One day, during rounds in the ICU, a patient who was recuperating after surgery told me, ‘You guys are more bothered about chart care than patient care’. Probing further, she told me that nurses spent more time at nursing stations filling out myriad forms and registers, and were more bothered about ‘maintaining the case files of patients than patient care. They are unavailable to attend to patients’ needs’, she continued.
This is not an isolated incident. I have heard of similar experiences from my relatives, admitted to various so-called ‘high-end, five star’ hospitals. Nurses spend more time tending to the health of patient charts and files, in the name of ‘documentation’, which has come to be the buzzword in health care delivery.
This change for the worse came about once Kerala decided to embrace ‘health tourism’ in a big way. This mandated hospitals to secure various accreditations like the NABH, Safe I, ISO, JCI, etc. Accreditation makes hospitals more appealing and render them more marketable in the international health care ‘market’. Yardsticks used in accreditation requirements call for maintenance of irrelevant records, which have no bearing on patient care. Hospital managements go all out to bag accreditation, some of which call for stringent documentation through numerous registers and forms. If documentation is thought to help in future studies, using case files as reference, this is not true, as variables documented are unworthy of any kind of study. It probably helps only in times of litigation, where case files are a source of valuable information.
Documentation thus made only augurs defensive medicine, if at all. The case charts of patients look well-nourished, thanks to new forms, some of them absurd and which do not contribute to patient care. Committees appointed by hospitals to ensure they qualify for accreditation vie with one another to introduce more forms and registers. Nurses are made to fall in line to fill these irrelevant forms, adding to paper work and leaving patients to the strength of their lucky stars.
Accreditation organisations conduct regular visits to hospitals to ‘inspect’ their worthiness for the accreditation. Before such visits, hospitals conduct regular internal ‘audits’. These, even as important activities like rounds are in progress, crop up as a nuisance. They, along with mock drills, create mayhem and throw the functioning of hospitals out of gear. Hospitals are not factories where mock drills can be conducted to anybody’s fancy. Health care is far more delicate a service to be played around with. Inspections ideally must be conducted unannounced, if they are to be meaningful. Such ‘inspections’ are a bane to patient care. Nurses bear the brunt of this new trend in hospitals. They are called upon, by their superiors through threats of disciplinary action, to fall in line. Doctors are required to play their part by filling and signing numerous forms. Hospitals, thus, have turned out to be places where sheaves of paper are cared for more than patients. The authorities must put an end to this unhealthy trend which is silently eroding the health of the state’s health care delivery systems. earaly@hotmail.com