Inject trust back into the healthcare system
Trust between patients and private hospitals sank to new depths this year, with complaints of overbilling, negligence and complicity between medicine practitioners and the pharmaceutical and medical-devices industries making headlines across India.
The mistrust has been building for a while. It’s become routine for patients to complain of being overcharged for both necessary and unnecessary treatments, and for doctors to accuse patients of unfounded scepticism that leads to their spending more time on treatment-related paperwork than on the practice of medicine.
Both parties are at fault and need to take a step back to get perspective. Hospitals need to be transparent about possible outcomes before beginning treatment, while patients need to have realistic expectations of the costs of therapies and of treatment outcomes.
“These frictions can be reduced substantially if hospitals adopt a transparent system of billing,” ruled the Bombay high court on Wednesday, pointing out that there would be fewer disputes if hospitals gave an estimate of final bills to patients and their families.
“Today, it is uncertainty in the bills that is causing problems, and except in emergency cases, this can be reduced if hospitals give a fair idea of the likely bill to the patient or his relatives in advance,” the court said.
It’s clearly unethical for hospitals and nursing homes to detain patients or withhold dead bodies when dues are disputed or not paid. On the other hand, it’s equally important to establish a mechanism to ensure money is paid for treatment. Desperate families sometimes demand or agree to expensive treatment plans when the patient is ill, but refuse to pay if the outcomes are not what they hoped for.
If the patient as a client is not happy with the service, he has every right to complain. Just as the hospital has every right to explain why it chose a certain modality to treat a particular disease or condition, and why the treatment failed, if it did. Medicine is a science and treatment follows validated protocols. If documentation is needed to prove the right treatment was given, it should be maintained and shared with the patients and their families.
This is not often done, and the result is confusion and discord. It’s vital to take time out to counsel and explain why a particular treatment is being considered so patients aren’t forced to turn to the internet and its medley of conflicting and often inaccurate advice.
Transparency is key. Doctors must acknowledge the patient is a client and the corporate hospital, a service provider — and often a very pricey one. Doctors charging thousands for consultations and lakhs for surgery must stop acting like they are doing the patient or humanity a favour. And if their work falls short of expectation, they must understand that they will be judged and held accountable like other professionals are.
Overcharging patients for devices and consumables is the other factor that feeds the fear of an industry-doctor nexus. Following the capping of the price of stents used by cardiologists to prop open blocked arteries and orthopaedic implants for replacement surgeries, the National Pharmaceutical Pricing Authority investigating the death of seven-year-old Adya from dengue haemorrhagic fever noted that Fortis Memorial Research Institute, Gurugram, had on occasion marked up consumables by up to 1,737%. The case made headlines after Union health minister JP Nadda tweeted in support when Adya’s father posted details of the Rs 16 lakh bill charged by the hospital during her 15-day ICU stay.
Fortis Healthcare countered the charges of overpricing with a telling statement: “Our end-price to the patient is very much in line with what other private hospitals in India charge”, indicating all private hospitals mark up the price of consumables used for treatment.
This brings us back to transparency. Hospitals rarely discuss potential costs upfront, and doctors, trained to save lives, are hesitant to outline potential negative outcomes to patients and their families.
As Atul Gawande says in his best-selling book, Being Mortal, doctors are acutely uncomfortable discussing their patients’ anxieties about illness and death and fall back on false hopes and treatments that do not improve life. And families go along with it, either because they don’t know any better or because they are desperate to clutch at straws.
The doctor-patient relationship is just that, a relationship, and has to be nurtured with honesty and faith.