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.

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The Advent of ‘Reverse Medical Value Travel’

Well, I don’t know what else to call it.

But this seems to be an emerging opportunity in the broader Medical Value Travel firmament. Last week, I learnt that my friend and former colleague Dr. Sunil Prakash, who is a well known nephrologist in New Delhi, was a part of a team that performed a kidney transplant at the Muhimbili Hospital in Dar es Salam, Tanzania. Dr. Prakash posted happy pictures with the patient and it appears the event generated excitement and a lot of publicity in Tanzania. Apparently, this was the first ever kidney transplant conducted in the country.

Essentially an Indian team of doctors carried out a complex surgery in a hospital in Eastern Sub Saharan Africa. Instead of the patient making the journey to a hospital in India, a team of doctors traveled and treated the patient in a foreign hospital.

I would call this ‘Reverse Medical Value Travel’ and I expect this to increase in the coming years.

This is certainly not new phenomenon. Many years ago Fortis Hospitals had tied up with the Talimi Hospital in Basra, Iraq. Fortis started conducting cardiac surgeries in the hospital in Basra. A team of surgeons, anaesthetists, perfusionists and a bunch of nurses would arrive in Basra and would go straight to the hospital and operate patients, who were pre-selected and already admitted in the hospital. A new team would arrive every week to replace the previous team and the teams would typically rotate every 6 weeks or so. This was a very successful program, ran for several years and I am told over 900 surgeries were conducted. I remember the initial problems we had in getting the clinical teams to travel to Basra but once the program started, it really took off.

I am sure there would be other examples of successful ‘Reverse Medical Value Travel’ elsewhere too.

The Reasons for the Emergence of Reverse Medical Value Travel

The primary reason for the inevitable rise of ‘Reverse Medical Value Travel’ is not difficult to understand. In many parts of the world, with healthy economic growth, are emerging exciting opportunities in the business of healthcare. Enterprising organisations and individuals are willing to invest in healthcare infrastructure such as hospital buildings and medical equipments, essentially things that money can easily buy. One can build a reasonably sized hospital in under 2 years but it is indeed difficult, well nigh impossible to develop a steady pipeline of clinical talent to work in the hospital. It takes several years if not decades for good medical teaching institutes to produce high quality medical talent. Thus, there is an emerging and deepening shortage of qualified and experienced medical teams who can sustain the new hospitals coming up at a frenetic pace.These hospitals are relying on importing medical talent from abroad. Successful clinicians with good patient base rarely uproot themselves and move to new pastures. Thus, we see clinical teams traveling for short durations and the emergence of “Reverse Medical Value Travel”.

The Advantages of Reverse Medical Value Travel

One of the key advantages of Reverse Medical Value Travel clearly is that it saves sick patients long distance travel. It allows patients to be treated closer to their homes, surrounded by family and friends and in a familiar environment. After being discharged from the hospital they can straightaway head home. I am sure this leads to faster healing and recovery.

The other advantage lies in sheer numbers. A single team of doctors can treat a large number of patients in one visit. Thus, a team of 5 can perhaps operate 25 patients over a a week. This implies that less number of people need to travel. Usually, when patients travel, they are also accompanied by family members and care-givers. The hassle is so much less.

Reverse Medical Value Travel brings the benefits of training and learning to the local clinical teams. They inevitably join in the surgeries and learn by working with experts from abroad operating in their hospitals. This is of immense value as the local teams learn and practice new skills with old masters. This transfer of skills and knowledge creates a ‘guru-shishya’ relationship with strong and long-lasting bonds. It also develops tremendous goodwill and bonding.

For the visiting clinicians operating in alien environments, often facing a language barrier and working in different cultural settings is also a tremendous learning. Most love the challenge and enjoy proving their mettle in these relatively difficult situations.

The local governments consider ‘Reverse Medical Value Travel’ as a boon. The precious foreign exchange outgo is much less, the skills enhancement and the goodwill generated in the local communities is tremendous, the media is very supportive – perfect for local politicians who welcome the foreign clinical teams with open arms.

This is a win-win for all.

The Pitfalls

While “Reverse Medical Value Travel” gradually takes wings, one has to carefully consider the risks as well. The clinicians operating in foreign hospitals have to be well protected with indemnity insurance and in some difficult places with blanket immunity. The hospital infrastructure has to be very good and the doctors should not be pressured into operating cases that they might not be comfortable with. The clinical protocols of the hospital, infection control measures and other critical medical parameters must be of a high order. The teams for post-operative care should be well trained to look after the patients once the foreign teams have departed.

In most countries, local hospitals or governments take care of most of these.

I believe that “Reverse Medical Value Travel is a great opportunity for Indian Hospitals. It can help them earn not only dollars but universal respect and tremendous goodwill.

The Hindustan Times and the Hospitals in Delhi

HT Report 1The whole of the last week The Hindustan Times carried a series of stories highlighting incidents of ‘negligence’ in high profile private hospitals in Delhi. The hospitals featured included Fortis Escorts Hospital, Max Hospitals, Apollo Hospital, Sir Gangaram Hospital and Rajiv Gandhi Cancer Hospital. Now these hospitals in Delhi are the best that we have. While, Hindustan Times has a right to expose cases of negligence in hospitals I am still not sure what purpose was served by these reports.

Here are a couple of points I would like to make about these ‘exposes’.

The cases reported highlighted horrific experiences consumers had in these hospitals. Most people featured in the story lost a loved one because the hospital failed to deliver adequate care and refused to take responsibility for what went wrong. These I am afraid were random cases picked up by intrepid journalists and made for riveting reading. However, the journalists doing these stories did not investigate the reason for these failures. The question why did these hospitals fail in their duty towards their patients remains unanswered. Was the failure a result of a doctor not discharging his duties properly, or was it a failure of the hospitals processes or both? Or was it negligence or an error of judgement on the part of a doctor? Did he deliberately mistreat a patient, was callous in discharging his duties, wilfully deviated from standard medical practices or just did not care enough?   Continue reading

The Marketing of a Hospital

Before I get into the business of writing about the Marketing of a Hospital in India I must establish my credentials.

I have been working in the arena of Marketing of Heathcare Services for the last 8 years or so. I have been involved with Apollo Health and Lifestyle Ltd., which is the franchisor of Apollo Clinics part of the Apollo Hospitals Group, headed the Marketing and later the Corporate and International Sales for Max Healthcare a large healthcare services company based in Delhi and for the last two years have been heading the Sales and Marketing function at Artemis Health Institute, a tertiary care hospital based in Gurgaon and promoted by the Apollo Tyres group.

When I started working for Apollo Hospitals as the Marketing Manager for The Apollo Clinics and later at Max Healthcare I was often asked the question as to what really a Marketing person did in a hospital. Marketing of hospitals was understood to be a big no no. If you had a good hospital infrastructure and some well known doctors working for you the conventional wisdom dictated that the patients will follow.   Continue reading