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Note: Though this is a medical post that concerns hospital care in the USA, I believe the issues covered in these videos are universally applicable to hospitals and patients all over the world. I urge everyone, especially those visitors who are not from the USA to view the videos.

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In a series of three short videos, produced by Dr. Val Jones of Better Health,  Paul Levy, President & CEO of Beth Israel Deaconess Medical Center, and author of the blog Running a Hospital talks about providing safe, quality care in hospitals.

In the first video Paul discusses his innovative approach to keeping patients aware of the safety record of his hospital.

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In the second video Paul discusses how patients can have a better hospital   experience, by keeping themselves informed and having an advocate.

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In the third video Paul discusses how to keep in touch with friends and family while in the hospital, and how to get the best aftercare.

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Nobody can disagree with Paul’s opening lines in the first video

For the most part patients cannot really find out very much about a hospital’s quality measures and record on safety.

Here in India, I think we can safely remove the first four words and the “really” and replace “very much” with “anything”. While Paul and BIDMC are pushing the envelope with the publication of safety data every quarter, no hospital in India has even made an attempt to address the issue of transparency about safety and quality.

Here’s what he says about the data published in his hospital’s website…

…and in addition it presents a summary every quarter of what kinds of harm we have caused to our patients that could’ve been prevented. We do that because we think that it helps people improve our processes of care and our results by knowing where we stand relative to audacious goals that we’ve set for ourselves.

One of those “audacious goals” is to “eliminate central line infections,” a problem that plagues intensive care units and hospitals around the world.

The Levy-BIDMC philosophy of transparency in a nutshell…

The main purpose of transparency is to hold the organisation accountable to a very high standard that we’ve set for ourselves. Transparency is not about competition with other hospitals, it’s not about finding fault, or blame. But unless you have an audacious goal, like zero central line infections, you’ll never really get as far as you can go.

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The second video is about the necessity for every patient to have an advocate for themselves. Paul says…

The best way to stay safe is to bring someone with you who can be your advocate. When you’re a patient, you’re in a vulnerable situation…you may not be hearing things clearly, you may not be asking the right questions because you’re upset. And your advocate, your friend, your spouse, your partner is there to ask those questions. To take notes, to follow-up, to let you know what he or she heard… One of the key roles of an advocate is to talk to the nurses who dispense medication to you. To discuss with them what the purpose of the medication is, to actually look at the vial and see if it’s the right dosage and the right medication. … Another thing that patients and their advocates could really focus on … is to be clear why they’re there! What’s going to happen to you? Over what time table?

The major problem that hospitals and doctors face in India is one of plenty. Too many advocates for a patient. There are times when as a young intern and resident medical officer I have walked into a patient’s room to find more than a dozen members of the patient’s extended family waiting to “talk to the doctor.” Most often the team taking care of the patient has to fend off queries from people at the periphery of the circle of family and friends while their time is best utilized dealing with the one(s) in the center.

Paul talks about the importance of having a clear “Clinical Pathway.” I can already see some of the doctors and nurses shaking their head and saying, if not aloud, then to themselves at least, “We wish there was a clear clinical pathway for every patient or disease.”

A key aspect of hospitalisation is to learn as much as possible before you get there about your own medical condition, about that disease or that treatment in general. To talk with the doctor in advance, do your homework so you know what the expectations are.

Though this may not be possible in all situations, especially in medical emergencies, there are huge advantages to the patient if they are a bit knowledgeable about their disease and the treatment options.

From personal experience and from anecdotal accounts from my friends and colleagues, I do know that most of us (doctors in India) do not see this as a big advantage. More often than not, it is a major stumbling block in building a trusting relationship with the patient. One of the things that a doctor (at least, here in India) hates is a know-it-all patient or family member who questions or second guesses every step in the evaluation or treatment.

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The third video has stuff in it that has little and great relevance in the Indian scenario. Keeping in touch with friends via email and web pages is not relevant in the vast majority of Indian hospitals with the exception of the top rung megacorporate hospitals in the major cities.

The stuff about “appropriate food” is hugely relevant. Every Indian doctor or healthcare worker who watches the video will have a tale (or two or more) to relate about totally inappropriate food that makes its way into patients rooms in Indian hospitals.

Paul says…

Nurses and doctors cure the patient but social workers heal the family.

The concept of medical social workers is almost non-existent in India. It is often the role of the circle of extended family and friends to support the patient and the immediate family during and after an illness and hospitalisation. It is not considered an imposition to take care of one’s family member or a friend who is sick or is recovering.

A friend of mine, who runs his own business, took a month off to go visit and take care of his nephew who was being treated in a rehabilitation clinic in the US. He related to me one instance that he witnessed and could not digest. He got quite friendly with an elderly lady who was a patient in the same floor as his nephew. One day he saw the old lady talking with an elderly gentleman in the cafeteria. She called my friend over and introduced him to her husband (they had been married for more than 30 years) who was visiting her. They were at the end of their visit and the husband was saying his goodbyes. My friend says the lady told her husband as he was about to turn away to leave, “Thanks for coming.”

My friend just could not understand why a wife would thank her husband for visiting her in the hospital! He shook his head and told me, “It’s a different culture, Vijay!”

I agree.

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