Monday December 10, 2018

Why patients are not put first in Indian hospitals

By Dr Aniruddha Malpani
New Delhi: Despite most Indian hospitals claiming that serving the patient is their only priority, the reality is quite different.
Most patients in government-run hospitals are treated very shabbily – and their family members are treated much worse.
Why do hospitals continue putting patients last?
I think there are two reasons for this.
One, of course, is the fact that the hospital authorities can get away with it. They’ve done this for many years, and they feel that it’s not a problem which they need to address.  The number of hospital beds are far fewer than the number of patients, and since they have enough bed-occupancy (and, therefore, enough profitability), they see no need to change what they’re doing.
Their primary focus today is in incentivising doctors ( and other middle-men) to make sure that their beds are full, rather than trying to delight patients. This is a short-sighted approach which will come back to haunt them later.
Times are changing, especially in large cities, where lots of corporate hospitals have empty beds and are no longer profitable. At some point, when they find that their balance sheets are in the red, they will hopefully get their act together.
I think the second reason is that whatever initiatives they’ve tried in order to put patients first haven’t worked very well. Part of this is because they’ve been very half- hearted interventions – for  example, holding a conference;  or adding a few videos on their website.
However, the problem is that no one in senior management has taken ownership of trying to delight patients.  Each hospital should have a chief patient officer, whose job is to make sure that everyone in the hospital remembers that the only reason the hospital exists is to help patients to get better. He needs to champion the cause of the patient if we want things to improve. Ideally, this should be the Chairman of the Board, who can inspire change by taking rounds daily.
Dr Aniruddha Malpani is the Medical Director at Malpani Infertility Clinic
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Aggressive Treatment Of Prostate Cancer May Also Lead To Usage Of Anti-Depressants: Study

Sexual dysfunction is a common adverse effect of antidepressants

Anti-depressants, prostate cancer
The antidepressant drug Prozac, also known as fluoxetine, is pictured. VOA

Men with prostate cancer who get surgery or radiation are also more likely start taking antidepressants than their counterparts who don’t get aggressive treatment, a recent study suggests.

Many men with early-stage prostate cancer may not need treatment right away, or ever, because these tumors often don’t grow fast enough to cause symptoms or prove fatal. In the absence of symptoms or tests that suggest tumors are growing quickly, doctors may advise men to put off immediate treatments like surgery or radiation and instead get regular screenings to reassess whether the cancer is dangerous enough to warrant

For the current study, researchers examined data on men with early-stage prostate cancer, including 4,952 people who had surgery, 4,994 who got radiation and 2,136 who opted instead for surveillance, or “watchful waiting.” In the year before their cancer diagnosis, 7.7 percent of the men were prescribed antidepressants, and this climbed to 10.5 percent in the first year after diagnosis.


Cancer, Prostate cancer
British Prime Minister Theresa May, right, is shown the advanced radiotherapy system during a visit to announce new funding and research into prostate cancer, at Addenbrooke’s Hospital in Cambridge. VOA


Compared to a control group of men in the general population without a prostate cancer diagnosis, men with prostate cancer were 49 percent more likely to be taking antidepressants five years after surgery and 33 percent more likely to take antidepressants five years after radiation treatment, the study found.

But watchful waiting wasn’t linked to any increase in the odds of men taking antidepressants.

“Prostate cancer patients often fit the demographic profile (white, older age, and male) of someone at risk for depression,” said senior study author Dr. Robert Nam of Sunnybrook Health Sciences Centre in Toronto.

“Once they receive treatment for prostate cancer, whether that is surgery or radiation, they may experience treatment-related side effects, such as erectile dysfunction, incontinence, and bowel dysfunction, which can significantly
worsen quality of life,” Nam said by email.

Cancer, Prostate cancer
Prostate Cancer Blood Test

Roughly half of men diagnosed with prostate cancer receive treatment known as androgen deprivation therapy, which suppresses production of the male sex hormone testosterone and contributes to mood disorders, Nam added.

Men in the study who received surveillance tended to be older and were more likely to have multiple chronic health problems than the patients who got surgery or radiation.

Limiting factors

The study wasn’t a controlled experiment designed to prove whether or how different approaches to prostate cancer treatment might directly impact mental health. Another limitation is the potential for factors not measured in the study to have influenced both the treatment decisions men made and their mental health, researchers note in European Urology.

A separate study in the same journal, however, looked at trends in management of erectile function after prostate cancer surgery and offered fresh evidence that many men may be missing out on interventions that could improve their sexual health and quality of life.

Prostate cancer
FILE – A patient receives chemotherapy treatment. VOA

The study examined data on 2,364 patients who had prostate cancer surgery at one U.S. academic medical center between 2008 and 2015.

Researchers didn’t find any meaningful changes in the proportion of men who had erectile dysfunction up to two years after surgery, despite advances in surgical care and postoperative penile rehabilitation during the study period.
This study also wasn’t a controlled experiment, and it’s possible that results from a single medical center might not reflect outcomes for men who got prostate cancer treatment elsewhere.

The study also didn’t examine how any use of antidepressants might have played a role in men’s sexual health after prostate cancer surgery.

Also Read: Pain After Delivery Linked To Postpartum Depression

“Sexual dysfunction is a common adverse effect of antidepressants,” Nam said.

“Identifying the cause of the sexual dysfunction can be complicated as these symptoms are also associated with depression and can be improved once the patient’s depression is treated,” Nam added. “A healthy lifestyle, consisting of a well-balanced diet and exercise, is an important way to promote good sexual function, regardless of underlying medical
conditions.” (VOA)