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Hospital Commerce

I was climbing the stairs of my hospital. Had to make way through a group of doctors and relatives at the first landing. A lady was crying badly, requesting to wave off her husband's bills.

The treating orthopaedic surgeon was trying to explain in vain that he had waved off his charges. Actually neither she understood it, nor did it solve her problem. She was persistently requesting that she had even sold her Mangalsutra for his treatment but the calls to deposit more and more money continued.

He was a patient of crushed lower limb due to a run over accident by a lorry. The necrosed (dead) tissue had disseminated in the body, causing renal (kidney) shut down. He was under dialysis every alternate day. He was taken to some other hospital for the same by ambulance and used to come back to sleep in our hospital. Akin to going to his job in the morning and comes back home at night. I asked the duty doctor in ICU about the need of keeping him here! The night halt was costing him about thousand rupees. Seven hundred bed charge and three hundred doctors visit fees.

I was the case in charge and used to sign sincerely on his case sheet after writing ct all (same to be continued). I had realized how precious my signature had become after getting attached to this multi specialty hospital. No need to operate upon to earning livelihood. Just shake hands with physicians and create an opportunity to sign over in a few files in the name of so called surgical check ups. It is both ways. We also call them to sign by sending those calls for medical check up without any obvious need. Any way, I was a bit ashamed to see my accumulated chunk of money , or rather my contribution to make her sell her Mangalsutra. I was trying to justify myself that after all he is a medico legal case. If any thing goes wrong, it is I who will be facing the court, where they will pay me only Rs 20 for that visit. After all I have to make up for my losses. How can I spare her? The duty doctor was trying to convince me that all the other doctors were not taking any fees, you also kindly consider.

This patient was brought by his brother from the medical college. On admission I had laughed at the lady when she expressed how poor she was. It was just the opposite in college, whenever any body used to try to influence us by his status or money, we used to say, why you didn't go to a private hospital. This is for poor people. But she seemed sincere about her statement.

I said that you have taken a wrong decision by bringing him to a private hospital. We are vultures. You will not be spared by anybody. Don't come to us if you do not have enough flesh.
Unnecessary expenses start at any private hospital right from the entry. The first one to earn is the ward boy who shifts the patient to the casualty. Then to write down your Address and Telephone No they charge you Rs 100. That is called Registration fees. The casualty doctor examines the patient. He is a bit more literate than relatives. Usually they are BAMS or Homeopathic doctors who are trying to get exposure in big hospitals before they start their private practice in periphery. After wearing apron, all look alike. We do not have any regulation to write our degree etc below our names. At this entry point of the hospital, we have appointed the most incompetent person. At the point where life and death could matter in minutes. In one of the hospital, we have a retired deaf fellow to receive the emergency. There is non MD or MS doctor in my knowledge who receives a patient in any of the 110 hospitals of our town. I always advice to go to medical college for emergency, but the irony is people rush towards a private hospital in odd hrs.

The causality doctor notes down brief history and there is a ready made seal of investigations, which he stamps on the case file, calls for a patho boy to collect the sample. After he has collected the sample and he goes away. These patho boys are very expert at puncturing the vein.

Now this fellow plunges the needle 5-6 times before he enters a vein successfully to start IV drip. I wonder shy blood sample cannot be taken before starting an iv line of saline and save the patient of these multiple pricks, but after all this is the only place where this junior fellow will learn how to start a drip. The patient has to undergo array of unnecessary tests, to repay the loans of those costly gadgets. Hospital authorities have their own explanation. They say if the patient is not properly investigated, we are pulled in consumer forum. Looking at the safety part and good paper work, it is necessary to carry on the investigations on over side. Well that is justified.

So the patient has already spent about Rs 800 before the consultant visits him and proper treatment starts. When I receive the call at midnight, I feel that I should not have to wait for the x ray and Sonography after going to the hospital. My prolongation of sleep for about half an hour costs him further Rs 800. So he is down by about Rs 2000 before I come into picture. I write Rs 300 against my name before I start talking to him (because sometimes you forget to write after examining the patient). May be many such unnecessary visits and investigations could be avoided if the hospital employs a good CMO. But the hospital will have to pay him at least Rs 15000 a month.

I call for the responsible person and give him an idea of what lies ahead as far as expenses are concerned. (I am explaining this after having made him spend about 2500/-).

He says "don't worry, doctor. Give the best to my brother. Any way. Of the eight persons seen at night, only three are visible next morning. Brother is missing. I asked the lady about him. She said he has gone to arrange money. I am yet to see any person coming back, who has gone to arrange money. Now a days I don't feel the need to go physically to arrange money, if it is there. A telephonic message is enough to get it.

I again explain to the lady. See, I don't feel his brother will spend so much on him. You seem to be a middle class family. Middle class people take the financial burden only of their wife and children, not of brothers and sisters. Even the burden of parents is not happily bourn by a single person. He tries to share it with other brothers or expects the father to part with his retirement benefits.

I see her eyes swollen due to a sleepless night. She was clad in the same clothing. I asked her to take bath, some snacks and a little rest. But she is in panic and not responding.

By afternoon her brother who has heard of the accident has come to console his sister. He had brought some money which he deposited at the counter.

By evening the crowd has dispersed with only the patient's brother in-law remaining with him.

Reception counter was persistently asking The patient's relatives to deposit money. They were saying that we do realize the problem of arranging money at midnight, but now the whole day has passed and you have deposited only Rs 3000. You need to deposit atleast Rs 10,000/- on the first day of admission.

I overheard his brother in law telling to his neighbour " Bhaiyya, ye to aise peechhe pade hain jaise hum kaheen bhage ja rahen hai! Mareej bhartee hai aaj nahi to kal paise de hee denge" (They are after money. After all the patient is going to remain admitted, shall we run away without paying the bills?)this is a typical dialogue. It is true if the patient survives but what if he dies? Then they say (See what time has come, they are asking money even after the death of our patient)" Batao bhala murde per upani roti senkte hai, insaniyat to bilkul bachi hee nahi".

When I went to see him at night, it was now 24 hrs after the accident and found him irritable. I asked to repeat the blood profile. The relatives said," it is not even one day and you are repeating the same investigations, are they necessary?" How can I tell them that now they are really necessary, they were not at admission. (When you people thought that they were necessary).

When you build your first house, during the laying down of the foundation, you say to your builder "I don't want you to compromise in any matter, use the best material. The house should be strong. Give it an extra strength by using 8 mm steel rods instead of the usual 6mm. As the construction progresses, and you are drained of the funds, during plumbing and electrification you request him to save money as much possible! Same is with the patients. On admission they are surrounded by a crowd of well wishers. Every body is ready to contribute in that wave of sympathy, but as the time passes, near and dear ones gradually cut off themselves and help remains in the form of 'get well soon' cards.

On the third morning his real brother arrives. He says "It was March ending, so I had to hand over the charge to another officer for closing. The patient's brother in law is relieved to see him and tells him about the need to deposit money. Mean while the lady arrives. The brother says "I am going to get an advance from my office within 2-3 days. I have applied for the same from my GPF." When he asked his wife to spare some money till then, she refused bluntly saying "Tab tumhare bhaisaheb kahan they jab hame pappu ke janeu ke samay kuchh paise kam pad gaye the?" At that time this lady had refused to help them, saying why are they spending so lavishly on the ceremony when they don't have money ! Actually these ladies never let the brothers remain united, any way.

"Bhabhi why don't you try to create some money if you have a few ornaments to spare. I feel sorry to suggest this, but after all it is 'stridhaan', we save it for these bad times only. Bhaiya will get your ornaments back when he recovers. Life is more precious than gold, isn't it? "It becomes easier to say this and face his brother too, as by this time brother is semiconscious. Had he been fully conscious this fellow would not have courage to say this because of the nostalgia of childhood, those good and bad times they had spent together!

He remained over night as a guest and left behind his son to take care of his uncle. This child in fact was an additional liability for that lady. He went away assuring that he will come back soon with money.

By now the lady had realized that she was in a thick soup!

The visits for dialysis continued. Every gram of gold lowered the blood urea by 10 mg. Over night it came back to the original value. Ortho surgeon chopped off the dead mass which was releasing this venom in to circulation. Deterioration continued.

Today her last piece of gold, her Mangalsutra was sold.

The patient's brother had yet not come.

Dialysis has been stopped. Chemist has refused to give further medicines. We are arranging samples for medical representatives and treating him as much as possible. Blood urea is going up by 10 mg every hour.

Lady has accepted her defeat in battle.

"How will I take him back?" is a question going on in the back of her mind.

Duty doctor was requesting me again and again to waive off my charges. The question remains, should I?

My share is hardly 3% of the total expenditure. The major chunk is the hospital bill. If I had refused admission, foreseeing all this, the directors would ask me for explanation. None of the directors bother to look round and see the actual situation. They are busy in their AC chamber manipulating the figures. They will never have any sympathy with this or such patients. What they will see is a case sheet written "concession please" by the duty doctor. They ask whether any body had called for this patient (any politician, or one having some nuisance value). If it is not so they usually do not consider. Why should they, when the hospital has to pay in commercial rates for taxes, electricity etc. The govt does not exempt hospitals. They also have to pay interest to banks for all loans on routine rates.

We also do not have any liberty to say no to any emergency by law. Then why should I waive off my charges?

The lady having lost everything, with a dying husband does not understand this hospital commerce.

She insists on discharge. His brother has come back and is creating a nuisance . He says "I had left my brother fully conscious and talking. If you cannot make him well allow us to take him some where else."

We are insisting on him to clear our bills.

One of them says "How can you keep a serious patient in your hospital without giving him any treatment"

Another says" They are merciless people. They will even retain the body for money".

I feel it would have been better if he had died peacefully in the govt medical college without crashing the economy of his family. Whatever remained would have helped her for the restart of her life.

Who is to blame ? His brother - who took him out of the medical college and brought him to our hospital with all good sentiments?

Or the hospital which is a purely a commercial place?

Or Dr DU who is bent upon taking his charges?

Or the society , near and dear ones who withdrew?

The questions emerge like those in the tale of 'Vikram and Betal'

He asks to himself " Bata DU kya sahi hai, nahi to tumhare sir ke sou tukade ho jayenge"
Me in the role of King Vikram wave off my charges; and take oath not to treat a poor patient again and become party to ruin his family , because the social structure will not change.

Let us accept that poverty is a curse, with illiteracy added it becomes still worse. You do not know your limits. May be my wife will have to face the same if she takes me to a big hospital in Mumbai, or for that matter if an average person from Mumbai goes for treatment to New York.

The duty doctor was hanging on my shoulder like dead body in the story.

When I gave him the knowledge of hospital commerce, he was satisfied and flew to attend the new admission in casualty with a huge crowd, responsible person saying "Don't worry Doctor, give the best to my brother".