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.

The Advantages of an Aware Care-Giver

My father started Chemotherapy and concurrent Radiation therapy for an oral carcinoma earlier this month. Cancer is a scary disease and putting a loved one through the ordeal of  cancer treatment is not easy. The disease is a devious one, you beat it back in one place, it pops up somewhere else, you get rid of it for a few years, and you never know when it will turn up again. Now while I have worked in hospitals and am familiar with terms like Chemotherapy and Radiation Therapy and things called IGRT (Image Guided Radiation Therapy-the first machine in Delhi was installed at Artemis in Gurgaon, where I was employed), it is only now that I am discovering how little I knew about the disease and its treatment.

I believe it is very important for family and care-givers to be well-informed about the disease and the treatment modalities being offered by the doctors. While we chose a hospital and the team that will take care of my father’s treatment, I read as much as I could about the disease. With the knowledge explosion around us and the almighty Google, at my service I found a treasure trove of information that was very handy in equipping me with managing my father’s illness and monitoring his treatment.

My father suffers from a cancer of the base of the tongue. The disease had spread to his adjacent lymph nodes, when it was diagnosed. A FNAC, wisely ordered by our internist revealed the tumour. The onco-surgeon I met ordered a PET-CT Scan to check if the disease has spread any further. I knew about the PET CT and how it worked and what it revealed, to understand why was it necessary. Once we had found the Primary tumour and settled on the treatment modalities (Radiation with concurrent targeted chemo-therapy), I read about the latest advances in these areas.

I also met medical oncologists who explained to me how the targeted therapy worked and why it was far superior to the conventional chemotherapy, which entails horrendous side-effects. The Radiation oncologists I met, explained to me about the radiation planning, the fantastic capabilities of modern-day radiation equipment and how they can deliver high doses of radiation with a great deal of precision and finesse. While, I marveled at the technology at our disposal, I knew the real test would be when we go through the therapy and how would my father cope with the like side-effects of the treatment.

Learning about the disease and the treatment options have helped me tremendously. Firstly, it has made me a partner in the fight against the disease. I am able to understand, what the medical teams are doing and how it might be helping us in dealing with the disease. This is most important as it gives me a semblance of control, a little power over a mighty foe. It also allows me to explain to my father about what to expect, to comfort him and to give him strength. Last night, as he blew his nose, a blob of blood coloured his handkerchief. Alarmed, he called me and I was able to explain to him that this was something that we would expect because of the radiation he is undergoing. A small matter, but a big reassurance for the patient.

Knowledge about the disease also allows me to hold informed discussions with the doctors treating my father. They too feel that they can explain to me in simple terms, what they are attempting and what has been the progress so far. Communicating well with your doctors is always a good idea, once they are comfortable, they can share with you a lot of information, which one can use and relate to during the course of the treatment.

Most importantly, as I sit besides my father watching the cocktail of the chemotherapy drugs drip into his forearm, I am able to supervise his treatment. This is not to say that the team of nurses and the residents are not good enough, but as we all know mistakes do happen and when one is dealing with cancer, they may prove very costly. Also, I realize the fact that for the nurses and the doctors, my father is one of the many patients they handle in a day, for me he is the only one and hence, even if I raise a few false alarms, it is worth it.

Finally, I would like to believe that a well-informed care giver, who is actively participating in patient care, while ensuring he does not get in the way, is a huge asset for the patient as well as the medical teams. I am willing to bet, medical outcomes would be far better for patients, who get this kind of support.

When faced with a sudden medical exigency it is imperative for caregivers to arm themselves with the relevant knowledge of the disease and for medical folks to encourage care-givers to do so. It really helps everyone.