Mumbai’s best hospital

Which is the best hospital in Mumbai? For most ordinary Mumbaikars, this is a facile question. Even unkind and inappropriate. Choosing a hospital for the poor is largely about something they can afford.

Sanjay Nagral
Aug 01, 2022, Hindustan Times

Which is the best hospital in Mumbai? Is ABC a good hospital? Is XYZ better? Questions I get asked but dread. I know that they are posed with good intention and out of a felt need. Since I am an insider, it is presumed I would know. But much to their disappointment and even annoyance, I often respond with nebulous answers like “There is no short answer” “Depends on where you stay and what you can afford”. And finally my commonest response. “I can recommend good doctors and departments but there is really nothing like a good hospital”.

For most ordinary Mumbaikars, this is a facile question. Even unkind and inappropriate. Choosing a hospital for the poor is largely about something they can afford. Often, this means the nearest municipal or government hospital or a private nursing home. Hospitals are also chosen by people where they seek a certain doctor. Sometimes it’s about a treatment being exclusively available at the particular hospital. Or where the employer or insurance funds the treatment. In supposedly cosmopolitan Mumbai, community networks also play a strong role in people choosing hospitals. But with a large number of private ‘corporate’ hospitals springing up, a certain strata of society is now spoilt for choice. And questions like the best hospital are beginning to resonate. Media publishes such ‘best hospital’ lists in sponsored features.

In the good old days, it was largely the family doctor who suggested a specialist doctor or a hospital. For multiple reasons, this process has been disrupted. The family doctor as an institution is on the decline. This has to do with loss of identity and credibility. And partly the dominance of speciality medicine. With hospitals reaching out directly to people with advertisement blitzkriegs, the referral process is also being bypassed.

Referrals in private healthcare now largely happen through Indian healthcare’s biggest open secret - commissions and kickbacks. The ethics and legality of this practice is a separate discussion but it certainly muddies the referral process. You don’t have to be a whiz kid to understand that such an incentive-based model has its own logic and can lead to both unnecessary and inappropriate referral. (Does anyone remember a law that was announced by the Maharashtra Government amongst much fanfare in 2017 which has been given a quiet burial?)

There is also now a growing number of individuals seeking doctors and hospitals through the internet. This had to happen. It’s the contemporary way of seeking reliable information about all services. People not only seek information but also look at ratings and reviews. Needless to say the internet is a double-edged space not difficult to game. Who creates the content? Is it independent ? With doctors and hospitals learning the game of marketing through social media and the internet, honest information is a challenge. Hyperbole rules because it works. Every big hospital in Mumbai has been awarded a ‘best hospital’ award.

Finally, the commonest informal and grounded mechanism through which citizens choose doctors and hospitals is word-of-mouth social networks. The felt experience of a hospitalised patient shared with others is perhaps the credible way for people to choose a hospital. It may even be the least biased method.

To those of you who may have started reading this piece expecting a list of Mumbai’s best hospitals or how to identify them, I apologise for meandering. Let me return to the original question. Is there indeed a reliable, objective way of assessing a good hospital? For a meaningful answer, we need to identify what ‘good’ means in the context of healthcare. Whilst there are many criteria from a patient’s viewpoint, a ‘safe’ hospital, with a proven track record of good outcomes is perhaps what matters. For example, if one is undergoing an operative procedure the complication rate is what should matter. Is such information collected? Is it available to the patient? Is the information verifiable and accurate? I am afraid the answers are no.

In the developed world, there is a steady movement towards such data being put in the public domain. Whether in the universal healthcare model of Europe where the state monitors outcomes or the insurance-based model of the US where insurance companies do it, data on outcomes is available to those who seek it. Whilst accreditation from organisations like the NABH is now increasingly common in India, we are far away from outcome data being publicly available.

But whilst we wait for a future where such data maybe available there are visible soft markers of an institution’s priorities. The next time you visit a hospital you can look for them. Do all the staff wash their hands before touching you? Is a pharmacologist checking the drugs and dosages? Do the staff communicate in a transparent and detailed manner? Is your pain given priority? Who mans the hospital at night? Does the hospital have an end-of-life care policy and is willing to withdraw care in futile situations?

Which are Mumbai’s’ best hospitals then? I am afraid I have no readymade list for you. But it may be worth remembering that even when it comes to healthcare and hospitals, the best may be the enemy of good. And to quote Dylan ‘The answer my friends is blowin’ in the wind.’