What were hospitals called in old times - Shifa Khana. A healthcare facility where patients receive treatment filled with expectation, hope, and empathetic healing. The term healing has taken a big hit, hospitals are no more called “Shifa Khanas” (places of cure), and doctor is also not regarded as “messiah.”
Where do things go wrong? “Scared to go to the Hospital”, it is not Nosocomephobia (Fear of Hospitals) a type of anxiety disorder related to other fears associated with hospital milieu, such as germs, disease, blood or needles, operation theatre, machines like MRI, CT etc.
Even at times the hospital smell itself can cause symptoms and panic attacks. But the scare I am talking about today is different and mostly related to exploitation, inpatient experiences with undesirable events, a visit to a hospital is often viewed at with great anxiety.
If the doctor advises a surgery, high tech diagnostic or an interventional procedure as a treatment option, most of the patients worry about what to expect other than patient outcome is hospital bills, charges, payment, and costs. In India, the state has a chequered history in healthcare.
Challenges in state administered hospitals are different than in Private sector. Despite almost free treatment especially after introduction of Golden Card in state-run hospitals, an intriguing question which haunts me often; why do so many poor patients drop out? Going to Government hospitals is best avoided, say a majority there are huge challenges on QPS (quality and Patient safety) confronting a Public Hospital.
In my opinion as healthcare quality control expert, the main challenges confronting the public hospitals today are not limited to (1) Deficient infrastructure (protocols & processes of provision of care), junked and non-operational tools, diagnostic or therapeutic modalities not upto date (2) Non-availability of specialists or lack of skilled professional manpower (3) Unmanageable patient load (4) Equivocal quality of services & essential safety requirements (5) Non-availability of essential medicines & high out of pocket expenditure on cancer drugs (6) Long stay in queues, waiting times, appointments compounded with “sufarish or VIP preferential culture.
Golden cards not accepted for all treatments, and interventions at all Govt hospitals, and also many major private hospitals have not registered for empanelment and those who accept mostly flaunt rules, patients suffer, people are facing lot of problems and there are so many sad stories, scams even from empanelled hospitals in much publicised PMJAY scheme.
What causes long queues and how to solve is not the intent of this piece? The simple answer is that there is a mismatch between customer demand and the resources available to serve them, which can cause queues to get longer as demand exceeds resource capacity-healthcare leadership’s failure to improve upon failing queuing strategy on mitigating long queues and waiting times with service resetting tools and techniques.
The commercial forces have steadily encroached into our understanding of medicine and health, thus the moral foundations of the medical profession losing their influence on the behaviour of physicians and private hospitals. I received my undergraduate and postgraduate medical education before the culture of large corporate hospitals emerged.
The ethos of medical practice was distinctly different then. With the advent of corporate hospitals, access to quality healthcare improved for those who could afford to pay. The poor could not afford such care, while those in the middle class who accessed high end private care suffered severe financial strain.
Up to the early 1990s, doctors working in government hospitals of many states did private practice in the evening, after their regular working hours. They never neglected patients or students during their daytime commitment to government healthcare institutions. The growth of corporate hospitals changed that ethical conduct.
Once government doctors started moonlighting in private hospitals during their working day, attention to patients as well as bedside clinical teaching suffered, as very little time was spent in the public hospital which was their place of duty.
It is time we pay our Government doctors well, while barring them from private practice. Having trained and worked at SKIMS, AHA India, abroad with JCI, CBAHI, ISO,GE healthcare international & ISQUa, I know the value that dedicated time commitment, clinical auditing, implementation of QPS quality and patient safety brings to the quality of patient care.
Scared to go to the Hospital. Private healthcare must fuse moral ethics with efficiency. Regulatory vacuum in healthcare is aiding exploitation by private hospitals.
A lack of investment in public healthcare apparatus has necessitated a dependency on private hospitals, which in turn exploits the absence of regulation of fees in the sector.
The lack of public investment in healthcare infrastructure development has created a dependency on the private sector to meet peoples’ healthcare needs. However, there is a regulatory vacuum when it comes to healthcare charges.
Often, private hospitals take full advantage of this regulatory vacuum and overcharge the patients. The measly expenditure of 1.28% on health is pushing people to private healthcare who are known to fleece patients.
I remember how we would have to be very careful with what we were using. And it is for this reason that there is an urgent need to increase the healthcare spending to + 3% of the GDP
Dr. Fiaz Maqbool Fazili, is senior consultant surgeon, experienced in clinical auditing and healthcare quality control.
DISCLAIMER: The views and opinions expressed in this article are the personal opinions of the author.
The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.