VENKATESWARA NETHRALAYA ** Eye Hospital & Lasik Centre***
1. Some BIG Advertisements appear frequently in newspapers ,magazines & TV (almost every 10 minutes) about "Worlds Cheapest Lasik" for as low as Rs 28,999/-? Why are they so desperate & Why do they lie ? Can it be offered even cheaper??
The Advertised price of Rs28,999/-( 575 USD) or still cheaper prices of Rs 24,999/-( 500 USD) etc of certain Chains of Eye Hospitals is a marketing model designed to enhance the uptake of addon procedures priced at at premium such a femtosecond laser etc. Such Base prices are not all inclusive and will never be for the latest state of the art procedure suited to your case. Advertised Prices follow marketing models that utilizes gimmicks/celebrities/ Hype/ Fear/ Grandiosity in a desperate attempt to attract the patient only.. & once the patient agrees to the procedure, the cost will exponentially rise on one account or the other. Besides, Eye Hospital Chains rarely provide personal care and customised solutions. They are more known for their factory like atmosphere where patients are treated as commodities and attention to individual detail and needs are rarely covered to the routine patient unless you are a VIP - In which case everything is provided without asking.
Patients are brought in with lure of cheap lasik through mass media advertisements, commercials etc, but once inside, there is a heavy counselling effort to upsell other add ons, which may not be warranted in over 95% of the cases. Such add ons may be related to the different methods of flap making ( With a microkeratome / With a Femtosecond Laser),Flap less Lasik or SMILE, Different Technologies of Laser Delivery, Tracking, Iris Registration etc. Some of them are indeed useful in some patients with complex parameters, but patients are given the impression that such add ons will make a progressive corrective impact in all cases at all times and if the patient is willing to pay, then he must go for it irrespective of whether he will benefit from it in a significant manner. This strategy is successful in boosting the cost to 3X to 4X of the advertised price in most cases.
2. As I want the best for myself, could you tell me more about problems that may occur in "Big Hospital / Chains" that can result in poor satisfaction in 3-5% of patients?
Although Lasik is a very successful procedure the world over with over 95% success rate, there is a 3-5% of patient population that is still unhappy with the results for quite a few reasons. While some reasons may relate to improper patient selection, overpromising the results prior to surgery, underdelivery on the results, poor handholding of the patients during this entire exercise etc, some of the poor satisfaction scores are purely related to the business models of the Large Hospital chains that encourage a "Factory like" approach instead of " Individual needs" based approach.
Problem No 1= "Continuity of care"
The Main problem with Major Centres and EyeCare Chains with multiple doctors would be lack of Continuity of Care. In the name of the Chief Medical Doctor, Usually, the preoperative assesment is done by some overzealous hardselling doctor belonging to some "A" team who overpromises on the results to make you agree to the procedure while the procedure is actually performed by some doctor belonging to some "B" team who will see your face/eyes for the first time just prior to the procedure while the Postoperative Care is provided by some junior doctor belonging to some "C" team who will be a trainee doctor trying his luck to climb up the value chain.
Problem No 2 = "Medical Process Outsourcing(MPO)"
Let face the truth, When patients seek quality care for their ailments it usually requires individual attention, significant chair time, detailed evaluation, balanced approach to investigations, experience in clinical skill in understanding the patients needs, and skillful diagnosis.
While this is virtually impossible to provide in a large volume targeted Big hospital/chains, Patients are likely to be dis-satisfied because the doctor patient one to one relationship is compromised at many levels due to Medical Process Outsourcing (MPO) to Junior Doctors/Technicians/Paramedics with varying levels of skill /expertise/ knowledge/ commitment . This results in windfall benefits to the Hospital where patients think the star doctor in a branded hospital is in full control of the quality of care being given by his team members, but in reality the team members are chosen by the HR managers of the Hospital who base their recruitment on lower and lower remuneration attracting poorly skilled or trained junior doctors/techs/ paramedics. This then results in varying results for the same medical condition. Patients rarely get to choose their doctor based on skill, knowledge and expertise for resolving their problems,.. rather what happens is that the hospital/doctors with their projected "STAR/BRAND" value gets to choose the patients based on the patients high paying capacity, complexity of the case, poor literacy levels, pts with low level expectations who do not ask too many questions. This group of patients form a significant major proportion in developing countries as access to quality health care provided by the state is poor forcing a large population to seek available private healthcare irrespective of the business models practiced.
Problem No 3= "Multiple Tactics used to mislead unsatisfied patients"
In an unregulated environment where the patients have the least voice when they are not satisfied with the overall result, the above arrangement is a sureshot recipe for frequent suboptimal clinical outcomes. When the results refuse to fall in place and the patient is deemed to be unhappy, each provider drops his responsibility and starts blaming the patient or someone from the other team. Tactics commonly used for unhappy patients are denial of immediate follow up appointment dates, long waiting hours, shifting the patient from one room to another for unnecessary investigations, Preventing the patients from speaking to other patients, Limiting immediate access to hospital patient data, Multiple doctors speaking to the patient in one voice, Motivating the patient to slowly believe that it was somehow his condition that is responsible for poor outcomes, or as a last resort motivate the patient to philosophically accept his "fate".
Sometimes the doctor who operated the case, leaves his job and his patients to another hospital where patients are then redirected as the hospital will not take responsibility for poorly satisfied patients of a former employee.
Sometimes if a doctor has a lot of unsatisfied patients which has reached unmanageable proportions, the doctor is transferred to another city and a new appointee takes over who will suggest more additional procedures at a greater cost.
If after many such tactics patients are still unhappy and keep asking uncomfortable questions either physically or on various online fora , then a new team that consists of lawyers, Online Marketing Executives along with hospital Management executives take over and "badger" the patients attitude, motives, background and character.
With these tactics, The patient then starts to realize the futility of engaging the system to address his/her needs having fallen victim to the defects of a Heavily Advertised, Large, Branded Practice where individuals fail to take responsibility for suboptimal clinical outcomes as their primary responsibility is towards the welfare of the Hospital company and its investors who control the expenses to realize their profitability first.
Problem No 4 = Big Hospitals/Chains dont depend on good results and happy patient referrals through word of mouth as that takes a lot of time, they depend on illegal and unethical advertising with false overpromises for attracting new patients in an exponential manner
Since Doctors in Quantity Centric Big Hospitals/Chains are protected by a large banner as well as malpractice insurance, individual patient satisfaction is not the top No 1 priority in each and every case...rather unsatisfied patients are just reduced to overall numbers in the daily statistic of the hospital..and business goes on as usual as newer patients are anyway brought in not by Old satisfied patients/ Word of Mouth but by Unethical but Attractive Advertisements in TV/Radio/Newspapers which are played in rotation sometimes desperately every 10 minutes. Such Advertising is banned both by the Hippocratic Oath that doctors take as well as the Code of Ethics Guidelines issued by Govt of India. These Advertisements are disguised and disseminated as Noble Patient Education programmes whose only purpose is to trick and deceive the prospective client into buying a service at any cost.
3. Is the Doctor not the "BOSS" and the final authority in BIG hospitals?? If yes, why do doctors agree to work in such hospitals??
That is a wonderful question. Most Sectors in the 21st century have degenerated in our capitalist society pursuing shareholder value above everything else. BIG corporate Hospitals and corporate doctors are no exceptions as they too have to survive with the profit motive on top of their minds and fight it out in the same environment. Patient Interest & Social Responsibility is very much lucky if it finds itself at least at the bottom of the priority list.
Read the following only if you are keen on understanding the problems with the Health Care delivery mechanism as it exists today in our society. Otherwise i suggest that you skip this question by clicking here and going on to the final paragraph in this article.
As far as Lasik laser treatment is concerned, successful outcomes are most likely to happen when the entire care whether Prelasik, Lasik and Post lasik or for that matter any other intervention- is the responsibility of a single provider and course correction/ customisation as per patient preferences is easier. Single providers still depend on the traditional Word of Mouth referrals from old satisfied patients and will strongly resist using tricks/gimmicks or other unethical means of attracting patients.
The Quality of work that we do will ultimately determine our practice reach and the focus is always on the patient satisfaction and not on the competition.
So in that sense, Our patients don’t complain about our cost because we are reasonably priced for the high safety margin that we provide besides being all inclusive.
At 300 $ / Rs 15000/- for a simple laser vision correction procedure for both eyes, we are proud of the level of honesty that our pricing reflects. Only those patients who have cylindrical powers and higher order abberations are advised to consider higher packages.