The doctor is part of the patient's tool-box of dealing with illness

One of the problems with modern healthcare is the excessive importance given to doctors. When patients fall sick , they are very happy to dump their problems on the doctors's lap and they expect him to provide a quickfix. Unfortunately , this is an unrealistic expectation; and gives rise to a lot of unhappiness and stress both for patients and for doctors.

An illness is just an episode in the patient's life; and that while the doctor usually sees only a disease which needs to be treated and is fixated on fixing the medical problem, the patient has a life which is much more than just his illness.

One way of putting the patient at the center is by changing the way we look at doctors. Doctor should be treated as just one of the tools which are available to patients to help them manage their illness. There is no doubt that the doctor can be an extremely valuable tool, but this is no reason to treat them as gods.

The doctor is so important because he plays so many roles. He needs to make the right diagnosis; confirm it ; formulate the treatment plan ; and provide counseling . The doctor acts as a gatekeeper to the entire healthcare system and the good doctor guides the patient down the right path. However , doctors are not indispensable , and thinking of the doctor as a tool helps the patient to realise how important the role he himself plays .

Smart patients know which tools to use- and when. Clever patients have multiple tools in their toolbox - and these include: spirituality; friends and family for support; humour ; and information therapy. The more the tools you have in your armamentarium, the better equipped you are in your ability to manage your illness.

As with all tools , doctors can be used and misused. The trick is to identify the right tool and use it for the right purpose. While doctors may be very good at making a diagnosis , mastering the tools to live with the illness are skills the patient needs to learn for himself. Insulin is a tool a diabetic uses to to manage his illness. However, he cannot depend upon insulin alone. He also needs to learn how to control his diet ; how to exercise; and how to improve his lifestyle.
Similarly, a doctor is also a tool - and patients need to learn how to use this powerful tool intelligently and sparingly !

Learning health from the scriptures:

Learning health from the scriptures: " It is often said that Indians are fatalists who leave everything to fate or to God. The excuse patients usually quote is: "Our religion tells us that bodily sufferings are a result of sins incurred in our past life". This excuse is used to avoid taking medicines or insulin, and to explain inertia on part of the patient. "My sugar levels are always 400: they will never come down." What do our scriptures actually teach us? Lord Krishna exhorted Arjuna to fight the Mahabharata, not to bow before his enemies. Lord Ram and Hanumanji fought Ravana and his army of demons. Hindu scriptures talk of Gods fighting 'asuras'( demons) whenever they are attacked. Sikh and Islamic tradition boast of fighting against injustice (and winning). Christianity speaks of Lord Jesus healing the sick, thus giving divine approval to our fight against illness. What, then, do we learn from the scriptures? We learn to fight disease, to fight diabetes, to fight its complications. We learn not to admit defeat, but to persevere. Because if we persevere, victory will be ours."

Patient Education in Ancient India

Patient Education in Ancient India " The treatise Sutrasthana mentions four essential parts of a successful treatment regime, known as The Quadruple of Atreya.

The four components necessary to treat diabetes, or any other disease, are

1.The Physician.
2.Drugs.
3.The Patient.
4.Attendants. [ = Family = nurses]

Just as successful cooking requires utensils, fuel /fire, food items and a cook, successful medicine requires all the above four. Similarly, the potter has to coordinate earth/clay, water and his wheel to create good pottery.

And just as a strong table needs four equally stable legs to stand, all four components of the quadruple of Atreya have to be equally effective .A chain is just as strong as its weakest link, and diabetes practice cannot be stronger than the weakest link of the quadruple.

Thus the concept of team work, patient education and diabetes awareness was propounded over 3000 years ago. The physician represents today’s diabetologist or endocrinologist, while the patient stands for an educated, empowered person with diabetes in equal partnership with his doctor."

There's nothing new under the sun !

Doctors , patients, problems and solutions

Patients come to a doctor because they have a problem and want a solution. Doctors are fascinated by problems - especially those which are rare or complex. Differential diagnosis can be one of the most intellectually challenging parts of a doctor's practise - and since most doctors are intelligent, they love "cracking diagnostic conundrums" and interpreting scans and images. However, once the problem has been diagnosed and the disease given a name, many doctors lose interest, because treatment is usually quite cut and dried and not very intellectually stimulating. After all, zebras are fun to talk about while horses are boring.

On the other hand, while some patients are quite happy to be the center of medical attention because they have a complex problem, most just want a solution so they can move on with their life.

A good doctor will spend as much time and energy on crafting a treatment plan for the patient, as he will on creating a plan for a diagnostic workup. This can actually be harder to do, because it requires the doctor to see things from the patient's point of view - and offer advise which the patient is willing to carry out !

Why doctors should not educate their patients

I am a big believer in patient education . I feel this empowers patients and allows them to form a partnership with their doctors. All these years, I have advocated that doctors spend time on educating their patients, but I have now had to change my beliefs, and I no longer think doctors should educate their patients.

Let me clarify.

1. Most doctors are not good educators. They use complex medical jargon and are not able to simplify matters, so that that patients often cannot understand what they are saying.

2. Doctors have not been taught how to teach patients , and this is not always an easy skill to acquire.

3. Because doctors can be intimidating , patients are very reluctant to ask questions. This means that even though the doctor feels that he has provided an adequate explanation, the patient often understands very little, and is still full of doubts and queries. After all, good communication is always a two-way process.

4. Often , the doctor may not provide the right information , because of a vested interest or a hidden agenda.

5. Doctors find educating patients very boring and get fed up very quickly of answering the same questions

6. The doctor's time is precious , and could be better utilised in providing clinical care ( making the right diagnosis; and executing the treatment plan. )

So what is the solution ? Just like we have independent trained counselors who can guide patients, we need to have patient educators to educate patients. This does not mean we need to create new jobs or positions. It just means that the clinic should identify one person who likes talking to patients and is good at this . This is often an innate skill( these are "people persons " !) which can be polished with training . This person could be a nurse or a secretary who then takes on the additional responsibility of educating patients. They are likely to do a much better job than the doctor can , for many reasons.

1. They often have more time

2. Patients are much more comfortable talking to them , rather than the doctor; and are much more likely to ask questions

3. They are much more likely to use the local language , when providing explanations. This helps patients to understand complex concepts much more easily

4. Because they spend a lot of time educating patients , constant repetition will ensure they get very good at it. They can use a number of teaching tools and models to help them get their point across

This is a much more cost effective way of educating patients , rather than using the doctor's expensive time !

This model means that doctors will continue to prescribe information therapy. It is just that the information therapy would be dispensed by someone else in the clinic other than the doctor.

In the past , doctors would do all the lab tests themselves. Today , these lab tests are outsourced to a specialised pathology laboratory. Using exactly the same analogy , patient education can be better provided by an individual who has a special interest in this field. This creates a win-win situation, where everyone benefits. More importantly , it also serves to emphasize how highly the doctor regards patient education ! If we have specialists for taking x-rays ( called X-ray technicians), why can't we have specialists for educating patients ?

Microsoft says Web 2.0 Can Give Consumers More Control over Health Care

Microsoft says Web 2.0 Can Give Consumers More Control over Health Care: " Ben Flock, a Microsoft Healthcare & Life Sciences Industry advisor, told attendees during his closing keynote at Microsoft's Health & Life Sciences Developer and Solutions Conference, held April 22 through 24 in Atlantic City, N.J., that Web 2.0 technologies moved information out of isolated silos and into interlinked community computing platforms that function like software for users.

Flock said applying those same concepts to the health care industry would provide tools that would allow for better and more relevant information sharing, collaboration, and ultimately better care as consumers gained more control over their information and, ultimately, their health.

Web 2.0 features like product and service ratings, information search, social communities, and tools are a natural evolution of health care technology, Flock said, and represent a new business paradigm that companies and institutions will have to adopt in order to remain competitive and relevant."

Payer Pilots Diabetes Smart Phone App

Payer Pilots Diabetes Smart Phone App: "Owings Mills, Md.-based CareFirst BlueCross BlueShield will conduct a pilot study in which it will offer 260 patients mobile phone-based diabetes management software from WellDoc Communications Inc., Baltimore. The 12-month study seeks to evaluate the effectiveness of such disease management software on reducing Ac1 hemoglobin levels of patients with Type 2 diabetes.

The application enables diabetic patients to enter their blood sugar readings into their mobile phone and receive real-time feedback on what they should eat and other ways they can help stabilize it. The software also can alert patients when they need to test their levels.

Further, the application sends the data to the vendor's servers, where it is analyzed and can be accessed by the patient's physicians and disease management case workers. It also can support glucose meters that can send data via Bluetooth wireless technology."

Virtual office visits appeal to patients, physicians, insurers -- OrlandoSentinel.com

Virtual office visits appeal to patients, physicians, insurers -- OrlandoSentinel.com: "The cost to her for the online consultation: zero. Her insurance company, Cigna, paid Dienst $35 for the virtual office visit, and under her health plan Steinert had no co-pay (compared with a $20 co-pay for an office visit). 'I'm not into computers,' said Steinert, 57. 'But this was easy. It's a good idea.'

It's a good idea for doctors, too, said Dienst, who is among the first physicians in Central Florida to conduct online, reimbursed consultations with patients. With three major health-insurance plans now reimbursing physicians for online consultations, Dienst expects he'll soon have plenty of company."

Half of Americans don't get a second opinion - Health care- msnbc.com

Half of Americans don't get a second opinion - Health care- msnbc.com: " Even if you don't take the second doctor's opinion, simply knowing your options and thinking through the pros and cons can improve your care. You don't have to have a serious condition to benefit. 'There may also be more than one way to approach the same problem, or there may even be a financial incentive for a physician to recommend one treatment over another,' says Gail Gazelle, MD, an assistant clinical professor of medicine at Harvard Medical School and president of MD Can Help, an online patient advocacy practice. 'Also, doctors can diagnose any problem incorrectly.'

Now you can get an elite doctor to weigh in as well: Top medical centers such as the Cleveland Clinic and Partners' Center for Connected Health (which is affiliated with Harvard Medical School) offer second-opinion services via the Internet. This practice of consulting from afar using patients' medical records and test results is having a profound effect on how problems are treated. According to Partners, although its experts changed only 5% of diagnoses during its first year of providing e-consults, 90% of the treatment recommendations differed from the referring physician's plan."

I have now been offering a free second opinion for infertile couples for over 5 years . I enjoy doing this - and have helped many couples , which means good karma for me !

HELP to setup Patient Information Centers in Hospitals in India

Objective:

· To set up a Multimedia Patient Education Resource Center in the hospital to attract more patients; improve patient care, and enhance patient satisfaction.

Background of HELP:

· The Patient Education Resource Center of HELP is located on DN Road in Mumbai. The centre hosts a large number of visitors daily. It is a great way to experience the power of ‘Information Therapy ’ first hand. The numerous success stories of patients who are empowered by the information provided here has prompted HELP to set up more centres all over India.

· HELP is a one of the world’s largest patient education and information centres. It has been recognized by the Limca Book of Records. Established in 1997, HELP has over 10000 books and 500 videos. It set up India’s first health website www.healthlibrary.com. It is a self-sufficient, registered charitable trust and a non-profit organization.

Current Market Status:

· The market scenario with regards to patient education is not very organized at present. The increasing instances of violence in hospitals, litigation, etc. are an ample testimony to the fact. A well-informed patient is a happier patient because he has realistic expectations. Moreover with the increasing level of awareness, people nowadays prefer doctors/hospitals who keep them informed and updated about their medical condition, prognosis and the course of treatment. The days when the doctor’s words were unquestionable are over.

· The commonest complaints patients have about medical care in hospitals are:

1. Being made to wait
2. Not being told about how the patient is progressing
3. Poor doctor-patient communication

· Slowly, but surely, hospitals are realizing the fact that educated and informed patients are happier patients. Further, partnering with a patient’s family to provide information is a vital ‘differentiating’ factor for a hospital.

HELP value proposition:

• HELP sets up a branded information centre in the hospital. This centre is instrumental in increased patient satisfaction as it provides vital information to the patient and his family. For example, a son can learn about his hospitalized father’s hepatic failure in the information centre.
• The centre also draws in people from the neighborhood. People living in the close vicinity of the hospital enhance their knowledge about the chronic conditions being faced by themselves or their family members. For example, A type II diabetes patient can frequent the centre and subsequently can become a patient in case he needs hospitalization.
• The information centre also solicits questions from the users. These questions are then e-mailed to the main HELP hub in Mumbai. The answers to these questions are sent within 48 hours of receiving them. Moreover, the website the hospital also carries a link where people can post queries and the answers are given on the behalf of the hospital within 48 hours.
• Patient education has been shown to improve doctor-patient communication; save the doctor’s time; improve patient satisfaction; and improve patient compliance and treatment outcomes. Information Therapy can be a powerful medicine.
• Each inpatient gets at least about 5-15 visitors daily. In one sense, this is a captive audience who is very likely to be responsive to healthcare marketing, because they have come to visit someone who is ill, and therefore have a heightened sense of their own biological frailty. Visitors can spend time at the patient education library , which is likely to induce them to select your hospital whenever they need medical care. This free service will also help to create a lot of goodwill for the hospital; improve brand visibility; and provide a unique selling proposition.

Execution Plan:

1. A Patient Information Centre site is recognized at your hospital.

2. This site is ‘branded’ and done up by you based on the recommendation of HELP. The required amenities like book shelves, computer, etc. are installed.

3. Patient educational material is provided by HELP

4. Your staff members are trained by HELP to run and manage the Patient Information Centre. All aspects of running the centre are taught to one or two of your staff people.

5. An additional backup to answer patient’s queries free by email is also set up. Your web site ‘Ask Us’ icon is linked to our main information hub.

6. Printed information prescription pads to encourage doctors to refer patients to the information centre are provided.

7. The collection is upgraded every year.

Responsibility Matrix:

1. HELP provides the books (100 titles ) and DVDs (50 titles) to start the core collection.

2. You provide space ( about 500 – 1000 square feet in a high traffic area) and infrastructure ( racks for the books; signage; DVD player with TV; Xerox machine; internet computers) ; and staff. Branding material is provided by HELP, which is installed by you to do up the information centre.

3. HELP trains your staff members (free 3-day training at HELP) so they can manage the show effectively.

4. HELP provides strategic guidance as to how you can maximize the utilization of the library – for example, by developing your own patient educational materials; having talks and seminars by your doctors.

5. HELP answers questions free by email, through your website , if your patients have further queries

Implementation Time line:

1. Identifying and Purchasing books – 1 month

2. Supplying books – 1 month

3. Training your staff members – 3 days

4. Inauguration of fully furnished library – 3 months

Action Points:

1. Visit HELP so you can see the valuable services a Patient Education Resource Center can provide

2. Sign MOU

3. Identify space and set up infrastructure

4. Depute staff member for training at HELP

5. Include the Ask HELP service in your website

6. Set up a Department of Patient Education in the hospital.

Complicated medical lingo can confuse patients: researchers

Complicated medical lingo can confuse patients: researchers: "Using complicated medical jargon can be confusing, anxiety inducing and potentially dangerous for patients, a new study found.

The research, the focus of this week's editorial in the Lancet, finds that when doctors speak to their patients using the terminology they learned in medical school, patients can fail to identify what it is that's being said, be confused about their diagnosis or incorrectly interpret their condition.

According to health experts, the confusion can happen very easily.

'There are words that sound the same, like hypo and hyper,' Dr. Peter Lin, a Toronto-based general practitioner, told CBC News Thursday. It would be very easy for a patient to hear the opposite of what was said by a physician, leading to an incorrectly interpreted diagnosis, he said."

How to Make a Hospital Hospitable

Hospitals can be very unfriendly. Even though hospitals are meant to serve patients, in real life they seem to be designed to serve doctors. Not only do hospitals strip you of all your dignity (having to wear a half-open hospital gown which barely covers your body properly does not do much good to your ego!), but they also subject you to painful routines and humiliating rituals performed by a retinue of strangers. You are woken up at any time of the day, (or night), deprived of your privacy, forced to eat unpalatable food, cut off from friends and family, and denied a lot of the independence which you take so much for granted in daily life.

What are commonest complaints patients have about hospitals ? It’s a long list, but the primary concerns are:

1. Waiting interminably to see the doctor

2. Being kept in the dark about the treatment

3. Not knowing how much it’s all going to cost

What can you do to take care of yourself ? The simple answer is – find a good doctor in a good hospital. While this is the best possible solution, it’s also a fact that you may not be able to do this. So, is there anything hospitals can do to resolve the problem ?

Hospitals need to reinvent themselves to keep up with the changing times, and there is a simple solution which can help them to keep their patients happy . The answer is Information Therapy for patient education. This is a win-win situation, which will help hospitals, doctors and their patients.

Hospitals need to understand that patient education is not an expense – it’s a basic service which can actually help them to improve the quality of their medical care – and their profitability as well ! A Patient Education Resource Center is a great way of marketing medical services and getting more patients. For example, if a patient is admitted with asthma and they sell books on asthma, the chances of the patient ( or his relatives) buying this book are huge ! Ideally, the hospital should have a circulating collection of books, which patients can borrow and read, so they understand more about their illness. This is an effective way of empowering patients.

Another great opportunity which hospitals routinely ignore is educating the patient’s visitors and relatives. Every patient in hospital routinely gets about 10-15 visitors every day. However, most hospitals barely tolerate the presence of visitors, who are usually treated as pests who just get in the way of the staff and the medical treatment. However, these are all potential future customers for the hospital, and should be treated with respect ! Because they have come to visit someone who is ill in hospital , they are very motivated to do something to prevent themselves from falling ill. ( For example, if you go to visit a friend who has had a heart attack, your wife would be very happy to buy books on how to prevent a heart attack !). Not only is this a great “teachable moment”, it’s also a good way of promoting the hospital’s heart health care services to potential new customers !

Similarly, the TV screens in hospital OPDs can be used to show health educational films, so that patients can learn about their health and ways of improving it, instead of watching soap operas or the news.

It’s a fact that patients are increasingly unhappy in India today – and while they are still not as likely to sue as in the US, angry patients do burn down hospitals and beat up doctors. Errors do happen even in the best run hospitals – and well-informed patients ( who ask questions and know what to expect) are extremely good at preventing problems because they can speak up and prevent errors. Patient education has also become an integral part of risk-management. While a bad outcome does not always mean to a lawsuit, if this mistake is compounded by poor doctor-patient communication, this is likely to lead directly to the court. By educating patients and communicating with them on an ongoing basis, the chances of the aggrieved patient going to a lawyer are dramatically reduced.

Some doctors used to feel threatened by a well-informed patient. However, this is no longer true; and the younger generation of doctor respects a well-informed patient, because both doctor and patient are on the same side. It’s true that patient education can take time – but it’s much better to answer the patient’s questions now , rather than his lawyer’s questions in a court of law !

In a hospital setting, doctors are a scarce resource and they are usually the bottlenecks. By setting up a separate Dept of Patient Education, the doctor’s time can be saved; and your time can be utilized constructively, instead of wasting it. Patients often get impatient when made to wait without rhyme or reason ! Thus, if you go to see your doctor and if he is running 45 min late because he is held up in surgery, his secretary can request you to go to the library where you can read a book or watch a DVD about your problem. You will be called on your mobile when the doctor comes to the clinic. Not only will this prevent you from getting upset because of the delay; it will also help to save your doctor’s time, because you will be much better informed about your problem. Similarly, your doctor can hand out patient educational brochures ( published by the hospital, with their logo and address) to you patient after the consultation. Not only will this reinforce the information given to you; it will also help to improve the level of health information in your family - and thus the community .

Patient education can be a great way of improving patient satisfaction, because a patient who has had all his questions answered , is likely to be much happier with the doctor; and have realistic expectations of the treatment. Patient education also helps to cultivate empathy in the medical staff, who learn to see things from the patient’s perspective; and can help to teach the staff to respect the patient.

If it’s so simple and obvious, why doesn’t every hospital do this ? Actually, the world’s best hospitals do this routinely. For example, Mayo Clinic has a separate building devoted to Patient Education. Also, the JCAHO guidelines ( the US body which provides accreditation to hospitals) also makes patient education compulsory. Unfortunately, it’s not a very glamorous service to provide, which is why most Indian hospitals don’t bother to do so. Also, they are so busy competing with other hospitals on how many slices their newest CT scanner offers, that they end up ignoring such a basic need. This is a shame – and a great opportunity as well , because a simple inexpensive change in attitude can remarkably improve the patient’s hospital experience – thus improving the hospital’s bottom line !

I write this article for my Empowered Patient column for Times Wellness.

Notes From The Personal Health Information Workshop

Notes From The Personal Health Information Workshop: "Health is a function of human behavior – the trick is identifying the right behaviors for each person and helping to motivate them to adopt and stay with those behaviors. The greatest opportunity in this space lies in providing better consumer outcomes, whether by helping to manage behaviors with human interaction (“skin-wrapped software” American Healthways, Canyon Ranch) or with the internet (RealAge, Fitlinxx).

Although it is far from complete, there is a great deal of patient health information today within the health systems, and there is value to be derived from mining this data to provide better outcomes (Aetna, Humana). Perhaps most interestingly, the government is highly motivated to find effective ways to control chronic disease costs and improve patient satisfaction before the baby boomer retirees swamp the Medicare system."

What is Patient Centered Care?

What is Patient Centered Care?: " Each day I prepare myself for work by playing the same CD in my head over and over again. “What if it was your mother, your wife, your daughter or son? How would YOU personally want to be treated? What is it about a particular facility that makes you uneasy?”

For the past 19 years, our mission in life has been to create an environment of care that provides a loving, nurturing feeling for families and their loved ones. It has been to provide a center of excellence that addresses not only the need to be competent, but also the need to be human.

It has been my goal to create a truly healing environment where patients have an opportunity to take part in their care and to make decisions about the type of care they receive. It has been about creating a place where Care Partners provide support for their loved ones and where they can actually participate in their loved one’s care. "

Quest Diagnostics to Support Google’s New Online Health Initiative | HealthNEWS. Direct!

Quest Diagnostics to Support Google’s New Online Health Initiative | HealthNEWS. Direct!: "Mountain View, CA based Google Inc., an American public corporation that provides services and technology to organize and access information, has collaborated with Madison, NJ based Quest Diagnostics Incorporated, a leading provider of diagnostic testing, information and services, to help patients access their diagnostic laboratory data through Google’s online personal health record platform, Google Health.

MedPlus solution’s Care360™, a patient-centric physician electronic network, will serve as a platform to securely transfer patient diagnostic and laboratory data onto the Google Health portal, Google’s new offering, created to enable patients manage and control their personal health information through a 24/7 secure access to an efficient online medical record system. More than 100,000 physicians employ the Care360 suite of products to access online diagnostic test results, share clinical information, and perform electronic medication prescribing and ordering of lab tests. Through this collaboration Quest diagnostics would develop solutions that allow these physicians to securely transfer current and historical laboratory information into the patient’s Google Health account and provide an overview of test results to explain their health status."

These innvoations will change the entire healthcare ecosystem !

From ‘Informed Patient’ Care to ‘Patient Informed’ Care”

From ‘Informed Patient’ Care to ‘Patient Informed’ Care”: " In a soon-to-be-published article, Ruth Gardiner argues, we are seeing a shift from the ‘informed patient’ which has resulted from improved access to healthcare information, primarily from the Web, to the ‘participative patient’ as we move into Web 2.0 territory.

This is a “major turning point” according to Gardiner, “that could present greater challenges for healthcare professionals, organizations and the patient or client.” How will providers adapt? What impact will Google et al. have in their attempts to “own” the health care consumer? And how will even newer information technologies — such as digital video change the healthcare landscape, she asks.

The distinction Gardiner makes is an important one. "

The Informed Patient -- DeMaria 51 (15): 1505 -- Journal of the American College of Cardiology

The Informed Patient -- DeMaria 51 (15): 1505 -- Journal of the American College of Cardiology: "It is now abundantly clear that the transmission of medical information to the public is of great importance to physicians. Patients seek this information; it can be of value to them in choosing healthy lifestyles and it can affect medical decisions. It is important, therefore, that the information be accurate, unbiased, and understandable. As is true of so many health-related things, we physicians are in the best position to oversee this transmission of information and to ensure that it is done optimally. The ACC has already taken a proactive step in this direction in initiating CardioSmart, a Web site that will be of great value to our patients and to ourselves as we advise them. It will be of increasing importance for physicians to stay abreast of what is being presented to our patients so that we can reinforce the accurate information, rebut any that is erroneous, and interpret that which is equivocal. I’m afraid that Reader’s Digest may soon be as important to read as JACC for cardiovascular specialists."

Reader's Digest is a lot more readable and far more interesting ! I am sure JACC can learn from the RD editors as to how to present their matter more entertainingly !

The Informed Patient- The Clinician's Pledge

The Informed Patient-The Clinician's Pledge : " I want you to be an informed patient.

This means that I or one of my colleagues will:

1. Involve you in decisions about your care, and respect your preferences. This means I will listen to you and do what I have promised.
2. Ensure that you are treated with dignity and respect.
3. Be honest with you about your management options and the evidence supporting them and make sure you understand them.
4. Keep you fully informed about what is happening with your care.
5. Provide you with written information about your diagnosis, treatment and what will happen at each stage and, if applicable, support you in your self-management strategies.
6. Ensure you have access to information about the quality of care and waiting times to help you make informed choices.
7. Copy you in on all correspondence with other people involved in your care.
8. Put you in touch with other patients or groups who can provide support.
9. Respond to your messages/queries within an agreed timeframe.
10. Respect your wishes on how we will involve your family.
11. Seek out and respect your preferences on end of life care if necessary.

This agreement requires that you as a patient/patient representative/carer be honest and open with the treatment team."

The Informed Patient

The Informed Patient The term, ‘Informed Patient’, presumes that people with illnesses (‘patients’, but not just those awaiting treatment) need appropriate information in order to be properly involved in their healthcare – be it to seek care, decide on the best courses of action with care professionals, or to follow through the agreed course of treatment. The project deliberately focused on patients, excluding wider issues of health promotion and education, though these aspects may be critical in terms of preparing the public to avoid illness, or for any encounter with illness or the healthcare system.

Why are doctors stuck at remaining skilled labourers ?

I met a very interesting person who is the CEO of a healthcare consulting company. I was showing him around HELP, and was asking him why he felt doctors did not do more to educate patients. His answer was very enlightening, because it offered me a new perspective about the healthcare industry.

He felt that most doctors were happy to remain just skilled labourers. They were so focussed on providing high quality medical care to their patients, one-on-one, that they failed to think about the bigger picture, leave alone trying to improve it.

This is extremely true, and I think there are many reasons for this.

Firstly, it's the way most doctors are trained. The heart of medicine is the doctor-patient consultation, and most doctors are taught to do this extremely well. This is why most patients are quite happy with their personal doctor, even if they feel the healthcare system itself is sick.

Secondly, doctors are not taught to look at the big picture - and even if they are, they don't know what to do about it. While they are very good at talking to individual patients and treating them effectively, their skill-set stops here. Thus, even though they are taught about community medicine, they don't know how to deal with the community or society at large.

Finally, doctors are not very good at taking collective action. Doctors are happy to become members of medical associations and societies, but these are often quite impotent, because they are not formed with the intention of helping to fix societal problems.

This tunnel vision is hurting both doctors - and their patients. Most doctors feel that if they take good care of their patients in their personal practise, they are doing a good job. I don't think this is true. As Rudolf Virchow pointed out many years ago, " Medicine is a social science and politics is nothing but medicine writ large !" As advocates for our patients, we need to take a more active role in helping to improve the care everyone in society receives.

We need to step outside the comfortable environs of the four walls of our clinics and hospitals ! Doctors have the training and intelligence to become agents for improvement on a much bigger scale - why are we wasting this opportunity ?

The Wisdom of Patients: Health Care Meets Online Social Media - CHCF.org

The Wisdom of Patients: Health Care Meets Online Social Media - CHCF.org: "The Internet has evolved from the information-retrieval of “Web 1.0” to “Web 2.0,” which allows people who are not necessarily technologically savvy to generate and share content. The collective wisdom harnessed by social media can yield insights well beyond the knowledge of any single patient or physician, writes report author Jane Sarasohn-Kahn. The outcome of this development is “Health 2.0” -- a new movement that challenges the notion that health care happens only between a single patient and doctor in an exam room.

Using examples, this report describes how the Web is becoming a platform for convening people with shared concerns and creating health information that is more relevant to consumers. Social networks, ranging from MySpace to specific disease-oriented sites, are proliferating so rapidly that new services are already under development to help health consumers navigate through the networks.

The report details how innovative collaborations online are changing the way patients, providers, and researchers learn about therapeutic regimens and disease management. It examines the benefits and concerns regarding Health 2.0 and it also includes an extensive listing of health media resources."

How Information Therapy helped me get better medical care !

HOW INFORMATION THERAPY

HELPED ME GET BETTER MEDICAL CARE

“ An excellent place to be if you really want to empower yourself and not let the doctor take you for a ride. This is the place to be. Keep it going. – wrote a reporter from a leading Mumbai newspaper.

“The concept of self health education must catch on!” – writes a well known Doctor.

These are only a couple of compliments being regularly received by us from our readers and speakers at Health Education Library for People – HELP.

At HELP we have made it our goal to provide the best health information for every patron every day. The words of our readers say it best. Their stories are really the story of our Library. All the formal awards and accolades just can't tell the HELP story better than the words of our readers.

When one is very ill and things look their worst, nothing seems more inspiring than reading about how other patients survived against the odds and coped with their situations. There are as many different ways to survive as there are patients, and so we can learn something different from each one. At the same time certain similarities, certain patterns emerge.

Now, you can actually tell us how Information Therapy has helped you look after yourself or your family members, your acquaintances etc to help each other.

Perhaps you have a story to contribute. You need not be a "miracle cure" to contribute here - all you need is the desire to use your experiences to help someone else.

Some of the people have voluntarily come forward to share their experiences with HELP. Their ‘stories’ have helped us to provide better information to other, newer readers. Each of these stories illustrates the way someone was helped to overcome and defy the odds and shows how people have redesigned their lives to be meaningful and fulfilling following what could have been a life-shattering event. Their stories are tributes to the ability of people to triumph over adversity and to succeed when life is at its hardest. You will be amazed at their courage, energized by their achievements, and awed at the miracles they managed to accomplish. Some of these stories will bring a tear, some a smile, but all will inspire you with the knowledge and confidence that ‘ordinary day-to-day miracles’ do happen. Some were born with disabling conditions, others suffered illness, some were injured, and some experienced the ordinary conditions of old age. All of them required help to learn or relearn the skills they needed for the job of living, and with the aid of a good book, a CD, or a HELP Talk, they all found the strength and courage to do so.

Nowadays there are so many tragic and angry stories about healthcare--not just in Mumbai and rest of India, but everywhere. What we are looking for are stories that show the humanity within the medical system… stories of hope that were made possible by services offered by Doctors, Nurses, Emergency Medical personnel or HELP Library.

These stories could also be about those times that a medical professional has allowed compassion to be their guide and have "bent the rules" “gone out of their way” in order for you or your loved one to experience a joyful moment, something meaningful. These events are the sorts of things that never seem to make it into the local newspapers---but we tell our readers and the world and we will never forget them.

We now INVITE you to share your story with us. The best of your stories will be posted on our website – with your permission of course! The best story of course deserves to receive a prize – we will send you a copy of our publication – The Healthwise Handbook – so remember to send us your address.

Guidelines:

Your story should clearly and concisely state your experience.

1. You could avoid the diagnostic test details and mention only the main problem.
2. Names of Doctors/Hospitals may be avoided to protect privacy.
3. Nature of research conducted by you to help yourself – this could also include any second opinions, research from books, visits to quacks etc and their effect on the problem.
4. The story could be in the form of a skit, poem, or plain essay.
5. You may protect your identity/privacy by writing in the third person.
6. Stories should REACH US BY 5^th May’08 either by email: helplibrary@gmail.com or helplib@vsnl.com or by post/courier at the following address:

Audio Features - www.healthleadersmedia.com

Audio Features - www.healthleadersmedia.com: "An Embarrassment of Riches?
Aniruddha Malpani, MD, an IVF specialist in Bombay, says India's booming healthcare industry might become too much like the United States."

Please listen to my interview with Rick Johnson, Senior Editor, Healthleadersmedia.com, and let me know if you agree !

Blogging Live from the World Health Care Congress 2008

Blogging Live from the World Health Care Congress 2008: " Here’s a smattering of quotations form some national thought leaders talking about health care reform and other key health care issues, during World Health Care Congress keynote sessions:

“The problem in dealing with health care issues in the world today is not ignorance, but pre-conceived ideas.” Hans Rosling, MD, PhD, Professor of International Healtht, Karolinska Institute, Sweden

“In today’s world, more efficient and effective caregivers simply deprive themselves of income.” George Halvorson

“Interestingly, physicians practicing in regions with the greatest supply of hospital beds, or regions with the greatest supply of specialists, perceive the greatest shortage of those beds or specialists.” Elliott Fisher

" When you pay for incremental reforms in funding, you only get incremental reforms in care.” Mark McCellan

“Health care costs are a very solvable problem. 70% of costs are driven by behavior. 74% of costs are confined to just four chronic conditions.” Steven A. Burd, Chairman, President and Chief Executive Officer, Safeway, Inc.

“Just like Blackberrys and Smart Phones filled a need for everyone in the audience, there is a deep need for the family health manager to have a mechanism to share store and manage their family health information.” Peter Neupert, Corporate Vice President, Health Solutions Group, Microsoft, Inc.

“Health care has traditionally been horrible about understanding people- consumers.” Reed V. Tuckson, MD FACP, EVP and Chief of Medical Affairs, UnitedHealth Group

“There are two major barriers with health information for consumers. How do you transport information from one setting of care to other settings of care, and how do you educate consumers to be literate about health information?” Reed Tuckson

Innovation xChange

Innovation xChange : "Do you want to improve the U.S. health care system? Or at least be part of the much-needed dialogue? If you have ideas or solutions to improve the system, submit your ideas through ChangeNow4Health’s Innovation xChange and you can win up to $10,000 or have your ideas published in the e-book, Tomorrow’s Health Care.

The Innovation xChange is looking for practical ideas and suggestions for improving the health care system. All participants in the system, from providers and health plans to consumers and government, are encouraged to join in the discussion.

To participate, simply click to register and then submit your idea(s) in one of the following four categories:

1. Helping Consumers Make Smarter Health Care Decisions

2. Simplifying the Business of Health Care

3. Preventing Sickness and Maintaining Health

4. General Innovations in Health Care"

The state of e-Visits in 2008

The state of e-Visits in 2008 : "A recent article called them 'mouse calls.' Some call them web-visits, or online consultations. The American Academy of Family Physicians (AAFP) defines an e-visit as an evaluation and management service provided by a physician or other qualified health professional to an established patient using a web-based or similar electronic-based communication network for a single patient encounter, that occurs over safe, secure, online communication systems.

e-Visits, introduced at the start of this decade, continue to gain momentum as technologies improve, consumer demand increases, experience from prior pilot studies becomes more widespread and major health plans advance and adopt e-visit initiatives. For common, non urgent ailments, an e-visit can simplify life for a consumer, and for a provider and plan too (because the entire transaction has already been converted to a documented electronic transaction.)"

Doctors talking to doctors - why leave patients out in the cold ?

After a doctor ( usually a family physician) refers a patient to a consultant, the specialist sends a note ( often by email these days ) about what his findings were; his clinical opinion; and his recommendations. While this is very useful, often what happens as a result of one doctor talking to another is that the poor patient gets left out in the cold. He cannot decipher the jargon in the referral note or the consultant's opinion; and since specialists are often extremely busy, they rarely spend much time with the patient - or fob him off by saying that "your family physician will explain everything to you" !

We use an alternative model, which we feel is much better. Rather than send a note to the referring doctor, I explain to the patient what my findings are and what my advise is. I then request him to go back to the referring doctor, and to tell him what I said. I feel this is a better model for many reasons.

Firstly, the patient is center of all the action, so he does not get lost or confused.
Secondly, it's a great check on my communication skills as well ! If the patient can explain what my treatment plan is to the family physician, this gives a lot of comfort to the doctor that he has sent his patient to the right specialist.
Finally, this is an effective way of improving the level of medical knowledge about infertility in the entire community , so that the many myths and misconceptions which surround this get gradually dispelled.

What the Indian government can do to promote medical tourism

Medical tourism has become a hot area in India today; and the government promises to do everything they can to promote this. After all, not only does it earn the country valuable foreign exchange, the fact that patients come to India from the US and the UK adds to our national prestige .

The tragedy is that a lot of the promises are just hot air. Ideally, the government should promote medical tourism by providing subsidies and infrastructure services to hospitals and doctors so that they can improve the care they provide. This is done routinely for the IT industry, which gets large tracts of real estate from the government at highly subsidized rates, so there's no reason why this cannot be done for hospitals ( which provide employment to thousands and a socially useful service to local citizens as well !) I guess this is asking for the moon, so let's see if they can do something much simpler which would not cost them anything.

In order to promote exports , the government offers a lot of sops and carrots to industries which earn foreign exchange. For example, companies which earn foreign exchange are eligible for tax exemptions , which means they pay much less tax than others. Why can't the same rules be applied for doctors and hospitals who earn foreign exchange from overseas patients ? Why shouldn't the export of all services which earn foreign exchange ( whether in the IT industry, jewellery industry, the hotel industry or the healthcare industry) be treated on par ?

Test tube baby tourists - and why they come to India from the UK

Which is the best way to educate patients ?

If there is so much free, high quality patient information around, why don't more patients utilise this ?

I can think of two simple solutions to improve utilisation.

Firstly, doctors should prescribe this information. Patients have high regards for their personal doctor, and most of them will follow instructions, when told to do so by their doctor. If a doctor gives you a brochure to read, the chances are very high that you will do so ! However , doctors are busy people, and often forget to prescribe information. Also, doctors can be intimidating ! If you don't understand what your doctor says, you are too scared to ask for clarifications. Also, his time is precious, and using it on educating patients may not be the best way of maximising physician efficiency.

There is another option, which I feel will be far more effective. This is to get patients to teach other patients. There are many benefits to this approach which has been done informally for many years, but can be done much more efficiently on the web !

The " expert patient" is one who has had the illness for some time; knows a lot about it because he has done his homework; and is willing to share his knowledge with others, as a labour of love. This person is likely to be a much better teacher than any other source, for many reasons.

Firstly, because he ( or more often than not, a she !) is doing this because he can empathise with the distress other patients are suffering, he is likely to devote considerable time and energy into doing a good job. While educating patients is often a low priority for doctors, for the expert patient, this is a high priority because he wants to share his learning, so that others do not have to suffer.

He is much more likely to "think out of the box" and use all the clever new technological options to make the learning much more fun, stimulating and interactive. Most doctors know a lot about medicine - but they don't know much about teaching or learning. E-learning has gone through dramatic improvements, and it's possible to create clever games , simulation and videos to make learning much more sticky and fun !

Because he is not a doctor, he is likely to use simple English to explain complex concepts. Not only is this much easier for others to understand, it is also much easier to read and comprehend. While doctors are good at writing for other doctors, they are often not good at communicating in simple terms.

The expert patient writes as a result of his personal experience. This makes his writing much more authentic and heart-felt. Equally importantly, because he has "been there, done that", he is much more empathetic and this is communicated to the reader very quickly. This allows the reader to identify with the writer and this emotional bonding sets up closer ties, which makes learning much more painless.

It's much easier for the reader to ask questions and get clarifications. While doctors can be intimidating, it's not very scary to ask a fellow-patient questions which are likely to get intelligent and intelligible answers.

Because all this information is usually provided with a prominent disclaimer which usually states that " I am not a doctor", it encourages the reader not to accept this as gospel truth and to do his own exploring. Just because information comes from a doctor or Mayo Clinic does not mean that it is true - but because it has been produced by an "expert", readers are much less likely to question it , which means they are less inclined to find their own path.

What about the risk that this information my be incorrect ? It's true that there are a lot of dogs on the internet ; and that a lot of information can be rubbish, but this is true of information published by doctors as well ! Community monitoring to ensure correctness of answers can help to ensure the content is reliable and uptodate. The wikipedia is an excellent example of what an empowered community of lay-people, experts and non-experts can do !

Also, because of the " wisdom of the crowd " , this sort of format is likely to allow a number of alternative viewpoints to emerge. I don't think anyone has a monopoly on truth and this approach can help to clearly define the controversial areas. Because it also emphasise the areas of ignorance and doubt, it can actually help research to focus on finding answers to problems which are important to patients !

Because this information is produced by a patient, it is far more likely to be practical and of greater utility to the patient in his daily life. Thus, while a doctor may wax lyrical about theoretical concepts and his pet areas of research, patients are much more focused on stuff they can use in their regular day to day activities.

Finally, because expert patients are not likely to have vested interests ( at least until they get bought over by pharmaceutical companies), it's much more probable that this information is reliable and not contaminated by commercial influences !

I feel it's not possible to teach anyone - everyone has to do their own learning ! Cleverly produced materials from another patient are much more likely to encourage patients to do so.

The resident doctors strike and the commercialisation of medical education

The newspapers have been full of articles about the recent medical students and residents doctors strike in Maharashtra ( which has just been called off). Reading about this strike makes me cry - but not because I think doctors should not go on strike ! Let me explain.

Medical students are going to be the doctors of tomorrow. They enter medicine because they want to help other people ( and yes, they also make money in the process, and I think it's perfectly justified for them to do so !) . Sadly, the conditions under which they work are so miserable, that their resentments and grievances keep on festering; and when they find no one is willing to listen, the only option they have left is to go on strike. Now this is not something which future doctors do lightly. Doctors have a conscience, and the fact that patients may get hurt when they go on strike is a major deterrent for residents. The major focus for residents and students is their education and they want to complete this as expeditiously as possible so they can get on with becoming doctors. Also, it's possible for the government to take punitive action ( such as cancelling their registrations), so going on strike can have serious repercussions . It takes a lot of guts to go on strike !

The tragedy is that these strikes seem to have become regular affairs - and they fail to achieve their purpose. I remember going on strike 20 years ago; and these seem to happen every 3-4 years. The strike is called; the newspapers report this; the politicians and bureaucrats promise to take corrective action so that the strike is called off; but nothing happens, so that the residents are forced to call for another strike after a few years.

The trouble is that it's a very uneven and unfair battle. Residents come and go, because once they complete their training and become doctors, they move on. Unfortunately, government bureaucrats remain forever, so they are formidable opponents, whereas residents are unarmed and inexperienced in these confrontations. Also, the media usually supports the government, because they highlight the adverse effect these strikes have on the poor patients who avail the services provided by government hospitals, which means the public is full of sympathy for the poor suffering patients - and they have little compassion for the suffering medical residents. Unfortunately, there is little unity amongst doctors, so practising doctors do not provide the stroking residents with any support. The biggest tragedy is that the medical professors and teachers , who are supposed to nurture the next generation of doctors, also fail to support them with the result that the strike fizzles out very quickly, and never achieves its purpose.

What was the reason for the present strike ? The medical students and residents were agitating over the fact that the number of recognised postgraduate posts for specialistion in medicine in the government hospitals in Maharashtra has been progressively declining because the government has not bothered to upgrade the teaching facilities; employ the required professors; or get the needed recognition from the Medical Council of India. The authorities have promised to "look into the matter" in order to settle the strike, but it's very unlikely that they will do anything more than paying lip service.

The reason is simple. Along with the declining number of government postgraduate seats, there has been a corresponding increase in the number of private medical colleges in Maharashtra , which are now mushrooming all over the place. These private colleges offer "recognised" medical training for which they charge a fat fee, which means they are extremely profitable to run. And the vast majority of these are owned by politicians in the state. 8 cabinet ministers in Maharashtra own their own medical colleges today ! Not only are these highly profitable ( which is how rich politicians become even richer) - they are also a great way of providing favours for sons of influential and well-connected businessmen and doctors. This is the real reason why there is absolutely no political will to try to improve the sad state in government medical colleges today. After all, if ministers are spending all their energy on getting recognition for their own private medical colleges, why should they care about what happens to the seats in government medical colleges ( which offer serious competition for them ! )

All of us are silent bystanders. Today, it's the medical students and residents who are suffering. Tomorrow, it will be all of us who will pay the price for our inaction and lethargy, because the quality of the doctors which are being turned out is going to drop dramatically as a result of this privatisation of medical education. I guess we will get what we deserve - and we only have ourselves to blame !

Which is the best way to rate doctors ?

We all want to find the best doctor for our treatment. How can you judge how good your doctor is ? This is a difficult problem and there is no easy solution, even though many techniques have been tried, such as physician profiling and outcome assessment, which often don't work well because physicians can "game the system" when they know what is being tracked.

The best method would be to ask around, so you can find a good doctor. This is what all of us do informally when choosing a doctor and this is a time-honoured method, because it forms the basis of a professional reputation.

However, this is an inefficient system - and this is especially true when you are new to a city and don't know whom to ask. A very effective solution would be to have a community of patients provide ratings for their doctors . While this can be quite a messy system ( because some patients are likely to be prejudiced for their personal reasons and may provide poor ratings to good doctors) , if you believe in the "wisdom of the crowd" then this is likely to be an effective technique for many reasons.

It will help patients because they will at least have a starting point which they can use as a basis for comparison. Patients will also learn what metrics they can use to better judge the performance of their doctors. Every community will have enlightened and articulate patient-leaders who will provide free and frank feedback, which can be very useful for other patients - and who can be better judge for a doctor than his patients ?

Interestingly, this system can be very useful for thoughtful doctors who are willing to use this feedback to improve. Doctors will get an online reputation , and when doctors know they are being judged by their patients, they are likely to improve their behaviour and better their performance - a very desirable outcome ! Equally importantly, if your colleague is gettig better ratings than you, this is likely to motivate a doctor to upgrade and improve his systems and processes.

I always feel that patients who do not come back to me for treatment after a first consultation can give me a lot of valuable insight as to why they chose to go to someone else, which can help me to improve . Every complaint is a gift - and it's better for me to know why my patients don't come back to me rather than to keep on losing them ! This will only happen when patients are given such a platform, and are empowered to provide frank feedback . After all, how will doctors improve until our patients tell us what we are doing wrong, so that we can fix our errors ?

Putting the myth of bed rest after IVF to rest

One of the old wife's tales which still plagues every IVF patient is the myth that they need "strict" bed rest after the embryo transfer. Many patients are scared that the embryo will fall out if they walk around - after all, if it was inserted artificially, isn't there a risk that it can "fall out" through the " track " through which the doctor inserted it ?

I remind my patients that God designed the body with enough sense that walking, running, coughing and sneezing do not cause an embryo to fall out ! Embryos are safe and secure in the womb , and just because they have spent 48 hours in the incubator in the IVF lab does not change anything ! IVF allows us to mimic nature , and once the embryo has reached the uterus, it's exactly like an embryo "made in the bedroom" ( embryos do not have a memory !) After all, when fertile couples have sex and get pregnant naturally, they continue leading a completely normal life after sex , so why should IVF make any difference ? Enough medical studies have been done by many IVF clinic which prove that embryo implantation and pregnancy rates are not affected by rest; and patients can walk out just 10 minutes after the embryo transfer.

In fact, enforced bed rest can have a very unhealthy effect on the patient. Being forced to lie down in bed when you are well can be demoralising, so say the least. Taking a bed pan ( during "strict bed rest") can be extremely humiliating. Also, if you are forced to lie in bed, then you tend to spend all your time thinking about what the outcome is going to be - a very unhelpful process, because the outcome is no longer in your hands. As it is, during the dreaded 2ww ( two week wait between the embryo transfer and the pregnancy test), each minute seems to last for an hour. Lying in bed makes the time crawl even more slowly !

So why do some doctors still insist their patients take "bed rest" after embryo transfer. I think this is a very clever way of "victim blaming" ! If the patient does not get pregnant, they can always "blame" the patient for the failure, because she did not "rest" properly. The biggest tragedy is when the family members start believing this untruth.

I think patients ( and their loved ones) need to understand that activity does not have any impact on the embryo inside the uterus, because it is protected from external influences in its uterine haven. Implantation is a biological process which is not affect by external activity - or by gravity ! We suggest patients take it easy at home for 48 hours after the embryo transfer , after which we encourage them to resume work, so they can keep themselves gainfully occupied. This is actually more for their peace of mind, rather than because it changes the outcome. I always tell patients that if resting helped to increase pregnancy rates by even 1%, we'd happily keep them in hospital for even 15 days after the transfer !

There is a difference between transfer and implantation ! While embryo transfer is a simple mechanical procedure, implantation is a complex biochemical event which involves a dance of exchanged signals between the endometrium and the embryo - something which cannot be influenced by diet or activity !

Being infertile is bad enough - don't make it worse by forcing yourself to rest in bed when you don't need to !

Why are patients in the US so unhappy ? ( and what we can do about it)

There used to be a time when rich patients from India would fly to the US to get medical care at Mayo Clinic and Johns Hopkins. The US still has these world- class centers of medical excellence, but the average patient in the US is unhappy ! The US is the world's richest country and spends gadzillions on medical care ; it boasts of some of the world's best doctors and hospitals - and yet most patients ( and their doctors) are unhappy with healthcare. Why is this so ?

There are many problems; and these include:

1. High costs of medical care, partly because of overtesting, ( imaging companies want to sell their latest scanners , gadgets and gizmos); and overtreatment ( because greedy pharmaceutical companies want to sell their newest ( and most expensive) drugs).
2. Too much paperwork, because of a bloated bureaucracy. There are more medical administrators and paper-pushers than there are doctors in the USA !
3. Poor insurance coverage, because of high costs
4. Rushed doctors, who do not have enough time to spend with the patient, because of the quotas they need to fill, set by the hospital administrators
5. The threat of lawsuits for negligence, which forces doctors to practise defensive medicine and spend more time on documenting care rather than on providing it !

With such a long list of problems, how do we find a solution ? The issue seems too complex , especially when you realise that healthcare costs over a trillion dollars in the USA today.

I feel the real reason for this unhappiness is far more basic. We need to remember that while policy analysts and Presidential candidates love to talk about the "healthcare industry", for most of us healthcare means the one-on-one interaction we have with our personal doctor. This is the heart of all healthcare - the doctor-patient relationship - and this is what we need to improve if we want to correct the present situation.

The rule is simple - unhappy doctors make for unhappy patients - and happy doctors create happy patients. ( Incidentally, the obverse is equally true , in that happy patients make for happy doctors !)

If we want to have happy patients, we need to create happy doctors - doctors who enjoy looking after patients, and have fun taking care of them. If we start from the bottom-up, and then work upwards, we can solve the problem ! It's just a question of improving these "moments of truth" which occur daily in the doctor's life - and which have such a profound impact on the patient's well-being.

If we treat each doctor as just another expensive employee; or a "healthcare worker" ; or a
" skilled professional" with a special skill set, we'll never be able to tackle the problem. However, if the entire industry learns to treat each individual doctor with the same respect and care with which each patient treats their personal doctor, I think we will be able to make progress !

" Ask-Tell-Ask for Understanding Medical Information

"Ask-Tell-Ask" for Understanding Medical Information: "Several authors have suggested an 'Ask-Tell-Ask' method to improve patient understanding. This approach entails the following: Ask patients to describe their understanding of their disorders and treatments; Tell them additional needed information in a way that incorporates their perspective; and then Ask what they understand and feel about the information given."

Improving medical care by cutting out the middleman

Improving medical care by cutting out the middleman: "It is time for a change. We can either complain and live with the status quo or we can inspire meaningful change, save money for families, ensure health care for the less privileged, and keep good doctors in practice. At My MD and Me we focus on inspiring positive changes by uniting doctors & patients.

My MD and Me has negotiated free membership with PrecuraCare, a database that links Patients with Doctors and health practitioners enabling enhanced communication, relationship development, health education, and care collaboration. This eliminates the need for many 'non-care' aspects of health that cost you thousands of dollars per year."

4 Big Health Whoppers - Health.com

4 Big Health Whoppers - Health.com: " Most of us want to believe in “miracle” cures. But if it sounds too good to be true, it is. The 4 big whoppers are:
Weight loss formulas
Colon cleaners
Arthritis fixes
Alzheimer's cures."

The Scary Truth About Surgery - Health.com

The Scary Truth About Surgery - Health.com: "I found even more after talking with more than 25 experts involved in various aspects of surgery and surgical care, and after reviewing a half-dozen governmental and medical think tank reports on surgery in the United States. Here, what you need to know about five surgeries that are overused, and newer, sometimes less-invasive procedures and solutions that may be worth a look.

Surgeries to Avoid:

#1 Hysterectomy »

#2 Episiotomy »

#3 Angioplasty »

#4 Heartburn Surgery »

#5 Lower-Back Surgery »"

Wise Patients Know to Read Behind the Headlines | Battling Healthcare

Wise Patients Know to Read Behind the Headlines | Battling Healthcare: "One thing I’ve learned over time is that often the headlines, and sometimes the opening paragraphs of any given article, aren’t exactly representative of the real story.

It’s understandable. The people who write the headlines aren’t usually the people who write the stories and articles, too. The headline writer’s job is to condense information in such a way as to suck people into the rest of the story. They “sell” the article to the reader, so it makes sense for them to be sometimes inflammatory, often intriguing, and revealing of only part of the story."

The Wise Patient's Guide to Being an Empowered Patient

The Wise Patient's Guide to Being an Empowered Patient: "Patient empowerment has a handful of definitions. Most focus on the concept of the patient taking an active role in his own disease management, and supporting that participation by learning all he can about his disease or condition and treatment options.

Until the past few years, the thought that a patient would participate so fully was unheard of. Today, many patients realize that this level of participation is vital to maintaining health in the face of medical problems or challenges."

Open Health Tools

Open Health Tools: "Open Health Tools is an open source community with a vision of enabling a ubiquitous ecosystem where members of the Health and IT professions can collaborate to build interoperable systems that enable patients and their care providers to have access to vital and reliable medical information at the time and place it is needed. Open Health Tools will generate a vibrant active ecosystem involving software product and service companies, medical equipment companies, health care providers, insurance companies, government health service agencies, and standards organizations."

Making the Most of Your Doctor Visits

Making the Most of Your Doctor Visits: "To get the most out of your visit, approach it as if you were planning for a business meeting. Organize your thoughts, establish an agenda, and by all means, write things down.

Do you have symptoms? Jot down notes about when they started, what happens when they occur and what makes them better or worse. Are you on a medication? Write down questions about how long you're supposed to take it, the likely side effects, the costs, and if there is any food, drink or activities you should avoid while taking the medication."

Lots of useful tips you might want to review before your next appointment.

The Physician Empowerment Movement - www.healthleadersmedia.com

The Physician Empowerment Movement - www.healthleadersmedia.com: "Physicians are central in determining health access, coverage, and reform. After all, physicians are the primary professionals licensed to practice medicine and deliver care. Yet physician voices remain curiously muted. Pundits, politicians, employers, health plans, and health-firm executives dominate the discourse about healthcare change.

For various reasons, including the feeling that the deck is stacked against them by government, health plans, and others, physicians are collectively mobilizing, uniting, expressing, and empowering themselves. This empowerment is partly due to a sense of outrage at current practice conditions, system inequities for patients, and a desire to improve care. Physician shortages, the demand for more physician access, the laws of physician supply and demand, emboldened physician organizations, and social networking physician Web sites contribute to this new sense of physician empowerment."

Map of Medicine

Map of Medicine : "120 of the Map of Medicine clinical pathways have now been made available to patients via the NHS Choices website. The Map of Medicine Healthguides presents the different steps of a patient journey, from symptoms to diagnosis and treatment, in easy to follow charts. Healthguides gives patients access to the same information as the doctors who are treating them.

This is a great example of how it's possible to simplify complex information, so patients can make sense of it.

Should we still be doing a laparoscopy for infertile women ?

When we first started practice , a laparoscopy was considered to be a basic tool in the evaluation of an infertile woman. Laparoscopy was considered to be a major advance , because it allowed us to inspect the pelvis and actually look at the fallopian tubes and ovaries to accurately diagnose anatomical problems. It was considered to be minor surgery , because it was minimally invasive; and we performed them routinely for all our patients.

Doctors routinely continue to perform a laparoscopy for all infertile couples. However, we have not performed a laparoscopy for the last 5 years in our clinic ! Why the change ? And why are other specialists doing so many unnecessary laparoscopies ?

I think there are many reasons for this. For one , gynecologists like doing surgery, and are quite happy to do as many of them as possible. Also old habits die hard. They have been so conditioned to thinking of a laparoscopy as a basic tool in the evaluation often an infertile couple , that some still believe that without a laparoscopy , the evaluation is incomplete.

However I think laparoscopies are overused and misused , and often create a lot of harm. For the doctor, all surgery is minor surgery. However, the reality is that is an operation which carries definite risks, and these should not be glossed over.

The key questions are - Do we have a better alternative ? and How will doing a laparoscopy change the infertile couple’ s treatment plan ? After all, if a laparoscopy is an investigation, then like all diagnostic tools, it should be used only when it changes treatment options !

Today , the truth is that a laparoscopy is of very little use to an infertile couple. It is much cheaper and easier to confirm tubal patency by doing a hysterosalpingogram; which means that patients do not need to be subjected to the risk of a laparoscopy just to find out if their tubes are open or not. Another justification for a laparoscopy is that it allows us to correct problems such as endometriosis or peritubal adhesions, thus improving the patient's fertility. However there is very little evidence that these procedures actually increase the patient's fertility. While doing surgical procedures can be enjoyable for the doctor , this is not a good reason to do them ! Controlled studies have shown that operative laparoscopy does not actually improve a patient's fertility ; and that there is no need to correct minor endometriosis or a few adhesions.

Even if a patient has already had a laparoscopy elsewhere, many doctors will insist on repeating the laparoscopy, because they want to see “ with their own eyes”. This is adding add insult to injury ! Others will “diagnose” subtle problems ( which no one else can see !) on ultrasound scans, and use these as a justification for doing a laparoscopy !

In our clinic our treatment plan is formulated without doing a laparoscopy. If the hysterosalpingogram shows the tubes are blocked, then a laparoscopy cannot help to correct this problem. If, on the other hand, the HSG confirms the tubes are open , then there is no need to do a laparoscopy. Our philosophy is not to diagnose problems, but to solve them ! We do not think a laparoscopy helps to do this, which is why we have stopped doing them !

IVF treatment for social reasons

We are now increasingly seeing fertile couples who want IVF treatment because they want a baby quickly. While they are quite capable of making a baby in their own bedroom , they often come to us for medical assistance because they do not want to waste time on getting pregnant. These are often successful older couples, who are very used to making their decisions for themselves and getting what they want . They see IVF as a tool in order to achieve their life-goals, and not just as a treatment option to solve medical problems. For example, I recently saw a 36-year-old CEO who told me she wanted a baby in the next 2 months ; had realized that Nature was not very efficient in making babies ; and wanted IVF treatment in order to improve on nature’s inefficiency. This might seem like a very cold-blooded way of planning a baby, but from her point of view, this was the most time-effective option for her. She told me, “ I understand that it’s more fun making babies in my bedroom, and I do have a very active and satisfying sex life , thank you very much . I like to be in control of my life , and I want you to do IVF for me to maximize my chances of conceiving quickly, so I can have my baby, and move on with my life. After all, if I chose to spend thousands of pounds to fly the Concorde to save a few hours of my life ,why can’t I invest in IVF to save a few months ? “

This is a smart, well-informed woman, who knows her own mind, and is choosing to spend her own money to do IVF treatment. If medical ethics tell us to respect patient autonomy , am I justified in refusing to do IVF for her ? Am I being very old-fashioned and paternalistic in telling her that IVF is a medical treatment option for infertile couples and cannot be used for any other reason ? Who should make these decisions ?

Just like birth control allows women to regulate their reproductive destiny, doesn't IVF also empower them to do the same ? Can't women be trusted to make these decisions for themselves ?

Simplify versus complexify

Many doctors take great pride is using jargon and polysyllabic words. Doctors do this for two reasons. One, in order to impress their patients that medical science is a very complex topic ; that they are the experts ; and therefore patients should let them make the decisions. As Nicklaus Wirth, Professor of Computer Science said, “ People seem to misinterpret complexity as sophistication.” I think the second reason is that often they are confused themselves because they have not taken the trouble to think things through clearly. I believe that complexity signifies confusion in the mind of the doctor – and this confusion creates more confusion in the mind of the patient .

Simplicity is good. A true expert should be able to explain anything , no matter how complex it
is ! An excellent example from whom we can all learn is Richard Feynman, and I'd strongly encourage anyone who wants to be able to explain complex concepts clearly to read his writing.

The message is simple . If you cannot understand what your doctor is saying the fault is likely to be his , not yours !

The Doctor's Office - WSJ.com

The Doctor's Office - WSJ.com: "Two University of Colorado researchers won an academic award last January for their paper proposing overbooking as a solution to the loss of productivity for doctors when patients don't show up. My practice depends on patient visits as the main source of revenue so any missed appointments cost me money. The overhead meter for the office keeps running whether patients show up or not. In a busy practice, patients who don't show up take away a slot that someone else could use."

IUI versus IVF - Time versus Money

Often patients are confused as to whether to pursue IUI ( intrauterine insemination) treatment or IVF ( in vitro fertilisation) treatment. Many times, it is their doctors which contribute to this confusion. For example gynecologists who only perform IUI treatment, are reluctant to refer their patients to IVF specialists. They mislead patients, by claiming ridiculously high success rates for IUI treatment; they keep on doing IUI treatment, cycle after cycle , even when they have reached the point of diminishing returns; and also misuse it for inappropriate reasons, such as male factor infertility due to a low sperm count, by saying – all you need is one good sperm !

This often means that patients get fed up and frustrated . Because they have wasted so much time, money and energy on failed IUI treatment cycles, they are very reluctant to pursue more effective treatment options.

On the other hand, IVF specialists tend to overprescribe IVF treatment. In many couples , IUI is a simple and less expensive option but instead of giving this a fair trial, IVF clinics recommended IVF straight away.

So what is a confused patient supposed to do ?

I think the trick to making a well informed decision is to weigh the pros and cons of both options. Each has advantages and disadvantages and you need to decide what is right for you.

Often the major consideration is not medical , but something which many doctors – and patients - overlook. This is the trade-off between time and money. IUI costs less money , but because it has a low success rate , it takes longer to conceive with IUI, as compared to IVF. IVF is more expensive, but it has a much higher success rate . For patients for whom money is not a constraint, I suggest that they go for IVF directly , if they want to get pregnant quickly. It might seem mercenary that medical treatment decisions are being based on the ability of the patient to pay, but we need to remember that what infertile couples are really looking for is a baby - they usually don't care about how they achieve their goal ! For many of them, if IVF increases their chances of getting pregnant as compared to IUI , this becomes their preferred option, because they would rather spend more money to get a baby quickly rather than waste time on IUI , in order to save money !

Welcome to MyDrugRef — MyDrugRef.org

Welcome to MyDrugRef — MyDrugRef.org: "Need to know what doctors think about a drug? What's the latest drug warning buzz? Unsure about if two drugs interact? Want to know the drug of choice for a health condition from your 'trusted' group members? You are in the right place! This is a social network of clinicians who like to share ideas about drugs. The drug code used is based on the Health Canada drug database."

The Top 100 Open Source Software Tools for Medical Professionals

The Top 100 Open Source Software Tools for Medical Professionals: "Open source software benefits professionals in all industries: government, Internet, business, education, and even health care. Expensive software and subscriptions for anti virus systems, supporting electronic medical records and even phone or e-mail communications can put on a strain on small clinics as well as larger hospitals. Open source tools are free, highly customizable, and secure enough to handle the sensitive data that medical professionals often work with. Read the of the top 100 open source software tools that benefit health care professionals."

Protect your heart from your Heart Doctor !

Protect your heart from your Heart Doctor ! : "Patients with chest pain are routinely not given the opportunity for informed consent. Dr. Wayne’s common sense discussions on heart tests and treatments go a long way to filling that gap.

" It would seem logical that prevention of ischemia would prevent this cascade of events from taking place. In fact, that is exactly what occurs. In patients on a full medical program designed to minimize or eliminate ischemia, particularly of the silent variety, there is a dramatic reduction in the complications of chronic ischemic heart disease. Heart failure rarely occurs, the incidence of recurrent heart attacks is very low (1-2% per year), and mortality rate is also extremely low (1-1.5% per year). Because the progression of the disease is extremely slow on such a program, more heroic treatments such as bypass surgery or angioplasty are needed only rarely. A good medical program will allow a patient to be symptom free and enjoy a normal life span. Whether this happens or not depends entirely on the ability of the cardiologist to identify patients with silent ischemia who stand to benefit the most from a medical program similar to the one described in this chapter. Patients who have symptoms will be treated, for they demand attention. It is those without symptoms who have the most to gain, and the most to lose if they are ignored. If you have coronary artery disease, your survival will largely depend upon whom you chose to treat you. So choose well!"

WHAT YOU NEED TO KNOW WHEN GETTING A PRESCRIPTION FOR A DRUG

WHAT YOU NEED TO KNOW WHEN GETTING A PRESCRIPTION FOR A DRUG: " Be a part of the decision-making process when your doctor offers a drug:

Get a thorough understanding of what he or she is prescribing and why.

Ask exactly what the drug is and why it has been chosen for your condition. How does it work?

Find out if it is new on the market. If so, why was it chosen over older drugs?

Find out if the drug is safe to take:

How will this drug interact with your other medications or over the counter drugs or
natural remedies you are taking?

What does your doctor personally know about the safety of the drug? How long was
it tested? How long were patients followed after taking it to determine if they developed bad effects? Has the FDA published any reports of adverse effects?"

RED FLAGS
These answers should give you strong reservations about taking the drug:

Your doctor is unclear about the mechanism of action of a drug (what it is doing inside the body). Either the mechanism is not known and only guessed at, or your doctor doesn’t understand it.

The drug was approved within the last two years. Thus it lacks an extensive safety record in the general population.

Your doctor doesn’t know of any adverse effects aside from what he reads along with you in the package insert. Since your doctor has not looked at the FDA website of adverse drug events he or she knows of no warnings to give you. This is something you will have to question carefully to see if your doctor is saying, “I know there are no special warnings to give you” or if your doctor is actually expressing, “I don’t know of any special precautions (because I haven’t bothered to look, all my data comes from the manufacturer’s glossy brochures).”

Your doctor is writing with a drug-maker emblazoned pen, jotting on a note pad sporting the logo of the drug manufacturer or carrying a coffee mug advertising the latest. These are indications of a heavily drug-salesman infiltrated office, and may well reflect an inordinate reliance on sales talk in the absence of careful review of the scientific pharmacologic information.

The drug is a look-alike or ‘me-too’ version of an older drug. This is offered to you at much greater expense without obvious medical advantage.

Ten Myths About Doctors And What You Can Do To Dispel Them

Ten Myths About Doctors And What You Can Do To Dispel Them: "Ten Myths About Doctors; and What You Can Do to Dispel Them is written for every man, woman and child who has ever been given little or no information regarding his or her medical situation and has no idea where to turn for help and how to obtain it. Information is also given on how to get healthcare providers to treat you, the patient, as a unique individual and not just the 'gallbladder' or 'arthritis' patient. The author has been there and speaks with experience and authority in these matters. She is a survivor (and an overcomer) herself and hopes to remain one with the knowledge she has learned and now imparts from this book.

Ten Myths About Doctors tells the reader about the most glaring myths concerning doctors that our society has set up and in most cases accepts because the doctor 'knows best.' What is found between the pages will help the reader learn what his rights are as a patient, how better to work with his healthcare providers, and to know what he or she can do to change and dispel these societal myths. Appropriate quotations are included in each myth chapter."

Personalized Health Information Act

Personalized Health Information ActPersonalized Health Information Act by Congressman Patrick J. Kennedy. Purpose: The Act will create a public-private partnership to promote use of secure, transportable, and consumer-controlled personal health records and patient communication services for Americans.

Patient education for better managed care

Patient education for better managed care: "Managed care causes changes in the way we think about patient education and the responsibility we assume in the medical office. Sure, it has always been your job to give patients medical instructions at the time of their office visit and when they were discharged from the hospital. The next time they came in for an office visit you would ask if they followed your advice. Like most practices, you may keep a few instruction sheets or brochures about certain medical conditions. Pharmaceutical representatives have traditionally provided these printed materials. Enter managed care! It is time to get serious about expanding your patient education program. Patient education is the golden egg of managed care.

Assuming more responsibility for patient education in the ambulatory setting keeps patients healthier and keeps medical conditions from worsening. It can reduce the need for hospitalization."

Medicine on demand

Medicine on demand : " Medical video libraries are growing fast ! There are a lot of visual people out there. Until recently, they had to take their online medicine in text form. But as more people get high-speed Internet connections needed to view video, that's changing. Video has always been an incredible educational tool, but the Web in the past didn't support it,' says Nan Forte, executive vice president for consumer services at WebMD, a popular medical site. Now, health-information consumers are demanding online video and getting it."

BreastCancerTrials.org

BreastCancerTrials.org: "Joan, along with Joanne Tyler, another breast cancer advocate, conceived of BreastCancerTrials.org (BCT) as a nonprofit web-based service that would match breast cancer patients to clinical trials. BCT was developed in partnership with the National Cancer Institute, the UCSF Comprehensive Cancer Center, and the Center of Excellence for Breast Cancer Care. Patient advocates played a major role in its design and continue to be active members of the project team.

BCT matches patient histories to the eligibility criteria of participating clinical trials. Patients create an online Personal Health Record (PHR) that captures detailed information about their health and provides the basis for matching. Users can find matches whenever they log on to the site and can take part in automated matching. BCT runs automated matching once daily and alerts patients by email to new trials that match their PHR."

Patient (Self)Recruitment

Patient (Self)Recruitment : "By volunteering their own personal health records, patients can be matched to clinical trials. Here is how breast cancer patients did just that. Dr. Esserman described her clinical work in the area of breast cancer and the recognition that patients themselves could be the source for electronic health records (EHR). Once collected, these records could be used to match patients to clinical trials. In other words, the EHR becomes the source of data for patient recruitment. The concept became reality through the creation of the BreastCancerTrials.org web site created for the greater San Francisco and Sacramento area. With little, if any, marketing, the site became a successful destination for breast cancer patients and proved that EHR data could be collected and used without violating HIPAA regulations. Through a collaboration with NCI, it also became possible to perform patient screening against open clinical trials."

Who's your daddy? Answer's at the drugstore

Who's your daddy? Answer's at the drugstore: "DNA tests join other diagnostic tools ! The paternity kits have taken their place on store shelves next to other diagnostic tests that don’t rely on DNA, including those for pregnancy, HIV and blood sugar, said Michael S. Watson, executive director of the American College of Medical Genetics."

The Patient's Doctor

Information Therapy

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Information Therapy to empower patients


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Are doctors good for your health ?

We all want to remain healthy and we expect our doctors to help us to do so. However, while doctors are good at healing you when you fall sick, they are not very good at keeping you healthy. Today, doctors have become illness specialists, not wellness specialists. Things were different in the past. In China, for example, 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 whatever our doctor tells us to do – pop a pill, do a scan, run a test , get an operation – the list is endless ! We need to regain control over our bodies. If you want to remain healthy, you are likely to learn much more by copying the lifestyle of a fit and healthy 80-year old, rather than by going to your doctor. The fact that this person is not a doctor maybe his biggest advantage because he does not see the world through a doctor’s “illness” lens.

We have been brainwashed into believing that modern medical treatment is based on impeccable science. We trust that current medical treatment has been scientifically proven and that doctors “know best” , which is why we don’t question them. However, this is not true . Doctors are human and are as susceptible to the lure of technology as everyone else. Even though the efficacy of bypass surgery has never been scientifically proven , it is now at the heart of a billion dollar industry. Clinical trials have shown that bypass surgery improves life expectancy in only 5% of patients with coronary artery disease – but doctors continue performing this operation on thousands of patients who will not benefit from it. Angioplasty is no better, because coronary arteries which have been opened by placing a stent will often get re-blocked in a few months . (The coronary arteries are not like a drain-pipe that they can be unclogged ! ) Hypertension
( high blood pressure ) is not really a disease ( it’s just a finding on a clinical examination), but it’s overdiagnosed - and overtreated. Even though anti-hypertensives are useless for the majority of “ patients “ they are prescribed for, many people take them for their entire lives. Mammography has not been show to improve breast cancer survival rates but is still routinely advocated; inspite of spending billions on research, we are still failing miserably in our “war against cancer”. It’s become a fashion to check cholesterol levels, but it’s a fact that high cholesterol levels do not cause heart disease in most people ; and the overglorified cholesterol drugs ( statins) are a wasteful expense for the vast majority of people who take them.

There is now a long list of books which have documented how harmful medical care can be, and even their titles can be eye-openers ! These include: The Last Well Person: How to Stay Well Despite the Health-care System by Nortin M. Hadler; The Secrets of Medical Decision Making: How to Avoid Becoming a Victim of the Health Care Machine by Oleg I. Reznik; and Disease-Mongers: How Doctors, Drug Companies, and Insurers Are Making You Feel Sick by Lynn Payer. Even “ good “ doctors are tricked by the multi-billion dollar marketing budgets of pharmaceutical companies who peddle the newest ( and most expensive) drugs . There is now extensive documentation to show how the pharmaceutical industry has corrupted the medical profession .

Studies on iatrogenic disease (diseases caused by medical treatment ) suggest that medical treatment is one of the leading causes of death in the US. Hospitals can be dangerous places and the path-breaking Institute of Medicine study showed that thousands of patients die of medical errors even in the best US hospitals ! The moral is simple – don’t leave everything upto God – or upto the doctor, either. You need to take responsibility for your own health !

Before trusting your doctor, you should do your own homework so that you can verify everything he says independently. The good news is that it’s become much easier to do so . You can use the internet to do your “ due diligence”; and books and blogs written for patients ( and by expert patients) are chock-full of reliable and unbiased information. The true experts are
“ expert patients” , who have learnt to live well inspite of their illness. They can be great role models, and we can learn from their personal experience .

If doctors ( the word is derived from the Latin root, “docere” , which means to teach) help patients to do their homework intelligently, everyone will benefit! Educating yourself about your health is one of the most cost-effective ways of improving your health. Well-informed patients take much better care of themselves, and information therapy helps to make medical care much more patient-friendly.

We have a rich and ancient heritage . Indian medicine was rightly called Ayurveda - the Science of Life , not just 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 ( for example, through support groups and online social communities), rather than depending upon doctors. It’s your body – you cannot outsource your responsibility of taking good care of it to anyone else !

I wrote this article for Times Wellness !

Career Burnout - a Healthcare Hazard

Career Burnout - a Healthcare Hazard: "Healthcare workers experience a relatively high risk of career burnout. It's not surprising really, when you consider the emotional intensity of the work and the potential it brings for life-altering, even life-ending, failure.

At highest risk are those most often considered the best providers; the most dedicated caregivers. They often take the job home with them, and are frequently willing to displace personal priorities in order to meet the needs of their patients. They rarely hesitate to take on additional work, have high standards and perfectionist tendencies, and are intensely driven."

5 ways to help your doctor help you

5 ways to help your doctor help you: " 1. Bring in a list of medications
2. Come armed with your personal health history
3. Bring in your recent test results and doctors' notes
4. Make a list of your concerns
5. Don't ask your doctor insurance questions"

Six Tips for Happiness by a Harvard Teacher

Six Tips for Happiness by a Harvard Teacher: "Studies describe a set of wellbeing practices that are correlated with the feeling of happiness . I tried to summarize them in the mnemonic MOTORS because the pursuit of happiness, in its altruistic sense, can be the motor of your life.

“MOTORS” stands for:

Meaning -- find a meaning in what you do for a living but don't forget to set limits around it
Outlook -- have a positive outlook on life. Be philosophical but also focused on success
Time -- spend quality time with F&F (Family & Friends)
Out of of yuppie values -- don't focus on chasing money or prestige
Religious / spiritual practices
Self care practices, like sports or meditation"

Ten Web 2.0 Things You Can Do in Ten Minutes to Be a More Successful E-learning Professional

Ten Web 2.0 Things You Can Do in Ten Minutes to Be a More Successful E-learning Professional: All doctors need to keep on learning - and Web 2.0 technology offers some great learning tools ! What is e-learning and how can you use it to become a better doctor ? This post has lots of useful information on stuff you can try - most of which is free . I can guarantee you that you'll find more than one tool which you will wonder how you managed without !

Medicine 2.0 Blog Carnival

Welcome to the Medicine 2.0 Blog Carnival ! The purpose of a carnival is to celebrate, and that’s what I hope to do with this carnival. My theme is - How can Medicine 2.0 contribute to healing the healthcare system ?

I feel the healthcare system today is sick because it is doctor-centric. Healthcare is fragmented and disorganized and there are too many specialists , most of whom have tunnel vision. In order to reform the healthcare ecosystem , we need to put patients back where they belong - at the center. We believe that patients are the largest untapped healthcare resource ! Patients ( or their relatives and friends) are : intelligent and capable; and because they have a lot at stake , they are motivated to get good health care and will be willing to invest time and energy if given the right tools to ensure a good outcome. We need to provide the tools directly to patients.

The good news is that what the medical profession has not been able to do for so many years, is now gradually becoming possible because of Web 2.0 ! As Clemanceau said, " War is too important to be left upto the Generals. " This is equally true of medical care – it’s too important to leave upto the doctors !

It’s good idea to start with students first. Most practicing doctors will find it hard to change their habits – but medical nursing students are much more flexible – and if they can use Web 2.0 tools for their own training, they are much more likely to use these for improving the care their provide to their patients ! Dan Weberg has a good list on the Potential Uses for health 2.0 in nursing education at Lets Upgrade Health Care Innovation. Here is another excellent overview of the 6 axes of medical education in Web 2.0 style.

Phil for Humanity presents The Controversy over Stem Cell Research posted at Phil for Humanity. Here’s a good example of what well-informed patients can find out on their own Not only is there a wealth of information , but because it is being shared with others, it becomes much more useful and powerful !

One of the good things about the Web is that it allows doctors to look at things from the patient’s lens ! Doctors who blog are much more patient-centric – and blog about things which are likely to be of interest to their patients ( rather than stuff which is only of interest to them and their colleagues). This kind of blogging is bound to help a doctor become more empathetic – and improve his bedside manner too ! Ed Odom, MD presents Top Ten Ways to Survive 'til You're 35 posted at thehonestdoctor.com.

Lots of doctors are using Web 2.0 innovations very cleverly. One of the most high profile doctors is Dr Jay Parkinson who announced hello health at the Health 2.0 conference in San Diego. What a great idea ! It's a very good example of how technology can be used cleverly to cut out all the "middle-men" between the doctor and patient, so doctors can focus on doing what they do best - providing high quality medical care - one-on-one ! Over!my!med!body! has some concerns about this style of practise , because it selects for the healthier patients, and it's going to be interesting to see how this model evolves.

Mic Agbayani presents Take Your Reading With You With ReadTheWords posted at geekydoc.This is a very clever application – and it’s free. Doctors are very busy – but they can use ReadtheWords to listen to journal articles or abstracts while driving or commuting ! Now someone needs to make similar applications for Indian languages too !

He also offers an alternative viewpoint on Twitter at Rants: Too Much Twitter. I’d agree ! Sometimes, less is more !

Jose DeJesus MD presents Lowering Prescription Drug Costs posted at Physician Entrepreneur. The private sector has used some innovative tactics to encourage the use of generics, and the public sector would do well to learn from the trails they have blazed. After all, the private sector puts its own money on the line and unlike the public sector, will not throw good money after bad in some failed social experiment.

Dr Bill Crounse has a thought-provoking entry on how Unified Communications can provide better tools to manage caregiver communication and collaboration in healthcare. Clever use of these tools can help to improve the doctor-patient relationship by providing more opportunities for interaction, without either the doctor or the patient having to actually travel to the clinic !

David Rothman, the medical library geek, has an entry on some clever alternatives ( with some exotic names ) to PubMed , which allow for much more focussed searches. No more sorting through hundreds of papers you don’t care about to find the handful you were looking for–our search engine does it for you.

Vince Kuraitis has a very thoughtful comment on Search Engines Using Your Personal Health Information: Creepy or Cutting Edge? posted at e-CareManagement. Like all advances, this can be used for good or evil. I guess it’s going to be up to patients to decide whom they want to trust – and whom they don’t !

Bob Coffield also discusses PHRs and patient privacy when ruminating on HIPAA, privacy rights, who is (should be) the steward of medical information, and the pro/cons of patients (consumers) self treatment.

Larry Ferlazzo highlights a clever example of how web technology can be used to make the hospital a less scary place for children at Hospital Connection | Larry Ferlazzo's Websites of the Day... posted at Larry Ferlazzo's Websites of the Day.... I wish they allowed children to add their own comments to the site – this would make it a truly Web 2.0 application ! Kids can be surprisingly smart – and if children in hospital are given a chance to publish on a website ,I am sure they will come up with all sorts of clever things we can never predict. Wouldn’t this be a simple thing to do ? Why don’t we do it ? In fact, why don’t we allow all patients in a hospital the chance to blog or podcast – so we can learn more about their needs , and how we can meet them ?

Walter Jessen presents The Doctor’s Channel - A Media Snack for Doctors posted at Highlight HEALTH 2.0. In today’s fast-paced, hectic world, everyone is busy, especially doctors. With patient visits, paperwork and meetings, doctors have little time to learn from each other and the healthcare community. The Doctor’s Channel, an internet TV site for doctors, is a time-saving tool that offers doctors an informative media snack, enabling them to learn about the latest news, ideas and information quickly.
I am sure it’s just a matter of time before you will be able to can watch this on your mobile too ! This is the likely to become the newest form of CME ( continuing medical education).

There is an uptodate list of medical wikis at List of Medical Wikis – another great tool to get users to collaborate .

Everyone seems to be beating up on PubMed ( and with good reason, I think). Bertalan Mesko offers a possible solution ! Check out Scienceroll Search which is a personalized medical search engine powered by Polymeta.com. You can choose which databases to search in and which one to exclude from your list. It works with well-known medical search engines and databases and will evolve as more people use it and provide feedback !

Google continues to experiment with new areas and an interesting entry highlights its Predict and Prevent program which plans to use information and technology to “empower communities to predict and prevent emerging threats before they become local, regional, or global crises.”

Most people don't care much about Health 2.0 or 1.0 because they have a much more pressing concern - Can it help me lose weight ? Lots of people would like to know , and there's a great comment on this medical journal article with the heavyweight title, “Comparison of Strategies for Sustaining Weight Loss: The Weight Loss Maintenance Randomized Controlled Trial ” at the health 2.0 Blog. Lots of food for thought here !

How do we extract the signal from all the digital noise we are going to create ? The Digital Pathology Blog reminds us that we end up getting " more numbers and data in the chart to filter through which may be of minimal importance. "

Not everything about Web 2.0 is brand new. One of the interesting trends I have been watching is the proliferation of websites which rank and rate doctors and hospitals. There are many examples, including – While many doctors are uncomfortable with these sites ( and these ratings are full of flaws), in one sense these sites are another type of Web 2.0 technology, because they use the wisdom of the crowds. No one has developed a better system as yet – and while judging a doctor only on his bedside manner may not be the best way to judge his clinical ability, it will have to serve as a surrogate marker until we can come up with something better. Actually, doctors have always depended upon word-of-mouth marketing – and these websites are a highly evolved form of this kind of reputation grading.

Another great example of an old technology which allows effective user-generated content is the Bulletin Board. These have become much better – easier to publish and much easier to use. They are extremely popular amongst infertile patients – and even amongst IVF specialists. I use the one at ivfforum.net frequently , which provides me with a great way of interacting with other IVF specialists.

Finally, how we use some of these tools depends upon the lens with which we perceive the world. Clever entrepreneurs are setting up sites which allow patients to bypass doctors, so that they can take better care of themselves. A good example is Mymedlab which allows patients to order their own medical tests.

To summarise, I feel there are 4 major influences which will help patients to regain control over their healthcare.

1. Patients will keep their own medical records using a PHR ( Personal Health Record)

2. Information Therapy can be prescribed to them, tailored to their needs, based on their medical problems captured in the PHR

3. Web 2.0 technologies will allow them to form social communities to help and support each other

4. We can deliver this information to them 24/7 through their mobile, wherever they maybe, whenever they need it !

The next edition of the Medicine 2.0 Blog Carnival is at Digital Pathology Blog and will be live on 13rd of April. Please send in your entries !

Private sector can help overcome doctor shortage: Report-India-The Times of India

Private sector can help overcome doctor shortage: Report-India-The Times of India: "According to a Planning Commission report, while India is short of six lakh doctors, 10 lakh nurses and two lakh dental surgeons, Indian doctors who have migrated to developed countries form nearly 5% of their medical workforce.

'The group is of the view that the only way to accomplish this (bridging the gap in doctors) is for the medical education sector to be opened up completely for private sector participation."

I think this is a very ineffective way of trying to address this chronic problem. Governments have tried to improve the provision of healthcare services for many years by trying to train more doctors - or by providing a new cadre of "barefoot doctors". Unfortunately, all these solutions are doomed to fail because of the nature of the medical profession. Doctors ( just like bureaucrats and lawyers and all professionals) will always try to create more demand for their services - so that the more the doctors you produce, the greater will be the projected need for their services, which means this is a Sisyphean ordeal which will never succeed. Successive officials will continue trotting out the same old solutions in different garbs - but this will only serve to enrich a select few ( in this case, the politicians who own the private medical colleges).

A much more effective way of tackling this problem is to acknowledge that the secret does not lie in trying to improve the supply of doctors; but in helping patients make more efficient use of the existing doctors. The secret is patient education - and enlightened patients can make much better use of the existing healthcare facilities.

The trouble is that we do not respect our citizens . We do not think they are smart enough to be able to make these decisions for themselves . If we give them the right tools, I think they can ! Let's acknowledge the fact that the patient is the first medical decision-maker. She ( usually it's a she) decides when to go to a doctor and when to manage the problem at home; which doctor to go to; when to get a second opinion, and so on. Unfortunately, a number of times these are poorly informed decisions, because we have not taken the time and the trouble to help patients make well-informed decisions.

It's high time we looked at this problem with a new lens if we expect to resolve it !

The Health 2.0 Blog: Health 2.0, Computable Data Exchange, and The Sparse Information Model, by David C. Kibbe, MD MBA

The Health 2.0 Blog: Health 2.0, Computable Data Exchange, and The Sparse Information Model, by David C. Kibbe, MD MBA: "What I perceive that Health2.0 needs to adopt is a sparse information model for health and wellness. We need a way to unambiguously compute using a small but highly relevant core set of personal data, such as one's demographics (age, sex, etc.), insurance information, diagnoses and problems, medications list, allergies, and immunizations, etc. We should be thinking of the many low and medium value things that can be done with a sparse information model in Health2.0, rather than the much fewer very high value things that require oodles of health data."

Keep It Simple, Stupid is always good advise !

IVF clinics in Kenya

An IVF Task Force set up by the Ministry of Health in Kenya came and visited our clinic on Tuesday . They wanted to learn what they should do in order to regulate the provision of IVF services in Kenya.

They had numerous concerns , including whether it would be cost effective to provide IVF; and how to prevent exploitation of ignorant infertile couples.

Now I am not a big believer in regulation, but I did make the following suggestions.

1. Invest money in patient education, so patients have realistic expectations of what IVF can offer - and equally, what it cannot, so they will not be taken for a ride.

2. Set up an IVF clinic in the government hospital. It's possible to provide inexpensive cost-effective IVF services in a government hospital by not trying to ape the West. Kenyan women marry at a much younger age; and many of them have tubal factor infertility. The clinic should be run by a young gynecologist, who only does IVF and nothing else, so he quickly acquires the expertise and experience needed. He can start by selecting young women; and superovulating them with clomid or low-dose HMG, so the cost of the drugs is minimal. The capital equipment cost for starting a basic IVF clinic is about US $ 20000. Most hospitals already have an ultrasound scanner and the manpower - they just need to buy the CO2 incubators and the microscopes and a laminar flow hood. Once they start getting pregnancies ( after ironing out the teething problems), they can get more ambitious and start freezing embryos and offering ICSI. With this model, it would be possible to offer basic IVF services for less than US $ 300 per cycle on a cost recovery basis - since the manpower costs are zero ( doctors are already employed by the hospital) and the disposables and culture media would come to less than this amount.

3. This approach would create a win-win situation. It would allow the government to help infertile women - a basic service any Dept of Family Planning and Welfare should provide !
Once the government starts providing IVF services, this will automatically help to put a cap on how much private clinics can charge. Also, it will allow medical colleges to train the next generation of gynecologists, so they can provide IVF services for the future.

I am sure the Indian government could adopt a similar approach too !

The ubiquitous mobile phone can play a big part in helping you manage your health.

The ubiquitous mobile phone can play a big part in helping you managing your health: "A surprisingly large number of medical complications arise due to the patient failing to correctly follow prescription, failing to take medicine on time, forgetting to buy refills, altering doses. This “non-adherence” (as the doctors call it ) to the prescribed treatment leads to increase in hospitalizations as well. The underlying cause of this behaviour may be a hot topic for the research fraternity to ponder upon but one thing is certain, having some device to keep track and remind all these activities for you would definitely be a big big help!. The ubiquitous mobile phone can play a big part in helping you manage your health."

Even though India is an IT powerhouse and has thousands of doctors ( and millions of patients ! ) , there are surprisingly few innovative healthcare services being developed here. Yos Technologies , a company in which I am an investor, is a recent entrant in this space !

The Whole-Person Integrated-Care (WPIC) Wellness Solution

The Whole-Person Integrated-Care (WPIC) Wellness Solution: "What's necessary for people to change the way they think, feel and act in a way that promotes healthy living?

I assert that AWARENESS is the place to start. It's obvious that people have little incentive to change if they are unaware that they have health problems, risks, or are managing chronic conditions poorly. Things that can promote self-awareness are other people, media, and information technology. These people may be sick-care professionals (e.g., doctors, nurses and therapists); well-care coaches and counselors; family and friends; and even 'virtual acquaintances' through Internet-based social networking (Web 2.0)). Media include the web sites, TV, movies, newspapers, books, etc. Information technology includes health information systems, such as personal health records (PHRs) and online health data repositories.

In this post, I focus on the good and bad of health information technology for consumers since there is great debate about their usefulness.

I content that we are in the "Stone Age" of health information technology. Current day products are not very useful to the typical consumer, and could be much more useful to professionals. That's because the greatest value information is not obtained by simply having a place to store personal health data. Instead, value comes from using these data to help consumers and their healthcare professionals prevent physical and mental health problems, treat acute illnesses, and self-manage chronic conditions.

What's needed is an easy, low-cost way for data from health care providers and consumers, no matter where they are stored, to be transformed into useful information."

Doctor, patients connect through web portal

Doctor, patients connect through web portal: " Canada's first interactive patient health portal was launched in Vancouver yesterday, connecting doctors and patients over the Internet.

The Canadian Medical Association portal, called mydoctor.ca, allows patients to input their health information for the doctor to monitor.

'It is, in fact, an extension of the doctor's care, and the doctor's office,' said CMA's Larry Mohr, who designed the $2-million system.

The portal currently can track asthma, blood pressure and obesity. It will be expanded to include diabetes, smoking, mental health, prescription renewals -- even 'doctor e-visits.'"

Navigating a Changing Health Care System

Navigating a Changing Health Care System " Imagine a world in which clinicians delivered just the right information to their patients at precisely the right moment. Imagine that clinicians were able to focus their limited time helping well-prepared patients to put that information into perspective for their particular situations, guiding them to a decision that balances the best available scientific evidence with what matters most to them. Imagine that the collaboration continues over time, with clinicians delivering tailored information at the right time to help people consistently make informed choices and do their right things for themselves."

World Health Day Health Mela at HELP !

Using IT to improve healthcare for seniors

Using IT to improve healthcare for seniors As the demographic tidal wave of baby boomers approaches retirement and old age, our already challenged ability to meet the health care needs of the growing number of seniors is likely to be overwhelmed. This crisis demands fresh thinking and new approaches. Research suggests that certain emerging information technology (IT) applications show promise in improving health and safety for seniors at home by improving the flow of information among healthcare personnel, family members and seniors. But despite the appeal of these technologies, progress toward wide-scale deployment has been slow. This issue brief discusses the challenges facing seniors who are aging at home, and how technology can help promote their health and well-being.

Managed Care Plans Push PHRs

Managed Care Plans Push PHRs: "A growing number of health insurance companies are offering their enrollees some version of personal health records. They say these records can help them to provide consumers with timely information on how to stay healthy, among other benefits."