Medical Outcomes and Customer Experiences

My father was diagnosed with an oral cancer last March. He had been staying with me in Delhi and fortunately, we had plenty of choice in selecting a hospital, where we could possibly have him treated. After carefully evaluating these choices, we zeroed in on two possible facilities –  Medanta Medicity, the new hospital in Gurgaon and Max Hospital in Saket. At Medanta the leaders of the Oncology team were my colleagues during my stint at Artemis Hospital in Gurgaon, and I enjoyed a great relationship with both Dr. Ashok Vaid and Dr. Teji Kataria, the medical and the radiation oncologists respectively. At Max Hospitals I did not know the doctors personally, they did not have a cancer facility when I worked there, but I had plenty of other close friends who ran the hospital and vouched for the caliber of their team of Dr. AK Anand and Dr. Anupama Hooda. Ultimately, with all things equal we chose Max, simply because it is closer to our home and the logistics prevailed.

This was in March and my father had since undergone Targeted Chemotherapy and Radiation Therapy on an IGRT machine. Post the treatment, he is doing as well as can be expected and I am extremely grateful to the oncologists at Max Hospital. In these past 6 months, I have been visiting the facility often and have become familiar with the customer handling processes at the hospital, which unfortunately still leaves a lot to be desired. While, the medical outcome of the treatment we have received at the hospital has been good, purely as a customer, my experience with the hospital services can hardly be termed satisfactory.

Here are some suggestions as to what can be done to improve the overall hospital experience.

The Issues with Group Practice

The radiation team at Max Hospital follows a group practice system and is led by Dr. AK Anand, who comes across as an extremely competent and experienced physician. He has a fairly large team of physicians, who support him in the OPD. Now, these are mostly young physicians earning their spurs under Dr. Anand’s supervision. Since, the team works on a group practice system, a patient gets seen by any of these physicians in the OPD. Thus, more often than not it so happens that one meets a new physician whenever one visits the hospital. From a patient’s point of view, it is very disconcerting to interact with a new physician and start the entire conversation right from the beginning every time one visits the hospital OPD. Also, the entire team is not of the same pedigree, many doctors are younger, less experienced and seem to be apprenticed with Dr. Anand. They often do not come across as confident and as sure as Dr. Anand, a very important factor, when the disease involved is a cancer.

The entire system revolves around a physical file, where all the doctors jot down their noting on loose sheaf of paper, which is than filed away. Each OPD visit means that the physician assigned to see the patient goes through the file, figure out what had happened in the previous visit and issues fresh instructions on the file. I submit it is quite impossible for a physician to study this file in the time that he is spending with the patient and fully understand what has happened thus far. The chances of human error are high. Max Hospital is bristling with posters on the notice boards about a state of the art e-initiative which is supposed to take care of all medical records electronically. While one goes through the tall claims about this new system, one finds it hard to reconcile it with the archaic processes in the Max Cancer Centre.

The system seems to have been designed around the physicians, one feels it should be, in this age and time around the customers. It should assign a particular doctor to a patient and he should see the patient through. If there are junior doctors involved, they should see patients along with the seniors, till they themselves feel comfortable in handling patients on their own. The physical files are ridiculous and can be done away with completely. Like in any other modern hospital, the information should flow seamlessly on a well-connected network. Reports, instructions etc. can and should be as far as possible e-mailed to patients.

The Appointment System

Strange as it may sound the appointments given to the patients have little value. Almost all patients are required to wait for a minimum of 30-40 minutes, whether they have a confirmed appointment with their physicians or not. Because of the prevalent group practice system, it is also quite immaterial whether you have an appointment with Dr. A or Dr. B.,  you can be ushered into the office of any  doctor on the team and he will see you irrespective of the fact that you have an appointment with a particular doctor. Thus, I have not really understood, why are appointments given for any particular doctor. In this system, it would make greater sense if one was to just walk in and gets seen by which ever doctor who is free at that point in time!!!

The Files

The files are the most important element in this entire process. Sometimes I have wondered what would happen if it would be misplaced. Actually it happened with us once, when the file had been requisitioned by the medical oncologist, and it took two hours, some very heated words and a few very flustered employees to find it. In the absence of the file, I would reckon the doctors too would be quite helpless. I have been assured that the paper file does have an electronic back-up, which honestly I doubt. I shudder to think that in this age and time, at Max Hospital, we might be at the mercy of a file, which changes hands every time a doctor sees us and God forbid, if somehow it is lost in the hospital.

While all this may sound strange and terribly dated, I must say that the system somehow works. We have no complaints on the medical outcome, which is the primary reason we have been visiting the hospital. As a patient and a care-giver I do not have much to complain about. However, as a modern-day paying consumer, wouldn’t I want my hospital experience to be far superior and fool-proof than what it is.

Hospitals must understand that in this age of customer experiences, it isn’t the medical outcome alone that counts. Max should know this better than anyone else.

Panel Discussions on the occasion of The World No Tobacco Day

Today is the World No Tobacco Day (WNTD). It is observed every year on May 31st. World Health Organisation started observing WNTD from 1987 and it is promoted globally to create awareness about the perils of tobacco abuse and to encourage people to give up using tobacco.

To commomorate the day, I moderated two panel discussions in New Delhi on the harmful effects of tobacco and how can one kick the habit for good. The panelists were all eminent doctors from Max Healthcare. These included Dr. Sandeep Buddhiraja, who is the Director of Internal Medicine practice at Max Hospitals, Dr. Samir Parikh, who is a well-known psychiatrist and also heads the Mental Health institute at Max Healthcare, Dr. IS Virdi, who is the director of Cardiothoracic Surgery at Max Hospitals, Dr. Harit Chaturvedi, who is a Onco Surgeon and the Director of Onco Surgery at Max and Dr. Anupama Hooda, who heads the medical oncology practice at Max. We had a packed house, a very interactive audience and some very interesting discussion.

I have known Dr. Buddhiraja for many years. He is a founding member at Max Healthcare, we worked together for almost 5 years, when I handled the Marketing function at Max. He continues to be my physician and has on numerous occasions treated many members of my family. In all these years I have known him to be a quiet, sincere and thorough professional, somebody whom you can implicitly trust. Today, I discovered another facet of Dr. Buddhiraja, that of a fiery crusader against tobacco abuse. Sandeep, had come prepared with all the facts, which pointed to a huge burden of disease, that is caused by tobacco abuse. He spoke with great passion, while talking about the harmful effects of tobacco. He is clearly much distressed about the increased use of tobacco in its myriad forms, cigarettes, gutkhas, chewing tobacco, pan masala, snuff etc., which is being impudently hawked on our streets. ”On one end of a cigarette is fire and ash and on the other a moron”, is how Sandeep succinctly put it.

Dr. Virdi, made a simple point saying that you can trace almost any lifestyle disease today to tobacco. Be it heart disease, peripheral vascular disease, a stroke and oral and lung cancers, tuberculosis of the chest, all of them are linked to tobacco. This hit home much closer, and I wondered aloud about my father’s illnesses in his almost 60 years as a smoker. He has had tuberculosis twice, a stroke last year and is currently battling with an oral cancer. So much for a puff!!!

Dr. Chaturvedi and Dr. Hooda had a field day, with oral, lung and other cancers having a clear association with tobacco. They too are passionate doctors and see enough and more cancer victims every day, who would be  healthy, if only they had stayed away from tobacco. One can feel their pain and if I may say anger at young people not realizing the grave danger of abusing tobacco, till they reach the office of an oncologist. Dr. Chaturvedi, wondered how is it that once someone is diagnosed with oral cancer, he gives up smoking without missing a beat. My father kicked a 60-year-old habit, the day we told him about his cancer, incidentally diagnosed by Dr. Chaturvedi himself. He wondered that giving up tobacco can not be all that hard.

Dr. Samir Parikh is one of those irrepressible live wires, who have a view on almost everything. Being a psychiatrist and that too one of the most well-known in Delhi, Dr. Parikh counsels and works with lots of people struggling with substance abuse including tobacco abuse. Dr. Parikh and Dr. Buddhiraja talked about how and why one starts with tobacco. Peer pressure, cultural shibboleths including smoking being ”cool”, and myths like ”I can quit anytime”, came up as the most prominent reasons for most people lighting up. Samir and Sandeep, both were emphatic in their pronouncement that tobacco abuse is not merely a habit but a disease. They cited ICD classifications on nicotine abuse and gave medical reasons for nicotine addiction and elaborated on the treatment that can help one kick the disease. They run a tobacco cessation clinic at Max Healthcare and work with smokers, who are keen to quit, but find it hard to get rid of the problem.

My colleague Saurabh Avasthi, who smoked 30 cigarettes a day and then gave up one fine day in October last year also spoke about how he started and how steadily tobacco caught him in its vise like grip and how one day, he just decided that enough was enough. He said that he symbolically buried cigarette sticks and then just never lit up again. The first ten days were hard, when the pull of nicotine, was at its worst and he would count his smoke free days. Over a period of time, he realized that the urge no longer existed and now he says that the stench of tobacco nauseate him.

In the final analysis we concluded that there is no running away from the fact that even one cigarette per day is really one too many. In over 150 people, who attended today’s panel discussion, even if one decides to give up tobacco as a result of today’s session, I would reckon, we would have achieved a lot.