HELP educates patients in partnership with Tulsi - the Pantaloon Pharmacy chain !

Pantaloon Pharmacy customers can log onto www.pantaloon.com/tulsi.htm and get all their health queries answered. This is a great win-win partnership; and allows us to offer a value-add services to Pantaloon customers; and reach out to many more people !

Clever way to enhance patient understanding !

Demand Management: The Patient Education Connection

Demand Management: The Patient Education Connection : "Does the pairing of demand management and patient education surprise you? It shouldn't. After all, demand management is largely a process of educating patients about how to make appropriate use of health care services. Every time you tell a patient not to worry about a temperature of 101°F, you're managing demand -- as you are every time you try to get a patient to understand that antibiotics aren't effective against cold viruses and every time you say, 'and if it doesn't get better in a week, call the office.' While the purposes of patient education are usually thought of as increasing adherence to therapy and reducing health risks, demand management is and always has been an integral part of it. The concept of patient education is central to all efforts to manage demand, from computerized or telephonic decision-support systems for self-help and triage to the poster about the risks of high cholesterol that hangs on your waiting room wall. Are these demand management tools that provide patient education or patient education tools that manage demand? Your answer probably depends on whether you're a managed care executive or a physician. But the benefits of these strategies accrue to both groups, and to patients too."

Demand Management: Putting Patients First

Demand Management: Putting Patients First : "Demand management is the process of empowering patients to make wiser health care decisions. It is not necessarily about reducing demand or keeping patients out of your practice. Rather, the goal is to engage patients in the quest for appropriate care. If you doubt the necessity of managing demand, think about all the patients who press you to prescribe antibiotics for their colds or demand other interventions you know to be unwarranted. Multiply the effect out across the country, and consider that the United States spends an estimated $200 billion a year on unnecessary and inappropriate care.2 To tackle this problem, demand management employs essentially two strategies: * First, it seeks to reduce the need for services by improving patients' health. The emphasis here is on wellness, health promotion, risk reduction, prevention and early detection. * Second, demand management attempts to improve patients' decisions. Patients may need to be taught, for example, when they need to see the doctor and when all they need is self-care. Tools such as patient education materials and telephone advice lines can aid the decision-making process."

Patient-Physician Partnership Agreement

Patient-Physician Partnership Agreement

This form can be downloaded as a PDF.

OBJECTIVE
To better manage your diabetes through a patient-physician partnership and goal setting.

REASON
Medical research and clinical experience have shown that optimal management of diabetes significantly reduces the known complications of this disease, including blindness, heart attack, kidney failure and loss of a limb.

EXPECTATIONS
You can expect your physician to provide the following services, which are an essential part of diabetes management.

• OFFICE VISITS - every three months for reviewing your progress.
• MONITORING - blood pressure, other vital signs, foot examination and hemoglobin A1c.
• ANNUAL SCREENING - lipids, microalbuminuria (test for kidney protein), eye examination and monofilament testing (sensory examination of feet).

PERSONAL GOALS

Weight/Body Mass Index:	Current:	________/______	Ideal:	_______
Hemoglobin A1c (<>	Current:	_______	Goal for 6 months:	_______
Blood pressure (<>	Current:	_______	Goal:	_______
Total cholesterol (<>	Current:	_______	Goal:	_______
LDL (<>	Current:	_______	Goal:	_______

YOUR RESPONSIBILITIES
• Schedule follow-up appointments every three months or as indicated by your doctor.

• Monitor blood sugars at home at the agreed testing frequency: _______.
• Work toward attaining the personal goals noted above.

PATIENT SIGNATURE	____________	Date:	_______
PHYSICIAN SIGNATURE	____________	Date:	_______

Simple tool to help doctors to help their patients make the most of their visit to the clinic

Today’s Visit

Main reason for today’s visit: _____________________________________________

_______________________________________________________________________

Other concerns I would like to discuss if there is time: _______________________

_______________________________________________________________________

Check all that apply:

o I have prescriptions that need to be refilled.

o I need a school or work excuse.

o I need a referral for my insurance company.

o I need the attached forms filled out.

o I would appreciate prayer today.

Patient’s name: __________________________________________________________

Date of birth: ___/___/___

Developed by Cornerstone Family Health, Williamsport, Pa. Copyright © 2003 American Academy of Family Physicians. Physicians may photocopy or adapt for use in their own practices; all other rights reserved. “Focusing on Today’s Visit.” Redka JW. Family Practice Management. June 2003:59-60, www.aafp.org/fpm/ 20030600/59focu.html.

End of box file

Improving Care With an Automated Patient History - July/August 2007 - Family Practice Management

Improving Care With an Automated Patient History - July/August 2007 - Family Practice Management: "One of the biggest challenges of using an electronic health record (EHR) system is how to fill it with patient data. What data should be entered, who should enter it, and when should it be done? I've seen many strategies tried, and in my experience the ideal solution is to have patients enter as much data as possible themselves before beginning a patient visit. This saves physicians time and can even lead to higher-quality data. After all, the patient is the person most interested in providing a thorough history."

Healthcare Scheduling - AppointmentQuest Online Scheduling Software

Healthcare Scheduling - AppointmentQuest Online Scheduling Software: "Patient scheduling is an integral part of daily work for healthcare professionals, from family practices to large clinics, from physician offices to hospitals. Medical office staff has to schedule patients for dentist, optometrist, ophthalmologist, surgeon, psychiatrist and other general care and specialist appointments. Scheduling quickly becomes complicated if the doctor is practicing in several clinics and travels between medical offices. Appointments need to be coordinated, medical support staff have to be constantly aware of all new patients and doctor’s schedule. Patient scheduling can be greatly simplified with capable online scheduling tools and appointment management software. With the help of online scheduling, medical office staff can easily manage doctor’s appointment schedules, patient records and individual appointments. Small medical practices can even allow patients to self-schedule their appointments online. Many doctors and small medical offices have already established their own web sites — online scheduling is a great addition to any such web site, an invaluable tool for communicating with patients."

Are Your Patients Ready for Electronic Communication? - October 2007 - Family Practice Management

Are Your Patients Ready for Electronic Communication? - October 2007 - Family Practice Management: "Overall, we were pleased to learn that 88 percent of our patients are able to access the Internet or e-mail either at home, through a public facility, or through family or friends. We had anticipated a much lower number. We were also impressed that 78 percent of patients with Internet access (either at home or elsewhere) expressed interest in using some form of electronic communication either to contact our office or to receive health-related information from our office. Acting on the numbers The results of our survey convinced us that patients are ready to begin using the Internet to communicate with our practice. The patients we surveyed were enthusiastic about receiving appointment reminders by e-mail, scheduling appointments online and receiving test results electronically, and we are planning to offer each of these services in the near future."

Virtual Office Visits: A Reachable and Reimbursable Innovation - October 2007 - Family Practice Management

Virtual Office Visits: A Reachable and Reimbursable Innovation - October 2007 - Family Practice Management: "Virtual visits satisfy patients' thirst for timely access to care and allow them to communicate with their doctor when it's convenient for them, whether from home or work, regardless of the time of day. With a virtual visit, patients don't have to wait on hold to schedule an appointment, they don't have to miss work and they don't have to waste time in a waiting room. This type of information exchange allows them to describe their problem and formulate their questions without feeling rushed, and because they have their physician's response in writing, they can reread the information as often as they like or need to understand the content. Virtual visits are generally paid for out-of-pocket by patients, although some insurers are beginning to reimburse for the service because they believe it is cost effective and increases patient satisfaction."

The Ideal Medical Practice Model: Improving Efficiency, Quality and the Doctor-Patient Relationship - September 2007 - Family Practice Management

The Ideal Medical Practice Model: Improving Efficiency, Quality and the Doctor-Patient Relationship - September 2007 - Family Practice Management: "What do you get when you mix low overhead with high technology and wrap it around an excellent physician-patient relationship? You get an ideal medical practice - a practice model designed to enhance doctor-patient relationships, increase face-to-face time between doctors and patients, reduce physician workloads, instill patients with a sense of responsibility for their health and cut wasted dollars from the entire system. The model encompasses the ideal micro practice model, which focuses on optimizing the smallest functional work unit capable of delivering excellent care: the solo doctor, even without any staff. The key principles ideal medical practices pursue are high-quality, patient-centered, collaborative care; unfettered access and continuity; and extreme efficiency."

Q: What Scares Doctors? A: Being the Patient -- Printout -- TIME

Q: What Scares Doctors? A: Being the Patient : "Even more insidious is the danger of overtreatment. With well-insured patients inclined toward hypervigilance, doctors afraid of missing something and a reimbursement system that rewards testing over talking, there is embedded in the system a dangerous impulse toward excess. Specialists are typically paid much more to do a procedure than the family doctor who takes the time to talk through the treatment options. A doctor who does a biopsy may be paid as much as $1,600 for 15 minutes' work, notes Dr. Jerome Groopman of Harvard Medical School. 'If you're an internist, you can easily spend an hour with a family where a member has been diagnosed with Alzheimer's or breast cancer, and be paid $100. So there's this disconnect between what's valued and reimbursement.' And yet sometimes, talking is the more important and certainly the safer treatment. Ten more minutes spent taking a family history can reveal clues that prevent a misdiagnosis or an unnecessary test; that childhood injury, that illness during a trip abroad, that family history of excessive bleeding. "

Good doctors, safer patients:

Good doctors, safer patients : "This report aims to create a new approach to promoting and assuring good medical practice and protecting patients from bad practice. The Chief Medical Officer was asked to undertake this broad review of medical regulation, following Dame Janet Smith's inquiry into the circumstances surrounding the murders committed by Hyde GP, Dr Harold Shipman. The CMO's report, Good doctors, safer patients, advises Ministers on measures to strengthen the arrangements in place for the protection of patients. The report contains 44 detailed recommendations. Proposed changes include devolving some of the powers of the GMC to a local level, changing its structure and function, and creating a new framework for revalidation."

Doctors can be harmful to your health !

We all want to remain healthy and well and we expect our doctors to help us to do so. However, this is a big mistake ! While doctors are very good for making you better when you fall sick, they are not good at keeping you healthy. After all, doctors are illness specialists, not wellness specialists ! In fact, most doctors have pretty unhealthy habits themselves ( even though you would expect them to know better !); and I sometimes feel that most doctors would not recognize a well person because they never see one ! ( For example, I am an infertility specialist, and see only infertile patients all day long. I never see fertile women, so though I help infertile women become fertile, I am not really an expert on optimising natural fertility !)

Things were different in the past. In China, doctors were paid as long as the family was healthy. If someone fell sick, payments were stopped until he recovered, because the fact that the person fell ill meant that the doctor was not doing a good job . This was a very sensible approach – and it’s one we should consider revisiting !

Unfortunately, today we seem to have lost our commonsense . We don’t trust our own bodies; and everything has become medicalised . We blindly do what doctors tells us to do – pop a pill; do a scan, run a test – the list is endless !

We need to regain control over our bodies – and the true experts are people like Mr Dalmia . He is great role model, and we can learn from his personal experience . Though he is apologetic that he is not a doctor , in fact I think this is his biggest advantage – he does not see the world through a doctor’s “illness” lens.

We have a rich and ancient heritage . Ayurveda is the Science of Life – not the science of just treating illness. I believe that people are the largest untapped healthcare resource – and if we want to remain in the pink of health, we’d be much better off learning from each other, rather than depending upon doctors.

An attitude of wisdom

"Be Confident enough to act on the best knowledge you have now;
Humble enough to doubt what you know; and
Wise enough to face the hard facts when better evidence comes along."

This is from the book, Hard Facts, by Jeffrey Pfeffer and Robert Sutton, which talks on Evidence-Based Management.

I guess this would be the businessman's version of the Serenity Prayer , which states -
God grant me the serenity to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference.

The Healthy Way to Natural Living - Mr Dalmia

HELP recently organised a talk on - The Natural Way to Healthy Living. This was given by Mr Dalmia, one of India's leading industrialists. He is an excellent role model of how to live a healthy life !

Here's his talk - in full !

I am a businessman not a Doctor. My age is 66yrs. As per Reader's Digest test few years ago it was determined as 40 yrs. I took last medicine in 1967 and have not suffered from any illness since then. In last 40 yrs I have lost 4 working days due to catching cold in Cal monsoon. My experience confirms that disease-free living is possible without foregoing all pleasures of life. What is being shared, even I do not practise 100%, but I am conscious. Till 1975 my life style was not any different from others. It changed gradually. By the time I was 40 yrs old a lot of improvement had taken place. Looking after your BODY is like driving a car, when it deviates from its path, the driver corrects the course in time. If one is sensitive and responds, it is possible to correct before it is too late. Whatever is being shared is based on my own experience/analysis and interaction with Naturopath Doctors. If mothers want their children to lead a disease-free life they should inculcate right habits during childhood. Modern medicine is very good for emergency, particularly accidents, but not for every day life.

Every 'BODY' like every individual is different. All medical sciences works on averages. We must understand the limitation of average. Haven't you heard the sad story of a man, who drowned himself in a pond average 3 ft deep'.

A. Disease-free body is not muscular body of gym. Immunity gives disease-free body.

1. Causes of disease a. inheritance or b. own life style. Control life style before disease forces you to change. Disease is caused by accumulation of toxins in body ie elimination process not satisfactory. We allow toxins to accumulate upto the tolerance limit. Even after that by taking medicines we try to suppress it rather than eradicate.

2. Dr Swaminathan was a very strict naturopath. He was confident that if he was to drink a glass full of all types of bacteria nothing will go wrong with his body. How many Doctors can claim this? Immunity is affected by lifestyle. Western children have much lower level of immunity than Indian children, who live in more unhygienic conditions. Too clean homes are not good for children. US children now are developing allergy to simple things like groundnut. Instances of death by eating groundnut have also been reported.

3. Body's capacity to rejuvenate - Human BODY has immense capacity to rejuvenate, provided we help it and at least donot interfere. It is a masterpiece feat of Almighty and is impossible to match.

4. Toxins = waste from food + dead cells ++. Some food waste is more difficult to eliminate. Some practices/processes help waste elimination. We clean our house daily and some intense cleaning periodically. Are we careful re internal body cleaning? Do we do some intense cleaning of our internal body at all?

5. Ext vs int hygiene - Few people brush teeth at the back. Even fewer are aware of the internal cleanliness status of their body. Emphasis is on cleanliness of the visual parts. We need to learn how to improve internal hygiene. Mothers need to inculcate proper habits for good internal hygiene from childhood.

6. Obesity is a sign of ill health. Today people want to remain slim for looks. Classic joke "There is no such thing as an obese centenarian."

7. Body systems are very strong when young, as such one tends to develop wrong habits which one cannot cope with at a later age. Stop bad practices before they tend to become a habit. One gentleman weighed himself daily in say 10gm units. He will endeavour to eliminate any extra gm next day before it became permanent part of the body.

B. Toxins elimination

1. Accumulation of TOXINS is like Slow poisoning - realisation comes too late. If we put a frog in a bucket of hot water, the frog will try to jump out. If the frog is put in a bucket of water at room temperature, and heat is applied gradually, it stays there till it is too late. Unfortunately our knowledge re warning signs is poor, hence we donot pay heed to such signs. Fever or any other need to take medicine is already late. Even then we suppress the sign and ignore the cause. We seem to have got habituated to live with unhygienic conditions in our internal body.

2. Gaseous toxins removed through breathing - Lung volume for an average person is 5 litres, but most people inhale 1 lit +/-. As a result quality of air in the lungs is dirty. We clean our external body daily, house daily but make no efforts to clean our lungs. Pranayam helps cleaning of lungs. In Pranayam emphasis is on exhaling to get rid of accumulated toxins. There are 108 types of Pranayams. Some are meditational eg Anapan, Sukh Pranayam, Nadi Shodh, Anulom-Vilom etc. Kapal Bhati, Bhastrika emphasise on exhaling. Standard practice during pranayam is that time to exhale is twice the time to inhale. Laughing also helps cleaning of lungs. CORRECT WAY TO BREATHE IS TO LET STOMACH ALSO BLOAT DURING INHALING LIKE A NEW BORN CHILD DOES. I am told that Baba Ramdev was paralysed and regained normal body functions with the help of Pranayam and Yoga. I also understand that anyone practising Transcendental Meditation pays reduced premium on medical insurance in USA.

3. Liquid toxins removed through urination & sweat. We should drink 2-3 litres of water daily. Any liquid intake is not same as water intake. Air-conditioning prevents toxins elimination thru sweat - a contradiction for disease free life style.

4. Solid waste removed through stool. Have we ever experienced absolute clean intestines? Can we interpret inside happening by looking at our stool? Our knowledge re this very deficient. Ideal is 1motion for 1 meal. Effortless, smooth and quick elimination are some signs of clean intestine. Look at tongue. If intestine clean, no deposits on tongue - not necessary to clean tongue. Do we know what to do, if any problem with stool passing other that laxatives? Now a days there is a machine which washes the colon known as 'Colon Irrigation or Hydrotherapy'. There are yogic kriyas given below.

Case story - One patient was very sick - unable to stand/walk. Doctors were not sure if he will survive through the night. Heavy Enema eliminated the accumulated toxins. He passed comfortable night and was ready to run next morng even before eating any food.

5. Fasting helps detoxification - Fasting for health is not like modern days fasting by ladies for religious rituals. For detox one has to live for a few days on liquid food or only water. One naturopath lived for 23 days on water alone with full rest. At the end of the period higher energy that before fasting. An alt can be to have 4days cycle - 1st day only liquid, 2nd day fast, 3rd day liquid & 4th day solids. Cycle may be repeated. Naturally solid food has to be light food. Child's concept of light food is a piece of cake and that of balanced food a piece of cake in both the hands.

6. Yogic Kriyas a. Jalneti b. Sutra/Rubberneti c. Kunjal d. Vastra dhouti e. Laghu Shankh Prakshalan - drink warm salt water say 2 glasses and perform some Asans/excercises. Repeat the process 3-4 times. Most of the water gets diverted to intestines and washes the colon. Almost clear water comes in the end. Rishis did Maha Shankh Prakshalan before tapas. With total clean system, no food, few breaths, metabolism came to stand still. Ageing process stopped. To learn more about toxins elmination through yogic kriyas/yoga and nature cure - visit a good Nature Centre. Naturopathy is serious about teaching you how to remain disease-free and not treat you like a customer to be pleased. In commerce of health they hardly tell you to be disciplined. Disciplined life style only will help develop immunity. Pl remember that a Naturopath Doctor also gets a degree from the institute. Their courses on anatomy etc. are as detailed as for Allopaths. Treatment system taught is obviously different. There are also degrees for Yoga. One young girl practised Yoga during pregnancy under the guidance of an expert. As she narrated to me, her delivery was very smooth and almost painless.

7. Case histories:

a. One man from Dubai came regularly for say 15 days to a nature centre for detox. During his normal living, he indulged in everything not allowed by Naturopathy eg meat, smoking and alcohol. His approach was to overhaul the system like any machine, use it for one year and come back for overhaul every year. During the period of stay, he followed all the disciplines of the Centre and resorted to normal practices as soon as he stepped out.

b. One Mr J of Cal goes regularly for detox. He takes some medicines regularly for old illnesses. Whenever Doctors want to increase medicines or dose, he goes for detox instead of more medicines.

Learn to use the power of DETOX in your life... and you'll start to regain the health and energy that is your birthright.

C. Food

1. Hunger - Do we eat when really feel hungry or by watch. One senior industrialist asked me when I was about 12 years old whether I ever felt hungry. Looking to his seniority, I was taken aback by such a question. I did not want to be impolite by not responding. I mentioned that I felt hungry as everybody else. HE EXPLAINED THAT THIS WAS NOT HUNGER. HUNGER IS WHEN YOUR MOUTH STARTS TO WATER BY LOOKING AT THE MOST TASTELESS FOOD. All ladies know the remarks of family when food is not upto individual's taste. All because WE EAT EVEN WHEN NOT HUNGRY. Has anyone ever complained re nutrition? I can say I have never felt such hunger. Please analyse for yourself whether you eat when you are hungry or by watch.

2. Taste vs nutrition - Nutritious food must be pleasant but may not always be tasty eg Neem, Karela etc. When someone tries cheese, coca cola, he does not find it tasty. This applies even more to alcohol and smoking. But people adapt to taste of these things. We must adapt to the taste of healthy food. Ladies should see to this particularly for children.

One person went to a Swami ji and complained about his health and inability to take food. Swami ji requested to list out all the foods he liked and all the foods he did not like. After seeing the list, Swamiji said he should eat all the foods that he did not like and not eat all the foods that he liked. If this is how we adapt to taste, we can not have disease-free life.

3. Chewing is very important for proper absorption by the body. Chewing makes the bite finer and salivates it. Mother's concept is that the more the child eats, the better for him. In her pursuit

for this, she does not teach the child to chew. Mothers prepare next bite and bring it to the mouth as soon as previous one is in the mouth. As a result child learns to gulp. We have been taught to chew every bite 32 times. My perception is that the extent of chewing depends on the food eg boiled rice cannot be chewed even 32 times. Whereas certain hard/fibrous foods eg carrots or even sprouts can be chewed upto 200 times. Taste is also a reason for us to gulp. When food stays in the mouth for longer period, taste gets diluted. Hence, tendency to gulp and get the new bite for better taste.

4. Impact of Cooking/Heating

a. Roasted or boiled seed does not germinate. There is no change in chemistry of food by boiling/roasting.

b. We all consider CHHENNA to be healthy. It is considered light and full of nourishment. MAWA is considered to be heavy that is difficult to digest and not so healthy. We all know that both are milk solids. For making CHHENNA water is separated through chemical means whereas for MAWA water is removed through evaporation. Water leftover after recovering CHHENNA is considered to be very healthy as it has water soluble vitamins and minerals. As MAWA is prepared by water evaporation, these vitamins and minerals are supposed to be present in it. Chemically protein, carbohydrate and fat content of CHHENNA and MAWA are identical.

c. How long can you keep cooked food? May be for a few hours without freezing.

d. How long will raw fruits & vegetables last? May be few days.

e. What happens to sprouts everyday after germination. They are growing daily.

Conclusion

Roasting/boiling deprives the seed of life giving capacity. Heat has made MAWA unhealthy although its chemical nutrition is the same as CHHENA. It is obvious that although chemical nutrition may be similar, but there is difference depending on the source and how it is prepared. In my perception, cooked food is like dead body. It starts decaying soonafter being prepared. Fruits, vegetables and sprouts are live foods. For proper nourishment to sluggish or dead organs we need nutrition from living food and not dead food. On this basis, meat is even worse than the cooked vegetarian food as decay starts immediately

after slaughter. So it becomes like 24-hours old cooked food or dead body after 24hrs. Today American Institute of Cancer Research is recommending more and more use of fruits, vegetables, salads and limit meat taking to the minimum. It is my belief that in years to come they will recommend no meat at all. Possibly, if they do it today, its acceptablility in the society will be difficult. USA is very conscious when marketting a new product or idea re it's acceptability with the customer.

Case stories:

a. A lady had 3rd stage uterus cancer. Doctors wanted her to undergo standard treatment of radiation, chemotherapy etc. She refused any such advice and changed to 100% raw food. After 1 yr Doctors confirmed NO DETERIORATION!! It will require lot of guts on part of Doctors to confirm improvement merely by taking raw food.

b. One diabetic patient's wound was not healing after surgery, although sugar was kept under control with the help of medicines. A naturopath approached the family and suggested that his prescription be tried. When enough time was lost without sufficient progress, everybody agreed to try his prescription. His prescription was to have only raw food with even reasonable quantities of fruits such as banana, mangoes etc usually not allowed to diabetics. Sugar remained under control without medicine and the wound was healed. Sugar was under control in both the cases though by different means but healing rate improved considerably when the patient was only on raw food.

Recently there was an article 'Raw food slows down ageing'.

5. Acidic and alkaline foods - Cereals & dals are acidic foods, while fruits & veg are alkaline. In net food must be alkaline, therefore more fruits & veg. Some say max 20% Cereal+Dal, others accept upto 33%. It is a challenge for the ladies in the house how to give such a high proportion of fruits, vegetables to the family. You may mix veg in Khichri and even flour before making roti. Please remember fruits clean the body and vegetables build the body. Potato is a vegetable but not considered to be 100% vegetable, but is very healthy. It is a misconcept that Potato is fattening. It has 80% water and is too porous, hence can absorb a lot of fat without showing. It should always be taken with the skin. Fruits are predigested food, hence should be eaten separately from main meal or 30 to 45 minutes before meal. Although vegetables are not predigested, but it is also

recommended to take salads, etc. before the meal, as time reqd to digest is much lower. Nutrient density ie special nutrients/cal of intake is max in fruits & veg.

6. Milk - Most Naturopaths believe that nature has made milk only for the baby of the same species. However, everyone is unanimous that if external milk has to be taken, source has to be cow. Best is to have Dharoshna milk i.e, milk as it comes out without much delay. In any case, boiled milk is not recommended. It is better to have curd instead of milk. Alternative suggested is Soya milk.

7. Fat, salt and sugar

Fat - A perception has been developed to avoid fat for healthy diet. Fats are absolutely necessary and must form part of diet. Vit A & D are fat soluble. In absence of fat, body may become deficient in Vit A & D. Fat is very rich in calories hence its intake must be limited particularly for those who are not involved in physical labour. Fried food in any case is bad because of heat exposure. Frying temp is much higher than normal cooking temp. All ladies know that after some time, batch of frying medium needs to be changed otherwise the food may become poisonous. Obviously sustained high temperature changes the character of fat making it almost a poison.

White Sugar - taken only for taste. It has only calories. Due to lack of other nutrients, its nutrient density is nil. God has made Vit B composite with all sugar containing fruits. Vit B is required for digestion. In absence of Vit B, it takes Vit B from other parts and deprives the body of Vit B. It is also said to be Calcium thief. It deprives the body of Calcium. Net value of white sugar is negative. Sweetners like jaggery and honey are nutritious.

Common Salt: Rarely required for nutrition. Exceptional cases where salt may be required to replenish for people who sweat too much like working in hot conditions etc. Other than that its nutritional value is practically zero. Sodium deficiency is a very rare phenomenon. We all know that it tends to increase blood pressure and creates many other complications. As such it should be taken in very limited quantity for taste only.

Recent UK study showed high level of sickness among children. Their conclusion was that readymade foods contain excessive salt and sugar. Soon they intend to legislate restricting the amount of salt and sugar added to readymade foods. Choice will therefore be up to the individual to supplement salt & sugar as per his taste/wish. It will in any case not develop taste among children towards highly salty or sweet foods.

8. Sprouts - Sprouts can be prepared from different cereals and pulses. Most commonly used are Chana, Moong and Moth. However Wheat, Groundnut and Methi can also be sprouted. Methi sprout is a very good detoxifier and also helps control Cholesterol. Best is to have all varieties of sprouts. Generally, people tend to take sprouts with salt and lemon. There is nothing against lemon, but salt is not a desirable additive.

9. Micronutrients - We all know about major nutrient like carbohydrate, protein, fat etc. Ultimate difference in food value is because of micro nutrients. All cars have wheels, engine, steering, brake, etc. but not all cars are same. It is the minor additions which make all the difference between a good, better and best car. Micronutrients are like that. Lot of Micronutrients are still unknown. Hence, using maximum variety of foods is desirable. American Institute of Cancer Research emphasises that food plate should have all colours like rainbow. Green colour is due to Chlorophyl. Molecular structure of chlorophyll is identical to Haemoglobin except for Iron in the core. As such, it is the easiest raw material to produce haemoglobin. This is the main reason why emphasis on green vegetables. There are lot of micro-nutrients in Wheat Grass, Barley grass and even common grass. Haldi, Tulsi, Clove, Ginger & Lemon are natural antibiotics. We all know that mercury is a poison and cannot be consumed by the body. Tulsi is the only source of digestible mercury. This gives it the antibiotic property. Neem and Amla are very good blood purifiers. Karela is also rich in micronutrients and good for diabetics. There are lot of antioxidants in fruits and vegetables.

10. Genetically Modified food - There is a lot of talk about GM Food based diet. I understand GM food cannot generate own seed. What may be its impact over time on regeneration capacity of the people who use this regularly, needs to be understood.

11. CD/computer programme to educate children - I will suggest that someone develops a CD/computer programme to educate children re food choice. All types of food are lying on a table and children are given option to select the food from the buffet. Computer programme gives them marks based on food chosen. Children may have the option to take out some food and replace by alternative. This may develop a good concept among children regarding good and bad food as well as balanced diet. Good food chosen improves score and vice verse. PAVITRA's STORY, PK to narrate.

12. Chocolates, Icecream, Chips - A post mortem study of children 10-15yrs of age, who died prematurely was carried out in US. Blockage of artery was noticed in many cases. On checking the food habits of the children where blockage had started it showed common eating habits of potato chips, chocolate & Icecream. Today US schools are banning carbonated drinks. If we reward a child with junk food eg chocolate, the child will never understand that chocolate is bad for him.

13. Chilled water/Icecream - Digestion is a chemical process. All chemical reactions slow down at lower temp. Impact of chilled food or water in whatever form is to slowdown the digestion process.

14. Qty of food vs energy - Energy in the body depends on various factors. Quantity of food is definitely a factor but a less important factor. Among the type of audience here, lack of quantity of food cannot be a reason for lack of energy or nutrition. I strongly feel that after certain age one should reduce their food intake considerably. As per Ayurveda, one who survives on one meal a day is a Yogi; one who consumes two meals a day is a Bhogi and one who consumes more than two meals a day is a Rogi.

15. Blood Pressure - As a general belief that BP increases with age. When the arteries/pipelines are clean, heart can pump adequate quantity of blood with relatively low pressure. As the arteries get clogged, blood pressure tends to rise as any engineering student will know. This strains the heart. On the one hand our heart also has aged and has to work under higher pressure. Nothing can be worse than this for the heart. Constant care is required to prevent clogging of arteries.

16. How to murder yr Husband

There was a joke many years ago in Reader's Digest with the above title. It merely said feed your husband with very rich food and when he wants to go for exercise donot let him go on one plea or another, thereby showing how much you love him. Nobody will ever blame you for his premature death. Lot of us may be doing this ignorantly.

D. Life style

1. US Cancer statistics - One in four persons in US suffers from Cancer. This is totally due to their life style. This is also the reason why so much anti smoking consciousness has developed there. Besides tobacco, their beef eating is also possibly responsible for high incidence of cancer. I have not seen any country where steak is taken even for breakfast.

2. Indulge with responsibility - A School in Delhi, unlike most schools gives a lot of liberty to parents for letting their ward to be absent from school. They believe a child's education is incomplete without good family bonding. The Principal explains that if child's uncle/aunt have come with their kids and family is in a mood to go for a picnic, just go. As responsible parents how frequently this should be done is for the parents to decide. This is an absolute exception to what most schools allow. Similarly, as responsible individuals we have to decide regarding our indulgence. If we evaluate a doctor based on how much he allows us to indulge or a hospital based on its flooring we need to evaluate ourselves if we know enough to indulge.

3. Eating out - Eating out is so common these days. Eating out is always prone with poor nourishment and bad hygiene. Even if the establishment boils all the forks, spoons, etc. most bacteria may be destroyed but not most viruses. All establishments for eating out get business based on taste and not on nutrition. Naturally their emphasis is on taste ALONE. If our frequency of eating out is high, our nourishment goes down and risk of viral exposure goes up. One is not even sure of their cooking medium and how long it has been used before changing.

4. General

a. Sitting posture vs blood flow - In the olden days we used to work by sitting on the floor in a cross legged position. These days everybody from childhood sits on a chair. Just visualise the blood flow in the body in the two postures. All our active organs are above the abdomen. While sitting on the chair, lot of blood flows to the feet unnecessarily. To that extent, all active organs above abdomen right upto the brain receive reduced quantity of blood. Naturopaths recommend sitting in Vajrasana after meal to allow more blood and energy to organs involved in the process.

b. Stomach pumping and Nyoli Kriya are 2 activities which massage all active organs in the abdomen area.

c. Stay healthy without excercise - if we walk instead of using a car, go up the stairs instead of using the lifts, wipe the floors, stretch to access goods on the higher shelves, etc. we do not need to exercise specifically.

d. Standard of life vs standard of living - Now a days there is greater emphasis on standard of living ie indulgence, instead of standard of life.

5. Excercise - Syt GDBirla used to walk 25km daily. Instead of going on a horseback, he walked upto Kedarnath at age of 85yrs+. If he could find time, it is difficult to accept that we miss exercise due to lack of time.

E. Pollution & Environment

1. My father Syt Jai Dayal Dalmia told me in '70s

a. drinking water will be sold in bottles.

b. Air/O2 will follow

c. bio-degradabilty of certain materials in everyday use.

Please evaluate the impact of drinking water industry. How much pollution is created in transportation of so much water all over India. Disposing of the plastic bottles is a nuisance due to its non bio-degradability. Term biodegradability is somewhat understood now but in '70s it was an almost unknown term.

All these also contribute directly or indirectly in one form or the other to ill health.

There was a news article in Times of India dated 7 Oct07

London: The world moved into "ecological overdraft" on Saturday ie 6 Oct, the point at which human consumption exceeds the ability of the earth to sustain it in any year and goes into the red, the New Economics Foundation think-tank said.

Ecological Debt Day this year is three days earlier than in 2006 which itself was three days earlier than in 2005. NEF said the date had moved steadily backwards every year since humanity began living beyond its environmental means in the 1980s.

At this rate, Oxygen in the air will go on diminishing and will be substituted by Carbon Dioxide. On the one hand the forests are getting depleted due to limited consciousness regarding use of wood and paper. If it continues at this rate, my father's imagination that one day everybody carry air/oxygen cylinder for breathing will come true.

F. Medicine=Health?

If medicine is to help us live disease-free, how do Pharmaceutical cos forecast growth? It is only because if we take one medicine today, we will need MORE medicine tomorrow. General approach today is that you indulge we are there to look after. In any case not enough emphasis for diseasefree body. When someone suggested to Dr. SR Jindal in one of the open sessions at Jindal Institute, Bangalore, to open more such institutes all over India, and if there be constraint of funds, these may be operated on commerical basis. His response was that any institute which runs on commercial basis has to please the customer. Such institutes cannot impose discipline, which is a must for disease-free life. Now there is a Centre started in US to counsel on Life Style. Counselling Doctor's problems a. takes longer than prescribing medicine b. insurance does not pay for it

G. Misconceptions

a. Toothpaste cleans the teeth. This is not true. Function of tooth paste is only to lubricate. One person even suggested that it may be better to clean with soap. Salt will provide medium where bacteria cannot flourish. This was used for cleaning teeth mixed with few drop of oil. Rinsing the mouth with salt water last thing in the night possibly is better alternative than brushing the teeth.

b. Dettol etc have antiseptic properties. This is not true. Only publicity has given us this perception. These are just detergents as good or as bad as any other soap/detergent.

H. Impact on GDP

1. Many people believe that if we do not indulge, our economy will suffer. I believe, there is a good GDP and bad GDP, like productive employment and unproductive employment. GDP will fall if

a. Cancer is wiped out of USA

b. People stop smoking

2. Calamities like Earth Quake, Floods increase GDP, without increasing nation's wealth. Unfortunately nations do not keep record of Gross Domestic Wealth, like balance Sheet of a co. Even Wealth does not include education level, health level in the society. Bhutan carries out a survey regarding 'Happinesss Index' of their people.

I. Impact of change

1. Deterioration is like slow poisoning. Unless one is conscious it may not attract attention. Improvement is even slower, just as going uphill is slower than going downhill. Improvement is like adding 1 drop of colour in a bucket of water daily, nothing visible till a long time, so do not get disheartened if improvement takes time to be seen.

Engaging the Consumer to Improve Healthcare

Engaging the Consumer to Improve Healthcare Some of the most important steps to improving health care begin with the people who drive the entire system – the public.

The health care industry has long recognized that when individuals are more engaged in their own care, the result is better clinical outcomes and greater cost-efficiency. So today, each of us is being asked to take on increasing responsibility for our well-being. Health care providers are encouraging patients to play a more active role in preventing illness and managing chronic conditions. Health insurers are empowering members with products that give them a greater range of benefits, a wider choice of providers and more flexibility in determining their deductibles and other out-of-pocket expenses.

Indeed, Americans are no longer simply “members” of a health plan or “patients” of a provider; we are becoming “consumers” of health care – with all of the responsibilities the word implies. As consumers of other goods and services, we routinely attempt to make well-informed decisions to best meet our individual needs and desires. As consumers of health care, we also must learn to shop wisely. This requires a fundamental change in the way consumers interact with the health care system.

Promoting Healthcare Consumerism - the role of Insurance Companies

Promoting Healthcare Consumerism - the role of Insurance Companies Humana’s shift toward consumer empowerment is getting results. In the three-year study of SmartSuite customers, annualized cost trends were in the 5-6 percent rage compared to the national health cost inflation rate of 12-14 percent during the same period. Members changed their behavior by relying more on preventive services and less on costly—and often less effective—“after-the-fact” interventions. And the percentage of overall benefit costs borne by employees stayed constant over the life of the study. America’s health care system is broken. Without change, it will cost $55,000 a year to insure the average family by 2022.

Fortunately, change is already happening. Consumers who are used to having control in every other area of their lives are beginning to take control of their health care. And Humana is there to help.

Humana Backs ‘ChangeNow4Health’ Web Site to Spur Change — Digital Healthcare and Productivity

Humana Backs ‘ChangeNow4Health’ Web Site to Spur Change — Digital Healthcare and Productivity: "A major health insurer, Humana, is backing the latest entry in the crowded field of “health 2.0” social media -- in this case an online community -- aimed at spurring immediate action in health care reform. “Our health care system is badly broken, but there are disconnected pockets of progress around the country,” Humana president and chief executive Michael McAllister said Monday in announcing the launch of the site, called ChangeNow4Health. “People are acting on ideas right now but don’t always know about it.” The new site is intended as a public forum for generating and exchanging ideas. “We want to move from what I call chatter to ideas to action,” McAllister added during an online press conference from New York. ChangeNow4Health has areas of interest for consumers, employers, providers, and health plans. It features three online forums, each moderated by a health care blogger."

Stress and IVF - tightly entwined but can they be separated?

Stress and IVF - tightly entwined but can they be separated?: "In summary: the complexity of our stress responses and potential impact on the delicate aspects of egg production, quality, subsequent embryo development and ultimate chances of conception is still not fully understood. Yet logically the step of reducing stress can only likely benefit outcome. No study has ever shown low stress levels to have a negative impact! The question remains, should all couples having IVF treatment make all efforts to remove unnecessary stressors and potentially be on 'holiday' or is it just for some people that this may have a crucial role in the outcome and chance of pregnancy?

We certainly have seen a better than expected success rate even in couples whose chances are low after two or more failed attempts. The feedback from couples opting for this is always 'how much easier the treatment felt'. Even from the physician perspective it is often remarkable the difference in the 'affect' of the couple on the first day of coming into the clinic - often visibly uptight, to the couple that we see on the day of the embryo transfer.

When asked the patient's link this more relaxed feeling to being removed from work, home and their typical lifestyle - not surprisingly as most of us are more relaxed when on holiday! Many also feel that having time together is a significant plus. Specific use of acupuncture, reflexology and massage are generally met with huge perceived benefits to the state of well being for the patient."

Is this one of the reasons reproductive tourism has become so popular ?

InstyMeds - We Make Patients Better, Quicker!

InstyMeds - We Make Patients Better, Quicker!: "InstyMeds™ is the health care industry’s first fully automated ATM-style dispenser of prescription medications. State-of-the-art InstyMeds technology dispenses medications directly to consumers at the point-of-care, such as the waiting rooms of clinics and hospital emergency departments. It has been successfully used in busy health care settings and is ready to roll out on a national basis."

PLoS Medicine - Following the Script: How Drug Reps Make Friends and Influence Doctors

PLoS Medicine - Following the Script: How Drug Reps Make Friends and Influence Doctors: "Physicians are susceptible to corporate influence because they are overworked, overwhelmed with information and paperwork, and feel underappreciated. Cheerful and charming, bearing food and gifts, drug reps provide respite and sympathy; they appreciate how hard doctor's lives are, and seem only to want to ease their burdens. But, as SA's New Hampshire testimony reflects, every word, every courtesy, every gift, and every piece of information provided is carefully crafted, not to assist doctors or patients, but to increase market share for targeted drugs (see Table 1). In the interests of patients, physicians must reject the false friendship provided by reps. Physicians must rely on information on drugs from unconflicted sources, and seek friends among those who are not paid to be friends."

Horizon Patient Kiosk Expands Personal Health Management Suite

Horizon Patient Kiosk Expands Personal Health Management Suite: "In the latest expansion of its personal health management suite, McKesson announced the addition of Horizon Patient Kiosk™, a touch-screen solution for hospitals and physician offices that enables patients to electronically check in for appointments and procedures at the point of service. They can also access and review their own demographic information, view appointments, check outstanding balances and co-payments, and electronically sign consent forms. By automating routine processes, patients enjoy shorter wait-times while medical staff eliminate paperwork and increase throughput."

Rx for Clever Startups: Take Operations Overseas - Medical Tourism

Rx for Clever Startups: Take Operations Overseas- Medical Tourism: "Think globalization means little more than call centers in New Delhi? Then you haven't seen what happens when seriously large numbers of Americans, who spend more than $570 billion at U.S. hospitals annually, start taking health-care holidays in far cheaper climes. Nor have you seen how much money there is to be made by helping them get there.

We're about to find out. This year alone, upwards of 500,000 Americans are expected to travel overseas to get their bodies fixed, at prices 30 to 80 percent less than at home.

Medical tourism, as the practice is known, is rapidly becoming the top choice for consumers who grapple with hefty medical bills. Adult Americans who are either uninsured or considered "underinsured" number more than 61 million - a figure that's likely to soar in coming years.

With places like Costa Rica, the Dominican Republic, India, the Philippines, and Thailand pitching their low-cost care, Americans are expected to help turn global medical tourism into a $40 billion-a-year industry by 2010, according to David Hancock, author of The Complete Medical Tourist.

Five-Star Hospitals

Five-Star Hospitals: "While new payment schemes, clearer pricing, and increasing competition are driving most hospitals to hack and trim in desperate efforts to survive, the executives at Griffin and other “five-star hospitals” have taken a different tack. They’re attempting to build health-care centers with the customer-friendliness of Nordstrom, the reliability of FedEx, and the transactional accuracy and simplicity of American Express. They believe that making hospital stays more pleasant will pump up market share and revenues, boost the quality of clinical care, create less stress for the staff, and generally turn their business around. They are transforming themselves to better serve the consumer."

Are Patients Ready for Kiosks? « Patient Centric Healthcare

Are Patients Ready for Kiosks? « Patient Centric Healthcare: "Everyone is moving to self-service. Quicker. Cheaper. Privacy. Automated. Etc. There are lots of benefits. Think about all the information which is needed in healthcare along with all the linked processes. If this can be simplified and some of the burden pushed to patients that is great. Now, this will vary by age and demographic. Typically older people will be more hesitant to use automated technology. Just look at your self-service grocery lines. Additionally, you have to watch interpretation of questions. I will never forget the doctor asking my grandfather if he smoked and him saying yes. I asked for a point of clarification and found out he had smoked 35 years ago. I couldn’t find all the examples, but I have talked with vendors using kiosks for checking in to an office or hospital, providing translation services, helping match basic needs with over-the-counter medications, simplifying basic services (e.g., picking up a refill prescription), or for pushing information to the patient. Kiosks blend challenges with physical design (height, location, screen size) with application challenges (number of screens, simplicity, data entry) with business model challenges (costs, advertising (Y/N), patient utilization). But, done right, I clearly see this as key to the future of healthcare. "

Health Care's Retail Solution

Health Care's Retail Solution: "It’s clear that the future of health care in the U.S. will be consumer-centric, but exactly how this will play out is still coming into focus. The evolving model will be influenced by a number of factors, including retail health experiments now unfolding in other countries, as well as by the experiences of other consumer-driven industries such as retailing and banking. What is certain is that the health-care landscape is undergoing a profound alteration that will change the dynamics of all the industries connected to it. The shifts will create enormous opportunities that will challenge and reward insurers, providers, product makers, intermediaries, and even new entrants. Virtually all of these opportunities are in new or significantly altered competitive spaces. And in each of these spaces are gaps that need to be filled in order to connect increasingly involved consumers with the right providers, in the right setting, at the right time, with the right services, at the right price. When that does happen, we’ll see genuine competition that addresses the affordability crisis, increases coverage for the uninsured, and provides a sustainable private-sector solution for healthcare in the United States."

Patient Centric Healthcare

Patient Centric Healthcare: "Obviously, one of the big mistakes that people make when they are trying to solve a problem is to ask the wrong question. I was thinking about this on the plane and wondered if we think about healthcare wrong. In a fully-insured world, managed care companies make the most money when patients are healthy. In an ASO (employer self-insured) world, employers save the most money when employees are healthy. In both cases, prevention and wellness are drivers of business value. Obviously, retention and turnover impacts companies ability to capitalize on their investments in these areas. But, I don’t hear people asking how can I drive wellness and preventative activities to maximize savings and profits simultaneously. All I hear people asking about is how to fix our confusing and broken system. Maybe we need to find a way for insurance to stay with the individual (not a new scenario but not one I hear much about right now) - aka portability. In that case, the company would want to drive satisfaction and minimize costs to retain the members and keep them healthy. A win-win??"

Healthy dividends

Healthy dividends: "“ The health of employees is at a premium today. The bottomline of businesses is being increasingly determined by the preventive healthcare programmes that companies provide to their staff at the workplace. Indian industry will have to compete globally in all the areas, including providing adequate healthcare benefits to employees.” Leading consultancy PricewaterhouseCoopers (PwC) has sized up challenges facing businesses as a result of lifestyle diseases in its report, Working Towards Wellness: An Indian Perspective. Says Rajarshi Sengupta, partner, PwC India, “Indian Companies are trying to drive such behaviour for their own benefit, for the benefit of the employees and that of the local communities through such programmes.”"

HELP is setting up mini-health libraries for corporates at their offices to help them keep their employees healthy ! We also answer health queries free by email as part of our corporate health service program - and this is a great return on investment for these companies !

NDTV.com: Infertility treatment faces setback

NDTV.com: Infertility treatment faces setback: "One of every six couples in India faces difficulty having children. There are several medical treatments available now but the costs are prohibitive. Unless insurance covers infertility, most couples desperate to start a family are not able to use these treatments. Rekha is 35 and has been trying to have a baby for five years. She has been unable to conceive naturally. ''We have the right to have a child and there is a treatment which will increase the probability of us having that child but we can't avail of it because it requires a lot of money because of which I am not in a position to go in for it.''"

NDTV.com: Smart health cards for govt schools

NDTV.com: Smart health cards for govt schools: "If one starts caring for their health when young, they will have ample reason to smile later. Dr Anbumani Ramadoss, Union Health Minister, seems to think so and has introduced smart cards for health as a part of a new National school health programme. It is a Diwali gift to schoolchildren from the Union Health Minister. Faced with growing number of childhood diseases including obesity, Dr Ramadoss want schools to provide annual health checks-ups in order to catch them young. ''Smart card will be issued to every child to provide with an overall check up,'' he said. Under the scheme, children, both from private and public schools will receive free check ups. Those found to be ill or those with hearing or vision impairment, will receive free treatment. The scheme will be run with the help of NGOs and the private sector. The minister also wants health to be part of the school curriculum. Talks are on with the Union human resources development ministry. ''The national school health programme is expected to be launched within a year,'' he added."

NDTV.com: Smart health cards for govt schools

NDTV.com: Smart health cards for govt schools: "If one starts caring for their health when young, they will have ample reason to smile later. Dr Anbumani Ramadoss, Union Health Minister, seems to think so and has introduced smart cards for health as a part of a new National school health programme. It is a Diwali gift to schoolchildren from the Union Health Minister. Faced with growing number of childhood diseases including obesity, Dr Ramadoss want schools to provide annual health checks-ups in order to catch them young. ''Smart card will be issued to every child to provide with an overall check up,'' he said. Under the scheme, children, both from private and public schools will receive free check ups. Those found to be ill or those with hearing or vision impairment, will receive free treatment. The scheme will be run with the help of NGOs and the private sector. The minister also wants health to be part of the school curriculum. Talks are on with the Union human resources development ministry. ''The national school health programme is expected to be launched within a year,'' he added."

Self-Management

Self-Management : "In the discussion of patient empowerment, it is worth considering how much care the patient should take on their own shoulders, and when they should turn to their doctor for help. Physicians often do more than would be required if the doctor and the patient was committed to maximum self management. But, on the other hand, it is entirely possible for the patient to do too much, or wait too long, before turning back to the doc for help. So, what's the answer and where's the ideal balance between self-care and 'doctor visit' care In general, it seems proper for patients to take responsibility for educating themselves about their condition, carefully consider questions they would like the physician to answer, and commit themselves to an overall fitness plan. The physician should commit to monitoring their condition, obtaining appropriate laboratory and screening tests at the right time, performing periodic examination, filling and refilling medication prescriptions, and providing recommendations and suggestions about modifications to treatment approaches. But, this is not a clearcut forumula and, I think, the only way to strike a proper balance in defiing the right roles for an empowered patient-doctor relationship is to maintain an open attititude, discuss the issues regularly, and be prepared to adjust roles."

As Gautam Buddha wisely said so many years ago, the True Path means you need to find the right balance !

Self-Management

Self-Management : "In the discussion of patient empowerment, it is worth considering how much care the patient should take on their own shoulders, and when they should turn to their doctor for help. Physicians often do more than would be required if the doctor and the patient was committed to maximum self management. But, on the other hand, it is entirely possible for the patient to do too much, or wait too long, before turning back to the doc for help. So, what's the answer and where's the ideal balance between self-care and 'doctor visit' care In general, it seems proper for patients to take responsibility for educating themselves about their condition, carefully consider questions they would like the physician to answer, and commit themselves to an overall fitness plan. The physician should commit to monitoring their condition, obtaining appropriate laboratory and screening tests at the right time, performing periodic examination, filling and refilling medication prescriptions, and providing recommendations and suggestions about modifications to treatment approaches. But, this is not a clearcut forumula and, I think, the only way to strike a proper balance in defiing the right roles for an empowered patient-doctor relationship is to maintain an open attititude, discuss the issues regularly, and be prepared to adjust roles."

As Gautam Buddha wisely said so many years ago, the True Path means you need to find the right balance !

Data, Information, Knowledge and Wisdom

Data, Information, Knowledge and Wisdom: "One of the challenges of being a doctor in the 21st century is information overload. More medical literature is published every year than a doctor can read in a lifetime. As electronic health records become more common, doctors can be overwhelmed with data gathered about each patient. Doctors do not want to review hundreds of normal findings, they want to know what is actionable for each of their patients to keep them healthy Healthcare CIOs should implement applications which filter data so that it becomes information, transform information into knowledge, and ulimately provide clinicians with wisdom based on that knowledge at the exact time they need it.

Here's an example. Suppose a patient's blood pressure is 100/50. That's data. Suppose that patient has a ten year history of blood pressures of 150/100. That's information. Suppose that the patient has a known history of coronary artery disease and is now experiencing chest pain. The sudden drop in blood pressure could indicate a serious myocardial infarction in progress. That's knowledge. It's time to give the patient an aspirin, oxygen, and nitrates immediately. That's wisdom."

How consumers make health care decisions in Massachusetts

How consumers make health care decisions in Massachusetts " In light of the dearth of credible information for making health care decisions, it’s not surprising that Massachusetts adults spend little time in choosing doctors and hospitals.Indeed, most spent no more than an hour or two collecting information the last time they had to choose a doctor or hospital (compared to several hours or days spent in choosing a car), and nearly six in ten (58%) chose their last hospital in less than two hours, with 40% making their decision in a few minutes. Similarly, 55% chose their doctor in less than two hours, with 30% saying they only spent a few minutes deciding. Those without post-secondary education spend the least time selecting their doctor. Sixtytwo percent of those without a college degree say they spent no more than an hour or two deciding compared to 52% of college graduates."

How can patients be expected to make intelligent decisions without enough data ? No wonder so many people feel that the medical profession is engaged in a conspiracy of silence against patients ! It's high time we started giving patients what they need and what they want - and this will help us to become better doctors too !

The Partnership for Healthcare Excellence

The Partnership for Healthcare Excellence: "There are a lot of things you can do for your health. You can exercise and eat right — but one of the most powerful things you can do for your health is to be an active and engaged patient. That’s where The Partnership for Healthcare Excellence can help. The Partnership for Healthcare Excellence is dedicated to helping you — as a patient and as a consumer — get the high quality care you and your family deserve. Research shows that patients who are informed about their health, ask questions, and get involved in making decisions, actually get better care. That’s why we’re making it easier for you to get the information you need, by offering you tools, tips and resources that you can use to improve the quality of care that you and your family receive."

Institute for Healthcare Improvement: Massachusetts Engaging Consumers as Partners in Care

Institute for Healthcare Improvement: Massachusetts Engaging Consumers as Partners in Care: "The fact is that 80 to 90 percent of the health care we receive in our lifetimes is delivered not in hospitals, nursing homes, or doctors’ offices, but in our homes — in bathrooms, bedrooms, and kitchens — and not by medical staff, but by ourselves and members of our families. So, the way I look at it, consumers, patients, and family members are among the most powerful and least mobilized stakeholders in the health care system. Consider this picture: a family, a husband and wife, say, with a sick relative, and on Monday they’re in the ICU with 40 people taking care of the patient. On Wednesday they’re on a medical-surgical unit with 10 people taking care of the patient. And on Friday they’re back home, in their dining room, with a bed set up and the medicines all on the night stand, and it’s just them, the two of them, taking care of the patient. So what this partnership is all about is helping the consumer become informed and engaged, and take on this role as a partner in care. If we want to dramatically change the way patients participate in health care, we have to create that system. This isn’t a quick fix;it’s about culture change, and we know that takes time. So we’re planning for a five- to seven-year campaign. And we have three basic goals: 1) to make consumers aware of the problem of current variations in health care; 2) to encourage consumers to be much more involved in their health care; and 3) to mobilize consumers to be advocates for system change.

Amazon.com: Medical Tourism in Developing Countries: Books: Milica Z. Bookman,Karla R. Bookman

Amazon.com: Medical Tourism in Developing Countries: Books: Milica Z. Bookman,Karla R. Bookman: "Western patients are increasingly traveling to developing countries for health care and developing countries are increasingly offering their skills and facilities to paying foreign customers. This international trade in medical services has huge economic potential for developing countries and serious implications for health care across the globe. The potential is explored in this book through analysis of the market for medical tourism and identification of its link to economic growth. The authors propose that medical tourism is not a universally feasible growth strategy. Instead, it is successful only in countries with economic and political advantages that enable them to navigate around international and domestic obstacles to trade in medical services. It is also suggested that a successful medical tourism industry, when coupled with cooperation between the private and public sectors, may lead to public health improvements in developing countries."

I changed my doctor

I recently saw a patient who told me that she changed her doctor because even though he was very competent, she was fed up of having to wait for over 60 minutes every time to see him. I am sure this is a common complaint, but there was no safe mechanism by which she could let her doctor know why she was unhappy with him or that she planned to leave. This means that he never had a chance to improve his practise; as a result of which not only do his patients continue to remain unhappy with him, he never makes an attempt to improve, because he is blissfully unaware of the problem ( since he has a waiting room full of waiting patients).

Customer feedback is vitally important for all service industries - and especially suggestions from unhappy customers. It is only by responding to complaints that organisations can improve.
Even though medicine is a service industry, it's very disheartening to note that doctors don't make any concerted effort to collect and analyse patient feedback. This would be extremely valuable in helping them to improve their bedside manners ! After all, every complaint is a gift !

American physicians have had enough

American physicians have had enough: "1) In this age of “accountability,” loss of autonomy – the freedom to treat patients according to their best clinical judgment – galls physicians because autonomy defines them\r role as medical doctors. 2) American physicians have had enough, which is why a broad and growing physician shortage exists, why ambitious and bright young people are choosing fields other than medicine, medical students aren’t choosing primary care residences, physicians are demoralized. A survey by the College of Physician Executives indicates lost autonomy, low reimbursements, bureaucratic red tape, patient overload, loss of respect, and an adverse malpractice climate discourages more than 60% of American physicians. The reality is that American physicians have had enough."

Is Health Care Making You Better—or Dead? — HBS Working Knowledge

Is Health Care Making You Better—or Dead? — HBS Working Knowledge: "The solution I will discuss here goes by the name consumer-driven health care. It's a term that I popularized, and it's become a common way to describe this new health care solution. Google it and see for yourself. Consumer-driven health care empowers individuals and brings their force to bear on the offerings of doctors, hospitals, and insurance and pharmaceutical companies. It converts the entire system to one that is responsive to you and me as the ultimate consumers of its goods and services. As I will show in the course of the book, there are consumer-driven health insurers that give you the health care you need at a price you are willing to pay; there are lower-cost hospitals that do not treat you like a slab of meat; and there are governments that do what they are supposed to—help the poor, provide transparency, and protect against fraud and abuse—rather than telling your doctor how to practice medicine. There is a way to create dynamic markets for health services that are more effective, more efficient, and more responsive to the patient-consumer—and her doctor—than anything we have today. The last chapters are devoted to describing that system, how to make it work, the proper roles of government and business in creating and sustaining it, and the benefits and good health it will bring to"

A Broad Vision of Health 2.0: Reformulating Data for Transparency, Decision Support and Revitalized Health Care Markets Brian Klepper and Jane Sarasoh

A Broad Vision of Health 2.0: Reformulating Data for Transparency, Decision Support and Revitalized Health Care Markets Brian Klepper and Jane Sarasohn-Kahn

Advice on Dealing with Complexity

Advice on Dealing with Complexity: "Experts say the health system and medical practice itself are so complex nobody can understand them (or by implication) do anything about them. When I hear this line, I think of Edgeware: Insights from Complexity Science for Health Care Leaders, VHA, Inc 1998). The book lays out nine pieces of advice. You may find them useful, even they come from a hospital organization and are being delivered by a blogger who has deputized himself as American physicians’ defender-in-chief. The Nine Advice Principles on Dealing with Complexity"

From Web Pages to Patients' Pages

From Web Pages to Patients' Pages: "It is now possible to use the Internet to create an electronic physician-patient interface (ePPi) which actively connects patients with their doctors in a secure and confidential fashion. By using an interactive program, Patients will have the ability to: * reach a secure, confidential , interactive portal to the medical practice without having to access a third party * request an appointment with the practice from their computer in their home or office without seeing other names on the schedule * request prescription renewals at any time * ask questions to the doctor, nurse, or other staff members * receive information customized to their diagnosis, medications, or other healthcare needs * receive lab and x-ray reports in a timely fashion"

The Physician Executive: Envelopes and the Greek Medical Business

The Physician Executive: Envelopes and the Greek Medical Business: "[Informal payments] are especially prominent in the case of in-patient care, and are made to doctors, mainly surgeons, in public but also in private hospitals. These payments are also made in the case of outpatient care. The rationale is to jump the queue or to secure better quality services and greater personal attention by the doctor. Unofficial payments are considered to be a major problem in the Greek health care system. It is estimated that about half the total private expenditure on health care involves informal payments. There is no really reliable estimate of the size of the unofficial market, partly because it is so widespread, and partly because of the complexity of the Greek health care system. Almost 60% of total out-of-pocket payments (official and unofficial) are made to doctors and dentists, 20% go toward pharmaceuticals, with the rest being mainly expenditures on private diagnostic centres and private clinics. Out-of-pocket payments (both official and unofficial) represent roughly 6% of household income (1990 figures)."

Repairing the Healthcare System

Repairing the Healthcare System: "The consumer must fix the healthcare system. None of the other stakeholders has been successful. In fact, of the last 30 years the healthcare system has been made worse by the insurance industry, government and policy makers. All their systemic changes have failed, because they have, for the most part, been to the advantage of the facilitator stakeholders and not the primary stakeholder, the patient. Facilitator stakeholders’ profits have soared, insurance premiums have skyrocketed while access to care has plummeted. Patients, physicians, hospital systems and the government have adjusted to changes to the detriment of the patient. The facilitator stakeholder adjustments have resulted in further dysfunction in the healthcare system."

Guide to Biostatistics

Guide to Biostatistics Here is a compilation of important epidemiologic concepts and common biostatistical terms used in medical research. You can use it as a reference guide when reading articles published on MedPage Today or download it to keep near the reading stand where you keep your print journals. For more detailed information on these topics, use the reference list at the end of this presentation.

Information Therapy…and Other Ways to Change the World

Information Therapy…and Other Ways to Change the World: "Will the biggest disruption in health care be an Internet-based health care industry? We already know that more consumers get answers to their health care questions on a daily basis from the Internet than from their doctors. But do we think that online tools will evolve enough to allow consumers to organize and make sense of that information without trained professionals?"

The Indian Healthcare Scenario

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No wonder this is such a hot area !

Clinicians - openEHR :: future proof and flexible EHR specifications

Clinicians - openEHR :: future proof and flexible EHR specifications: "Clinicians and their clients are what openEHR is about. The power to create life-long and future-proof health records that support health and health care across the full range of health care environments. By separating the specification of clinical information from the model on which the software operates, clinicians can go on extending their shared information requirements to meet evolving needs. As a clinician you are in the position to present your information requirements to the openEHR community and ensure that the specifications really do allow you to do what you need. These are specified as archetypes - allowing them to be shared across systems implementing the openEHR architecture. You can join the mailing lists as a first step. There are more than 1000 people from 75+ countries already there. The openEHR community is presently building a repository for the web-based authoring of archetypes. This Archetype Library is an early prototype and includes an OWL repository for aiding the documentation of archetypes and helping us find them."

Chatting with the MEDgle.com Founders - Medgadget - www.medgadget.com

Chatting with the MEDgle.com Founders - Medgadget - www.medgadget.com: "With the many time constraints placed on physicians, physicians are unable to discuss options or differential diagnoses to patients. Patients feel they lack the knowledge to ask appropriate questions and get relevant answers. Even though 80% of internet users search health related topics currently no tool is available that is easy to use, and provides a list of reasonable options that can empower consumers in their discussions with physicians. Thus MEDgle was conceived to enable an equal and fruitful discussion between physicians and patients with the search results being the starting point for such a discussion."

Another step in levelling the playing field between doctors and patients, so that patients don't need to feel so powerless any more !

CareFlash

CareFlash: "Careflash is an online community that facilitates the communication between friends and loved ones during a health care event. People of all ages use CareFlash to chronicle pertinent information about their ailments and treatments throughout their recovery process."

Web 2.0 for patients.

Patient Education, VisualDx Health

Patient Education, VisualDx Health: "Patient education is an important aspect of today's health care, but finding trusted resources is a serious concern. To assist you in guiding patients to trustworthy and timely information, we've created the online resource, VisualDxHealth.com. Our expert physicians and medical librarians continually review health sites and medical literature to ensure your patients have access to the best health care information and images available on-line. VisualDxHealth.com provides patients with valuable tools that can help them make more informed decisions about managing their health."

The Doctor's Doctor

The Doctor's Doctor: "This web site is dedicated to patient empowerment. Much of the information a physician uses to make a diagnosis comes from clinical laboratory tests and tissue biopsies. These tests are usually overseen or interpreted by a pathologist. This site is run by pathologists who want to help patients understand their test results and diagnoses."

Consider It Done? The Likely Efficacy Of Mandates For Health Insurance -- Glied et al. 26 (6): 1612 -- Health Affairs

Consider It Done? The Likely Efficacy Of Mandates For Health Insurance : "Several health insurance reform plans, including the recently enacted Massachusetts plan, envision the use of individual or employer mandates to increase coverage rates. In this paper we summarize and analyze existing evidence on the effectiveness of mandates, drawing on evidence both from health insurance and from other arenas where mandates are often used. We find that mandates can, but do not always, increase participation in programs. The effectiveness of a mandate depends critically on the cost of compliance, the penalties for noncompliance, and the timely enforcement of compliance."

HL7 EHR System Functional Model

HL7 EHR System Functional Model: "The HL7 EHR System Functional Model provides a reference list of over 160 functions that may be present in an Electronic Health Record System (EHR-S). The function list is described from a user perspective with the intent to enable consistent expression of system functionality. This EHR-S Functional Model, through the creation of Functional Profiles, enables a standardized description and common understanding of functions sought or available in a given setting (e.g. intensive care, cardiology, office practice in one country or primary care in another country). The HL7 EHR Interoperability Model establishes an industry consensus view of 'What is EHR Interoperability?' It provides a reference list of characteristics of (and requirements for) interoperable EHR records."

HEALTHTRACKS: A PARTNERSHIP FOR ELECTRONIC PERSONAL HEALTH RECORDS

" Given the proven effectiveness of these tools to manage chronic conditions and improve health outcomes, we recommend not only broader adoption within the health plan community, but also enhanced use of these tools by the provider community in reaching treatment decisions at the point of care. Recognizing the benefits personal health records (PHRs) offer both to consumers and providers, the health plan community has developed a model PHR to enable individual patients and their providers secure, timely access to important health information, such as allergies, medications, and patient history."

American health insurance companies are promoting PHRs actively . Hopefully, Indian health insurance companies will start doing so soon !

Helpful Health Claim Appeals Tips - HealthClaimAppeals.org

Helpful Health Claim Appeals Tips - HealthClaimAppeals.org: "# Review the benefits of your health insurance plan # Request a full explanation of the reason for the denial # Engage your doctor - ask for a letter explaining why you need the treatment or service # Include as much supporting documentation as possible # Ask for assistance from your doctor, health plan or state department of insurance"

Health Insurance Business Forum 2007

Health Insurance Business Forum 2007: "AHIP’s Business Forum 2007 is designed to encourage discussions about the products and services that are being heralded to catapult our health care system forward. To keep the conference lively and bold, the speakers are from all areas of the industry—employers, health insurance plans, government, academia, and product vendors. The size of the conference encourages candid debates designed to break through the clutter and sculpt real solutions. For example: * How are employers and health insurers working together to create value in health care? * How can wellness programs increase employee productivity and decrease cost? * Will PHRs help to streamline care and create efficiencies? * How can health insurers streamline their business operations to be more efficient? * How can the industry work together to educate and engage consumers to become more involved in decision-making?"

Smart Indian health insurance companies can learn a lot from their US counterparts !

Using graphics and humor to convey healthcare essentials - Boston.com

Using graphics and humor to convey healthcare essentials : "Potter was asked to create materials for an educational series about patient safety and decided to apply the advice she had wanted to share with her colleagues that day. She put her ideas on a series of bulletin boards and used both graphics and humor to draw attention to the message. The bulletin boards were so successful that Potter has been designing them ever since, creating dozens on topics as wide-ranging as firework safety, hand washing, immunizations, and health literacy. In a recent conversation, Potter passed along some of the lessons she's learned and identified some helpful resources all healthcare professionals can use."

Healthcare IT key to patient-centered care

Healthcare IT key to patient-centered care: "Healthcare IT is generally underused, but organizations using healthcare IT applications are enhancing physician-patient partnerships and patient-centered care. A report released by the Commonwealth Fund said hospitals and other providers can promote patient-centered care by employing healthcare information technology and effective leadership."

Requesting Your Medical Records

Requesting Your Medical Records: " It's a good thing to keep a copy of all your records, particularly when you are dealing with an ongoing condition (but generally as well). Request the records be sent to you if you are switching practices as well and then you can bring copies of the records to each new doctor you see --- you will be better informed and it will cost less too. Some doctors are very strange about not giving you access to your records, they are actually required to do it under the Federal HIPAA law. You have to make a formal written request, and you need to specify both the time period and sometimes even the specific test results/appointments/etc. you are looking for. They have the right to charge you a reasonable fee. Your Rights Under HIPAA: Right to access, inspect, and copy health information Right to request correction or amend health information Right to request accounting of disclosures of health information—who has received it Accessing Your Health Records You have the right to access your health records. "

Health Insurers Develop Video Games to Educate and Engage Consumers

Health Insurers Develop Video Games to Educate and Engage Consumers: "Video games aren't just for fun, say some health plans: They can also teach you healthy habits. Both Kaiser Permanente Health Plan and Humana Inc. said in recent weeks that they are launching video games focused on such topics as obesity and diabetes. Humana is in the early stages of developing a series of video games entitled Games for Health, and Kaiser is distributing an obesity-focused game online (accessible at www.kp.org/amazingfooddetective) and at schools to children. The two insurers join a movement toward using educational yet entertaining methods to inform and engage consumers about their health. The efforts are referred to in some circles as 'medutainment,' meaning entertainment designed primarily to convey medical information. The format involves everything from computer and video games, to movies and television shows."

CEOs’ Take on Wellness as Corporate Strategy; Survey Finds Over Half of Multinational Companies Polled Plan to Invest in Workplace Wellness

CEOs’ Take on Wellness as Corporate Strategy; Survey Finds Over Half of Multinational Companies Polled Plan to Invest in Workplace Wellness: "More than half of multinational corporations surveyed expect to introduce or expand corporate wellness programs over the next five years, according to the results of a new survey of CEOs of global companies. The global workforce is becoming fatter, sicker and less productive due to chronic conditions such as heart disease and diabetes work becomes more sedentary, according to the results of the study. The report 'Working Towards Wellness: Accelerating the Prevention of Chronic Disease,' identified chronic disease as a growing and costly threat to corporations and their workers. It was prepared by PricewaterhouseCoopers Health Research Institute in conjunction with the World Economic Forum. The document calls on global CEOs to make wellness central to their corporate business strategy, suggesting that multinational employers have the greatest stake in and best opportunity to prevent chronic disease. For corporations adopting wellness programs, PwC provides a framework to ensure the effectiveness of those initiatives."

Moen’s ROI: $3 To $4 For Every $1 Invested In Wellness Programs

Moen’s ROI: $3 To $4 For Every $1 Invested In Wellness Programs: "For every dollar spent on wellness initiatives, Moen saves $3 to $4, the company found following a formal study in 2005 of the impact on the bottom line from such programs. The savings arise from reduced time away from work and healthcare cost savings, the company said. For example, the study found that while non-members spend about $46 for inpatient visits per $100 spent, wellness members spend less than $5. Of the 500 employees working in Moen’s North Olmsted headquarters, nearly half belong to the company’s on-site Wellness Center. Moen is a leading manufacturer of faucets in North America. The programs Moen offers are working — not only for its associates — but for the company, as well."

Project Care: Health Care Case Studies, Multimedia and Projects for English Language Learners

Project Care: Health Care Case Studies, Multimedia and Projects for English Language Learners: "Project Care is a website for high-intermediate to advanced English language learners who want to learn about caring for others while improving their communication with medical personnel. The website provides audio and video for listening practice, vocabulary development, and links to related-health information. Although this site has an accompanying book, we hope the free activities on this site will help students learn more about these health issues while practicing English."

Expanding the Reach and Impact of Consumer e-Health Tools

Expanding the Reach and Impact of Consumer e-Health Tools : "The economic pressures of ever-increasing healthcare costs and suboptimal health outcomes are driving the search for new approaches to health management. Policymakers and even the President now speak of the National Health Information Network and interoperable electronic health records as necessary elements of health care for the entire population. Based on multiple studies and reports on the need for patient-centered health care, public policy is attaching growing importance to the role of consumers in managing their own health, in partnership with healthcare providers. Consumer-oriented e-health resources are meant to help consumers manage the heavy demands of health management. Indeed, it may be difficult for consumers to meet some of the demands without e-health tools. “e-Health” is a broad term for the heterogeneous and evolving digital resources and practices that support health and health care. e-Health resources enable consumers, patients, and informal caregivers to gather information, make healthcare decisions, communicate with healthcare providers, manage chronic disease, and engage in other health-related activities. Most, although not all, of these resources are available through the Internet. e-Health tools offer consumers a broad range of integrated, interactive functions including those listed below. "

Medical Travel Today - - a US health insurer's perspective

Medical Travel Today - a US health insurer's perspective : "# Insofar as high quality care at a lower cost was available overseas covering it would advance the Harvard Pilgrim Health Care ( HPHC ) mission to 'improve the health of the people we serve.'
# As HPHC serves more large national accounts through its alliance with United Health it will deal increasingly with companies that have employees outside of the US and require solutions for these employees' needs. Skill in addressing overseas treatment would allow HPHC to serve its large corporate customers better.
# Self-insured companies are likely to see high quality/low cost overseas treatment for selected conditions as a benefit for themselves and their employees. In this way too, skill in addressing overseas treatment would allow HPHC to serve this segment of its corporate customers better.
# In the context of high deductible health insurance the EAG imagined that in the future health plans might wave the deductible for patients who had selected procedures done overseas. This would benefit the patients and the health plan.
# One EAG participant commented that "the U.S. health system is clearly broken and costs are out of control...from a competitive perspective, endorsing overseas treatment would send a strong message to U.S. providers that costs must be controlled better!" Another participant commented that covering treatment abroad is a form of "outsourcing cost containment, an area managed care has largely given up on in the US!"

Medical Tourism: Global Competition in Healthcare

Medical Tourism: Global Competition in Healthcare Global competition is emerging in the health care industry. Wealthy patients from developing countries have long traveled to developed countries for high quality medical care. Now, a growing number of less-affluent patients from developed countries are traveling to regions once characterized as “third world.” These patients are seeking high quality medical care at affordable prices. Reports on the number of patients traveling abroad for health care are scattered, but all tell the same story. An estimated 500,000 Americans traveled abroad for treatment in 2005. A majority traveled to Mexico and other Latin American countries; but Americans were also among the estimated 250,000 foreign patients who sought care in Singapore, the 500,000 in India and as many as 1 million in Thailand. The cost savings for patients seeking medical care abroad can be significant.