How to choose your hospital or health care provider?

There is a mushrooming of hospitals in India, especially in metropolitan cities. I recently heard from an entrepreneur that only one third of the population in India have access to health care, especially quality health care. So the business of hospitals is likely to grow in the future. But how do you make informed decisions about choosing hospitals for your health care needs? What kind of place would you like to have for your treatment?

Here are a few suggestions:

The hospital is a system and about personnel and not just buildings and equipment. There is a tendency to go to hospitals based on the appearance. Anyone with a lot of money can actually build a beautiful place, but hospital systems that treat patient well (medically) are quite difficult to create. Hospital systems stabilize over time and evolve to standards.

The quality of the hospital staff reflect the effort put in to make treatments safe. In the world of medicine, developments occur at fervent pace. But to translate the results in another institution to a locally suitable protocol is a very large project. For developing a protocol for pancreatitis management, it took one and a half years, even though the guidelines are available in public domain for more than 6 years. We developed a bleed protocol for patients with gastrointestinal bleed. It took 1 year to create one and another year to successfully implement it. Both these protocols are not based on buildings. It is based on people, people who are committed to make a difference. Both these protocols were developed an successfully implemented in CSI Kalyani Hospital, which is supposed to be a  mission hospital serving the poor and needy people in central Chennai. But to translate the same success to a larger corporate hospital is difficult and the to reproduce the successful results of the former organisation in a newer hospital is difficult, if not impossible to achieve. We had to change the nurse based protocol of a mission hospital to a consultant delivered care process in the latter. The cost of the process became 5 times the total cost in a mission hospital, to achieve the same net effect.

The second difference lies in equipment. Unlike the public perception of newer technologies, we doctors are aware of limitations of the technology. I would highlight one example of people's belief in technology. Now and then, we see a patient who asks me, whether I would do a surgery with LASER. There was a patient who asked whether I would operate on his hydrocele (a collection of fluid around the testis) with LASER. Medical LASERs have usually a role in stopping bleeding and a very minor role in the dissection during a surgery. While I am not averse to using this technology, I would not use it for all my procedures. The cost is prohibitive and I do not want to stoop to the level of lying about the use of lasers in my surgery. The private joke in Chennai about LASER is that it is the Latest Advance for Surgeons to Enhance Revenue. So much for jokes.

Liver resections, even for cancers can be done with very simple equipment,
which are available in most hospitals

What would be appropriate for one surgery would not be relevant for another. I have learnt to do my liver surgeries with very simple equipment. One of the suggestions in the training program at a major cancer centre in the USA, is that the trainee surgeon has to learn to do the surgery with simple technique called the "Kelly clysis", where you use a clamp to crush the liver tissue during dissection. The same surgery can be done with costlier equipment as well. But ultimately, it is the surgeons treatment of your tissue that will make a difference. The hospital needs to provide relevant equipment that will enable you to have a safe surgery, in the best possible way and the least expensive way.

Gall bladder cancer cancer invading the liver after excision

What I would see in a hospital if I am treating myself or a relative would be of much use to you. Before you choose a health care provider or a hospital, please ensure

1. That simple performance of commonly used clinical processes for the level of care that is being provided - things like standardised BP measuring equipment, correct medication timings etc.
2. Suitably qualified medical personnel, both doctors and nursing staff. Nursing skill is easier to see and decide. The Medical training is far more difficult to assess. What you should look for is availability in a crisis. There should be trained doctors round the clock.
3. The hospital has a system of treatment for the particular medical condition.
4. Make sure that your hospital has the necessary equipment to handle any complication that may arise.

Ultimately, the hospital should make you forget your disease and ensure your smiles. That is really a tall calling.