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.

Indian Hospitals Need New Online Initiatives

Websites of Indian hospitals are hardly something to write home about. They are mostly poorly done, difficult to navigate and usually the information lies buried so deep that it tests ones patience to get the relevant information . The other day, it took me close to 20 minutes and numerous clicks to locate the address of a hospital from its website. I needed the address to send a Diwali card to a friend who works at the hospital and try as I might, I just did not seem to find the address of the hospital.

Almost all of the hospital websites that I am familiar with are largely static. Thus, they do not interact with patients or caregivers looking for specific information. They do not allow one to book appointments, download reports, interact with doctors taking care of ones loved ones, send good wishes or chat with the patients. They do not support e-commerce. Thus if I was an NRI living abroad and wanted to buy my parents an annual health check or if I wanted to pay their hospital bills on line, I just can not.

In the era of burgeoning medical travel and with Indian hospitals attracting a sizable chunk of patients from all over the world, this does seem strange. For some unfathomable reason, Indian hospitals have not invested too much on their websites or for that matter on online marketing per se. I believe it is high team someone woke up and used the net better.  

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.  

Hospitals are all about People’s Skills

I 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

The HIS Devil in Healthcare Experiences

Information technology is meant to enhance the quality of service and experiences delivered in a hospital. Once a patient is registered in the hospital, the subsequent visits can than be recorded and the visit log used for either customising the services or improving the experiences. It also helps the hospital maintain patient records, which can be pulled out at the push of a button. These can help the medical teams see a fairly complete patient history and allow correct diagnosis.

More intelligent systems are now deployed at state of the art hospitals, which even provide aid to physicians in diagnosing and treating a patient’s condition. They also ask a question and alert the doctor if they spot an anomoly. For example if a drug prescribed to be administered is contra indicated or if it has been given by another doctor on duty two hours ago, the system can raise an alert and inform the doctor. These systems are great to have.