The Aggressive Patient

Why are we intimidating and beating up our doctors ever so often these days?

Every other day one see’s newspaper headlines where doctors find themselves facing angry patients and their attendants who believe that misbehaving with hospital staff and doctors is no big deal at all. That breaking furniture and maybe a few bones will get them better service or perhaps the hospital will waive off a portion of their bills. Doctors and hospitals today are quite scared of such hooligans, who create a nuisance in the hospital demanding better treatment for their patients without realizing that their behavior is putting other patients at grave risk.

Part of the reason for this I suppose is that we are becoming a more aggressive nation. The road rage that one witnesses on the roads in Delhi everyday, the ugly fights among neighbors usually for parking spots, the crazy honking even on a red light are perhaps all a manifestation of this malaise. The medical profession too I suppose cannot escape its share of problems in a society becoming louder, more aggressive and more demanding. Everyone seems to be on a short fuse.

In hospitals, where life and death situations are routine, people are perhaps a lot more stressed and express their frustrations by mishandling the folks right in front of them. These are mostly doctors and nurses, who bear the brunt of their anger. Little do they realize that beating up the doctor won’t help them get better care. And that beating-up anyone is no solution to any problem.

The other reason that I find for all this anger in the hospital is a lack of communication between doctors and the patient’s attendants. Usually, the clinicians are very busy folks who have very little time for patient’s attendants. They believe that their primary duty is to look after the patients, without realizing that in today’s world they also have an equal duty towards addressing the attendant’s fears and concerns regarding the patients. Hospitals spectacularly fail in impressing on the clinicians that they must meet the attendants regularly and address all their queries as honestly and as transparently as possible. This must be a part of a process and not a random meeting in a corridor or when a patient’s attendant catches hold of a doctor fortuitously. Better communication will help reduce these unsavory episodes far more than more security guards manning the hospital doors.

I also look upon these incidents as reflective of a loss of respect and trust between patients and doctors. With the media awash with stories of profiteering hospitals and grasping clinicians engaged in dubious practices, no wonder that the relationship between patients and doctors have almost broken down. The noble profession has been reduced to no more than a transaction. There is no longer the old world courtesy and respect that clinicians commanded not so long ago. No longer are they the Gods of their realms. This is rather sad. The relationship between a doctor and a patient and their care givers has to be a a bond of great trust. The patient willingly allows the doctor to treat and operate upon him believing that he will do so to the very best of his skills and ability. The doctor on the other hand accepts this as a huge and crushing responsibility and does his best to ensure that the patient comes to no harm, while under his care. This is the covenant that has always existed between doctors and patients. This sacred bond is now stretched almost to the breaking point.

What is it that we can do to get back from the brink??

As hospitals and clinicians we have to understand that the patients are increasingly getting impatient and we must learn to deliver all that we commit. We must find more time to address their concerns and not just fob them off with some sarcastic remark about their limited understanding of medical matters. We must engage with them more, learn to treat them as equals and partner them in their treatment. A dialogue is essential.

As patients and their attendants we must understand the tremendous pressure and responsibilities each clinician carries. We must also have an unshakable faith in their good intent, skills and abilities. This has to be a given. We must also have the wisdom to realize that in medicine an adverse outcome is not necessarily the fault of the doctor or the hospital. Actually, at times it is no one’s fault. We must treat our doctors and nurses as fallible humans, just like ourselves.

Finally, there will always be those who believe that creating a ruckus helps get things done in the hospital. In my view the hospital must deal with them firmly and take whatever action is required to ensure orderly conduct.

Violence can not be justified, whatever the reason or the grievance. Beating up ones doctor is almost the most stupid thing imaginable that one can do.

The views expressed are personal




Confronting Deaths in a Hospital

I have often wondered how ill-prepared Indian hospitals are when they are confronted with dying patients. When the inevitability of death looms large over a terminally sick patient, our hospitals tend to pretend that death does not exist. Most folks assigned to take care of a patient who is in terminal decline, find it hard to communicate either with the patient or the grieving relatives. Many including the doctors do not know what to say and inanities such as ”we will keep trying right till the last breath” or a barely muttered ” I am sorry, but his chances are really slim’ escape the lips of the caregivers. For some reason, everyone seems to talk in low hushed tones, when they know that death is around the corner.

Sadly many hospitals do not want the dying to pass away while admitted to the hospital. This is as shameful as it gets, but the fact is that many smaller hospitals will refer the patient to some other facility, hoping all the time that the person will not die in their hospital. You see, a visit by the angel of death is not welcome, after-all there are hospital mortality numbers to be protected. Many hospitals will discharge a terminally ill patient informing their family that it is best that the patient dies at home surrounded by her family members, rather than in the hospital under a mountain of tubes and needles. Sounds altruistic and kind but I do believe that hospitals can handle deaths a lot better.

Here are some suggestions.

It is best not to pussyfoot around the matter of death. The senior most doctor under whose care the patient is admitted to the hospital must have a candid conversation with the patient’s attendants about the possibility of death. Giving false hope when there is a very small possibility of the science of medicine pulling off an improbable outcome is best avoided. A doctor must be honest and forthright in their assessment of the situation. This does not mean they have to be cold- empathy, warmth and honesty should go hand in hand. The hospitals must have designated patient conference rooms, where such discussions can happen. Busy OPD rooms or corridors outside the ICU are hardly the places for such conversations. Delegating this task to a junior doctor on the care team is also not right. I would be very uncomfortable with a doctor who cannot look me in the eye and talk honestly about death, particularly when everyone from the nurses to the ward boys is whispering about it.

Hospitals must employ some counselors who can help patient attendants cope with the bad news. They should be trained in talking with the patient’s loved ones, prepare them for the death in the family, ask them if there is something that the hospital can do to help ease the pain. I recall a grieving husband, who wanted a Sikh priest to spend some time with his young wife dying of breast cancer in one of the hospitals I worked for. Religious ministers of various denominations must be at hand and available, for patients and their attendants who may need them.

Designated rooms for patient’s attendants to mourn their loved ones will be a good idea in a hospital. I remember once when a distant relative of mine passed away in a hospital in Delhi, there was just no place for the immediate family of the deceased to sit down together and share their grief. Eventually, they huddled together in the hospital cafeteria with curious onlookers whispering about the misfortune of the family in having lost a member. Their personal grief was there for everyone to see, which made things a lot worse.

Hospital paperwork after the death and the release of the body by the hospital should be managed with a great deal of sensitivity. While one understands that the bills need to be settled and arrangements need to be made, hospitals should have trained staff handling this part. They should know well in advance that in the eventuality of death, who is it that they should approach for the paperwork to be completed. It would also be good if the hospital could help by recommending an undertaker or a hearse service, which most people will need once the dead body is released from the hospital.

While it may sound macabre, hospitals must have a sound system of delivering a great experience even when the matter may be as grave as a death. In fact, a death would be an occasion, when the hospital must make a big difference.

The Importance of Small Things in Hospitals

Here are a bunch of ‘small’ things I noticed during the 3 days I attended on my father, who underwent prostate surgery in a South Delhi hospital a couple of weeks ago. On their own, they really do not count for much and I am sure they did not impact the care my father received during his convalescence. However, do they add up to a less than satisfactory customer experience, I leave you to draw your own conclusions.

1. Right behind my father’s pillow, on the wall there were stains, which looked like congealed blood. In two places in the room, the plaster had pealed off.

2. The walls had marks, most probably made by the patient beds rubbing against them particularly when the patients are transferred from the room. The walls look like they need a fresh coat of paint.

3. The patient beds had mechanical controls requiring a lever to raise or lower them. The lever jutted out from under the bed and when not in place, one could safely conclude that it had been borrowed by the patient in the next room.

4. There were for some reason no curtains around the patient’s bed.

5. The sofa cum bed meant for the attendants had a ragged worn out handrest.

6. There appeared to be hoards of people in the in patient areas. The hospital corridors were always humming with either hospital staff or patient attendants. Many whiled away their time at the bustling nursing station, which also appeared to be the hospital staff’s favourite spot for socialising.  Attendants merrily browsed through patient files, their own as well as anyone else’s.

7. All the trolleys used for transporting food, medicines, linen etc. squeaked to high heavens. Someone just forgot to have their wheels greased in a long time.

8. There is nothing called ‘Do not Disturb’ sign in the hospital room. On a particular day we had 16 different set of people requesting permission for something or the other. When does a patient get to rest?

9. Newspapers were never delivered in patient rooms, while a huge bunch lay about at the Nursing station.

10. The F&B services really take the cake. On day 01, my father was served soup and sandwiches 5 times. The same soup and the same soggy sandwiches all the time. The next day, he did not get anything to eat till lunch because the dietitians thought that he was to undergo a surgery that day, never mind that that the surgery was scheduled the next day! The rice was served on the tray mats and one was to eat straight from there. In spite of requesting for a non-vegetarian diet, he received a vegetarian meal and the best of all, even after clearly indicating his allergy to egg (boldly mentioned on his medical file for all to see except the dietitians!), he did manage to get an omelet for breakfast.

11. The hand sanitizer was empty and was removed on my request. The new one never materialised.

12. My father was taken for an ultrasound. He was wheeled out on a wheel chair and taken to the radiology department and was kept waiting there for 40 minutes, with his bladder full. Apparently no one coordinates this. The OPD and the IPD patients are taken down Radiology and than they await their turn, without anyone knowing how the system works. (Strangely, when I screamed at a lady sitting in one of the offices adjacent to the Ultrasound room, my father had his ultrasound on the double).

13. Finally, I pointed out a small mice which ran around in the area occupied by the hospital’s TPA executive.

Looked in isolation these incidents perhaps do not amount to much. Some may even accuse me of nitpicking but the fact remains I did notice all this and it made me immensely sad. This is a hospital I was involved with during its early days and I am fully aware of its founder’s commitment and the high standards he had set towards patient care.

While my father had a uneventful surgery and a quick recovery for which I am immensely thankful, the customer experience was really not something to write home about. I wish someone, somewhere is listening.

The Need of Customer Experience Managers in Hospitals

Surgical GeneralI believe the time has come for hospitals to seriously look at taking on people tasked with managing the customer experience, while interacting with the hospital at its various touchpoints. The Customer Experience Manager must be an individual, who can integrate the plethora of experiences that one is likely to have in a hospital in one unique experience, even a memorable one, (which is difficult, considering one is talking about a hospital).

A Customer Experience Manager should be empowered to act on behalf of the patients in the hospital, have overriding powers and must be guided by just one consideration, which is, if I was the patient, would I expect this from my hospital. An affirmative answer to this question is what should guide the Customer Experience Manager.   Continue reading

6 Ways To Get the Best Out of your Doctor

Doctors too are humans. Very often, when confronted with a medical crisis we tend to forget this simple fact. In my many years of experience of working closely with doctors in large corporate hospitals, I have learnt that by observing the following few simple rules one can extract the best out of ones doctors.

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