My experiences at the Indraprastha Apollo Hospitals

The other day I landed at the Indraprastha Apollo Hospitals, a stone’s throw away from my residence in New Delhi. My wife needed a test and our doctor at Max Healthcare asked us to get it done at Apollo as the equipment at Max was out of order. The moment I walked in I felt as if I was on a railway platform. The hospital was full of patients as everybody appeared to be in a mad rush. In the OPD area, the ladies at the reception were busy, chatting amongst themselves, while patients and their caregivers waited for their attention. They wore no uniforms and for some strange reason, they were also collecting cash from the patients (apparently for the doctor’s consulting charges) and handing out receipts scribbled on small chits, which did not even have the hospital’s name on it.

Strangely, I was than directed to a cash counter to pay for the tests.

Since my wife needed some injections we were asked to go to the pharmacy and buy them, bring them back to the treatment room in the OPD area, where a nurse would help us with the shots. As we wound our way back to the Pharmacy we discovered that buying medicines is a huge chore. We submitted our prescription at a counter in the pharmacy and were handed over tokens and asked to wait. There was no place where one could even stand, without being pushed around. After being jostled around for 30 mins, we managed to buy the medicines, only to discover that we also needed to buy the disposable syringes, which the doctor had forgotten to mention on the prescription. So lo and behold the charade of the tokens was repeated.

During all this I counted 18 people inside the pharmacy store and the two guys who handed me the medicines and accepted my cash kept chatting with each other in a south Indian tongue, without bothering to pay any attention to me whatsoever.

We returned to the OPD and were directed to room no. 15 for the shots. This room was locked and we were than directed to a paediatric immunisation room full of anxious parents and bawling kids. This is where my wife managed to get the shots she needed. We wasted more than an hour in all this and ran around the hospital OPD trying to get some very basic services. The staff was uniformly disinterested in us, poorly trained and too busy to attend to us. Fortunately, the test my wife needed was routine and she is in good health. I can just about imagine the plight of patients and their care givers flocking to this hospital and being shunted around by a callous system, which barely works.

And now here is what happened when I came to collect her reports two days later.

I called up the hospital to check if the reports were ready. On being informed that I could collect these by 8 PM, I agreed to stop by to pick these up. As I walked in at about quarter to 8 in the evening I discovered a security guard merrily locking up the report collection area. He directed me to take another door into the radiology reception and 5 minutes later, when I walked in I found the lights switched off, the guard had also disappeared and there was not a soul to be found. Perplexed, I walked into another adjacent room and found someone busy on the phone.

As I explained my predicament, this gentleman informed that I was late and that the staff usually left 15-20 minutes earlier than closing time! Amazed and incensed at all this I asked to be directed to someone, whom I could lodge a complaint with. Much to my disbelief I was told to approach the Emergency Medical Officer in the Emergency!

At the reception in the Emergency, I found myself explaining my situation to a young man, who was simultaneously trying to answer questions from an anxious gentleman, whose father had just been brought in with severe chest pain!!! The emergency medical officer, who was supposed to record my complaint was predictably busy with a patient and I was asked to wait. After about 30 minutes of watching the bedlam of a busy Emergency room with no one paying me the slightest attention, I raised my voice (and in the process added to the chaos) and demanded to see the highest ranking hospital official to record my complaint.

I was than informed that the Night Duty Manager will now attend to me soon. Another wait of about 15 minutes followed and yet no one showed up. I again screamed at someone and in another 10 mins a nurse walked out looking for me. She understood my problem, asked me to wait and went to fetch my reports. She returned in a while with my reports and gently admonished me for being so late and irresponsible in collecting my documents.

This is a true story of Delhi’s only JCI accredited hospital. God help us all!!!

The Dilemma of Single Speciality Hospitals

A recent cover story in Business World highlights the growing influence of Single Speciality Hospitals (SSH) in India. I read the story carefully. First and foremost, I was delighted to see a cover on healthcare in Business World. It is not often that the business of healthcare gets prominence in a widely circulated and highly respected business weekly. That, BW decided to do this story is a testimony to the growing importance of the private healthcare sector, which is something to cheer about.

SSH’s make good business sense at least in some specialities. The investment required is low compared to a large Multi Speciality Hospital (MSH), funds can be accessed through PE firms and financial institutions, the hospital can be set up quickly and if one ropes in a well known medical luminary of that particular field, it is not too difficult to fill up the beds. Once the operations stabilise, one can consider franchising or expanding by setting up super specialised centres in large multi speciality hospitals. Specialities like Ophthalmology, Dentistry, Obs and Gynaecology (remember the neighbourhood mother and child centre) have always had Single Speciality Hospitals and clinics. The trend is now towards large SSH for Oncology, Urology and even Day Care Surgeries.

These hospitals are presently being set up by eminent doctors, who are partly putting in their own money and getting PE funds and financial institutions to invest in their ventures. Thus these SSH’s are hugely dependent on the goodwill and equity of the owner-doctor. Also one is not sure, how capable these hospitals are of attracting the best medical talent and thus providing high standards of care to patients. Typically, in a doctor owned SSH set up, it is rare to find other doctors of similar or higher capabilities than the owner. The fear of always being eclipsed by the owner-doctor drives other talented doctors to MSHs, where the canvas is bigger and the environment less claustrophobic.

From a consumers perspective SSH’s are a huge dilemma.

My father, now in his seventies suffers from an enlarged prostate. This is a problem that most elderly men are likely to have. Like most people he is terrified of surgery and has been on medication for the last few years. However, we know that surgery can only be postponed for a while and sooner than later he will have to go under the knife. Now should I choose a RG Stone Clinic, which is a well known SSH for Urology, or do we go to the multi speciality Max Hospital. While RG Stone may have better and more advanced equipment for the treatment of his condition (some fancy lasers), I am not sure they are equipped to handle complications, which may happen. The last thing one would want to deal with is an emergency requiring shifting him to a larger hospital after the surgery.

Also, I am not sure about the credentials of the doctors in RG Stone clinic. On the other hand MSHs like Max and Fortis and Apollo are well established brand names, have systems and processes (Apollo is JCI accredited and the others are in the process of accrediatation) and some of the most well known surgeons in the city are associated with these hospitals. From a cost perspective RG Stone might be cheaper, but if the patient is fully covered by health insurance (as my father is), expenses are the least of ones concerns.

Thus, in a situation like this, I will be inclined to go to the bigger MSH and I would reckon most of you will do the same.

And here is than the lesson for the SSH’s. They need to establish themselves as a far superior option in their chosen speciality. They need to invest in the brand, move away from the perception of being owner-doctor driven centres, hire the best talent by offering a great work environment and competitive salaries and establish systems and care protocols comparable to the best in the business.

SSH’s must convince me, the consumer, that they really are super experts, before I can seriously consider entrusting them with my care.