Monday, February 28, 2005

Great stress buster !

Great stress buster - for a few cents a day ! Just like an apple a day keeps the doctor away, a daily chuckle will help you live a longer, healthier and happier life. While it's true that email can add to your stress levels, this service by DailyInk which offers you a daily email of your favourite comic strips is a great way of starting the day. I actually look forward to checking my email every day !

The Times of India and AIIMS cure heart disease

The reporting of medical news in the media has always left a lot to be desired. An excellent example of this is the story which the Times of India carried on its front page on 25 Feb 2005. This was headlined, "AIIMS scripts stem cell success story." While I must admire the writer's alliteration skills, the story just carries the tall claims made by the All India Institute of Medical Sciences, New Delhi, without bothering to verify them.
Stem cells used to be the media's favourite medical story in 2001 when the NIH first released their report, Stem Cells: Scientific Progress and Future Research Directions. There was a lot of hype about how these cells would transform medicine as we know it, and these cells ignited the public imgaination as well, so that stem cell research became a "hot area" in medicine, and stem cell researchers became front page celebrities. Stem cell research attracted millions of dollars of funding, and entered the vocabulary of the well-informed lay reader ( which is quite remarkable, when you remember that even most doctors were quite clueless about these cells uptil 2001 !) Unfortunately, none of these claims withstood the passage of time, so that serious researchers moved away from the glare of the media, and went back to their labs to try to convert the potential locked up in stem cells into something which would be clinically useful for their patients. They all agreed that it would take a number of years before stem cells could be used for actual treatment, because so much more needed to be learnt about them.
Now the AIIMS claims to have
marked a global first by pioneering stem cell medicine by the "injection method", placing the institute right at the top of the world's medicine map.
I wish this were true, but it's not !
In their anxiety to scoop the rest of the press,
"here is an exclusive story only in the Times of India"
the reporter has relied solely on a lengthy exclusive interview with Dr Venugopal, the institute's director. Unfortunately, the story is just a concoction of hype , hope and plans for the future.
The lead paragraph describes
Ishika, a 7-month old baby with cardiac myopathy, who has had stem cells injected into her heart. As she flashes a toothless smile, her mother hopes that Ishika's will be another success story of stem cell research at AIIMS.
Is this the stuff of front page medical reporting ? A mother's hope ? What happens if Ishika does not do well ? Will the Times report this failure on its front page too ?
The next paragraph is
about a 70-year old stroke patient is also set to be injected with stem cells to improve his condition.
However, only a crystal ball can tell us whether he will really improve or not.
Finally, the story reports a
path-breaking study conducted from February 2003 to January 2005, where 35 cardiac patients were given stem cell treatment and monitored,
and
the statistics speak for themselves.

Actually, the study is not even path breaking. Stem cell injections to improve heart function were first done in France way back in 2000 and the world leader today is Germany , where the first studies were done in 2001. If you subscribe to New Scientist , how stem cell injections have been used for treating heart disease has been racily reported in their 25 September 2004 issue, in an article titled , Don't go breaking my heart.
If the reporter had bothered to do her homework, she could also have read the well-written article, CELL THERAPY: Renovating the Heart in Science magazine. This well-balanced article provides a very good historical overview, tempers the promise with the practical real-life clinical problems, and also highlights the risks associated with this treatment. ( These include life-threatening problems such as arrhythmias and the risk that the stem cells may develop into cells other than heart muscle cells). Reading the TOI article which describes stem cells as "magic cells", one would think AIIMS has discovered the elixir of life all by themselves, when in reality they have not even been the pioneers in the field.
Secondly, when the results claim that "56% of the affected areas injected with these cells have shown improvement", you know that statistics are being used to mislead. While the number sounds very accurate , reliable and therefore trustworthy, every cardiologist know that it's impossible to be so accurate. Heart muscle function is assessed by echocardiography, and it's impossible for this tool to provide this sort of accuracy.
Unfortunately, the journalist has broken all the basic rules for reporting. She has not bothered to determine if the study was published in a respected peer reviewed medical journal - after all, such a major breakthrough, if it were true, would be the lead article in Science, Nature and the New England Journal of Medicine ! Also, she has not bothered to interview other doctors, or ask them for their opinions - one of the cardinal principles of reporting !
Even simple common sense would have caused her to pause before filing her story. If it's so simple and effective, then why aren't all doctors all over the world doing this for their patients ?
Medical stories are too important to be treated so shoddily. Readers respect the Times of India, and TOI stories are supposed to be trustworthy. Such shabby reporting creates a lot of harm, for both patients and their doctors. It creates false hopes, which may never be fulfilled. You can imagine the avalanche of patients who will be flocking to the AIIMS; or who will be carrying the cutting to their doctors, demanding a "stem cell injection " for treatment !
It also damages the credibility of the newspaper - and of institutes like the AIIMS. If they cry wolf too often, no one will take them seriously the next time, or respect their research.

Protect yourself from quacks !

Protect yourself from quackery :
All of us would like to become younger, sexier and thinner, and to live longer! Given these universal needs, it is hardly surprising that quackery flourishes all over the world. 'Quackery' is derived from the word quacksalver (a throwback to the days when travelling salesmen would boast about the healing powers of their salves). Since quacks quack, quackery's paramount characteristic is hype and promotion rather than simply fraud, greed, or misinformation - though these qualities often go hand in hand!

Saturday, February 26, 2005

Coaching for Effective Communication with your doctor

Coaching for Effective Communication: Excellent guidelines on how to coach someone to prepare for their consultation with their doctor, so they can express themselves clearly !
Although it is most often thought of in conjunction with sports, coaching can be an aid to better performance in many areas. Even highly paid executives use coaching in order to improve their administrative skills. When you give people the opportunity to practice something and then give them feed back on the results, you are coaching them. Coaching is most useful when a person is interested in trying a new behavior.
In this case, you can use coaching to improve your ability to discuss medical alternatives with your doctor.

Use This Pattern to Dialogue

Present the problem: When (describe the problem), I feel (describe the feeling) because (give the reason), Example: When you say that I need to have surgery next week, I feel apprehensive because I'm afraid that I'll have to give up breastfeeding, which is very important to me.

Listen to the doctor. First respond by demonstrating that you were listening: As you see it, it is vital that I have this surgery now and though it may interrupt breastfeeding, you feel certain that it is for the best.

Second, respond with a question: Is there any possibility that the surgery could wait six weeks?

Share information: l have been doing some research on the subject and I read that...

Make a request: Could you tell me more about... ?

Set a limit: I'm not willing to wean my baby right now.

Recycle the process three to five times as needed.

Thursday, February 24, 2005

Video Games Train Surgeons

"Video Games Train Surgeons": So the next time you see your child playing video games, remember he's honing his future surgical skills !

MyHealthTestReminder.com

MyHealthTestReminder.com
Here's a great way of reminding yourself when you need your next health checkup !

Wednesday, February 23, 2005

Using mobile phones to make a medical diagnosis

Using mobiles phones to reach a doctor Clever new uses for a better and faster way to make a diagnosis !

How To Communicate With Your Doctor Using Email

How To Communicate With Your Doctor Using Email The title says it all. Most doctors are still reluctant to use email to talk to their patients, and this article presents a great way of persuading your doctor to do so. It will help him and you as well !

E-patients

E-patients In the days
when the Net resembled the Wild West, Dr Tom Ferguson played a leading role in promoting the idea that patients could use it intelligently to help themselves. Unfortunately, this site has not been updated for a long time, but it still gives a good flavour of what patients did on the Net - and can do even today !

Tuesday, February 22, 2005

Is a little knowledge dangerous ?

A lot of doctors try to put patients "in their place" by showing them how little they know. Also, many family members discourage patients from getting information about their problem, by suggesting that: medicine is too complex; it will all go "over their heads"; and that "the doctors knows best". While it is true that a little knowledge can be dangerous, ignorance ius far more harmful ! A good doctor will help you build on your knowledge-base, rather than try to insult your intelligence or pooh-pooh your efforts to become better informed.

Email as the preferred mode of doctor-patient communication

I always request my patients to email me rather than phone me for non-urgent matters. I find this is much easier for them - and for me ! I reply to all emails within 24 hours - and since they have to write down their queries, they are well-organised and ask much better questions, so my answers are better. Also, since I give them a written reply, there is much less scope for misunderstandings ! This way, we don't have to waste time playing telephone tag also !

Any more questions ?

I always end all my consultations by asking my patients - "Do you have any more questions". Most say that they don't. And my reply is - "I worry when patients don't ask questions - no questions means you have not understood anything - or you've understood everything - and I can't give you a pop quiz to find out which is true !" I find this helps patients to ask questions and clear their doubts - so they don't need to call me at 10 pm !

Patients' unvoiced agendas in consultations

Patients' unvoiced agendas in consultations:
"Patients have many needs and when these are not voiced they can not be addressed. This suggests that when patients and their needs are more fully articulated in the consultation better health care may be effected. Steps should be taken in both daily clinical practice and research to encourage the voicing of patients' agendas. "
But just like good doctors encourage patients to ask questions, you should also remember that your doctor cannot read your mind - speak up !

Autopathography: the patient's tale

Autopathography: the patient's tale : "The case history was invented by Hippocrates. Since then medical practice has been straitjacketed by its artificiality, to the detriment of the patient's own narrative. But patients have found ways of expressing themselves other than by talking to their doctors. Over the past two years I have been collecting a bibliography of book length autobiographical medical narratives, each completely or largely devoted to the writer's personal experience of drug use or illness. My growing list currently runs to about 270 titles. " Trust doctors to coin long words to describe a simple story written by the patients ! "Autopathographies are 'medical confessionals,' but I prefer to call them 'patient's tales'---or, as Kipling might have put it, 'plain tales from the ill.' You don't need to write a book about your illness, but keeping a diary will help you unburden yourself ! These books can serve as useful models !

Making sense of medical news and headlines

Making sense of medical news "We are now awash in a flood of health information, and barely a day goes by without a report of a spectacular new cure for a formerly incurable illness. However, many people find themselves increasingly frustrated in the face of the media barrage of confusing and contradictory health advice. One day, drinking alcohol is bad for your health; the next day it is reported to help prevent heart disease. One day, margarine is healthier than butter; the next day it's not. One day fish prevents heart disease, then it doesn't! You may be exasperated enough to ask: Why can't researchers get their facts right the first time? And how are you supposed to make sense of what you read, if the experts themselves can't make up their minds?"

Saturday, February 19, 2005

RemedyFind

RemedyFind.com: Being ill creates enormous distress, and trying to make sense of all the treatment options available can be enormously confusing. This celever website tries to create an online patient community so patients can share their experiences and guide each other.
At Remedyfind we've listed the different treatments (remedies) that are used for specific health conditions. By giving a number rating to those remedies you have tried, you are able to share your personal health experiences with others. Obviously, there are no guarantees that what works for one person will work for another. Still, by quantifying the results of our actual experiences - both good and bad - our goal is for Remedyfind to be an invaluable resource for us to use in becoming better informed about our health.

Chronic Illness Coach

Chronic Illness Coach Patients with a chronic illness often find that they are lost and there is no one to guide them. While doctors provide them with the medical care they need, they often need help on how to cope with life. Here's an excellent website from someone who has "been there and done that" who offers guidance and advise in the form of coaching.
A chronic illness coach listens to a patient’s story - the problems and limitations they face because of their illness, what they’ve learned about life through their illness, and their hopes and dreams for the future. The coach then works with the patient to come up with specific strategies to help improve the individual’s daily life, and to make them feel more empowered to take charge of their health and disease management. This may involve an effective way to deal with the medical system to get the best possible treatment and care, or to help the patient create a strategy on ways they can achieve their personal goals. Ideally, sessions with a chronic illness coach will help the patient regain a feeling of control, positive expectation, and joy in living. Chronic illness coaching can be done through face-to-face meetings, telephone calls or email.

Thursday, February 17, 2005

BODYWORLDS- Living Human Anatomy

BODYWORLDS- Living Human Anatomy
This is an amazing site - one of the "must-sees" on the web. Gunther von Hagens has invented a technique called plastination, which allows him to display real human bodies after stripping off their skin, so you can admire your insides. However, this is not just a gory display of inner guts. This creative artist displays the bodies very imaginatively, so you appreciate even better what a work of art Man is ! A picture is worth a thousand words, so you've got to see this to believe it. What an inspiring way of learning about human anatomy !

Ask a Patient: Medicine Ratings

Ask a Patient: Medicine Ratings and Health Care Opinions
Here's an interesting twist. This site provides patient feedback on medications they have tried and what their experience with the medications have been. I guess it's worthwhile to hear things from the end-user's perspective, especially for medications like Viagra and acne treatment. This is onw way of getting more "end-user input " into the " healthcare industry " !

The Silent Health Care Epidemic

The Heartland Institute - The Silent Health Care Epidemic - by Conrad F. Meier A silent epidemic threatens the health of millions of people living in the United States; has no regard for age, race, education, or income level; is estimated to cost billions of dollars a year; is immune to preventative care and can’t be detected with a physical exam, blood test, or any high-tech diagnostic procedures.
Can you guess what it is ?

PatientPower - online patient medical records

PatientPower
Here's a clever way of storing your medical history and records online - and you can't beat the price - it's free !

Total Quality Management - Can It Be Applied to Medicine?

Total Quality Management - Can It Be Applied to Medicine?
Thought provoking article on why you cannot equate the "healthcare industry" with other industries; and why managed care often ends up as beig mismanaged care.

Tuesday, February 15, 2005

Media Doctor

Media Doctor: Media Doctor is a web site dedicated to improving the accuracy of media reports about new medical treatments. The media plays a very important role in disseminating information about recent medical advances to patients - but unfortunately, they often do a bad job in their desire to make medical stories "newsworthy". This usually means inserting "human interest", putting a spin , adding a "hook" or leaving out important facts. Hopefully, the independent and objective critiques at this site will help them improve !

Monday, February 14, 2005

Best Treatments

Best Treatments : There are often many treatment options available to treat any given medical problem, and this profusion of choices often leaves patients confused. How do you decide which is best ? Is your doctor advising surgery because it's the best for you, or the best for him ? Fortunately, the NHS of the UK has done a lot of this homework for you, to help you decide which the best choice is, based on EBM - evidence -based medicine, and this clever website will help you make a better informed decision.

Learn how not to talk to your doctor by watching this video !

"Do you ever feel you're wasting your GP's time?": Very clever video from the BBC, to help you to talk to your doctor. I wish all my patients would see this video clip, so they could polish their communication skills !

Talking to Your Doctor - Tips from the BBC

Talking to Your Doctor : Useful tips on helping you to talk to your doctor.
In the UK, the GP ( general practitioner) is the family physician and is the entry point to the National health care system.

Friday, February 11, 2005

Instant Medical History

Instant Medical History provides an excellent first person account of how a physician found his medical practise improving dramatically after he started using computer software to take a medical history from his patients. Maybe you should suggest this to your doctor ?

The patient-computer interview: a neglected tool that can aid the clinician.

Entrez PubMed: "The patient-computer interview: a neglected tool that can aid the clinician." Doctors are often too busy to talk to patients or take a proper medical history.Ironically, studies have shown that :
1. doctors interrupt patients with a few seconds of the start of the consultation; and
2. an accurate medical history is the most important diagnostic tool in medicine today.
If doctors can't be bothered to talk to their patients ( too busy ? too boring ?), then it makes a lot of sense to teach computers to do so !

Thursday, February 10, 2005

Prescribing Information !

Just like doctors prescribe medicines, they need to prescribe information as well, so that patients can become partners in their medical care. The Center for Information Therapy has taken a leadership role in thia area.
Information therapy is the prescription of the right information to the right person at the right time to help people make wise health decisions. Correctly prescribed, information becomes medicine — powerful medicine. It can be as critical to good health as any test, medication, or surgery.
And if your doctor does not prescribe the information, you can always self-prescribe !

Knowledge is power !

We all know that knowledge is power, and one would therefore expect patients to realise how crucial it is that they be well-informed about their medical problem . However, in real life, this is a concept to which most doctors and patients only pay lip-service to. While one could understand why doctors may not be very keen on educating their patients ( too time consuming; too boring; no reimbursement), why don't patients take a more active role in seeking out information ? Are they too intimidated ? unsure of their abilities ? worried about what they will find ? scared of asking questions ?

Wednesday, February 09, 2005

Researching the medical literature

If you have a complex or rare problem, you may need to do extensive homework in order to find the best solution to your problem. You may need to research the original medical literature ( medical text books and journals) in order to find out more information. Ideally, your doctor would do this for you, but doctors are busy people, who don't have the time or energy to do so. Why not offer to become an unpaid "research assistant" to your doctor ? You can volunteer your services to hunt down relevant information from the medical literature. While this may seem to be a daunting task, armed with a medical dictionary and with the assistance of a helpful medical librarian, you will be amazed at how much you can dig up. The literature is very structured, so it's easy to find stuff. The trick is in iterative searching - doing it repeatedly, till you hit pay dirt ! You can also search medical journals and textbooks online, via services such as MDConsult, to which your doctor may have subscribed.

Tuesday, February 08, 2005

How good is your doctor really ?

Most patients judge doctors purely by external appearances, such as: bedside manner; reputation; hospital affiliations; clinic decor; and how the phone is answered. Most take the doctor's technical competence for granted - after all, aren't most doctors equally good ? However, there is no doubt that doctor's skills can vary widely - and how good your internist is at unearthing rare problems or how well your surgeon wields the knife in the OR can make a world of a difference to you ! But how do you judge who is the best at handling your particular problem ? This is an amazingly complex question to answer, and The Bell Curve in The New Yorker by Dr Atul Gawande provides lots of food for thought - for all patients, and their doctors as well.

Doctors too have a sense of humour !

Some patients may find this hard to believe, but doctors too have a sense of humour. A lot of this may be "black humour" but this is often a useful coping tool. One of the best websites for humour for doctors is Hippocritis - and it'll make you laugh, whether you are a doctor or not !

Helping your doctor when he is stumped - using AI to make a difficult diagnosis

If you are unlucky and have a complex problem, you may find that your doctor is stuck and may not be able to make the right diagnosis. When doctors are stumped, they often order more tests, or ask their colleagues and specialists for help. However, if this fails to resolve the problem, you might want to suggest to your doctor ( tactfully, of course !), that he may want to use an expert system to help him with making a diagnosis. Medical expert systems use artificial intelligence, and two of these systems are robust and have been proven to be useful in clinical practise. The oldest system is Dxplain, a decision support system, and was pioneered at the Massachusetts General Hospital. It is available online at Merck Medicus. The new kid on the block is Isabel and this
gives the clinician a reasonable and relevant list of likely diagnoses for a given set of clinical features (symptoms, signs, results of tests and investigations).
. These systems can be extremely useful, but unfortunately, most doctors are still not aware of them , which is why they are still very under-used. Merck Medicus is free for all doctors in the US; while Isabel charges a subscription fee for access.

When not to go to your Doctor !

Today I saw a young couple who'd been married for 4 months and were worried that they had not yet got pregnant, even though they had been having sex frequently. I needed to sit down and explain some of the facts of life to them - the most important one being that Nature is not efficient at making babies, and it can take normal fertile couples as long as 1 year in order to conceive. I requested them to be patient and continue trying on their own - after all, it's much more fun making babies in the bedroom than going to a doctor !
Many patients misuse their doctor's services by seeking medical help for problems which are self-limited, and will get better on their own. It's just as important to know when not to go to your doctor !

Monday, February 07, 2005

Share your story ! Start a blog and stop being just a cog

Sometimes patients feel they are just cogs in a big wheel. However, the goal of medical science is to improve the care provided to patients, and patients can play a key role in helping to shape and improve this care. One of the best ways of doing this is by speaking up - and letting your doctor know what you are experiencing and what you expect. If more patients kept blogs, this would help interested doctors appreciate the patient's perspective with greater ease.

How good is Candian health care ?

Fraser Institute
This well-written report is a relatively painless introduction to the "big picture" way of looking at how governments plan and provide provide health care delivery to their citizens. When you are a patient and are suffering, you want the best medical care from the best doctor - but the sad fact is that this is not feasible for most of us. Health economics explains the limitations and constraints under which the medical system has to function.

Sunday, February 06, 2005

Medical Economics - 9 things you should never say to a patient

Medical Economics - 9 things you should never say to a patient
An excellent article which teaches doctors the basics of being service-oriented. All clinics should be patient-oriented - is yours ?

Help yourself by helping others

All great religions convey the same message - the best way to grow is by helping others. This is very true if you have a medical problem, too; and many patients find that the best way of helping themselves is by helping others. There are any ways of supporting other patients ! Join a support group - or start one ! Participating in bulletin boards on the net and providing insights based on your personal experience can be invaluable to others who have been newly diagnosed and are lost. Make constructive use of your suffering - you will become a much better human being as a result of this.

Friday, February 04, 2005

State Of Fear by Michael Crichton

I am thoroughly enjoying reading this book, and trying to make it last as long as possible ! It may not be a very good thriller, but if you read it as a science book, to educate yourself about global warming, you'll understand why I am so thrilled with it.
I have always enjoyed reading Dr Michael Crichton - and he is an excellent example of a superlative edu-entertainer - someone who can take complex scientific concepts and present them entertainingly , so that the reader can understand the facts.

Chicago Tribune | Fertility tourism is born

Chicago Tribune | Fertility tourism is born
This is an excellent example of how patients are actively seeking out treatment options, so that they can get the best treatment for themselves - treatment which is affordable and cost-effective. They are now no longer limited by what their local doctor offers them.
Information Therapy by Kemper, Mettler

This is an extremely well-written book about why information should be considered to be as powerful a therapeutic intervention as a drug !

Thursday, February 03, 2005

Why do different doctors have different opinions ?

Many patients get very confused when they get a second opinion which differs from the first, and often don't understand how two different doctors can have such widely varying viewpoints. Remember that medicine is an inexact science, and there are often many ways of skinning a cat, all of which may be equally effective ( and painful !)
Often, differences exist when medical science is not certain about the best way of dealing with a certain problem. The latest buzzword to try to promote consistency amongst doctors is EBM, or evidence-based medicine, but it's a fact that applying theoretical knowledge in clinical practise is still an art, and cookbook protocols laid down by HMOs still leave a lot to be desired.
Often, a doctor's personal philosophy will decide what option he prefers. For example, I am very conservative, while others are quite happy to jump on to the latest bandwagon currently in fashion. These are both valid choices, but you need to be sure that your doctor's philosophy and yours are similar ! I believe that every patient gets the doctor they deserve ( and this is equally true the other way round as well !)

The doctor can't read your mind

I just saw a patient who was waiting for his IVF ( in vitro fertilisation) treatment, and he seemed very tense and nervous. I asked him the reason, and he seemed very embarassed and hesitant. After considerable prodding, he finally blurted out, " Doctor, I am very scared about the possibility of my sperm being mixed up with someone else's in the IVF lab ".
I took him in the lab and showed him how we ensure this doesn't happen, after which he was much happier and very relieved.
The moral of the story is simply - The doctor cannot read your mind ! Let him know what your worries are, so he can allay them - after all, that's his job !
Remember, there is no such thing as a stupid question. " The only stupid question is the one you don't ask !"

What doctors can learn from quacks

Mid-Day, Bombay's leading afternoon paper has just published a list of 250 quacks in Bombay. This list was compiled by the Bombay Municipal Corporation, which is flexing its muscle to show the lengths it is willing to go to in order to protect its citizen's health. This is just the tip of the iceberg, of course - there must be at least 25000 quacks in Bombay !
However, the point I want to emphasise is that quacks have a much better bedside manner than regular qualified doctors do ! Since they aren't burdened with much knowledges, their entire livelihood depends on their ability to communicate with their patients. Regular MB,BS doctors should learn the art of patient communication and empathy from quacks !
The reason quacks do well is a little secret your doctor may not want you to know - 50% of what takes you to the doctor is because of a self-limited problem, which will get better, whether you go to the doctor or not. Often, all the doctor has to do is to hold your hand till Nature heals you - and quacks often do this much better than most regular MDs !

Wednesday, February 02, 2005

The impact of a highly motivated patient on treatment outcomes

There is a lot of research on how the experience and expertise of a doctor and hospital can affect the treatment outcome of a medical procedure. Thus, surgical teams which perform a large number of bypass surgeries have better results as compared to surgeons who do an occasional bypass operation.
However, no one has studied how the patient's motivation affects the treatment outcome. I have found that determined, well-informed and highly motivated patients do much better than others. They are active participants in their medical care, and can significantly influence the results of their treatment.

A little about me

I enjoy reading blogs, and am very curious about the author. Who is he ? Why does he write ? What does he do when he is not blogging ?
I guess my readers ( and may their tribe increase !) may want to know more about who I am.
Like all of us, I wear a lot of hats. Professionally, I am an infertility specialist, and run an IVF clinic in Bombay, India .
I am also a patient advocate, and run India's only patient education resource center. HELP - the Health Education Library for People.
I am an author, and have written 3 books, including: How to Get the Best Medical Care - A Guide for the Intelligent Patient);
and Successful Medical Practise - Winning Strategies for Doctors.
I have a lovely wife , Dr Anjali Malpani; and two beautiful daughters, Natasha and Sanjna.

Improving doctor patient communcation

Millions of dollars are spent on trying to teach medical students, residents and practising doctors communication skills, so they can talk to their patients in simple English. I feel this is the wrong end of the stick, and this money could be much more productively used in order to teach patients how to talk to their doctors. Patients need to learn some basic tools, so that they can get their doctors to listen to them and to understand their problems and desires.

The problem with trying to teach doctors is that good doctors don't need to be taught;and bad doctors will never learn !

Patients, on the other hand, are much more motivated - after all, they have much more at stake !

Tuesday, February 01, 2005

Dealing with difficult doctors

Just like some patients can be "difficult", so can some doctors ( though this is not something most doctors would acknowledge - at least not about themselves !) Doctors can be rude; inconsiderate; hurtful and insulting.
A good example would be the doctor who answers a patient's queries by saying - "Are you the doctor or am I ?" These doctors have an inflated sense of self-worth, and enjoy
putting patients in their place.
Patients need to remember that no doctor can survive without patients, and there is no need for you to put up with such behaviour. Medicine is a service profession
and any doctor who is not willing to serve his patients is not a good doctor.
Sometimes patients get intimidated by a doctor's reputation or his entourage of
assistants, but you cannot afford to leave your brains or your self-respect at home when you visit your doctor !
If you are fortunate enough to be paying your doctor ( fee for service), your best option would be to walk out. But even if you are in an HMO, you still have options, so don't feel helpless !

Helping patients to make sense of medical research

Often doctors are worried that patients will not be able to understand complex medical issues and will get confused by medical jargon. This is why many of them will oversimplify matters, or talk down to patients. However, it's important to remember that all patients are different , and many are very analytical and intelligent, and quite capable of doing their own research and making their own deicisons. Often intelligent patients are the best medical research assistants - and they do it all for free !

Doctors may need to guide them in the beginning, to help them sort out the wheat from the chaff, but patients are highly motivated, and can learn very quickly. Many of the clever ones will end up teaching their doctors too !

Earning your doctor's respect

If you want your doctor to respect you, you need to earn this respect !
There are some simple rules to follow.

The first one is the Golden Rule - treat your doctor the way you would like him to treat you ! If you want him to respect you, you need to respect him ( and his staff )as well. Be punctual; help him to help you by carrying all your medical records and paperwork; organise yourself so you can make effective use of his limited time; and prepare for your visit by doing your homework !
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