A Day of a Patient in Hospital: Case study


Prof. Dileep Kumar M.

Let me introduce myself. I am Mr. Sridhar, a resident of Amrita Colony; working as a class-one officer in one of the Nationalized Bank in Kerala. Last night, I have to face severe chest pain with high vomiting. Since the pain has on the left part of the chest, I decided to visit one of the hospitals near by with one of my relative. I have chosen this hospital for treatment because of the personal advice of few of my relatives. This hospital is 500-bedded multi specialty. 

The structure of the hospital is so huge and beautiful that it inspires every one who sees it from outside. Imported cars of Doctors and Staffs surrounded the hospital. Though, we feel that it is so congested and created difficulty to the patients to enter into the hospital. The front area of the hospital is crowed with patients and their relatives. The waiting area of the hospital is so small that the patients have to wait here and there, wherever they find comfortable place.  The building ventilation is not good enough to stay for long period there in the premises. More over, we observed inadequate security and attenders to control and help patient and their relatives to get avail of the service of the hospital.

I have seen one information counter in front of the hospital. But the person inside the information centre is sitting idle and no one approaches the cabin for information seeking. Since we are new to the hospital we decided to get some assistance from the information centre. We approached the information counter and enquired about consultation. The information officer asked us to go right and stay there in the queue. He didn't tell us for what purpose we have to be in queue. We have seen two rows near be the counter. When we reached the queue almost 60-70 people are standing in each row. We saw the board Registration Department in front of the counter.  Since we don't know the purpose of it, I asked one of the patient's relatives, who stayed in the queue, 'the purpose of this queue'. Instead of giving us a reply he asked a few questions. " Are you 'old cardholder' or 'new one'?" We didn't get what he meant. By understanding our face of expression he further asked us "are you the first time in hospital." Now we are clear about what he meant and replied immediately that 'yes, this is the first time.' He directed us to another queue where new cardholders are standing and asked us to register as new patient in the hospital. By giving thanks to the person we lined our self as 70-75th person in the new cardholders queue. We came to understand that this 500- bedded hospital has only a centralized registration counter and both new and old cardholders have to get the registration from the one counter. Since it is a single window process, the patient's relatives and patients have to stay in the long hours in the queue to get their name registered as new patient and get the medical record of the old patients.

While standing in the queue, we have seen lot of heated arguments between registration staff and the patient's relatives. Especially in the old cardholders queue, we heard 'Medical Record Missing' is the major issue. Though the department has installed computers it has been seen that the nursing assistants are undertaking half of the work manually. The computer entry and manual work are going together in the service area. It has created a lot of confusion among staffs of the department and they find it difficulty to search the old medical records.  We heard some of the comments of the staff members that the nursing sisters of the concerned departments might not have returned the medical charts to the registration department and because of which it is creating difficulty to find as and when it needs. We saw that the medical records are placed in haphazard manner. The medical record shelves are dusted and unclean. Proper lighting facilities are not there to identify the medical records. The nursing assistants and staff members' majority time has taken majority of their time in finding the old medical records of patients. Medical-Chart missing caused delay-in getting service from doctors.

We reached in front of the counter at about 9.30am, clearing one hour in the queue. Our relative advised us to consult only with Dr. Rajasekharan (cardiac specialist) of the same hospital, whose medical expertness is famous in the locality. We asked the registration staff to get the consultation of Dr. Rajasekharan. The staff immediately replies that Dr. Rajasekharan is overloaded with patients so that they have to consult with Dr. Radhamani (Chest Specialist). While our request continues, ignoring us, the registration staff asked the other person, who stayed back to us, to avail of the service. We embarrassed with the situation. The registration department staff asked us 'either to get the consultation of Dr. Radhamnai or leave from the queue'. Finally we compelled to take the consultation of Dr. Radhamnai, without our willingness and consent. I thought here patients don't have the right to choose any doctor they want to consult.  Though we are insulted by the incident, without making any further request or resistance, we left the queue to avail of medical service from the doctor.  We thought the service of information counter and the registration department is not patient friendly. The management is not taking care of major patient management services, which inculcate better impression feeling among them.

We don't know the exact location of the Out Patient Department (OPD) of Dr. Radhamani, Chest Specialist. There is no signboard indicating the locations for different medical services. Since we got a bitter experience from the registration department and information counter we are feared to ask any clarification from the staffs of the hospital. Looking and searching the Out Patient Department (OPD) of Dr. Radhamani, we lost around 15 minutes. Finally, one of the patients relative directed us towards the chest department, which is in the second floor of the hospital. When we reached the second floor we saw a queue of 60-70 people already waiting there to consult with Dr. Radhamani. Only a few chairs are arranged to the patients in front of the consulting room. We feel that the comforts of the patients are not in the hospitals prime agenda. Patients with severe stress also have to wait there without getting resting facilities.  One of the patient's relative, by directing us, helped to give the registration slip to the consulting room for patient's name-calling.  Here also we got very little information about the procedure to get consultation from the doctors. There is no one to assist the patients and give direction to them who are so tired. Twice I felt giddiness and suffocation while waiting for consultation.  I sent my relative outside to get some drinking water since there is no arrangement for drinking water to the patients. We waited in front of the consultation room till around 11.45am. Finally, at around 11.50 am our turn came.  Doctor made the initial enquiry to me. After hearing the case the doctor asked us to meet Dr. Rajashekharan to continue the consultation with, since he has better expertise in the area of illness. By hearing this we felt so bad about the registration department of the hospital from where we directed to a wrong consultation. We already lost half a day to get medical service.  The doctor apologizes and asked the attender to show Dr. Rajashekharan's cabin to continue the consultation. Cursing the system of the hospital we followed the attender to get the service of Dr. Rajashekharan. The consultation corridor of Dr. Rajashekharan is much crowed than Dr. Radhamani. There also we have to wait till 12.15pm to get the consultation. We detailed all the physical difficulties to the doctor. Hearing patiently, he asked us to go for an X ray of the chest. Further, he asked us to meet at 1 o clock with X ray.

Searching a lot places here and there; at last we found the X ray department. This time we didn't get annoyed, while seeing long queue of patients in front of X ray room. We waited there expecting the call. When our turn came the attender asked us the payment bill of X ray. Since we don't know the procedures, we asked the help of attender, what to do. He directed us to the cash counter, where we have to make the payment of the X ray.  Once again cursing the system, we went to pay the X ray bill. When we come back it is around 12.40pm. We waited further to take the X-ray. Around 12.50am our second chance came. After taking the X ray, the X ray technician asked us to wait another 15 minutes to get the film. We waited till 1.15 to get the X ray film. We saw empty cabin of Dr. Rajasekharan when we reached there with the X-ray film. The consultation finished at 1. O'clock. The attender asked us to come at 3.30pm for second OPD time.  We become so tired and helpless to strike back or tell anything. Thinking about the money spent and too much concerned about the illness, we decided to wait till 3.30pm the hospital premises.

We continued our stay at hospital consultation corridor. When the doctor came once again, we though our lot will be coming in the first place. But contradictory to that we came to know that there are patients who have already taken the consultation ticket in the evening hours.  We have to wait till 4.30pm to see the doctor once again. Doctor by looking at the case record and the X ray asked me to go for blood and urine test. He asked us to get the result before 7.00pm. Though, we have strong aggression towards the doctor by hearing another test, we obeyed his direction. 

Since we have a hard experience from the information counter, registration department and the X ray department we decided to pay the bill first and search the lab. We paid the bill and with the help of one of the hospital attender we found out the lab area. The area is empty when we reached there. We have given the slip and waited outside. Though there is no patient, the lab staff didn't call us for test. Curiously, we asked the lab staffs 'how long we have to wait here.' One of the staff replied that the lab staffs have gone for their coffee break and will be returning only after one hour. We thought, for a patient service institution, 'coffee break is more important that patient comfort.' Here also we have to wait till 6.00pm. When the staffs returned they took the sample of blood and urine and asked me to wait 45 minutes.  Though we informed them about the urgency in getting the result the staffs showed their helplessness by citing scientific reasons. We waited till 6.45pm to get the result.

With the result we once again come to the consultation area of Dr. Rajasekharan. There we have to wait another half an hour, even though we have consultation timing at 7.00pm. When our lot came, with tension and anxiety we have shown the test result to the doctor. By going through all the details and further physical tests he informed me that there is nothing to worry, it is not related to heart but because of 'gas formation inside stomach'. By hearing this I become so relieved from the frustration and tension of the whole day about knowing results of the disease. 

Since there is no patient out side waiting for consultation, I thought I should share with him our hard experience that we faced from different department of this hospital.  Doctor patiently heard all my complaints. After hearing all our difficulties Dr. Rajasekharan gives his personal visiting card to us and directed to come to his home clinic for private consultation in future. He told us that this hospital is not good in getting better services. For better treatment and special consideration private consultation is better. Here in this hospital, you have to face the same experience in every consultation. Hearing this remarks we become so annoyed. As an employee of the hospital the doctor is using his office premises for getting personal advantages. Instead of promoting the hospital he is thinking about personal gains from the difficulties of the patients. We paved 'good night' to the doctor and the 'hospital' and left the consultation room.

When we reached the hospital gate, a few of our relatives are waiting all along there.  With anxiety they asked us entire details. We told them that nothing to worry it only due to 'gas formation' inside the stomach.

Curiously with satire they asked us that big question, 'one day diagnose to identify the gas formation?!!!!!!! It's strange'


1. Do you feel that the patients have the right to consult doctors in accordance with their choice?

2. How the information system affects the customer relationship?

3. What is the importance of keeping the medical records system intact in the delivery of service?

4. How the hospital management system affects effective patient management in this case? Discuss?

5. Design a hospital management system, which help in effective patient comfort and satisfaction.

6. How the business scenario of this 500-bedded hospital, can be improved with management expertness?

7. How the employees in this organisation can be motivated?

Prof. Dileep Kumar M.

Source: E-mail April 20, 2006


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