Tag: medicines

Discharge procedures

Earlier today, I had gone to help out a relative who had been admitted to hospital, and who was getting discharged today. The procedure was bizarre, to say the least.

A little before noon, a nurse walked into the room announcing that the discharge formalities were being put in place, and asked us if we had insurance cover (we didn’t). She reappeared five minutes later in order to remove the thing through which the intravenous drip and medicines had been administered. We thought it was time for us to leave, and informed people at the relative’s home to get lunch ready. What we didn’t know was that the “release” process would take nearly three more hours.

Every few minutes, I would walk up to the nurse station on the floor, and ask them when the discharge would happen. For the first one hour, they would tell that the bill would be ready “in ten minutes”. Finally I lost patience (my loss of patience doesn’t exactly make me an appropriate choice of personnel to manage discharge, I know) and asked them to direct me to the person who was actually preparing the bill. The bill was ready a minute after I appeared in front of that person, and it had been settled in the next five minutes.

A word here about the billing procedures. The relative’s ward was on the fifth floor, and I went down to the basement (“floor minus two”) to the billing section where I got the bill. I had to then take the bill and walk up to the ground floor to the cash section to make the payment, and once again take the receipt back down to the basement to get a printed bill.

Anyway, I thought most of the ordeal was done and proudly announced to the nurses at the nurse station that the bill had been cleared and they should let us go. But the discharge summary remained, and for the next hour or more, they said it would be ready “in the next ten minutes”. And once it was done, a nurse had to run down to the basement (yet again!) to collect it and get the signature of the doctor on duty. And run back up six floors (in another bizarre policy, hospital staff are forbidden from using the elevators!).

Then there was the set of prescriptions that were delivered to us regarding the medicines we had to buy for the following one week (and I’ll write a separate post on drugstores located within hospital premises). This wasn’t the first time I was helping someone get discharged, and this wasn’t the first time the discharge process took this long. From my own anecdotal experience, and from that of other relatives who I was talking to today, this is more the norm than the exception.

This makes me wonder why most hospitals, without fail, have such screwed up discharge procedures? Is this a matter of such low priority that all hospitals can consistently choose to ignore it? It is not like the amount of work that needs to be done is immense, so I wonder what prevents hospitals from streamlining the procedure? Or, like some hotels do, fix a discharge time so that they can batch process the procedures?

The problem, in general, with people in businesses that makes them feel noble, I tell you, is that they are not willing to heed to advice. And are not willing to question themselves enough. The nobility of their profession, they believe, places them too high to deal with mundane trivialities such as time taken to discharge a patient! And I’ll write a separate post soon on people in noble professions.

The Trouble with Mental Illness

  • The “patient” has an incentive to overestimate the extent of his illness, since he can “get away” with certain things by claiming to be more sick than he is
  • People around the patient have an incentive to underestimate the extent of illness. They think the person is claiming illness only to extract sympathy and get away with things that would be otherwise not permissible
  • The second point here leads to internal conflict in the patient, as he can’t express himself fully (since others tend to underestimate). Feelings of self-doubt begin to creep in, and only make the problem worse
  • There are no laboratory tests in order to detect most kinds of “mental illness”. Diagnosis is “clinical” (eg. if 8 out of following 10 check boxes are ticked, patient suffers from XYZ). This leads to errors in diagnosis
  • The method of diagnosis also leads to a lot of people in believing that psychiatry is unscientific and some reduce it to quackery. So there is little the medical profession can do to help either the patient or people around him
  • That diagnosis is subjective means patients have incentive to claim they’re under-diagnosed and people around are incentivized to say they’re over-diagnosed
  • I don’t think the effect of a lot of medicines to cure mental illness have been studied very rigorously. There are various side effects (some cause you to sleep more, others cause you to sleep less, some cause impotence, others increase your mojo, and so on ), and these medicines are slow to act making it tough to figure out their efficacy.
  • There is a sort of stigma associated with admitting to mental illness. Even if one were to “come out” to people close to him/her, those people might dissuade the patient from “coming out” to a larger section of people
  • If you were to be brave and admit to mental illness, people are likely to regard you as a loser, and someone who gives up too soon. That’s the last thing you need! And again, the underestimate-overestimate bias kicks in.
  • Some recent studies, though, show a positive correlation between mental illness and leadership and being able to see the big picture. So there is some hope, at least.

Hospital Issues

There is one thing that I haven’t managed to understand about Indian hospitals – it is the dependence on patients’ attendants. Every patient is required to have an attendant next to him/her all the time. In case the attendant is going out, he/she has  to literally take permission from the nurses. Full time, it is the attendant’s job to monitor the patient and alert hte doctors/nurses in case something goes wrong. And the main job of the attendant is to bring medicines.

Yeah, you heard that right. Most hospitals here have attached pharmacies, and the usual practice is for the doctor/nurse to scribble down a prescription which the attendant has to fulfil from the hospital’s own pharmacy. I find this practice weird and ridiculous, and wonder why the hospital cannot short-circuit the attendant’s role and then finally bill the medicines to the patient along with the rest of the bill.

Over the last couple of weeks when my mother has been in ho0spital, I’ve found myself being woken up at all times – including 1 am and 5am to go get stuff from the pharmacy. Sometimes it’s been as trivial as a syringe. Usually it’s a much longer list. Such a long list that given the crowd at the pharmacy, it’s impossible to check if the pharmacist has given you everything he’s billed you for. And in the wee hours of Tuesday morning when there was an emergency and my mother had to be shifted to intensive care, the first thing the people there did was to give me an extra-long list of stuff to get from the pharmacy. This was at 3am.

I wonder why this practice came about, and why it still exists. Is it to facilitate easy transfer pricing for the hospital? Is it t give some sort of transparency to the patient about the medicines being given to him? If the latter, can’t the patient just sign on the prescription authorizing the hospital to procure the stuff from the pharmacy? And given the monopoly power that the hospital’s pharmacy has, service is usually slow and inefficient, thus leading to long queues. And in such scenarios, it’s not easy to actually check if you’ve received everything you’ve paid for. And on top of this, you have the hospital giving multiple prescriptions for the same non-consumable thing, maybe just hoping you don’t notice.

And then there is this thing about the attendants. Thankfully we have enough extended family here in Bangalore that it isn’t hard to find volunteers to do vigil at  the hospital when I’m away at work or other things. But what if we were in a place with no relatives around? Or if the patient were living alone in the particular city? How would the hospital handle this? Would they make the patient himself run around to get medicines?

Whenever I think about these things I tend to get extremely pissed off. The hospital has been otherwise good. The nursing staff are all very nice and never crib. The hospital is maintained extremely well and is clean in most places. There are enough duty doctors at all times. And then they expect an attendant to be with the patient. And the expect the attendant to run around all the time to fetch stuff from the hospital’s own pharmacy.