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SWANK HOSPITALS IN POOR SHAPE
By M H AHSAN
Hyderabad could well have become a healthcare hub with more five-star hospitals than even some metros. But, do the plush interiors of these hospitals ensure good service? Not always. If government hospitals are notorious for poor patient care and upkeep of their premises, sample these examples from private hospitals. It took a patient five long hours recently to get discharged from a hospital, as the billing formalities seemed endless and in any case much longer than the surgery he had undergone.
At another hospital, it took a patient over half hour to figure out where the X-Ray room was as the hospital staff seemed unaware of its location and shunted the bleeding patient from one floor to another. Cockroaches in the refrigerator and corridors of another hospital left a patient and her attendants fuming but the staff remained indifferent to this hygiene concern. It took two hours, five requests and a nasty verbal duel with the hospital staff for a bedsheet to be changed in the maternity ward of a hospital.
To reiterate, these are not horror stories from government hospitals but from the swank interiors of five star hospitals in the city. Objectively speaking, industry observers note that healthcare in Hyderabad was never so good. There are more private hospitals and nursing homes in the city than ever before offering all specialities and the expertise to tackle a variety of health conditions. In fact, Hyderabad beats even metros in tertiary healthcare, having more hospitals in that category than even the country’s biggest cities.
But, something is ailing the city’s healthcare system and patients, despite the choice they seem to have, appear more dissatisfied than ever before. They say that it is the service levels in these hospitals and quality of care that makes them feel shortchanged.
Hospital administrators would want to attribute this dissatisfaction to increasing impatience levels among patients and “improper awareness’’ about patient rights, industry observers do believe that private healthcare in Hyderabad can do well with better quality service.
There are a total of 900 private hospitals and nursing homes in Hyderabad and industry observers such as Vishal Bali of CII”s National Healthcare committee and CEO, Workhardt Hospitals, say, “Hyderabad has the distinction of having the maximum number of tertiary care hospitals in the country. It (the city) has a mix of corporate, single unit or promoter driven hospital, a model not replicated elsewhere in the country.’’
But, the adding numbers haven’t really ensured better quality service. Take for instance the long waiting hours despite having got that elusive appointment with a well-known specialist. Or, for that matter, the indifferent attitude of the specialist who dictates notes and list of tests to be undertaken to a junior doctor without as much as examining the patient.
While government hospitals are by now infamous for glaring problems such as lack of equipment, poor care of patients and cases of babies being stolen that are routinely reported, but patients seeking treatment in the private sector aren’t really a pleased lot.
“In our studies, we have found that people do not see much difference in the quality of service offered by public or private hospitals. This is essentially people’s perception,’’ says Dr C K George, director, Institute of Health Systems.
Among the parameters to determine service levels of a hospital were how comfortable were patients with doctors and how much time they had to spend waiting before they could meet the doctor and the results weren’t too heartening.
“My knee was hurting for a long time and I consulted a well-known orthopaedic doctor. He didn’t even see my knee or ask me to try folding my leg to examine where the pain was. Instead, he asked me to undergo a battery of tests. All I needed was physiotherapy which I found out later when I consulted another doctor at a government hospital,’’ says R Sridhar, 37, who developed the condition of a jogger’s knee for overdoing his morning jog.
Yet another patient narrates how after undergoing a gastro surgery, he was given a medicine that strictly said in its advisory that it could be administered only after a test dose was given. “It developed serious complications because administering a test dose is a standard procedure for that medicine. And this was in a superspeciality hospital,’’ he says.
Predictably, hospital heads disagree. They say that quality levels in the city have improved in the last few years. “And this is indicated by the number of patients coming from abroad to our hospitals,’’ says Dr Hari Prasad, CEO, Apollo Health City. He says that the JCI certification Apollo has got is ample proof that international quality standards have been met with. Besides, he notes that the patient feedback has been continuously improving over a period of time.
While there was a standard procedure to be followed in the case mentioned above, health experts rue the absence of any standardised procedures and hence making it difficult for patients to question the line of treatment.
“People are being given indiscriminate treatment simply because we don’t have standard operating procedures. Tuberculosis, for instance, has a defined line of treatment given by the Indian government depending on its various categories. But, how many are following it,’’ questions Dr George, adding that during his institutional assessment for the National Aids Programme, he found a study that stated that many of the doctors prescribing medicines for HIV did not have much idea about the complications it may lead to or weren’t aware of the alternate drug combinations.
Such conditions apart, health experts say even routine ailments have no standardised line of treatment. Now, the Armed Force Medical College (AFMC), Pune, is preparing some guidelines for treatment of certain common conditions for the Government of India, which will perhaps be the first step in standardising procedures for hospitals in the country.
However an element of distrust has crept into the once sacred patient-doctor relationship. Disturbingly, cases of patients’ attendants attacking hospitals and doctors have become routine. “There is growing mistrust now among doctors and patients. Patients may get cheated in some places but for an isolated case, the whole community gets blamed which is not right,’’ says Y Ravinder Rao, president elect of the AP State Nursing Homes Association.
Moreover, Bali feels that consumer expectations around healthcare have changed over the last couple of years. “Besides, (quality of) healthcare is perception based. What I perceive to be good can be perceived as average by another person. But, the perception may not be a gross reality,’’ he says.
Prasad of Apollo however blames it on “improper awareness’’ among patients. “People who are not into healthcare are passing judgments and it obviously results in this kind of reactions,’’ he says. Adding to mistrust is the price tag on procedures that vary from one hospital to another. For instance, the surgeon’s fee alone for a particular procedure can vary from Rs 2,000 for a minor surgery to Rs 20,000 for a major one, making patients unsure of the choice they are making. While packages are now available in hospitals for most procedures, the costs may change in case of complications.
Nevertheless, Ravinder Rao points out that healthcare in Hyderabad is still among the cheapest in the country and is a leading healthcare hub in attracting patients from other nations. Health industry observers point out that it is only a matter of a couple of years before quality standards in Hyderabad improve. “Investment in healthcare has been done more in Hyderabad than elsewhere. The foundation is all there but good management practices are needed in the city,’’ says Bali, who believes that the city will soon see better quality and better services in its hospitals.
With the government hospital infrastructure wanting, clearly it is the private hospitals shouldering an increasing load of patients, which works well for them in terms of business. And it is not just poor public health infrastructure adding to the coffers of corporate hospitals. Government employees under the Central Government Health Scheme (CGHS), for instance, avail of treatment at private hospitals, and thus directing government money to private players.
However, Dr George points out that people may still prefer a government hospital provided its accessible and has doctors and drugs to offer. Proving his point, he says, “No government hospital, despite its shortcomings, is underutilised.’’ Not many cases of medical negligence make it to consumer courts. Not because there aren’t many, but because they are difficult to prove.
Consumer activist N Ganesan says cases of medical negligence in the courts are very few because to prove such cases the patient not only has to produce adequate medical literature proving that what the doctor has done is medically not the right procedure. Predictably, a layperson is at a loss when it comes to deciphering medical jargon and besides there is a need for a second opinion that is difficult to come by from a tightlipped medical community.
“Doctors admit privately that a procedure performed is incorrect, but they don’t come forward to give evidence against fellow doctors,’’ Ganesan says, adding that the consumer should request the consumer court to offer experts.
Citing the example of a case of wrong procedure performed for an alleged condition of cancer, Ganesan says that the court was requested to get an expert from a cancer hospital to decide if the procedure was needed or not. The doctor from the cancer hospital said that the procedure adopted was wrong. While this case ended with the victim of the wrong procedure getting awarded a compensation amount, such victories are rare.
Another reason why patients are not able to drag hospitals or doctors to court is the poor maintenance of their medical records. Patients challenging a line of treatment are supposed to produce all the medical records of the treatment undertaken which is not always available with them.
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