Archive for the ‘Uncategorized’ Category

Meeting with the head of the hospital, Fortis, Bannerghatta Road, 071217

December 7, 2017

I had a long meeting (made longer by the delay in getting his visiting cards!) with Dr Manish Mtatoo, the head of Fortis Hospitals, Bannerghatta Road. I had a few major points to convey:
1. In spite of being an educated, articulate person, I did not find any process in place, to route my grievance through, when I found a lack of service in the hospital. I want other patients, too, or their representatives, whatever their level of literacy or awareness, to be given a concrete channel of grievance which is made clear to them at the time of their admission to the hospital.

2. I want billing practices to be improved in the following ways: Operation Theatre (OT) consumables and charges itemized separately, with the patient having the ability to cross-check the items with the doctor/surgeon, in case of a dispute. Other consumables to be itemized on the bill, with the patitent (or the family or friends) being able to query them. Not every patient will need, or want, this facility, but it should be in place for those who need it.

3.A system of prompt refund of any items over-charged, and a system that does not mandate the entire estimated amount to be paid upfront by the patient before surgery is allowed to proceed. Dr Manish denied that this was the case, but it certainly happened to me, and I am sure I am not the only one. I had to pay Rs. 1,50,000 upfront, and a refund of a single over-charged item which somehow escaped the detailed querying by my daughter, took 10 days to be credited.

4.I took along a friend of mine, Tara Ollapally, who is a legal mediator, to ask the hospital to build a system whereby, in the event of a grievance or of lack of service by the hospital (whether administration, billing, or medical/nursing care) , the patient or the representative can have the option to have a legal mediator (a neutral third party) present in the meeting between the hospital and the patient, guiding both to a practical and pragmatic solution, rather than a path to our time- and money-consuming courts.

Dr Manish and Nayna Pai both agreed to the point of view presented, and did mention that they would also want such practices embedded. Dr Manish mentioned how,often patients and their representatives threaten and do actually take physical action against doctors and hospitals. The idea is to reduce this culture of confrontation, where one party is aways jockeying for superiority with the bottom line being money, not the issues at hand.

If I am given clear documentation in the near future, that Fortis Hospitals, Bannerghatta Road, has changed the billing system, with more clarity and transparency, and is working, long-term, towards making patients more aware of their rights in querying hospital practices, I will certainly change my present opinion of them, and be willing to agree that there is hope for positive change.

As of now…my perception is that I don’t want to ever enter a hospital… or a court of law….if I can help it! I feel both may take years of my life, and/or chunks of my money, with nothing to show for it.

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From Nallu (Shiv Shankar Sastry, a gastro-enterlogist)

December 6, 2017

DOCTORS AND ETHICS

Medicine must be the only profession where the service provider, (the doctor) must do his best to ensure that his client, (the patient) goes off happy and never comes back to him and remains happy for not having to come back.

My internet service provider keeps promising me great offers and gifts if I can refer new customers to them and get them more business. Getting more business, attracting more people and ensuring that they keep coming back is a fundamental requirement for any business or commercial service. But not medicine. For doctors this is unethical.

Ethics is a strange beast. It is an ancient code of honour, a covenant to build trust and the understanding that the service provider will do everything possible for the good of the client and will not allow profit or greed to get in the way of selfless service. You will note that I am using the words “service provider” instead of doctor, and “client” instead of patient. I do this deliberately, because legally medicine is a service and patients are consumers. Medical treatment in India comes under the consumer protection act. This ruling came about because private medical practice is a “fee for service” entity – that is, the doctor provides a service and is entitled to charge a fee for that service.

The fact that doctors must charge a fee for their service was recognized in the west long ago. George Bernard Shaw actually wrote a play about the dilemmas that doctors face relating to service and fees. But western nations also realized that doctors must be compensated fairly for their service – and this has made a medical career in the west a magnet for young Indian medical graduates.

The story in India is different. Indian attitudes towards doctors are often based on an imaginary ideal – of a person who has dedicated his life to the service of mankind. He (or she) is the epitome of compassion and sacrifice. Pecuniary considerations are not for the doctor. When a patient, fearing for his life goes to a doctor, the last thing on the patient’s mind is that the doctor too may need to lead a life. The compassionate saviour mindset is drummed into young children as their parents desire them to become doctors. Television and other media stories regularly feature interviews of children of adverse circumstances, or of a specially gifted child who is asked about the future. “I want to serve society” blurts the child. “I want to be a doctor”. Funnily enough no one seems to realise that becoming a teacher is also service to society – but doctors are thought to be “serving society”. And of course we all know that social service must be done gratis. Free. Phukat. Or at least the doctor must at every instant of time be conscious of the fact that the patient is almost invariably poor, or, if not poor, has a daughter’s wedding coming up, or has already spent a lot of money on other doctors and other treatments and is now coming to this doctor as a desperate last resort because he has finally heard of this doctor’s great skill and compassion.

This is all very well but it is simply unrealistic. Ill health is only a problem for people who suffer from it. For the “health care industry” Ill health is supposed to be a profit making business. Like food and clothing, medicines are sure fire sellers – with huge and unceasing demand. Wealthy multinational Insurance companies are reported in the finance pages of newspapers as wanting to enter the “emerging market” of India’s health care industry. To them it is a market where their product is sold, and making a loss or being charitable are not part of the business plan. Doctors are a small cog in this huge business. They have to slot themselves into a position where everyone around them is intent on making a profit while they show the empathy and compassion.

If a patient needs an operation, the first person he must ask about the cost and the person he must depend on is the doctor. The doctor has to make a rough estimate of how much the hospital charges will be, how much the tests and medicines will cost and how much his own charges will be along with the fees of other essential doctors whose skills will be needed. The pharmacy is in it for profit and cannot give a concession on medicines. The hospital is a business – it could be a company with public shareholders. It must show a profit. Ultimately it is the doctor who is required to make a sacrifice and adjust his fees to suit the patient’s pocket. The doctor is a “third party” who neither sells medicine nor has control over what the hospital charges.

The three primary “health care delivery parties” are the medical shop, the hospital and the the doctor. The medical shop is a business that sells products at a suitably marked up price to make a profit. The hospital is like a hotel where charges depend on the facilities offered. A general ward, more crowded, less privacy is less expensive. A private room with more space, a bedside telephone and a TV attracts a higher charge. If the patient can afford more, he has the choice of paying more and getting more.

Doctors give exactly the same treatment to every patient, whether the patient is in the general ward or the private room. Therefore doctor’s charges must remain exactly the same no matter where the patient happens to be. This is an area where doctors have allowed themselves to be trapped by what I think is an unethical policy. Many corporate hospitals allow only lower doctor’s charges for patients in general wards and higher doctor’s charges for patients in private rooms. This is an anomaly. Should a doctor charge more for the same treatment just because a patient can afford a more expensive private hospital room? Or should a doctor accept a lower charge for his skills if the patient chooses a general ward? It is almost impossible for a doctor to give lower quality treatment to a patient in a general ward but he is forced to accept lower fees for the same skills compared to a patient in a private room. Doctors actually sign contracts to accept these terms and I think it is only a matter of time before some legal eagle points out the anomaly in different charges for the same treatment.

As far as I am concerned, I charge the same fees whether a patient goes to a general ward or a private room and I state my fees up front, telling the patient that he can himself make his treatment less or more expensive by choosing a general ward or private room. I feel that by doing this I am being transparent and not encouraging the dubious practice of different charges for the same service. Hospitals that have built in anomalous charges for the same service will, in the course of time, have to take note.

Trying to include accountability in hospital practices

December 5, 2017

Long and detailed post about my follow up on the bad billing practices at Fortis. Read only if you feel like it.

I spoke to an advocate friend of mine yesterday about the possibility of taking Fortis to consumer court. We agreed that it would take a lot of my time, effort and money. But mentioning consumer court to Nayna Pai (Customer Care exec) at Fortis has resulted in Dr Manish, the head of the hospital, agreeing to meet me after my appt with Dr Priyadarshan (that is another story…my wrist and elbow are extremely painful after a month, and the scar is absolutely ORIBUL, so I am going to ask if the scar can be reduced and made more aesthetic.)

Today my advocate friend called me back. She feels that I can make the case that the contract that the patient signs with the hospital must include a clause whereby, if there is cause for a complaint by the patient (could be medical negligence, bad billing practices, or whatever), the patient can meet the hospital representative with a legal mediator ( the cost of the mediator being shared by the patient and the hospital, or by the hospital) and the complaint thoroughly looked into and settled.

As this kind of accountability is what I am looking, for, I asked if someone she knew could come along with me on Thursday. She has suggested someone who is an advocate and a mediator, who can come along with me on Thursday. I don’t know if we will make any headway on the accountability thing…but I am going to try.

Crows using vehicles to crack seed pods! Ragihalli, 211017

December 5, 2017

I had read about how crows put nuts and seed pods in the way of approaching vehicles on roads and then eat the cracked nut.

here

is a very erudite study which does not rule out the possibility of crows using vehicles in this way, but suggests that they only drop the nuts on the road to crack them.

However, at the Ragihalli sheet rock area in the Bannerghatta National Park, on 21 Oct. ’17, we observed a Jungle Crow which definitely seemed to use the oncoming vehicles to crack the tamarind seeds that it was bringing, and then going to the road to eat the exposed soft tamarind.

Here’s the crow, which deliberately (and fearlessly) the crow leaves the seed pod and flies off only when the vehicle is almost upon it.

Here, the crow flies in after the vehicle has passed. You can clearly hear the excellent description of the crow’s behaviour by my friend Aishwary Mandal in the video.

Birding is not “ticking off” birds that we’ve seen…it’s also watching and learning more about the feathered creatures around us…sometimes they surprise us with what they do.

A blank wall

December 3, 2017

When I think of Death, I face a blank wall.
I realize that I do not know Death at all.
Will I just stop? Will I cease to be?
Or is there, just further, what I cannot see?
Will I be born again? / As a human, or a worm?
Would I move in someone’s bloodstream…
A single-celled germ?
Would my spirit float free?
Would my sins be wiped out?
Would I live on, just not me,
Only when I got talked about?
Would I really exist, apart from this shell?
Would I ascend to Heaven, or just go to hell?
For the answers to these…
Upon whom can I call?
I can ask as much as I please…
No one knows Death, at all!

How some balloons are useful!

December 2, 2017

Nature Feature on CitMat, Dec ’17

I often come across the

Balloon Vine

(also called “Love in a puff”)

IMG_6517

on my walks through the fields and forests around my city. It’s a very common vine, indeed….and in fact, in New Zealand, it is identified as a prohibited pest plant! However, in Kerala, the flower of this vine  is one of the ten “sacred flowers”

Seed pod and flowers:

DSCN8044

I found that the scientific name for the genus of this vine is “Cardiospermum”. The name intrigued me, until a friend and avid amateur botanist, Ajit Ampalakkad, showed me the seeds inside the “balloons”. Each seed was attached to the seed pod, and when removed, that area showed a beautiful heart-shaped pattern.

DSC04293

Hence…”cardio”, meaning heart, and “spermum” meaning seed. Voila! A tough-sounding scientific name was explained.

But there were more interesting things about this vine to be discovered; I realized that it has anti-diarrhoeal and homoeopathic properties.

Ripe seed pod:

DSC07747-001

Here

is a blog by Ramya Venkateshwaran in April 2015,  describing the various ways the leaves of this vine can be prepared.

I also came across this video, part of a food/travel series called “Suttralam Suvaikkalam”, hosted by

Rakesh Raghunathan

in which the green leaves are ground and added to rice batter to make tasty dosai (not dosas, which is a pan-Indian term…dosai is the Tamil word!)

So…do look around you if you are walking down country or wooded paths…if you collect the leaves of this vine (called “Mundakathan keerai” in Tamil), you will be doing yourself a good turn healthwise, if you include this in your diet!

Another surgery..and back home again

November 24, 2017

2 weeks after the surgery that I described

here

the knee injury that I had sustained in Madhya Pradesh (a young man boarding the train to Bangalore in a rush pushed me from behind, and I fell with my knee hitting the corner of a tin trunk, leaving me in excruciating pain) flared up again, and I could not even move a few steps.

I realized that the “settling” of the knee problem with antibiotics in September had not really solved the problem. So I went to the orthopaedic surgeon in Fortis while I was underoing the follow up after the surgery.

This surgeon did not give me any feeling of confidence, so I went back to Dr Ananda Murthy, the orthopaedic surgeon I had consulted in September.

I went only with the idea of having physiotherapy to clear the inflammation, but I soon had to change my mind. Dr Ananda Murthy clearly explained that I had a meniscus tear in my knee, and there was some other growth that he could see. I also mentioned the

Plica syndrome

the Dr J V Srinivas, the orthopaedic surgeon at Fortis Hospital, had found, and he said he would take care of that, too. He explained the process of

arthroscopy

clearly to me.

The decision made, I felt there was no point in delaying, and suffering. Friends took me to Shanthi Hospital which he asked me to go to, and was admitted. At noon, the arthroscopy was carried out, and I was discharged the next day (23rd November). The bill, by the way, was half was what Fortis would have charged! The hospital was small, pleasant, and quiet. Very clean, and a lovely private room with a view of a mango and a jamun tree! Good nursing staff, and good food (at reasonable rates for visitors,too).

With some amount of pain, Anjana took me to her home, but I found my knee progressing really well as the day wore on, and late that night, she drove me back home. I put some of the stuff away, let the others lie, and zonked out at 11pm…waking up only at 7.45am today (24th Nov) instead of getting up early and crossing the road to Dr Ananda Murthy’s clinic and being the first patient when the clinic opened at 7.30am!

I managed to cross the dangerous Bannerghatta Road and went to the clinic, where the doctor saw me and pronounced me fit to carry on normally. Both he and the physiotherapists at Shanthi Hospital and the clinic made the same statement:

“At your age, we usually have to tell people to walk more, and take the stairs, but we have to give you the reverse advice. At the outset, don’t walk more than 2 km per day, and be a little careful. After that, you are fine. We are impressed with your level of fitness..it’s closer to a 40-year-old.” That’s the kind of compliment that is very reassuring!

I underwent some physiotherapy, made the dangerous crossing (the road!) back home, and the compressive bandage having been removed, I felt such a sense of relief.

I had the hot-water bucket-bath of a lifetime,cleaning away all the plaster and bandage gums (oh how affectionately they cling!), tender massaging of the various stitches. This was followed by a self-pampering full-body moisturizing-cum-massage (done by me!)

I look at my body. Perfection in looks? No! So many bulges and bumps. So many places where the call of gravity is being heeded. So much efficient storage of fat. It doesn’t look anything like Miss World’s. But there is one great thing about it…it’s alive, it has carried me through 63 years of healthy life.

It has bounced back–fast– from so much that has been thrown at it, and it houses me in great comfort still.To me, this body is perfect. I will pamper it with a good lunch and a siesta now….or should I walk 2km to my daughter’s home and be with the grandchildren?

Advice to ill friends

November 20, 2017

Learning a lot from people’s reactions. When I listen to my body and do something, I have a lot of people around telling me I shouldn’t do it or I shouldn’t have done it (eg “Why did you go to Fortis?”…I was losing blood at an alarming rate and Fortis was the first multispeciality hospital I could think of where I would be likely to find good plastic surgeons; on that count, I was right)….but when I listen to my body and don’t do something, those people never seem to notice!

I listened to both the doctor and my body, and went to Dharwad. In Dharwad, there was no doctor; I listened to my body and cut short my trip. This past weekend, I listened to both the doctor and my body, which said (quite rudely) that it was not up to going out…so I didn’t go, in spite of a lot of advice (eg. “Why don’t you try mustard oil massage? You will be OK in 2 hours.”)

I live alone, and I need to walk a lot, so I am very aware that I must take great care of myself. I will not risk chronic bad health for even a Sclater’s Monal or a Clouded Leopard running on Bannerghatta Road! Rare is the person who tells me to listen to the doctor, or to listen to my body (but yes, I have such friends too, including my daughter)…I know that those around me are very concerned…but the concern seems to show in advice on what they think I should or shouldn’t do…even if it runs counter to what the doctor says(eg “Doctors will say you can, but you shouldn’t do xyz”) .

This is my learning….I should not go around offering ill people unasked-for advice. I should just listen to them, let them know that I would like to help, and render any help that I can. Now…as soon as I am OK, bring on that Monal and that Leopard!

The CGH

November 20, 2017

That old, almost-falling-to-pieces kaftan…slipping into it, when the day is done, is like nestling in the arms of one’s mother, a gentle lover….or the lap of the Almighty. The kaftan accepts my bumps and bulges; it comforts my bruised and cut skin; it welcomes me home. So…if I open the door to you in a tatty piece of attire,remember…I am wearing my CGH….Cotton Garment of Heaven.

Notes from a freak accident on 021117

November 7, 2017

I am going crazy repeating to every person who is enquiring, “What Actually Happened?”

Well, here it is:

I was showering at 8 am in the morning when the six-foot by five-foot glass sliding door of my shower stall broke. No clue why.The glass had been installed 13 years ago, and was not safety glass. The shards sliced a deep gash in my hip, er, well, my bum, on the left side; on my right, gashes in my elbow and wrist, and (as the surgeons told me today) several internal and external cuts on my back and sides.

I am amazed by how coolly I reacted.I saw the shards of glass with bits of my skin, fat and blood all over the shower area, and knew that it was quite a bad situation.

The sliding door with its remaining shards of glass was stuck, so I had to carefully squeeze my way out. I then realized that I was losing blood at an alarming rate from the huge gash on my hip/bottom, so I wadded a lot of toilet tissue and held the gaping wound shut.

The shock of what happened meant that I had an urgent bowel movement. So I did that neatly, too, on the throne, no poop to add to the blood all over the bathroom.

I’d just put shampoo in my hair, so I washed that out in the washbasin.

Holding the hip wound but bleeding from the gashes on my elbow, wrist and back, I went to the room where the phone was, and called my daughter (I’d just wished her a while ago for her birthday). Since she was in the gym and could not be reached, I called up my son in law and told him it was an emergency, and that he should locate her and ask her to come pronto.

I switched off the geyser, the lights around the flat, picked up my purse with cash and debit cards in readiness. I put on underclothes, and an old kaftan, as I knew it would be soon blood-soaked.

I opened the door to my daughter when she arrived. I held another wad of tissue to the hip wound while she lined the front seat of the car with newspapers. She then drove me to Fortis Hospital on Bannerghatta Road. I knew that the hospital was a money-making concern, but I felt I had the best chance of finding good surgeons to operate, so I decided to go there. Indeed the surgeons were good, though some of the nursing was pathetic, and the administration unethical in the billing (more about this later).

The wound was taped shut in Emergency, and I was generally cleaned up. I was made to wait for three hours for a room as I was told the hospital was full. Once I was moved into the room, I was not allowed to have even a drink of water (I told the nurses that I’d had nothing since dinner at 7pm the previous night) because of impending surgery. I am sure that hunger and thirst added to the shock of my accident.

Fortis then insisted on prior payment of a large sum of money (Rs. 1,50,000) (this itself seems unethical to me) and refused to carry out the surgery without it. My daughter and my friends Jayashree and Nayantara, who’d also arrived at the hsopital, organized it. Jai and Nayantara went home, but my daughter had to stay with me.

Though surgery was thus delayed, I was wheeled in at 7.20pm, and the surgery, which took a little over an hour, went very well. I returned to consciousness and was brought back to the room at about 9.30pm. Jai, who came back in the evening, stayed with me while Anjana went home to get things organized for the children for the next day, and returned by 12.45 am, when Jai went home. Though the surgeon had told me that I could have food after midnight, the nurses would not allow me to eat or drink anything until 1 am. Jai’s suggestion of a glass of Horlicks was excellent and a life-restorer.

Anjana, suffering from cold and fever, was out like a light; luckily, I was able to go to the toilet on my own, and considering the injuries, spent a reasonable night.

The other patient in my room was a gentleman who was having his knee fixed after some wire had broken in the knee replacement. For some reason, he was suffering from a lot of gas, and my night was punctuated by unmusical and loud emissions. Sleep was out of the question.

At 5 am in the morning, the nurse came and switched on all the lights, waking everyone, including my ill and exhausted daughter, for no good reason that I could see. I switched off the lights again to let my daughter sleep. I had to fend off the staff who came to sweep and then mop the room, to ask if I needed a bedpan ( an offer which I was thankful to refuse), an ECG for me, and breakfast service. I then kept awake to prevent the staff taking away the breakfast tray, as I had saved some of it for my daughter when she woke up. I also had a few friends visiting. Sleep? Rest? What are those?

At 6 am, one of the surgeons, Dr Sinha, came to see me, and pronounced that I was doing fine and could go home the same day.

The nurse told me that I could not be discharged without the main surgeon’s “discharge sheet” and the discharge summary. However, she said, the paperwork for claiming the insurance would take 3-4 hours and I could not leave until it was completed. I asked why someome else could not collect the paperwork after I went. The response to this was, “Speak to our in-charge”… a person who never appeared. I made a big fuss until I got some attention, and the main surgeon, Dr Priyadarshan visited by noon, and pronounced me fit enough to be discharged.

At 11am,Anjana had woken up, and Jai returned. I warned Anjana that the hospital bill would be padded up, and at noon, after the surgeon’s visit they both went to Billing, where, sure enough, there was overcharging to the tune of about Rs.6,000. Two and a half hours were spent on this exercise and I was finally discharged.

I am back home now, and have been told not to lift weights with my right hand as a tendon has been cut in the wrist. Other than that. It’s just been… a pain in the a**! This describes the injury, the effects of the surgery, the 6- hour delay in discharging me… and the over-billing, to the tune of several thousand rupees.

I am now facing the daunting task of downloading several forms from the insurance company’s site, filling them up when my right wrist is tightly bandaged up, and making my insurance claim.

Update on 091117

I went to get my wounds re-dressed and we asked the surgeon what the surgical mesh was that had been used. The surgeon said he had not used any mesh. This was a charge of Rs.27,6000. With the earlier overbilling the total amount overcharged was Rs.32,100. The hospital was perfectly aware of what was being done. VERY unethical.

**********************

Sidelights (FB posts):

1.The surgeons were good at Fortis, Bannerghatta Rd.. I am comfortable.. But the rest.. awful. I am now bleeding from the spot where an incompetent nurse replaced the butterfly IV port. I am told that after the doctor ( no nurse will tell me when he might reasonably be expected) the insurance papers will take 3-4 hours and I cannot leave without them( I am not joking… I asked why I can’t send someone else to collect them, and was told it can’t be done!).…aaargh. The idea seems to be to keep me long enough to bill me for another day…and another, and another….

2.The doctors do their job efficiently, and then the patient passes into the hands of that monster, the Billing Dept. Today, it took 6 hours to get discharged. Fortis tried to bill me for: half a day’s room charge, meals that were not eaten, medication that the duty nurse took away before my eyes, and my daughter and my friend Jai, alert to this, found a total of nearly Rs.6000 over-billing. (the bill was around Rs.1,50,000).If, in the protracted, painful process of a patient’s discharge, one does not notice these ‘oversights’, one is the loser, literally and figuratively.

3.I found that the hospital staff had brought the mask used for my anasthesia back to my room. I decided to bring it back home. What a bonus! K2 added it to the doctor’s kit. I’ve just had my budpeser checked, my ears and eyes peered into, my heart and bristles(don’t ask me what those are!) listened to with the steth, and ofkose, with the mask, had a whole opewation done with a pair of large yellow tweezers, where my stomach was cut open but I did not die. I then told him to give me a bill, and he brought me some torn-up kitchen tissue to pay it with. The best opewation I have ever had.

4. One butterfly that I don’t like:

click here to view

5. I like to laugh….but I really didn’t need to be in stitches in the surgical way! Embroidered all over, l yet count myself lucky when I think where those glass shards could have fallen…and what damage they could have done.

6. A doctor friend called me up and asked why I had not given him a call immediately. He asked me to remember to call at once next time. I profoundly hope and pray that there will be no next time!