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6 March 2010

Best in town

MAR 05 -
A close relative of mine recently checked into the “best private hospital in town” with a kidney infection and left the premises suffering from an undiagnosed lung infection. Quality health care is more than just an ISO certification and an emphasis on actual customer service, rather than mere assurance.

When it came to assuring customer satisfaction, the hospital hit all the marks. Their nurses were friendlier than the ones I have encountered in other hospitals. Their business staff (or shall we call them sales representatives) were almost predatory in making sure we wouldn’t have to deal with any of the insurance hassles. And their customer care staff swiftly handed out feedback forms bearing

prodigious smiles.

While customer service is important—you wouldn’t want grim nurses berating you while infirm as they do in some other places—this hospital puts too much emphasis and effort in making the patient and their guardians ‘feel’ like they are being provided with quality care, and in doing so it seems to have overlooked the fact that, especially with health, what is more important is making sure that the patient is actually ‘receiving’ this quality care. Here, marketing is not as important as the product itself.

Ideally, a sick patient goes to the hospital to get better, because the doctor, with all of his/her years of training and study, knows best how to heal the patient. Yet here, our doctor, the urologist, was breezing through his rounds like a film star. He might have known best, but it came at the cost of being thorough and taking a holistic approach. But more likely, it was the system on which he depended that was not thorough. “She has a terrible headache, she has a cough, she had high fever last night, she really couldn’t sleep well, she has trouble breathing, her chest hurts,” we grieved. “Oh, it must be the smell in the room, as you know they’ve recently painted this room a dashing white. You’re the first patients to be housed here since. Not to worry, she’ll be discharged soon.” And while the air was still toxic, those exceptional service providers decided to have the air conditioners cleaned, just to throw a few contaminated dust particles into the mix. “But a patient is recovering here!” I protested. “It would have been worse for your patient, miss, if you had turned that machine on,” the cleaners responded.

Of course, us patients these days are less-than-ideal. We come with our own internet-based predictions and diagnostic predilections when resorting to health professionals. We have lost our trust in doctors who over-prescribe antibiotics and who sometimes let archaic social biases come in the way of their examinations. We have choice on our side—the freedom to migrate from one health professional to another health professional if the service does not satisfy us. And all the while, we run our mouths weary with all our carping. It is no wonder hospitals such as this find the superficial smile to be such a

valuable weapon.

Regardless, the Hippocratic Oath says nothing of good and bad patients—nor does it say anything about well-off and even-better-off ones. In its modern version, doctors swear to “apply, for the benefit of the sick, all measures (that) are required.” I would assume that the oath applies just as much to the individual practitioner as to the institutional care giver. So, why should those who rehabilitate in the standard rooms be denied peace and quiet, a requisite for therapy? While a private hospital is allowed to charge extra for additional services, essential services should not be offered on a cash curve.

What I would expect, given the emphasis on ‘quality’ customer care, would have been regular check-ins by an in-house physician if the specialists are too preoccupied, because an inexperienced nurse’s inspections does not suffice; proactive resolution of a problem (if the room smells of paint, then shift the patient out of there immediately instead of telling him/her to sleep with an open window all night in the chilled spring air of Kathmandu); a comprehensive diagnoses upon entry and a complete physical exam prior to release.

And what does the urologist have to say about all this? “If there are any urinary problems, please be sure to let me know.” As if his designation as an urologist comes before that of a doctor.

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