âNeed to Inform the Patients Transparentlyâ says Abhishek Bhartia, Director ofÂ Sitaram Bhartia Institute of Science andÂ Research, a nonprofit hospital, that hasÂ carved a niche in womenâs health. InÂ conversation with Shahid Akhter of ENN, heÂ focuses on the changing scenario in birthing.
When was the Sitaram Bhartia Institute of Science andÂ Research founded and what it its legacy?
Sitaram Bhartia Institute of Science and Research (SBISR) wasÂ founded in 1979. It took off under the aegis of its first director, Dr NÂ Gopinath, a renowned cardiologist noted for his expertise in heartÂ bypass surgery. The institute conducted one of the largest communityÂ based studies of coronary artery disease in India. It Â then took up a large study of blood pressure in Indian schoolÂ children. Similar studies yielded valuable information onÂ the risk factors for cardiovascular disease in our country.Â SBISR was established with a spirit of serving societyÂ through research and the motivation was to establish excellence Â in healthcare delivery, research and education.Â With the passage of time, we have evolved into anÂ organization that combines medical research with excellenceÂ in patient care.
When did you shift to patient care and whatÂ was the outcome?
Our research continues to focuses on collecting health relatedÂ information, translating evidence-based guidelinesÂ in clinical practice, developing cost-effective interventions forÂ improving care, investigating factors influencing disease development,Â and analyzing medical literature for developing clinical guidelines.Â In 1995, we decided to broaden our range of activities and thought Â of providing a sustainable base for research. The ground work wasÂ laid by eminent physicians and surgeons from All India Institute of Â Medical Sciences. Professors J S Guleria (Padma Shree), the late M MÂ S Ahuja, R Tandon, I K Dhawan, and V L Bhargava were among theÂ early faculty members to join. Today they serve as outstanding careÂ providers and role models for the next generation of doctors.
What clinical specialities andÂ services Sitaram Bhartia offer?
Our specialities are spread acrossÂ from anaesthesiology to urology, withÂ special focus on obstetrics and gynaecology.Â We offer radiology and diagnostics,Â laboratory tests, pharmacyÂ and preventive health check-ups.
Sitaram Bhartia is noted forÂ womenâs health. Tell us more onÂ the services in this speciality?
We care and support women in everyÂ phase of life, from adolescence toÂ menopause. True, Sitaram BhartiaÂ is a leading centre for womenâsÂ health. The patients admitted hereÂ rate Sitaram Bhartia high on desirableÂ outcomes and quality of care. InÂ obstetrics, our comprehensive birthingÂ program spans a duration of nineÂ months. It lays emphasis on educationÂ and empowerment as key elementsÂ for a fulfilling journey to motherhood.Â An inter-disciplinary team consistingÂ of obstetricians, womenâs health educators,Â physiotherapists, nutritionists,Â paediatricians and nursing staffÂ deliver the comprehensive program.Â When it comes to labour, delivery andÂ post-delivery care, Sitaram BhartiaÂ offers a safe and satisfying birthingÂ experience. The patient is comfortableÂ with physical and emotional supportÂ that reduces the need for medicalÂ intervention and improves infant outcomes.Â The mother is given lactationÂ counselling, and informed about post dischargeÂ care after the delivery.
What are your views on theÂ surge in caesarean rates?
Cesarean section is a major surgeryÂ and like all surgeries, it carries risk.Â Recently, the American College of ObstetriciansÂ and Gynecologists issuedÂ a statement that âpregnant women Â plan for vaginal birth unless there is aÂ medical reason for a cesarean.â TheyÂ pointed out that cesarean delivery canÂ increase the risk for infections, bladderÂ and bowel injuries, and seriousÂ complications in future pregnancies.Â They noted that babies born vaginallyÂ have fewer respiratory problems.Â Thus as a society we should be concernedÂ about high cesarean rates thatÂ are not medically justifiable.
“We are not onlyÂ disclosing theÂ cesarean rates inÂ our unit, but areÂ also providingÂ guidance onÂ how to interpretÂ those rates.”
How does one decide or chooseÂ the doctor and the hospital ?
Many of us do extensive research beforeÂ buying a mobile phone or a car,Â booking a hotel for a holiday or evenÂ selecting a new restaurant. But when itÂ comes to choosing a doctor, many of usÂ do little more than get a word-of-mouthÂ reference. Unfortunately, what oftenÂ drives patient satisfaction and thus recommendationÂ of a practitioner to othersÂ is âbedside mannersâ and may notÂ always reflect evidence-based medicalÂ practice. Doctors are picked on reputation,Â and yet some of the most popularÂ doctors have undesirable outcomesÂ such as high cesarean rates!
Is it important for maternityÂ providers to discloseÂ Cesarean rates?
Most hospitals donât collect data onÂ clinical outcomes â they may notÂ have electronic health records orÂ lack the manpower to manually collectÂ the data. Doctors and hospitalÂ administrators may also be hesitantÂ to disclose quality-related data becauseÂ of concerns about misuse byÂ competitors or patients. Yet theseÂ concerns should not hold back effortsÂ at promoting transparencyÂ if we want healthcare to becomeÂ better and safer. The National PatientÂ Safety Foundation of USA hasÂ identified transparency is âthe mostÂ important single attribute of a cultureÂ of safety.âÂ We at Sitaram Bhartia InstituteÂ are taking a step towards becomingÂ more transparent and accountable toÂ our patients by disclosing cesareanÂ rates of our staff Obstetrics and Gynecology(O&G) unit. We are not onlyÂ disclosing the rates in our unit, butÂ are also providing guidance on how toÂ interpret those rates.
What are the cesarean rates atÂ Sitaram Bhartia?
Our staff O&G unit delivered 561 babiesÂ in 2013 with a cesarean rate ofÂ 40 percent. This rate is much aboveÂ the 10-15 percent rate recommendedÂ by the World Health Organization andÂ the average rate in countries like SwedenÂ (17 percent), UK (26 percent) orÂ USA (33 percent). However, our 2013Â rate is an improvement over the 52 percent rate in our own unit in 2011Â and the 65 percent rate reported by aÂ leading health insurance company inÂ India for their claims.