Government medical facilities failing to inspire confidence in people during the heightened fear of contracting Covid-19 is understandable, but why patients are still hesitant in physically visiting professionally-run private hospitals and clinics, stringently following laid down safety protocols, goes beyond reasoning. A large percentage of people are learnt to still prefer tele-consulting for routine medical issues, when doctors across the board feel it leaves a significant margin for error of judgement on their part.

(With Inputs From Student Correspondent Sumeir Bhatia)

A large number of clinics across specialities and multi-speciality hospitals contacted by LifeInChandigarh.com over the past week reported a massive decline in footfalls from pre-pandemic times, though an odd ENT clinic claimed that it was routinely refusing appointments beyond a certain restricted number for the day necessitated by stringent safety protocols and truncated morning-only OPDs.

Hospitals are piling on the losses with the problem of low footfalls being compounded by a dramatic increase in overhead costs because of the additional protective measures mandated by protocols issues by the central and state governments from time to time. Most doctors are not carrying home even 50% of the earnings they had in pre-Covid times. Some specialities are hit even worse with zero to negligible footfalls.

In such a scenario bare survival has become an uphill task. Some hospitals are also learnt to be on the verge of closure if the pandemic lasts much longer or the footfalls do not increase substantially in the coming weeks.

Says Dr Mohinder Kaushal, Chairman & Medical Director, Trinity Hospital, Zirakpur, a non-Covid hospital, “As of now we are catering to only those patients who are in dire need of medical services, including emergencies. Only semi-emergent and emergency surgeries are being performed by strictly adhering to laid down protocols. As such, footfalls are down to less than 50% and financial losses are piling up.”

Dr Mukul Kaushal in his OPD at Trinity Hospital Zirakpur

“Every corner of the hospital is being sanitised multiple times during the day, all patients visiting the hospital are being thermal screened and hand sanitized. Wearing of mask or shield by the staff as well as visitors and physical distancing are being strictly followed. All these additional expenses are being absorbed by the hospital and not a single penny is being passed on to patient charges,” he emphasises.

Dr Kaushal adds, “Staff is working in shifts and each member of the staff is being assigned alternate day duties for their safety. There have not effected salary cuts for in-house doctors and visiting doctors are being paid on per visit basis.”

Sharing his experiences during the lockdown, well known cardiac surgeon Dr Virendar Sarwal, who besides running his own practice is also providing his services at Ojus Hospital Panchkula and Shalby Hospital Mohali, says, “initial days of lockdown were very tough on the patients as they could not approach hospitals. In fact, patients already admitted for heart surgeries had to be discharged and put on medicines. Initial non-availability of PPE kits also became a big issue with even urgent cases remaining unattended.

Well known cardiac surgeon Dr Virendar Sarwal

“Getting online consultation was a difficult task especially among patients in semi-urban and rural areas, they not being digitally savvy enough. People are still afraid to visit hospitals. Footfall in OPD is less than 50%, and planned heart surgeries are down to 40% of normal times. Being tested for Covid before performing surgery is still taboo for many patients,” he adds.

Dr Sandeep Chhatwal, Senior Consultant, Internal Medicine, Omni Clinics & Diognostics, is very articulate about his experiences and has many a tale to share.  

“After the initial lockdown was announced, and OPDs remained completely shut for three weeks, a couple landed up outside my residence, seeking consultation for the husband who was running fever along with cough, and was showing other pneumonia like symptoms. Since I did not have protective gear at home, and also had to consider safety of my aged mother, I felt bad about it, but then I had to politely decline examining the patient. I guided them to a government setup, which they did not appreciate, and perhaps did not visit.”

He says, “In mid April during the second lockdown we did start OPD services, providing for seeing 8-10 patients every alternate day. But out of 8-10 appointments on a given day, only around six could manage to reach the clinics on account of various issues like not being able to secure curfew passes, etc.

“When medical stores opened, there were issues with chemists refusing to provide medicines without prescription especially to epileptic and psychiatric patients who had taken online consultation. We had to call concerned medical stores to reassure them that these medicines were indeed prescribed by us.”

Dr Chhatwal shares, “There were also issues with people needing hospitalisation not being able to do so because they could not afford admission to big hospitals, which were functional.

All protected: Dr Sandeep Chhatwal, Omni Clinics & Diagnostics

“Patients were reluctant to visit the doctors in their clinics for fear of contracting Covid.  In such cases we managed with tele-consultation. We had to trust our judgement knowing fully well that there could always be an element of error, which we duly placed on the record in writing to safeguard ourselves in any eventuality.”

The internal medicine specialist also recollects non-availability of quality protective gear and overcharging by sellers. “We also had to keep our staff well protected and motivated as they were fearful of their personal safety.

“Even now, footfall is not more than 60% of normal times in any speciality. Reasonable time gaps between consultations to follow proper sanitisation protocols is definitely one of the reasons for it. In some specialities like gynaecology, dermatology, dentistry and physiotherapy, etc, however, the footfall is negligible.

“It’s however heartening to see that though most people are staying away from OPDs because of the fear factor, the ones who pay a visit are more than convinced with the safety protocols and thus do not hesitate to come on repeat visits.”

Dr Chhatwal asserts, “In our clinics we are taking the highest degree of care to ensure personal safety of patients and their attendants. While the entire staff wears different levels of PPEs, and the premises and equipments are repeatedly sanitised throughout the duration of the OPDs, the patients are thoroughly screened for Covid symptoms and no one is allowed in without wearing masks and paper gloves, which we provide each visitor.”

He rues, “all these measures have resulted in a dramatic increase in our overhead costs, but we have not increased the rates of our services beyond the normal annual revision we undertake at the end of every financial year to defray increased rental, running expenses, salaries, etc.”

Despite taking a stinging financial hit, and overexposing himself by coming in very close proximity with patients because of the very nature of his practice, well known eye surgeon and Director, Grover Eye Laser & ENT Hospital, Dr Rohit Grover has taken a few positives from the Covid times.

One, being a NABH accredited hospital the doctors and staff were already on the path of stringent protective measures. “It wasn’t, therefore, very difficult for us to adjust to the new guidelines and protocols. Maybe we had to make various processes 15-20% more stringent,” he shares and adds that “patients, who earlier used to just walk in, have now got into the habit of taking prior appointments, making life that much easier for us.”

Up Close: Well known eye surgeon Dr Rohit Grover

Sharing some interesting insights, Dr Grover informs, “though overall, OPD footfalls are down to 55-60% percent of pre-Covid times, and surgeries which can wait a few months are also not happening, we are getting a lot of new patients who are falling prey to digital strain or computer syndrome because of excessive exposure to screens on account of the new normal of work, study and teach from home. I would guess one-third of all patients these days fall in this category – company executives, school students and even school teachers.

“The pandemic has also given a further thrust to the trend towards getting laser vision correction done. Among the new people opting for this procedure are either those who wear contact lenses, and are now avoiding wearing them for fear of contracting Covid, or bespectacled people repeatedly getting their glasses foggy while breathing under the face mask.

“Economics have become tough no doubt, with revenues having plummeted to all time lows and running costs rising dramatically. Apart from the footfalls, the ticket size of patient has also dropped because the incomes of many of them have also dwindled in the wake of the lockdown. We, doctors have taken salary cuts, but remunerations of other staff have remained unaffected. These are tough times, but these too will pass,” he signs off.

A busy ENT specialist in Mohali, Dr Pankaj Arora says he gave free telephonic consultation to any number of patients who called during the complete lockdown days when OPDs were closed, though frankly, he stresses, he does not believe in online consultation as in ENT field clinical examination is of utmost importance before any treatment.

“I am doing half day morning-only OPD, no walk-in patient, only by prior appointment to avoid rush. Only patient or at max along with a single attendant is allowed in. Daily autoclaving of instruments twice a day for sterilisation and all other sanitisation measures as per laid down protocols are being strictly followed.”

Straight out of a Sci Fi movie: ENT specialist Dr Pankaj Arora

Dr Arora says he is seeing 20-25 patients every day in his morning-only OPD. “Requests from many patients are declined on any given day to stick to the daily limit of patients and offered appointments on subsequent days.” 

The ENT specialist is not doing routine surgeries and is referring emergency cases to hospitals. No, he has not revised his consultation fee despite incurring heavy additional overhead costs.

Dr RK Batra, Senior Consultant, General & Laproscopic Surgery, Alchemist Hospital Panchkula, feels that the biggest challenge posed to them in the initial phase of lockdown was rapidly changing guidelines and protocols forwarded by the Government of India and ICMR and non-availability of PPE kits. Getting quality kits is still a challenge, he says.

Senior General & Laproscopic surgeon Dr RK Batra

Online consultations were also a big challenge as several patients were not savvy enough to upload scans of prescriptions and investigation reports, which at times become absolutely necessary for arriving at any conclusion, he says, adding that planned surgeries have by and large been put on hold. Though RT-PCR test for Covid was made mandatory for patients before undergoing any surgery, some surgeries of urgent nature had to be performed without waiting for the test results as these took a couple of days, he shares.

Well known dental surgeon and current President of the Chandigarh branch of Indian Dental Association, Dr RP Gupta informs that after remaining closed for nearly 45 days, when his OPD opened in June he would attend to only urgent cases like dental bleeding, pain and crown having come off.

Well known dental surgeon & IDA Chd President Dr RP Gupta

“In the initial two-three weeks we did not do any procedures which involved generation of AEROSOL (air filled bubbles), though AIMMS Delhi continued to perform such procedures as well. The result was negligible revenue generation which did not even defray costs.

“Now we are running daily OPD for five hours from 10 a.m. to 3 p.m., maintaining high standards of protective measures. The footfall has slowly but steadily increased. Mondays and Saturdays are busier days for us. About 40% of our normal footfall has been restored, and we are hopeful that this trend will hasten as more patients shed their inhibitions of physically visiting a clinic,” Dr Gupta asserts.

For another well known Dental Surgeon & Oral Implantologist, Dr Jasbrinder Singh Teja,