A HOSPITAL EXPERIENCE

(By Rabia Ahmed and Imran Ahmed)


By Rabia Ahmed:

A Hospital is no place to be sick, said Samuel Goldwyn. Well, my husband was sick, and he was asked to check into a hospital in Lahore for a procedure the following day.

We reached the hospital in the evening, a cousin accompanying us for moral support, and made our way to a Reception desk in a room full of gloomy persons who looked suspiciously at us from their seats.

Unlike the English, who even when alone are said to ‘form an orderly queue of one,’ Pakistanis take the whole process of being served as a challenge, and the fact of not being served first as a personal affront. We waited, second in line while five consecutive first in line persons were served. 

Eventually checked in by a man who printed a form, handed it to another, who made a dot on it, and a third who removed the hospital’s copy and gave us the duplicate, we spent another twenty minutes at the cashier, then were directed to the ward, up a slippery ramp.  My husband, who doesn’t believe in being unfit unless unfit comes along and bites him on the bum, strode up, only to slip back to the beginning, arms flailing.  We tried again.

The room was nice enough, quiet and clean. The bed was comfortable, with a restful sofa bed in the corner. The TV worked, and so did the fridge.  We were both glad that my husband did not require a wheelchair, because the bathroom door was too narrow to let one through. I suppose sick people seldom use wheelchairs in Pakistan; to start with, ramps (if any) are too predatory as we just saw, so people prefer just being hurled through wherever they need to go; it’s quicker that way.

We made sure the patient had everything he needed, and then, since he was perfectly mobile and well enough to be left alone, left.

The next morning I was at the hospital by 8am, and my husband told me that after I left, he got into bed looking forward to some rest, when along came a nurse, to give him a drip, saying that he would have to fetch the medication from the pharmacy himself. A bit startled, since hospitals don’t normally expect patients to run errands for them, he asked her where the pharmacy was. ‘Outside,’ she told him, waving a vague hand towards the back of the hospital.

He braved the ramp and set off to locate the pharmacy. He said individuals from the milling crowd outside, even at that hour, were the ones to help him locate the pharmacy, not the staff.  Medicine’s procured, he returned, only to be told that a canula was needed. Annoyed, he asked why she hadn’t given him both prescriptions at the same time, and was told that this was ‘procedure’. He set off again, and when he returned, another man popped in the door and said a payment was required, for a blood test, and shrugged when my husband protested.  In short, he made five trips that night, the last three to: have a blood test at the lab which was located in the basement of a building next door, make a payment for an x-ray, and then to have the x-ray. He finally got the drip.

A mobile drip stand

It was past 2 am, when he was allowed to sleep.

Interestingly, a mobile drip stand, a common and standard piece of equipment was not available at this well known private hospital.  Without a stand patients have to hold the bag of medication in the bathroom, which is difficult, particularly for someone unfamiliar with the process.

The surgery was uneventful and on time.  In the recovery room still under the effect of anesthesia my husband said some interesting things. Later, being a doctor himself, he realized the nurse was making up fictitious vital signs figures because that equipment was broken. He questioned her, she muttered something.  At one point his heart rate was unduly erratic, and when I told the nurse about it, she made faint clucking noises, and said it was okay, without examining him, adding something that sounded suspiciously like ‘procedure’.  

Mercifully, we got through the next four or five hours and returned to the room after tipping several people hanging around clearly in wait for a handout.

An inveterate smoker, one of the first things my husband did when he was able to walk was make his way onto the balcony, which was quite raised off the ground, and looked out on to a narrow pathway. He left his pack of cigarettes and lighter on the window ledge, but when he went back for them later, they had disappeared.

I stayed with him for two days, and the same scenario was repeated: visits to the pharmacy all times of the day and night, and to the laboratory, and the cashier for payment for mundane medical equipment, all per procedure. I was glad at least it was I doing the legwork.

What happens to patients who have no one to look after them during their stay at the hospital? What’s more important is that if this is one of the better private hospitals in the country, what on earth are the others like, given this one’s inefficiency and lack of systems?

It was Florence Nightingale who said: The very first requirement in a hospital is that it should do the sick no harm.

Such penetrating statements should be translated, framed and tenderly placed in prominent places in med schools, nursing institutes and hospital all over Pakistan. 


A HOSPITAL EXPERIENCE

By Imran Ahmed MRCP

After working as a hospital doctor in England for twenty five years I moved to Lahore and recently, had the novel experience of being a patient myself.

The initial outpatient encounter was good. Arriving at the hospital the day before the surgery however, it was the chaos that struck me, the number of people behind the reception desk each one flapping around in a muddle.

Admission over, I made my way to my room up a steep soapy ramp, and promptly slithered back. Four decades ago that would have been a fun experience.  

As no further activity beyond a visit by the nurse had been indicated my wife and cousin who had accompanied me left, and I settled down to some TV and, as I hoped, sleep.

The fun started at midnight. I believe my wife has detailed my experiences that night.  By the time I was able to crawl back into bed, exhausted, and annoyed, it was 2am.

Most of my discomfiture was the direct result of a lack of communication between the healthcare staff, and myself, as patient. Hospital staff should be trained to help their clients just as they would help a guest. To require a patient or attendant to make repeated forays for minor pieces of equipment and payment betrays an utter lack of organisation and consideration. Items could be billed at the end of the admission, or payment taken at the outset as a larger deposit.

I would like to offer some suggestions which are neither difficult nor costly; they simply require some planning and a desire to make the patient’s life easier.

At their consultation I suggest that consultants hand out a patient information leaflet outlining the ‘whys and hows’ of elective surgery, how long to fast before the procedure and what tests/examinations/medication to expect on admission. This should be followed with information on common after effects, what to worry about or to accept as normal after the operation.

Prior to admission, it would have been useful to receive an information leaflet, or even just to read a notice board displaying the procedure for admission; what and how much clothing, paper records, old x-ray films, medication, toiletries and money ought to be brought in. Are credit cards, cheques, or cash preferred or acceptable as forms of payment? Details of public transport to the hospital, and of amenities available within, such as a restaurant, car parking, availability of attendant’s bed, on site pharmacy and laboratory; a map of the hospital and a price menu for the selection of rooms makes life easier.

The hospital policy on tips to staff should be clarified.

Upon admission, the admitting nurse should volunteer information and instructions on what examinations, tests, and visits by doctors the patient can expect, and when. The patient and attendant should be given friendly advice on the location of shops and restaurants.

My experience with the junior doctor who visited me in my room pre and post surgery was the most abysmal. The doctor failed to take a competent history, ask relevant questions or to conduct any relevant examination; he even failed to fully record crucial information on drug allergies and past operations that I volunteered myself. This makes it clear that he did not double check the appropriateness of the management or diagnosis proposed by his consultant, which is one of the responsibilities of a junior doctor.

He failed to take informed consent, or rather he obtained my signature to a form, but no information accrued to it.  In other words, he did not attempt to educate his patient. He did not deign to inform me let alone explain why he would be ordering (at different times, all after midnight) blood tests and x-rays or medication. A second junior doctor despite enquiring, neither recorded nor explained, nor passed on my postoperative symptoms and concerns to his boss. This dismissive and contemptuous attitude by doctors towards patients would not be tolerated by a civilised society.  These junior doctors clearly neglected to ensure that all bases were covered, so as to prevent mistakes, and to protect the patient. Pakistani medical teachers and consultants need to start teaching respect for the patient to their pupils.

The room itself was pleasant with a large TV, refrigerator and comfortable bedding. However, the bathroom was a disaster. The light switch was inaccessible until well inside, and the door so narrow that a person with a frame or wheelchair could not have passed through. Just within the door was a step that could easily trip an unsteady or unwary person.

There were no alarm cords and the floor was slippery. People fall and injure themselves frequently in bathrooms. One expects hospitals to give more thought to the design of bathrooms on their premises.

Nurses and doctors traditionally have scant regard for the privacy of patients. A knock on the door, a smile and a polite request for admission can smooth feathers ruffled by a doctor or nurse barging in on a sleeping patient and suddenly switching on bright lights. Unfortunately my feathers remained ruffled.

There was a large wipe board at the entrance to my ward where I was horrified to see the names of each occupant of the ward with details of their ailments and proposed operations. This practice dates to the dark ages: my medical details are private, not meant for the public at large.

My consultant kindly came to chat with me after my operation while I was still groggy. He chose this time to tell me in front of my wife, my son and several other people that (although this needed confirmation) he thought I had cancer, and spoke of five year survival rates. This disclosure that ought to have been made in private was gauche, and (mercifully) plain wrong and I hope he refrains from inflicting unnecessary pain on patients and their families in future.

Successful lawsuits have been lodged in the West on such occurrences and rightly so. 

The above article was printed in The Friday Times on the 24th of December 2010.