Habits Die Hard

My hospital is gigantic. When it was built more than 80 years ago, it was planned well, for the needs of people at that time. As the population expanded, and as specialties and super-specialties developed, the hospital also expanded. These expansions were wherever space was made available, not necessarily keeping the convenience of the patients in mind. Somewhere near the north end of the building, there is a wall, and there is a stone with the engraving “Women’s Exit” just above of where the exit was. The exit was closed long before I joined the institute as a student 34 years ago. I see it because it is seen from a window near my outpatient department. I wonder if anyone else sees it. The laboratory is at one end of the hospital, the collection center is approximately in the center of the hospital campus, and the outpatient clinic is at the other end of the campus. The sick patient has to go all the way from one end to the other, and many times like that if there is any problem with the collection, processing of the sample, and receipt of the reports by the nurse in the outpatient clinic. I don’t look forward to the prospect of going around the campus even when I am in good health and best of spirit. I suppose the patients do it because there is no alternative. But all troubles of the patients are not due to the improper locations of different services. Some are due to habits cultivated by some personnel. I have tried hard again and again, but the issues have not been resolved. One of them is the chest radiographs. The clarity of the radiographs is about 60% of that of good films obtained in the private sector. I cannot understand why it is so, since they use the same films in both the places. In addition, the radiologists do not report these radiographs. The patient brings the radiographs to us. We see those and then have to send the patients back to the radiologists for reporting, as is required by the law. It is not only two visits to the radiology department, but standing in a queue twice. I discussed the issue with the concerned head of department many times. “Yes, that issue needs to be resolved,” he said every time, but has not done so successfully. I suppose he must have more important things to do. The other issue is that of electrocardiograms or ECGs. When we send a patient requiring an operation to get an ECG, the technician sends them away, saying “come and get it done when you come for admission for your operation”. I explained to the technicians that the ECG was necessary for obtaining fitness for anesthesia, and if it was abnormal, the patient would have to get treated before being scheduled for the operation. So getting it done just before admission to the hospital for the operation was meaningless. That has not made any difference. The ECGs are sent to us without reports. Then we have to send the patients to the medicine department for getting those reported. The head of the medicine department told me that the ECG department was actually under the control of the cardiology department, and the cardiologists should be sorting out the problems as well as reporting the ECGs. The cardiologists do not do any such thing. Another tragic thing is that the medicine and anesthesia outpatient clinics and the ECG department are all situated close to each other, but do not coordinate their activity. So our patient goes there twice to get the ECG done, and then comes to us for further advice. We send the patient for ECG reporting, and anesthesia fitness. If she makes a mistake, she comes back with the report, and we have to send her back to the same area for anesthesia fitness. If the anesthetists do not like the ECG, they send the patient back to get a cardiologist’s opinion. Then we send the patient to a cardiologist, whose outpatient clinic is on another weekday. After a few visits to the cardiologist, the patient is back with us, and then back to the anesthesia outpatient. How they don’t lose their sanity is beyond my comprehension. I will tell you about a carpenter’s mother. This fellow was doing some work in my house, and told me about his mother’s experience. She was sent to multiple places for multiple times, and finally was called for admission for her operation to get a bone tumor from her thigh removed. When she reached the hospital the doctor on duty told her that she was called the next day, and sent her away. When she reached the hospital the next day, the doctor on duty was different from the one who had sent her away. He scolded her for not coming for admission the previous day, and sent her away, asking her to go the outpatient clinic the next week for a new appointment. He refused to listen to her story of the previous day. She went home, and declared that she would live with the tumor rather than go to the hospital again. The carpenter had lost 15 days’ earning because he had spent those days in the hospital with his mother, going around to get things done. She could not sit down and lie down on her back because the tumor was right on the back of the limb. That she should choose to live with it rather than go back to the hospital speaks volumes about how the poor souls are treated. No matter what we do to improve these inadequacies in management, there is no noticeable change. These habits die hard.