This Independence day, my only wish is that the citizens of India get quality care that they deserve whenever they are sick. The health-care system in the tier-II cities, where the patient-doctor ratio is increasing day-by-day is becoming atrocious.
October 10, 2016
As more and more patients are falling sick day-by-day, and most importantly catching lifestyle diseases like Diabetes, BP etc, it is imperative for the care providers to build systems processes to make sure that the care is being delivered to patients, and their caregivers, who travel in un-human conditions to make sure that they come to their destination, which in most of the cases are hospitals or nursing homes situated in these Tier-II cities.
Here's an account of my recent traumatic trip to Patna, the state capital of Bihar, for my father's cardiac ailment. It all started one morning last week. As I called my mom at home, she wasn't able to speak properly. My father had abnormal cardiac symptoms and considering there is absolutely no emergency care facilities in my home town in Bihar (app. 350kms from Patna), without wasting any time I decided to rush to Patna so that we can consult some proper cardiologist there.
It all started with finding right doctor for specific ailment
Having no proper knowledge about the capable cardiologists in Patna, we asked some friends and relatives. We got few names, such as Dr Aggarwal, Dr A K Thakur etc. Google & Practo search revealed a few names as well.
But there were few issues with most of these leads. E.g. there are four Dr. Aggarwal, who are cardiologists in Patna. How do we know which one is the best one, or the one we are trying to find. Most of the Dr Aggarwals are located across the nearby locations in Patna. Maybe a tactic used by the newer generation doctors to attract more patients who just know about some Dr Aggarwal. Govt. hospitals were out of question, as we had seen the situation recently. It's the same situation across all Govt hospitals across India & not just in Bihar.
We know for sure that Dr A K Thakur used to be one of the Bihar's best Cardiologist, since my father had consulted him back in 2005.
Incidentally, my father remembered about a junior doctor (Dr Prabhat Kumar) at Heart hospital. Back then he was the main assistant of Dr A K Thakur. so, we decided to consult him at Patna's Heart Hospital. The hospital is situated in Kankarbagh locality of Patna.
So, once we decided to consult that Doctor, I personally called on the landline number of that hospital and asked whether we can come and consult Dr Prabhat Kumar. We got to know that Dr Prabhat was out of town for some cardiac conference and was only coming back after three days. So, we patiently decided to wait for few days.
Age-old, inefficient and non-transparent appointment system
One the specific day, as mentioned by the receptionist at the hospital, we decided to go to Patna and meet the doctor. So, we again called the hospital and asked whether the doctors has come back from the conference, we got assurance that the doctor is back and we shall come and consult him and the entire procedure shall happen within a day's time.
Appointment at this hospital is taken at an enquiry counter, which more or less looked like a post office counter with multiple windows in it. without any proper queue system, people were almost fighting for sliding their hands inside a 6 inch hole. The same counter was also serving multiple other purposes such as bill payment, receipts collection, enquiry, announcements etc.
After waiting at the counter for our turn for almost 30 minutes, my father asked the receptionist (let's call him a receptionist, however I am sure he feels to be no less than the boss at the hospital, with the way he was treating patients, which reminded me of the Railway ticket counters) that he needed an appointment with Dr. Prabhat Kumar.
My father was almost shocked to hear that the appointments for Dr Prabhat will start being given next month for the month of November. for a minute, we couldn't believe of what we heard. How's that possible. I had personally called the hospital several times and had spoken with some Mr Sharma at the reception counter and he never mentioned about the three months waiting period. how come suddenly there is a waiting of three months. That seemed like insane to us.
Non-realistic appointment schedule, with three month's waiting
How is it possible to book an appointment today and see that doctor after three months? Well, it might be possible in case a surgery is planned for a future date, or once in a while, if the doctor has to travel or the patient flow is more than what can be accommodated in a day or week or month.
But why on earth a doctor would take advance appointment that too for three months for OPD? And imagine I am not talking about any government hospital, rather I am talking about a private heart hospital with more than 10 cardiac consultants in it.
How can a doctor of that stature and a hospital of that fame is letting this happen? We found this to be an age-old, inefficient and non-transparent appointment system.
We had two options- either wait for three months for that appointment, or scrap the entire trip and go back home, and plan for a trip to Delhi. My father personally hates medical trips to Delhi due to some bad past experience.
Enquiry counter in any hospital is supposed to be a place where all the information shall be provided to the patients, which can help the patients in decision making, and not a place where patients begun their nightmarish journey
I have been to more than 200 hospitals across India, on multiple healthcare projects and have seen their facilities. I had also seen the facility at this hospital back in the year 2000. I must say this place has been worst than what it used to be. You can see paints off the wall, old pictures pasted on wall, Old notices of govt. schemes yet hanging on front entry wall. A poster mentioning that the hospital is ISO 2000 certified had been put up on some wall. Pictures of Dr Thakur with the eminent personalities of Bihar, in the political as well as medical fraternity has also been put on the wall.
For an average crowd of 300 to 400 people at the hospital waiting lounge there are app. 50 chairs, old and broken. A TV has been put up there, which always play Bhojpuri movies, which actually helps caregivers get engrossed in it and forget about the fact that they are at the hospital.
Caregivers, whosoever accompany patients, try to capture a chair, as they know its going to be an entire day's engagement, even if you have gone there for an OPD consultation. In case one gets up from a chair to go to the washroom or so, someone for sure will jump onto it.
Fighting for a glimpse of the doctor & then spending quality time with the God-like Doctor
Amidst these ruckus, we were delighted as soon as my father's name was called. We rushed towards the entry gate of the consultation chamber.
But to our surprise, the attendant was only allowing the patient to get inside the room. Upon enquiring, he asked me to wait, as there're two more patients inside the chamber. Really? So, I insisted and he allowed me to get inside.
By the time I got inside, the previous patient inside the chamber was asking some critical questions and the doctor wasn't even listening to him properly. Another technician, in the meanwhile, wrapped Blood Pressure monitor on my father's arm. The doctor put his stethoscope on and took the Blood Pressure.
Without even taking out a new prescription from his pad kept right there, he preferred scribbling something on the very old prescription (maybe of the year 2006). Without wasting any time, the doctor asked what's the problem? My father wanted to tell him all his troubles in a story format.
But, instead he asked, what's the real problem right now? My father could only ask just one question. And the Doctor preferred answering that question indirectly.
Hesitantly, i decided to intervene and asked three critical questions to the doctor. He decided to answer two of them, with assurance that he'll see how the results of diagnostic tests will be, and accordingly he'll confirm whether an invasive procedure is required or not.
In total, the doctor gave us 3 minutes of his precious time!! And we were almost pushed out of the doctors chamber, as more patients were sent in.
Post-consultation traumatic experience
Post consultation the patients are left on their own without any clarity around what's the next step. One sent out of the doctor's chamber, patients aren't even provided with their old prescriptions, new prescription or any document which was submitted to the doctor during consultation.
Upon asking few times, with a lot of frustration, the attendant mentioned, "now your job is done, now we will follow up with you." With no idea of what does that mean, we asked people around if they know what's the next step... clueless as their turn hasn't come yet, they redirected us to the hospital pharmacy store.
Pre-conducted diagnostics tests & their non-relevance for the doctor
After waiting for another hour or so, we were able to find details of next steps, which were a series of diagnostic tests.
Even before we could know what are the tests prescribed, the guy at the counter asked us to pay a hefty sum for these tests. So we paid. We got a receipt, which mentioned more than 10 different blood tests, ECG, ECHO, TMT etc.
As I had remembered it, my father had gotten all these blood tests done just two days ago at my native place and all the tests results were submitted to the doctor along with the old prescription, I asked the receptionist whether we shall really need to get all these tests done again... without even blinking his eyes, he said tests from other doctors aren't valid at that hospital.
I was speechless. How can that be possible? It's been less than three days that those tests were conducted. What could have been the reason? Are tests conducted at smaller towns not of optimal quality, or is it all about the money game? Everybody knows that the healthcare centers make a lot of money as cut on these tests conducted at their setup.
As we didn't have any choice, we entered inside another room, marked as Lab. The guy sitting there already has the page the doctor had scribbled on. He looked at that again and asked for more money. We said that we had already paid money at the counter, and he mentioned that the money paid there was for other tests and not the blood tests which were to happen inside that room. I ran to that counter, and asked the guy. He said blood tests are to be done inside that room and charges to be paid separately. So, we paid. The same tests, which were done for Rs. 800 at my native place, cost us Rs. 1700 at that hospital.
Upon further exploration, we realized that the other tests were obnoxiously expensive than a Metro city. Maybe they have figured out this money making mechanism.
Patients hardly have any say in this. After all they are sick, how are they supposed to discuss these with the providers?
Un-ending wait at the hospital & Handing over doctor's prescription by almost midnight
By 5:30pm all the diagnostic tests were done, and the waiting hall was literally boiling with heat and humidity. As it was intermittently raining, the humidity level had gone up. With no idea about what's next, we asked the receptionist what's next and he suggested that we shall have our lunch now. We had completely forgotten that we hadn't have anything since morning except multiple cups of tea from the nearby dhaba.
After waiting for more than 5 hours, suddenly we started hearing names of patients, who were consulted that specific day. Since, ours was the last appointment, our turn came almost at midnight. Upon hearing his name, my father ran towards the counter and collected his envelope.
Confusion about the medicines prescribed and no-questions-may-be-asked system
Immediately after the final prescription and tests results were handed over to us, my father got anxious about the key findings of the tests and what medicines the doctor had prescribed. So, we opened the envelope that contained prescription, all tests results, and our previous prescriptions which were submitted to the doctor. To our surprise, all tests results were exactly the same as it was in the previously conducted reports. What a waste of money and resources!!
So, we looked at the medicines that the doctor prescribed, and decided to compare whether the doctor has changed any medicines and if that would mean, we needed to buy the new ones. Upon comparing, we realized that (in order to reduce the number of medicines, probably so that the patient would feel better about taking less medicines) the doctor had actually combined few molecules together.
Obviously, as a chronic patient, my father knows more about molecules and medicines that he's taking, and alternative medicines that his friends are taking or he might have heard of. So, he had some questions about these new medicines, as once one of his new doctor tried to change his medicine and that didn't suit him. So, he wanted to be sure about that.
Moreover, the cardiac tests results were included but no conclusions were deciphered by the doctor. So, he wanted to meet the doctor again and ask whether all tests were okay and whether he's to worry about something. So, we headed towards the doctor's chamber where he'd consulted him during the OPD hours. to our surprise, the doctor was not there and we found another guy typing something on computer. We asked whether the doctor is available and he mentioned the doctor was gone.
A series of follow-up questions were put forth by my father, as we were returning home:
1. How could the doctor leave without providing a system to ask follow up questions?
2. Who will detail about the key issues due to which the complication had happened to the patient?
3. Do we need to wait till tomorrow to see the doctor again?
4. If yes, will we get another appointment for tomorrow, since the appointment system has three months waiting?
5. One of the remarks in the prescription mentioned that my father should drink less liquid and increase salt intake... we all know that increased salt intake can be fatal for the hypertension patients. So, why did the doctor mention about increasing salt intake?
6. Ideally all these and more serious questions should have been answered by someone capable if not the doctor himself.
7. Upon asking about medicines, the pharmacy guys mentioned that one of the medicine name is probably wrongly written. The next day, we went to 7 pharmacy stores, and wasn't able to find that medicine. One of the big challenge with chronic patients is that they are very particular about buying the medicine the doctor has written. In this case, we had no idea who to ask about an alternative medicine.
And the fact is that despite the consultation process being conducted on 11th Aug, 2016, my father hasn't been able to commence the new medical regimen as yet, as he still has questions for the doctor.
Is this how the health-care should be in the 21st century of independent India? Maybe you can relate to this experience, if ever you get to be in my shoes. But, I feel like committed to change this for millions of patients, in the coming days. I am more motivated to do my startup better.
The author, Sanjeev Jha is the CEO of healthcare startup SmarterClinics