Who Will Cry for Our Doctors?

Unfortunate Incidents in the Recent Past

Some doctors in India are angry and for a good reason!

I was recently invited to an exclusive doctor’s event as a distinguished guest. This event was organised immediately after the two unfortunate incidents in Fortis Memorial Hospital Gurgaon and Max Hospital Delhi that attracted widespread adverse media publicity. The event started on a sombre note taking into account, inter alia, these two incidents. The clinician community was extremely unhappy with the way healthcare business is being run in the country. They lamented the way billing is done and how doctors seem to be at the receiving end all the time when things go wrong, while allegedly providers reap profits on the fringes. They even had carried out some calculations on how much insignificant money really a doctor made on each of these two mishaps and how they got the most flak for the incidents.

The Burnout

Most star super specialist doctors work round the clock and barely get enough time to rest and sleep, or to pursue hobbies. Being on call 24x7 has a negative effect on their health. Add to this commercial expectations from the providers. Some even have to continuously travel to drive outreach activities and attend promotional events with little or no rest. The net effect; a severe burnout. Many doctors face severe health problems because of the constant stress. This doesn’t do good to anyone and even militates against patient safety. Overtime, this will also adversely affect wellness of doctor and dent overall profitability.

Most star super specialist doctors work round the clock and barely get enough time to rest and sleep, or to pursue hobbies.

Effect on Doctor’s Morale

This would have adverse impact on doctor’s morale. Unfortunately, there seems to be a palpable disconnect among the ‘management’ and doctors in most hospitals in the country, save a few cases wherein the leadership itself is proactively driving the relationship and has put in place responsive measures to sincerely address routine administrative problems of doctors, which are many. Non timely payment of dues, frequent equipment breakdowns, non-availability of right staff or equipment and round the clock working conditions constantly take a toll and affect their functioning, while severely stretching interpersonal relationships in healthcare organisations.

Patient and his/her dependents too are becoming more conscious of their rights & privileges and are therefore becoming more and more demanding. Most patients now feel that a doctor is also a service provider like any other. Customer activism is redefining the patient-doctor equation – slowly but surely the power is moving away from a doctor in this tenuous relationship. There cannot be business as usual anymore. Willy-nilly this will have a far reaching impact on a doctor’s psyche and his engagement with a patient or healthcare provider.

Customer activism is redefining the patient-doctor equation – slowly but surely the power is moving away from a doctor in this tenuous relationship.

Rising consumerism and increasing cases of litigation in the recent past have further exacerbated the situation. Today, most hospitals have ongoing litigations and are fighting the war on two fronts – to stay compliant and do all they can to avoid any litigation for medical negligence while remaining profitable: a tough job indeed for most providers. Add to this the ever growing regulatory healthcare market conditions in the country.

The Real Revenue Centres

Frankly, doctors are the de facto revenue centres in a hospital. Their health and well being is in everybody’s interest. All the best equipment and infrastructure is worth nothing if we cannot optimise their performance and address their problems proactively so that they can concentrate on creating clinical excellence and continuously improve outcomes. This is possible only by making them free of any extraneous encumbrances and administrative burdens and creating an environment conducive to productivity.

Doctors are the de facto revenue centres in a hospital.

What do Doctors Really Want?

This brings us to the oft asked question as to what do doctors really want.

Apparently, they want better control in designing care and patient management. They want better control over pricing of products and the ability to give financial relief (read discounts) wherever due. They want to be relieved of all administrative hassles. They want better staff, fully trained to handle entire continuum of care, staff who can take away part of routine work, so that doctors can better concentrate on serious clinical tasks at hand. They want better equipment and medical devices that can help treat a patient better and ensure good and consistent outcomes. Put simply, they want all things that contribute to better patient delight and outcome. We need to indemnify them against potential backbreaking litigation or violence, when things do go wrong, as sometimes they will. They want all the modern technology tools. They need to be supported for continuous training and educational initiatives that enhance scope and scale of their services and clinical expertise.

Put simply, doctors want all things that contribute to better patient delight and outcome.

Last but not the least; a better compensation hurts no one and can smoothen many a frayed nerve!

What They Don’t Teach at Medical Schools

More and more people are suffering from incurable diseases that could kill them. As the life expectancy increases in India and as we head towards a bigger lifestyle disease catastrophe (diabetes, hypertension and other chronic conditions), doctors job is going to become more and more challenging.

Unfortunately, they do not teach so many things in a medical school that can prepare them for many of the real life challenges that doctors face while practicing medicine. Psychological handling of end of life situations, counselling of a patient or dependents on critical clinical condition or loss of life despite best efforts, are some of the issues that they are not trained for but learn the harder way. Intuition kicks in at times but the psychological toll it takes on them is high.

Unfortunately, most doctors are not well versed in the commercial side of the healthcare economics and resist or loathe any discussions on that count, thinking this to be the sole responsibility of the ‘management' alone. Unfortunately, that’s only half the truth, as doctors are an integral part of the cost optimisation and their practice building initiatives.

As the life expectancy increases in India and as we head towards a bigger lifestyle disease catastrophe (diabetes, hypertension and other chronic conditions), doctors job is going to become more and more challenging.

Today, medicine is one of the most challenging and stressful professions. Doctors, like many other highly stressful professions, also need to be trained in stress management. They have to be mentally attuned and they can make patients feel cared for and concerned about, only if they are stress free themselves. Yoga & meditation can help, as can other social engagements.

The ability to derive meaning from the work doctors do, can transform the lives they lead, while positively impacting outcomes.

Ethical Dilemmas

Who could be a better patient advocate than a doctor, an onerous responsibility indeed, given the trying times medicine is passing through in India.

Many a time, death will occur in a hospital because of clinical errors or failure of equipment or sometimes even because of sheer negligence. Nothing is harder for a doctor than to tell a loved one that their family member is dead. Most doctors grieve too, some even quietly. Unexpected death is universally heart-breaking but are patient’s dependents and near and dear ones really prepared to listen?

Nothing is harder for a doctor than to tell a loved one that their family member is dead. Most doctors grieve too, some even quietly.

Like most humans, doctors need empathy too.

Regrettably we in India at times try to hush things up for the fear of a strong patient or dependent backlash or a damning litigation. Unfortunately, this doesn’t help. Adverse media publicity too is now a real threat, as evidenced in the recent incidents. Most healthcare providers fear nothing more.

So how do you cope with them? How can doctors help sustain clinical and ethical propriety? What should be the role of doctors in handling such moral dilemmas, are some of the questions that easily come to one’s mind. Unfortunately, there are no cut and dry answers to these questions.

Conclusion

Doctors are increasingly faced with the threat of ever reducing time for patient care, as documentation has increased disproportionately and administrative burdens are getting worse. This anomaly needs to be set right ASAP. Technology can help bridge the gap, albeit in a limited manner. We need to encourage our government/regulators to address increasing regulatory burdens that are driving inefficiency, redundancy, and waste in India. EMRs & EHRs and other technology tools can partly mitigate the problem but few providers are willing to invest in technology and suitable software to ease the burden.

Needless to say, providing care is becoming ever more challenging and doctors need to be supported to ensure seamless care.

All doctors want is an opportunity to practice medicine in a way deserving of their dedication and respect. Let’s be fair to them and extend all support they need to run their practice with dignity and love so that we can expect excellent outcomes each time in the best interests of patients and providers alike.