Sunday, 14 April 2013

Our visit to the Fortis E. Heart Institute, New Delhi, in March 2013

After my mother suffered a mild heart attack in the beginning of March 2013, we took her to the Fortis E. Heart Institute in Delhi on the advice of several doctors in Guwahati. We were told that the Chairman of the Institute was the best there was, in his line of expertise, in the country.  While there, we saw a lot -- some good, some not so good -- but we didn't get a chance to see him live up to his reputation. The following is an account of what happened during our visit.


My mother has had a rather difficult heart condition for long now and when she had a problem early in March we had been advised to take her to Escorts for further treatment. Set off the Outer Ring Road beyond Nehru Place, with impressive buildings visible from afar, the set-up on the whole is very impressive. The beautifully maintained hospital area, the spotlessly clean hospital buildings, and the smartly dressed staff, were all big plusses for us as we made our way in. I called the doctor who we had contacted earlier, and he told us he would send someone to meet us at the entrance and guide us. The Chairman, unfortunately, was not in town, but we were ushered into his plush chambers.

While numerous photos, sketches, caricatures of the Chairman adorned the walls on one side of the room, the many certificates, degrees and honours which he had received from many august international bodies filled the long wall; the corner cabinet contained many trophies and memorabilia. Another side wall was lined with photos of him shaking hands with many well-known people. How can anyone sit in a room like this and keep sane, I wondered, why would anyone want to fill his own office with his own photos? Unable to make sense of this I asked this question to many others in the next days and slowly the answer dawned on me – it was to impress and overwhelm all those who came into the room for the first time. As if by having all those many faces bearing down on one, the first-time comer would be filled with a sense of how big and important he is and how excellent and reputed a doctor he is. Well…well…well… clearly this method does not work on everyone with equal efficacy.

But the doctor who we met was highly competent and he started the process of working out a plan of action for the next few days. Since that day was only Monday and the Chairman would not be back till Friday or Saturday, we decided not to wait for him and go ahead with the necessary investigations with whoever in his team was available from the next day. When we arrived for admission the next morning, we were again ushered into the Chairman’s plush chambers to meet the very friendly doctor who would take care of Ma. Soon she was admitted and things were beginning to happen. The rooms were very nicely done up and the predominantly Malayali team of nurses seemed to be trained, friendly and dedicated.

Ma needed an angiography to be done and soon we were told we had to go down to discuss ‘packages’, before the procedure could begin. We were told we would be ‘counselled’ about prices etc. but soon it was clear that the counsellors (young men dressed smartly like company executives) could help only in reading the figures they had just written down. Ideally they should have been able to advise, try to understand what the problems were, suggest solutions or alternatives, answer queries etc. But the counsellors had not be trained for that and had to keep reverting back to the doctors concerned for every little thing.

The package we were offered was remarkably cheap, a ‘one-day package’ including hospital stay and the angiography would cost a little more than Rs. 20,000. Well, so far so good we thought. But soon we had to go down again to talk about another ‘package’, because the angiography had made clear that Ma would need a stent to be put in, but suddenly the price of the ‘two-day package’ rose astronomically to more than Rs. 3 lakhs. When we complained, we were made to talk to the doctor who then did his best to scale it down somewhat but that was that. Seeing no other alternative we agreed. As the days went by we understood the smart business strategy – the price for the diagnostic angiography was kept deliberately low to attract patients, and once that procedure was done and angioplasty was recommended very few dared to come away without doing anything at all – and that was when the cost shot up to the skies.

We were also made to sign estimates that kept changing by the day (nobody could explain to us why) and finally the bill we got was again different. Now after coming out of the hospital after having paid all the dues, we still don’t know what was contained in the package and what was not. And there were little irritants: for example, faced with a bill of more than a couple of lacs we found it rather petty that one had to deposit another Rs. 1000 to get a CD of the angiography, which could easily have been included in the price of the procedure.

It soon became clear to us that the hospital was run as a business enterprise. Being university teachers of the old school who have long despaired at the stark commercialization of educational institutions, this illustration of commercialization of health-care services in the country did not go down too well with us at first. Of course we do see the logic behind it – one needs a lot of money to be able to provide quality health care. But to give precedence to money before patient-care perhaps implies stretching that logic a bit too far. In the little time we were there, we saw lots of harassed attendants running around not being able to pay bills, and patients who have been operated only a day or two back, having to wait for several hours before they were discharged because of some uncertainties in their insurance policies. But perhaps we did not see all.

And paying bills, even for those who had decided not to fuss about them but pay, was not easy. The tiniest room in the whole building had been allotted to the billing section. Three harassed employees sat there at their desks trying to serve the unending flow of attendants and others. Considering that the attendants of every patient who gets anything done at the hospital would have to enter that room at least once to pay the bill, it should have been housed in a more spacious area where people did not have to jostle with each other and be impolite to each other just because they didn’t want to lose their turn.

But even more unpleasant was the experience we had regarding the ‘food’ served to the patients. Since the ‘packages’ are supposed to include food for the patient, food from outside was not allowed to be brought into the hospital. This was very strictly monitored. Fair enough! But only as long as it meant that the patients did not have to starve in the hospital! I cannot speak for others but that is how things went with my mother. My mother has a problem with swallowing, so she needs over-cooked semi-solid food and we mentioned this to every doctor and nurse who bothered to ask. But we did not meet a dietician till the third day. And since my requests over telephone to the dietician were not taken seriously, Ma lived on precisely one slice of bread (that she had for breakfast) per day for the first two days of her hospital stay. 

When I heard that Ma had thrown up the suji broth she had been sent for breakfast on the third morning,  I decided I had had enough and when some young ladies (smartly dressed like air-hostesses) of the patient welfare department came up to ask us about ‘our level of satisfaction at the services provided’, I told them the whole story of our ‘dissatisfaction’. That at least had the immediate effect of our getting darshan of the elusive ‘dietician’ for the first time since we arrived there.

After that things went well and she got a nice plain khichri for lunch which Ma ate with relish. Thereafter her spirits also revived. But it took us all of three days to be heard. Ma joked that at least her 3-day forced vrat was going to gain her some punya in heaven, but I wondered why your hospital needed dieticians and nutritionists at all if they can’t be bothered to talk to the patients with special needs; that too in a hospital where one is not allowed to bring anything from outside. When Ma asked for plain ‘rusk’ biscuits instead of Marie biscuits (which stuck at her throat) the dietician told her that rusk biscuits were not in the approved list! When Ma asked what rice was being used (as the long grains were hard to swallow) the dietician told her that that was the business of some other department and not her concern. That was really not very funny. 

I must admit that I do not like the heartless management jargon that has crept into these institutions: ‘level of satisfaction at service provided’, ‘managing patients’, counsellors, patients as ‘customers’ and so on. There were many other little things that annoyed us like our having been issued only one attendant pass, the absence of a book/newspaper/magazine shop. But maybe it is only old fashioned people like us who need book-shops. And we were ready to discount all that.

Because, on the positive side, we were very happy with the professionalism and competence of the doctors and nursing staff and that is of course the most important plus in any hospital. Of course there was a tendency to consider doing an angiography on my mother as a rather routine procedure in the beginning, but that quickly changed once the doctor saw (after looking at her records) how complicated her problem was.  He was very friendly and polite to Ma (which she loved) and he explained things clearly and patiently to us at every stage. We really appreciate that.

Given the fact that this is a country where only connections work, we were really happy that we were taken such good care of, without having to resort to them, even though this was our very first time there. [Of course the other thing that seems to make things work in our country is money, and I am not sure whether we would have been treated as well if we had not paid our bills so meekly.]

However I guess it was connections, or rather their absence in our case, that made the Chairman, when he finally arrived, behave the way he did with us. We had heard so much about him that we were very keen to meet him. When we finally got his darshan on the Saturday, it was only for a couple of minutes in the corridor leading up to his office and although Ma was not at all well, he kept her standing all the time while our doctor briefly explained Ma’s case to him. I guess he was listening but his fingers were busily scrolling the messages on his mobile phone. He did not address Ma directly even once, ignored me completely, briefly shook hands with my husband, and then dismissed us, saying we should come back on Monday for a longer sitting. We wanted his expert opinion on how best to proceed given the various complications in Ma’s case. But on Monday when we arrived, we were told that it was not going to happen, that the meeting had been called off, and we were told that ‘Sir’ had looked at the angiography report but was of the same opinion as our doctor regarding how to ‘manage’ my mother’s condition. We would have much preferred to hear this from the horse’s mouth but with that were given the marching orders and told to report back to our doctor and consult him if there was any need in the future.

We are back in Guwahati now and Ma is ‘managing’. I had given a few pages of ‘feedback’ to the Chairman and also to our doctor at our brief meeting on the Saturday. I have not heard back from either of them regarding any of the issues I had raised (most of which I have mentioned above). Given all that, I am not sure I would recommend either the Chairman or his hospital to anyone else if I was asked.  Firstly, because it is a bad sign when feedback based on actual experience is ignored, as it means nobody wants to spend any time thinking about how anything can be improved – that too in a privately run institution where one is expected to pay through one’s nose for everything. All said and done we came away with the feeling that above everything else the hospital was a big money-spinning machine and the more the money that came in, the easier it would be to keep up the myth (of the excellence of the institution and the reputation of its Chairman) in place. But soon the Chairman is going to run out of space on the walls of his office to put up more trophies and medals. I only hope he doesn’t think then that ‘managing’ that problem is more important than ‘managing’ his patients. For the plain fact is, rather than being shown into his office in his absence to count the medals and degrees the illustrious doctor had received, we would have been much happier if he had spend a few minutes, after getting back, just talking to us, anywhere, about how best to treat Ma’s problem, even if he had nothing more to say than what we had already been told. After all, we had gone to Escorts only because of the reputation of its great Chairman.



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