A Time for Reflection

The last week of December is usually a time for reflection.

And the private healthcare industry in India has a lot to think about. The last two months have been those of turmoil for the industry. The crisis related to the implementation of a draconian Clinical Establishment’s Act in Karnataka led to angry protests by the medical community in Bangalore, while in Delhi two cases of alleged overcharging and medical negligence at the two leading hospital chains caused an unprecedented furor. Much has been said about these cases, I won’t add more, however, we must reflect upon what lies behind these flair-ups.

These cases must not be considered as an isolated outbreak of public anger with the media and the politicians blowing up the issues. While that did happen, we must look at them as a trigger for a far deeper malaise.

For a long time, private healthcare in India is increasingly being viewed by patients with a great deal of distrust. With the public healthcare in tatters, the consumers continue to flock to the private establishments, where the care and services are of high quality, however, they no longer trust their doctors and hospitals. This is an extremely worrying sign because the only thing that binds patients and clinicians is trust, an implicit faith in the system that the hospitals and the clinicians will always act in the interest of the patient.

We must ponder over what has led to this catastrophic erosion of trust.

Private healthcare systems are being increasingly looked upon as businesses with commercial interests, which far out-weigh patient’s interests. The media has been peddling this narrative for a while, highlighting cases of ‘wrong billing’ without diving into the arcane of what exactly is wrongly billed. Selective charges of profiteering on things like syringes and gloves are bandied about causing more damage. Somehow, the real narrative of hospital profitability measured in terms of financial parameters such as Return on Capital Employed (ROCE) do not find any mention in these stories. The fact that most private healthcare companies are barely profitable just doesn’t seem to register. Private Healthcare systems need to address this urgently. They must get together and build a counter-narrative, which highlights their often precarious finances and the enormous risks they have taken to build a healthcare system, which actually takes care of the needs of the majority of the people of our country.

While this needs to happen on the external front a lot of house cleaning must also happen internally. The hospitals must review their pricing structures and make them more transparent. The patients today are educated and if the components of a hospital bill are explained to them in detail, I am sure many will understand and appreciate.

The other big issue that destroys trust is the difference that the patients find in the estimates given at the time of admission and the final bill that they end up with. Medicine is at best an inexact science and in many cases, it is hard to predict a patient’s course during hospitalization. However, large private chains do have the data and technology to be able to predict estimates with a reasonable level of accuracy in a high number of cases. Thus a system can analyze bills of say, the last 500 patients who underwent a bypass grafting, exclude the outliers and predict the probability of the bill is a certain amount. This can be shared with the patients transparently. Even if hospitals do this for cases of planned and routine surgeries, I am sure the trust levels will increase.

The real trust builder is, of course, ensuring proper engagement and communication with the patients. Large hospitals, with hundreds of patients, often forget to pay enough attention to individuals leading to a sense of isolation and abandonment. The hospitals need to establish protocols for patient communication. The clinicians must sit down with the patients and their caregivers and explain how the patients are doing in the hospital, the challenges that they foresee and the prognosis. My view is that even if the prognosis is grave, it should be shared transparently with the caregivers. This should be done with great sensitivity and empathy and in a language which is shorn of all the jargon.

Finally, the biggest builder of trust is the time that a clinician spends with the patient and their caregivers. In busy hospitals, clinicians often just do not have enough time to spend with their patients. The out-patient consultations are frequently cursory and fleeting, often leaving the patient wondering whether their doctor has even understood their medical condition or not. While admitted to the hospital, sometimes patients don’t even see their surgeons even when they are being wheeled into the OT’s. Why can’t we have a system, where the operating clinician would himself visit the patient either in their rooms or in the pre-op area, reassure them once just before they face the knife. There can be many such processes that can be established, which gives greater comfort to the patients.

The media noise of profiteering resonates with patients and caregivers only because they find their hospital experiences sterile and scary. As the healthcare costs mount, the patients will need better experiences for them to trust their hospitals and care providers.

My belief is that the time has come for private healthcare providers in the country to walk the talk on patient-centric care. No amount of external regulation will help build the lost trust. It is only actions, which build trust in patients and their caregivers, which will help regain the lost ground.

And once we regain our patient’s trust, they will not find us profiteering nor will the media’s false charges stick.

Here is wishing all my readers a Merry Christmas and a very Happy New Year.

The views expressed are personal

 

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The PR Story

newspaper-storiesAs I wearily settled into the cramped seat of a Spicejet flight to Mumbai this morning, I pulled out the Metro Nation a tabloid format newspaper and started flipping through the pages. Suddenly an image of my former colleague Dr. Deep Goel, the head of Laparoscopic and Bariatric Surgery at Artemis Health Institute, Gurgaon caught my attention. Dr. Goel was featured in the story along with a 200 kg Canadian patient, whom he had successfully operated upon (performing sleeve gastrectomy) and discharged from the hospital with in 24 hours. The story albeit poorly written (the journalist appears to be totally ignorant about medicine, medical procedures, surgeries et al), did manage to inform the readers about Dr. Goel’s superlative skills and about the Bariatric Surgery at Artemis.

Last week I had come across the story of a successful heart transplant in Chennai, when the donor was in Bangalore a team of surgeons from Chennai successfully harvested a heart in Bangaloreand transplanted it in a policeman in Chennai. Stories about Pakistani children being successfully treated for congenital heart diseases at Narayan Hridyalaya in Bangalore and undergoing liver transplants at Apollo Hospital in Delhi have routinely appeared in national media. Celebrities being treated at Leelawati and Breach Candy hospitals in Mumbai are also commonplace.   Continue reading

When Things Go Wrong in a Hospital

Sudhir Sharma, 58  was wheeled into the operating room early in the morning for what looked like a routine bypass surgery. The surgeon Dr. Roop Singh met his worrying friends and relatives, reassured them that he does not anticipate any complications and hopefully he will be done in 4 hours. The doctor seemed to be in good spirits and quite confident of the outcome.  

The relatives and friends of Mr. Sharma repaired to the Subway joint in the hospital for a quick breakfast and the morning coffee. The mood was hopeful and upbeat.

Not known to them things in the OR had gone horribly wrong. As Mr. Sharma was being put on a heart lung machine, disaster struck. A terrible mistake was made. Mr. Sharma’s aorta was connected with the line supplying oxygen from the machine. The mistake was discovered immediately and the team tried to revive Mr. Sharma,  but by then it was too late. Everyone in the team was shattered and were in a state of shock. One small terrible mistake had cost Mr. Sharma his life.   Continue reading

Should Doctors Advertise?

Advertising has traditionally been a strict no no amongst the medical fraternity. It has always been considered infra-dig. A doctor’s face peering down from a bill board or staring you in the face from the pages of your favourite magazine does make one feel a little uncomfortable. We have all been brought up to look on the medical profession as something noble and with a strong orientation towards service to humanity.

However in today’s times I am not sure this argument really holds. If a doctor chooses to advertise his skills and does it honestly without taking recourse to exaggeration and hyperbole, is there anything really wrong with it? If a doctor has unique skills and training, which helps him get better results, than isn’t advertising these, allow consumers of healthcare make better informed choices? Why do we have to look upon this particular doctor as ‘too commercial’?   Continue reading

Hospital Advertising that Works

It is a myth to believe that hospitals do not need advertising.

Many a times I have come across the argument about hospitals wasting money on expensive advertising, which seldom works and puts off customers. In my earlier avtars as the Head of Marketing Communications in large hospitals I have been at loggerheads with my other colleagues, who have often voted against my advertising proposals. Here is why I believe they are wrong and advertising works in healthcare just as much as it does in any other service.

The caveat of course is that the hospital’s communication must be subtle, the message must be designed to ring a bell and should be done in a manner, which is consistent with the customer’s sensitivities. An over the top message, which is loud and persistant and tries to do too many things will certainly put off customers.

Advertising at the end of the day is a promise of service to a customer. This is true of all advertising and is just as much true for healthcare services advertising. There is no reason to believe that as a consumer of healthcare services I wouldn’t want to know what the hospital next door really stands for?    Continue reading