctor, get the tests done, lay their hands on that elusive report and get the hell out of the hospital. Since most people find it hard to understand matters related to their illnesses and treatment options, it is best that we have people who can explain these things patiently, without losing their cool and without showing the slightest signs of indifference.

Hunger for Knowledge:

It is a myth that in a hospital, medical knowledge should remain restricted to the medical folks and it is only they who need it. I have seen patients asking questions from patient care executives about arcane surgical procedures, about diagnostic tests prescribed by the doctors and even about their prognosis. To my mind, every individual working in a hospital should aim to acquire and benefit from basic medical knowledge. For me, part of the charm of working in a hospital has always been the immense amount of knowledge I gain by interacting with medical colleagues. In conversation with doctor colleagues, if I find myself lost, I never hesitate to ask them to stop and explain things to me in terms that I can understand. It always helps, when I am required to explain a procedure to let us say a foreign patient contemplating travel to our hospitals in Delhi.

Ability to Get Along with Doctors

It takes a special kind of skill to work with busy doctors, who are always short on time and stressed out. One needs to adapt to their work schedules and understand their pressures to put things in the right perspective. Also, one must remember that they are trained as doctors and not as professional managers, thus often their understanding of a manager’s world is not the same as that of another professional manager. In my experience it is best to always try to understand, where they might be coming from rather than articulating management dogma, which they may not understand well or may find obnoxious.

Optimistic and Cheerful Disposition:

Those blessed with an optimistic and cheerful world view do well in a hospital. A hospital needs loads of people with a sunny disposition, who always look at the brighter side of things and who are hard to put down. These are individuals, who are eager to help, who go out of their way, do that bit extra to make someone happy, because that is what makes them happy.

Rigorous training and an organisational culture based on openness and trust helps these people become good to great and transform the hospital into a wonderful place of healing and caring.

Why some of our doctors have such poor bedside manners?

I have often wondered, why some of our doctors have such poor bedside manners and never more so since my father’s surgery.

My father underwent an urgent Prostate Surgery earlier this week. The surgery was conducted at one of the most well-known and if I may add, sought after hospitals in South Delhi. The hospital and the surgeon are familiar to me from many years and yet this is what happened one evening.

The surgery in the morning had been uneventful and the surgeon was happy with my father’s progress. In the evening as my wife and I sat in his room in the hospital, two gentlemen barged in and started examining my father. They lowered his pyjamas for the examination, chatted with each other, assured him that all was well and walked off. As they were leaving I asked them who they were and one of them introduced himself as an associate of my father’s surgeon and left.

Now here is my problem.

I have no idea who these people were. They wore no surgeon’s gowns, they had no telltale stethoscope around their necks. They marched into our room without a knock and proceeded to examine a patient, without his permission. They removed his pyjamas for an examination, with two people sitting in the room and the door wide open. I was shocked to witness this humiliation and I could feel my father’s acute discomfort.

To the doctors, strangely nothing appeared to be amiss! When I stepped out to have a word with these gentlemen and pointed out their completely unacceptable behaviour, they appeared surprised that a patient’s attendant has the gall to question them and arrogantly dismissed me saying that if I had any complaints I needed to address those to my surgeon! They did not deem it fit to utter a word of apology for their appalling conduct.

All this at as I said earlier  at one of  Delhi’s finest and most expensive hospital.

Why do some doctor’s treat their patients as if they do not exist or matter? I believe this is primarily because we patients allow them to. In India, a career in medicine enjoys tremendous social prestige and doctors are treated with enormous amount of respect. We bestow on our doctors God like powers of life and death and since in our eyes they are Gods, we refuse to see their shortcomings and failings. Gods afterall can treat us, the mere mortals, as they please.

To make matters worse, most of our doctors receive their training in government hospitals, where the poor and the uneducated see these doctors in their shiny white coats and stethoscopes as people from another world. In these hospitals overflowing with people from ‘darkness’ (to borrow a word from Arvind Adiga’s ‘The White Tiger’) they are treated as the lords and the masters of all whom they survey. These doctors  from an early stage in their training imbibe these behavioural patterns and one assumes that in later life, in different hospitals and while treating educated folks, the old habits refuse to die.

Lastly I also believe, that parental and peer pressure force many a youngster to choose medicine as a career, while they just do not have the calling. The admission procedures are also flawed as they test knowledge but not aptitude. Thus we have doctors, who have no business being doctors. They are trapped in a glorified profession from which there truly is no escape. Can we really blame them for (mis)treating patients the way they do?

How do we cope with such arrogant and errant doctors? Well, I see no reason why we cannot simply ask them to treat us better. Their ego may stand in the way of apologising or showing contrition, but I am sure they will think twice about being discourteous the next time around.

And that should be a good enough start.

PS:Lest this sounds like a diatribe against doctors I hasten to add that I also know many very competent doctors who treat patients with great courtesy and professionalism. They are warm individuals, love their work, have great compassion for the sick and look upon their profession as nothing less than a calling. They not only treat but heal and that is where the real difference lies.

PicCourtesy: http://thyroid.about.com/b/2008/08/19/six-rules-doctors-need-to-know-and-six-ways-to-be-a-better-patient.htm

So much for my ‘Indian Hospital Experience’

Doctor WhoWhile trawling the net I came across a blog (http://www.travelblog.org/Asia/India/National-Capital-Territory/Delhi/blog-440604.html) about the travails of an American, getting treated for a mole/wart/skin cancer in New Delhi. The experience narrated in this post is exactly the kind of stuff we do not want. I am amazed at some of the narration and the stereotyping this does of the Indian doctors and medical system.

The blog has a semi mad sardarji (sikh) as a doctor who speaks and understands no English, laughs at his own jokes in Hindi and does not understand the difference between a mole and a pimple. The doctor has never heard of the United States and knows America, a country whose citizens are rich and ripe for fleecing. The doctor prescribes lotions and creams for treating the mole, which are not available at his own pharmacy and the patient (the author) walks out, having parted with Rs. 500 and nothing to show for it. Astoundingly, this gentleman returns to the clinic of the mad sardarji, encounters a ‘wildeyed’ patient on a wheelchair, and asks the doctor to burn off the offending mole in the emergency room next door.   Continue reading

Hospitals are all about People’s Skills

skill-setsI have rarely come across an industry, which requires a range of skills, which are wider than what one sees in the people, who work in hospitals. A hospital actually is an amazing aggregation of skills and talent, which one would hardly see in any other human enterprise.

Among the medical folks, there are doctors who are hugely knowledgeable, highly educated and supremely skilled in the art and science of medicine, there are nurses and paramedics, who symbolise compassion and care and there are support folks who provide critical support for running the medical function in the hospital.

Amongst the managerial teams, there are managers who handle the front office and interact with patients and their attendants. They are the face of the hospital, well trained, well groomed very presentable folks, who help put patients at their attendants at ease. They usually have very good communication skills, are people with immense patience and a sunny optimistic disposition.

A hospital also needs a lot of technical support and thus you find high tech bio medical engineers, who ensure that all the equipment in the hospital works flawlessly. Imagine what can happen if an equipment in the OR or in the ICU malfunctions at a critical moment. Much like doctors, their role requires quick thinking, complete mastery of  technical matters and planning for any eventuality.  Most bio medical engineers are rarely seen and heard in the hospital but behind the scenes they control the levers of the hospital.

These days a modern hospital runs on state of the art software, which connects every hospital function. A doctor can not write his notes or ask for medicines till the orders have been punched in the Hospital Information System (HIS). The nurses can not dispense medicines unless requisitioned through the HIS. A patient can not be admitted or treated unless the relevant files and records have been created in the HIS. While most hospitals do have a back-up manual system, it is rarely used largely because an IT team employed by the hospital ensures that the HIS is rarely down. These people are often quintessential techies, with very sound knowledge of hospital systems and processes.

At a 180 degrees of separation from these folks are people who look after functions such as Food & Beverages, Housekeeping and Security. They are all trained individuals as much an expert in their areas as any techie. They interact with patients and their attendants and hence also have superb skills in handling patient grievances. 

While all of those mentioned above contribute towards keeping the hospital humming, another set of people are those who manage the business side of things and have a completely different set of skills. These include the sales and marketing folks, who represent the hospital to an external environment, purchase managers and store keepers, who ensure that the hospital is well stocked with all the essential supplies and the finance guys, who keep an eye on how the money is being spent. People in all these functions have unique strengths. The finance guys are very good with numbers, the sales people drive innovation and have good communication skills and the purchase folks have tremendous negotiation skills and an uncanny smell for a deal.

A good hospital will always have good Human Resources and training personnel. They are the ones who ensure harmonious working relationships amongst a very varied and highly skilled workforce. They make the rules, which govern the conduct of individuals in the hospital, play a critial role in rewards and recognition systems, act as agony aunts and handle conflicts. To my mind the most important skill they bring to the table is an ability to get on with people, understand differing point of views and manage aspirations of a very diverse bunch of people. 

If I was to select two critical skills, which an individual who aspires to work in a hospital must possess it has to be compassion and communication skills. Anyone, who works in a hospital must have loads of compassion towards fellow human beings, an innate ability to see things from the patients perspective and take decisions with empathy and  with an utmost regard for the plight of the patients. The ability to communicate well with language or through a meaningful silence or by just a touch, would be a close second. Be it a doctor, a front office manager or a sales person the ability to communicate the right thing at the right time to the right person is an immensely valuable gift.

Pic courtesy www.flickr.com

Doctor Doctor!

doctorSushil Jain and I grew up together in Indore, a provincial city in Central India. We were classmates for about a decade and I have known him from the time when both of us were about 8 years old. Sushil is now a cardiothoracic surgeon. I remember him today because unlike anybody else in our school class, he was from very early on sure about the career that he wanted to pursue. From as long as I can remember he wanted to be a doctor, just like his father. 

Sushil chased his dream with a single minded focus, prepared hard, appeared for the Pre Medical Tests, failed once, tried again and eventually succeeded in joining the medical college in Indore. He worked hard and graduated, tried a couple of times for admission in a post graduate course, failed and tried again. Finally, he trained to become a surgeon and is now well into surgical practice in a hospital in Indore.   Continue reading

On Nursing

nurseNursing is perhaps the most important function in a hospital. The nurses spend the maximum time with patients, are physically involved in taking care of them, are the first port of call if the patients need anything. Nursing professionals are also drivers of the hospital imagery. They epitomise care and efficiency and the patient experience that they deliver is what the patients carry with them. Well trained, well groomed and efficient nurses are a huge asset to a hospital. They are really the backbone of hospital operations.

And yet they are often treated in hospitals in India as mere skilled workers. They are made to work long hours (double shifts are common), live in hostels with bunk beds and have little by way of personal lives.     Continue reading