Wednesday, November 30, 2005

Medspeak - making sense of medical jargon

I recently had a patient who had a hysterosalpingogram done and she commented - " How do people think of names like this !" Medical jargon can be intimidating, but it wasn't invented to keep patients in the dark !

Patients often complain that they can never understand anything their doctor says. This usually because doctors use medical jargon --- but you should never get intimidated by this! You just need to remember that such jargon is simply a convenient shorthand which doctors ( and other health care professionals) use to communicate with each other. Since these words are often derived from the classic languages ( Greek and Latin), they may sound unfamiliar and difficult to understand, but if you devote enough time and take enough trouble, you can definitely do so. Remember that it's not a secret code which is being used to keep you in the dark! If you have difficulty in understanding medical terms, you can ask your doctor to help you. Nurses, or family members in the medical profession, can also provide guidance. However, the easiest way to go about making sense of the jargon is to sit and decipher it with the help of a medical dictionary and a medical encyclopedia: the effort can prove very worthwhile! Spelling counts, and the first and most important step is to find out the proper medical terms and their spelling. Therefore, ask your physician (or the nurse or assistant) to write these down, as related to your specific case.

The words - or terms - which make up the language of medicine are referred to as the terminology of the medical field, or medical terminology. Like every other language, medical terminology has changed considerably over time, but the majority of the terms are derived from Latin or Greek.

As with all words, most medical terms can be broken down into one or more word parts. Basically, there are four possible parts, and any given medical term may contain one, some or all of these parts:

1. Roots,
2. Prefixes,
3. Suffixes, and
4. Linking or combining vowels.

Thus, if we analyse the word hysterosalpingogram, we see:
hystero = uterus
salpingo = tubes
graph = picture, which means that this is the name for a procedure which is used to take pictures ( X-rays) of the uterus and tubes !

You can also learn how to make sense of medical jargon !

This Man Wants To Heal Health Care

This Man Wants To Heal Health Care: Brailer, is the "national coordinator for Health Information Technology in the Health & Human Services Dept. Yet his task is sweeping: Give every American an electronic record of their health care by 2014, and link all the records into one giant medical Internet, called the National Health Information Network Inc. (NHIN)." What a challenge - and what an opportunity !

HealthBlog - following in Microsoft's footsteps ?

HealthBlog: "Microsoft is leading the way in using technology to open the lines of communication between our employees and the doctors who care for them. Prior to joining Microsoft in 2002, I co-founded a company that did some pilot work with Microsoft on technology allowing MS employees to access medical information, securely exchange e-mail with their personal physicians, and even schedule and hold 'virtual office visits' with their doctors using video web conferencing. We learned a lot during the pilot. First and foremost, we learned that patients really like being able to correspond with their physicians by e-mail, and physicians enjoy providing clinical cognitive services electronically when they get paid for doing so. We also learned that such technology enhances the physician-patient relationship, and more importantly, that our employees didn't abuse physicians with unnecessary or unwarranted communication." If Microsoft can do this, why can't we ?

MyHealthTestReminder.com

MyHealthTestReminder.com: "To help you remember to schedule your regular screening tests and blood donations, the College of American Pathologists encourages you to sign up for an e-mail reminder today. You can choose any date you like, and a message will be sent to the e-mail address you specify reminding you to schedule your screening test and/or blood donation appointment. " Clever use of technology - make use of it !

Really Personal PHRs - iHealthBeat - Daily News Digest on Health Care Information Technology

Really Personal PHRs - iHealthBeat - Daily News Digest on Health Care Information Technology: 'a marketing plan is crucial,' and health IT for consumers should be marketed as such.
We should look to a Procter & Gamble-type mindset of rich consumer insights to understand just what might make PHRs ( Personal Health Records) desirably 'personal' to consumers. P&G understand consumers' demands, as do the pharmaceutical companies that, whether you like it or not, have convinced consumers that they need prescription drugs for sleep deprivation and sexual dysfunction. " Sometimes patients may not know what's best for them - we need to educate and explain to them how PHRs can help them get better medical care !

Save the Patient card - print , clip and keep !

Save the Patient card Here's a useful resource you should carry in your wallet - it's likely to be more useful than a credit card when you visit your doctor !

At A Tipping Point: Transforming Medicine with Health Information Technology

At A Tipping Point: Transforming Medicine with Health Information Technology We are now seeing a renaissaince of interest in e-healthcare. Now that the technology is much more mature, and internet penetration far greater, are we ready to apply this technology to improving medical care ? Or are we going to make the same mistakes we did 5 years ago ? Are there enough doctors around who remember the lessons from the last time, to make sure we do a better job this time around ?

Healthcare Informatics: Customer Service

Healthcare Informatics: Customer Service: "'What patients wanted was to be able to talk to us, and we found patients are a lot smarter than we give them credit for,' says Barbara Walters, M.D., senior medical director. 'The patients write thoughtful, well-composed, insightful notes that to us are very surprising.' The quality of the emails also suggests that patients understand physicians' time constraints and inability to answer a bevy of messages from them, she notes."
I am glad that doctors are finally learning that patients are smart and intelligent - and capable of taking care of themselves ! As doctors, we need to give our patients the tools so that they can do so - and technology can help us to do this more efficiently. Doctors need to learn to use the web intelligently to reach out to many more people !

My Medical Record .com Patient Controlled Patient Managed Medical Record Information

Patient Controlled Patient Managed Medical Record Information: "The seven patient and consumer principles endorsed by the Personal Health Technology Council are:
1. Individuals should be able to access their health and medical data conveniently and affordably.
2. Individuals should be able to authorize when and with whom their health data are shared. Individuals should be able to refuse to make their health data available for sharing by opting out of nationwide information exchange.
3. Individuals should be able to designate someone else, such as a loved one, to have access to and exercise control over how their records are shared.
4. Individuals should receive easily understood information about all the ways that their health data may be used or shared.
5. Individuals should be able to review which entities have had access to their personal health data.
6. Electronic health data exchanges must protect the integrity, security, privacy, and confidentiality of an individual's information.
7. Independent bodies, accountable to the public, should oversee local and nationwide electronic health data exchanges. No single stakeholder group should dominate these oversight bodies, and consumer representatives selected by their peers should participate as full voting members.


'When all Americans have the ability to review their own medical records online, we then will begin to see a health care system that reduces disparities in medical care, and increases the quality of care for all Americans,' said John R. Lumpkin, M.D., M.P.H., senior vice president and the director of the Health Care Group for RWJF. 'People want to take advantage of health information technology, but they need to trust that the new information environment respects their privacy and ensures the security of their information. Therefore, the new health information technologies that are being created, as well as the health information environment itself, must focus on consumers' concerns about privacy, security, and personal control.' "

Sunday, November 27, 2005

Will praying help to improve a low sperm count ?

A patient just asked me if praying would help to improve a low sperm count. My knee jerk response was - Of course not ! But then I thought a little bit more about my reply, and modified it. " While praying may not help to improve the sperm count, it can definitely help you to cope with the problem - and its consequences - far better".

I feel that prayer, and belief in a higher being , provides hope and succour when doctors may fail - and as a doctor, I try to encourage my patients to make constructive use of these beliefs.

Saturday, November 26, 2005

Redesigning hospitals

While hopsitals can be very comforting, the biggest complaint patients have about hospitals is the fact that they are impersonal and bureaucratic.

I feel the best way of working around this problem is by allowing doctors to run the hospital. Today, hospitals are run by administrators, who are often only interested in the "bottom-line". Doctors, on the other hand, understand how important it is for them to keep their patients happy !

The best model would be a co-operative hospital, which is run by managers, but where the doctors are owners. Doctors could be treated as the shop-owners in a mall - the hospital would lease them consulting room space; as well as provide their patients with in-patient rooms, nursing care and theatre and lab facilities, for which they would be charged, but the ownership of the patient ( customer) would reside with the doctor.

Traditionally, most hospitals were started as small facilities, by individual doctors, to serve the needs of their own patients. This was a very successful model, because it allowed the doctor to provide his patients with personalised care very inexpensively, beause there were few overheads. However, as medical technology started growing by leaps and bounds, the capital equipment costs, space and infrastructure needed for taking care of seriously ill patients became so humoungous that these needs could only be met by large hospitals, which were very expensive to setup.

This is where governments, and then universities stepped in. While the purpose of government hospitals was to provide care to their citizens; and the goal of university hospitals was to further medical research and to train medical students and residents, corporates got on to the bandwagon and started setting up hospitals to earn profits.

We need to reinvent the hospital, and we can learn a lot from the hospitality industry, which offers tourists a wide range of options - all the way from inexpensive "bed and breakfast " accomodation to luxury upmarket 5 star hotels. It's a good idea to offer the patient a choice - and often for simple procedures ( such as childbirth and elective surgery), a simple basic hospital is far more cost effective.

This is why custom designed "day care surgery units" have done so well in the US. Why can't we extend the model and use it to manage simple medical problems which require hospitalisation ? We could have Level I hospitals, which would take care of the "bread and butter" basic problems; and the Level II hospitals, which would take care only of the seriously ill patients with complex problems. This would be a much more effective use of limited resources, and help to keep costs down !

This has been successfully done in India for many years; and an excellent example is the 100-bed Shusrusha hospital in Bombay, which provides very high quality medical care very inexpensively. Unfortunately, the current craze is to ape the West, and everyone is competing to build 5-star deluxe corporate hospitals , which cost the earth, and are prohibitively expensive !

Thursday, November 24, 2005

The doctor's power

Patients hang on to every word a doctor says, which means doctors wield immense power with what they say - and with what they don't as well ! Unfortunately, most doctors don't realise the importance and impact of their body language, because this is not something anyone teaches them, as a result of which they often mess up the verbal and non-verbal signals they transmit. Every doctor should remember that they are an "actor" in the consultation room, and they are performing for an audience of one - their patient !

OR-Live: Live and On-Demand Medical Healthcasts

If you've wanted to know what goes on in the operation theater, here's a website you'll love ! The Independent comments: "Major surgery has always been mystifying as well as frightening. A life hangs in the balance while the surgeon deploys his or her skills - but always in secret, behind closed doors. Now, anyone can get a grandstand seat at the operation itself. Like armchair travel, armchair surgery is a reality. Thanks to modern technology and the internet, it is possible to see for the first time how surgeons insert a knife into a patient's chest and stitch new blood vessels on to their failing hearts. Surgeons perform 3 million operations a year in Britain and most people about to go under the knife never question the competence of the person holding it. The website OR-live.com offers video footage and live broadcasts of operations as they should happen, but without the swooning relatives, bitching interns and conscience-stricken surgeons trying to do what's right for their patients."

Tuesday, November 22, 2005

The Indian healthcare industry is maturing !

This is from the Business Standard . " The Anil Dhirubhai Ambani Enterprise (ADAE) group is planning to foray into retailing of pharmaceutical products. Industry sources said most organised players in the market such as Planet Health, Apollo Pharmacies or Zydus Cadila group’s Dialforhelp had over 1,000 to 2,000 sq ft stores. A number of MNCs and other local companies is exploring the possibility of entering this highly lucrative retail business. Some of them are also scouting for partners and may enter the country very soon."

An organised drug distribution network will be very valuable for patients, as it will help to reduce the menace of spurious drugs.

However, this is going to be a very competitive space, and the retail drug network which pampers the patient is likely to thrive. Patients are going to demand amenities such as free home delivery, and this is unlikely to be a USP or differentiating factor. However, the network which invests in patient education ( for example, publishing printed materials about drugs and common diseases; offering their customers websites with a personal health record option so patients can access their medical data online; a drug-information helpline; SMS services on mobiles to remind patients to take their drugs on time; patient support groups to facilitate patient to patient networking; and real world events such as lectures and presentations by doctors on disease management ) will do very well !

Can you really trust your doctor ?

The secret of getting good medical care rests upon being able to trust your doctor - but how do you know if your doctor is really trustworthy ? There are 3 types of doctors:
1. honest and competent
2. honest and incompetent
3. dishonest

All of us would like to find a doctor who is honest and competent; and all of us fondly imagine that our own personal physician is in fact honest and competent ! But the sad fact is that some doctors are neither - and it's very hard for a patient to judge !

Thus, going by reputation or hospital affiliation is too dicey ( for example, the Head of the Department may be the head just because he is the hospital trustee's son-in-law ! ) A good bedside manner also is not enough ! Honest and incompetent doctors have excellent bedside manners, but poor clinical skills - and can mess up your treatment !

The most dangerous doctors are the ones who are dishonest. They may very well be competent and technically skilled, and they often have an excellent bedside manner ( because they need you to trust them unconditionally); but they only have their own interests at heart.

The only way to protect yourself, is to follow the axiom , "Trust, but verify !". You need to countercheck your doctor's recommendations , and this is why time spent doing some homework and research on the net or at your public library is so important. If what he says is corroborated by trusted authorities, then you can afford to be more trusting !

Sunday, November 20, 2005

Amazon.com: Let's Put Consumers in Charge of Health Care

Amazon.com: Let's Put Consumers in Charge of Health Care " Businesses spend billions on health insurance. And what do they get for their money? A lot of unhappy employees. Workers fret about the quality of the care they receive, the burden of their out-of-pocket expenses, and the gaps in their coverage. For businesses, health care has become a lose-lose proposition: They pay way too much, and they get way too little. The problem is that the health care industry has been shielded from consumer pressure--by employers, insurers, and the government. As a result, costs have exploded even as choices have narrowed. But if companies embrace a new model of health coverage--one that places control over both costs and care directly into the hands of employees--the competitive forces that spur productivity and innovation in consumer markets can be loosed upon the inefficient, tradition-bound health care system. Moving to consumer-driven health care requires that companies revamp their health benefits in six ways: Give employees incentives to shop intelligently; offer a real choice of insurance plans; charge employees prices that accurately reflect the company's costs; let providers set their own prices; adjust payments for each enrollee based on need; and provide relevant information. " Here's a business case for why it makes economic sense to provide patient-centric healthcare ! Not only will we get happier patients, and happier doctors, we'll also end up saving money !

Amazon.com: Hope or Hype: The Obsession with Medical Advances and the High Cost of False Promises: Books: Richard A. Deyo,Donald L., Ph.D. Patrick

What is wrong with American health care and how can we fix it? " Many recent books try to address this question. One of the central points of "Hope or Hype" is that "...the major reason for rising health-care costs and shrinking insurance coverage is the rapid introduction of new medical treatments, often before they can be adequately evaluated for effectiveness, safety, or cost."
The authors, a medical doctor and a social scientist, have had years of experience studying health care in the larger societal context. "Hope or Hype" focuses on what happens when we allow the hype in the media and the marketplace to overtake the good that medical advances can bring us. It tells the story of overmedicalization, wasted resources and greed. If you are thinking - problem, what problem? Start by reading "Part III - Useless, Harmful or Marginal: Popular Treatments that Caused Unneccessary Disability, Dollar Costs, or Death." The stories are first-hand accounts of what happened to medical researchers when they got in the way of special interest groups and big drug companies. The back stories surrounding those drugs and devices you see advertised on television are very interesting.
Deyo and Patrick have written this book for the general public, as well as for students and health care researchers. They provide an historical overview of our love of "technoconsumption" and our infatuation with the latest medical breakthroughs.
The final chapters address how we all can do better. For example, they suggest that decisions about using new drugs and devices could be "evidence-based" and that consumers could be better informed to help prepare them to participate in shared decision making. Finally, they suggest that the government could create a "Fed" for health care, a regulatory agency mandated to oversee the integration of new technologies in medicine while minimizing waste and potential harm."

Saturday, November 19, 2005

How does one market a free health education library ?

I run the world's largest free health education library, called HELP , in Bombay, India ( www.healthlibrary.com). Our major problem is that very few people make use of our services - even though they are free ! What are we doing wrong ? How can we get more people to use HELP ? Is it that people don't value our services because they are free ? I don't want to charge for what we do, because I feel patients should have free access to health information !

Thursday, November 17, 2005

How a medical expert can reach out to patients using the web

Brachial plexus injury is a rare injury which sometimes occurs after birth. Obstetricians and pediatricians usually advise parents that they just need to "wait and watch" and the problem will resolve on its own. While this is forunately true for the majority of these children, there will be a minority who will suffer a life-long disability, because of severe nerve damage. This can be surgically corrected in these children, provided it is detected in time, and the children operated on early enough. Unfortunately, there are few experts who know much about this condition, as a result of which the parents are often misled by the well-meaning advise given to them by their pediatrician. In the past, as a result, these children would often end up receiving poor quality care; and by the time they reached a knowledgeable expert, a lot of time had been wasted.
I recently met a plastic surgeon who had treated over 150 of these children, and he was complaining about how pediatricians refused to learn. By the time he treated these children, their nerves had already been irreparably damaged, and parents were understandably angry and upset with their pediatrician for not referring them earlier. When I asked him what he had done to try to improve the situation, he claimed that he had given numerous lectures on this topic to pediatricians at medical conferences, but few of them bothered to listen, because this was not a very "sexy" topic !
However, rather than complain about how poorly informed pediatricians were, he could have tried to redress the situation by trying to reach the parents directly. The internet provides an excellent method by which concerned parents can reach out directly to the expert, without having to wait for a referral from their local doctor ( who may know very little about such a rare condition). An excellent example of an expert is Dr Nath, who has done a brilliant job in reaching out directly to affected parents. This is a win-win situation. Affected parents can directly contact an expert for a second opinion; and the expert becomes even more expert as he accumulates even more experience in dealing with this specific problem !
Doctors have a responsibility to educate their patients - the word doctor is derived from the root "docere", which means " to teach". Why do so many of us do such a miserable job of it ?

Why don't Indian doctors do a better job of marketing themselves ?

Everyone acknowledges that Indian doctors are extremely competent and skilled. A significant proportion of doctors practising in the US and the UK are of Indian origin; and Indian doctors have proven that their abilities are world-class. However, even though doctors in India are equally skilled, and offer their services at a fraction of the cost of what doctors in the US charge, why aren't they able to attract patients from the USA ? After all, if a patient from New York is willing to fly down to Mayo Clinic for treatment for a complex problem to get world class care from the "best" surgeon, then flying down to India is really not much more difficult, is it ? And Indian doctors have far more clinical and surgical experience than their Western counterparts , simply because of their huge workloads ( the one thing India is not short of is patients !)

I think the problem is simply one of perception - Indian doctors have unfortunately not done a good job branding and marketing themselves. In the past, this was because marketing in the West was an expensive proposition which was well beyond their reach. Also, Indian doctors did not get a chance to publish their experience in medical journals, because most of these were published in the West, which was not very interested in articles from Indian doctors.
Today, however, the internet has dramatically changed things ! Patients are now actively looking for information on their medical problems, so they can seek out the most experienced doctor for themselves. There are few geographic limitations; and Indian medical care is a bargain ! The internet is very democratic, and which means all websites have an equally good chance of showing up - doctors with bigger budgets no longer have an unfair advantage, since publishing a website is so inexpensive.
Unfortunately, this is an opportunity Indian doctors have not woken up to as yet. Though they pay lip service to "medical tourism", there is little they do to actually display their skills and expertise on the web.
An excellent example would be the Muljibhai Patel Urological Hospital in Nadaid, Gujarat. Even though urologists worldwide acknowledge this hospital is a world-leader in providing state of the art care for complex kidney stones, you would never figure this out by visiting their website ! Not only is it boring, there is very little information about kidney stones; and it's hard to find out much about the hospital. Not only is the website just brochure-ware , to add insult to injury, it's a very boringly done brochure ! It should have been written for the patient; with the focus being on educating the patient about their disease; and then explaining why the hospital is the best choice for treatment. Why are Indian doctors so good at hiding their skills and expertise ? What a wasted opportunity !

Championing "patient education " in India

Though everyone agrees patient education is vitally important, it's still treated as a step-child in India. Doctors only pay lip-service to it, and pharmaceutical companies use it purely as a tool to increase their sales. This is such a shame !
An investment in patient education is one of the most cost-effective ways of improving healthcare in India. Well-informed patients will take much better care of themselves - and information therapy will help to make medical care much more patient-centric.
This is a major opportunity for health insurance companies who are just entering the Indian market. It's a market which is all set to explode, as the Indian economy is booming; and more Indians are now clamouring for health insurance, because of the increasing costs of medical care.
The company which champions patient education can "own" this segment in India - and this can be financially very profitable as well !
It is true that this is a challenging area , and there are still many problems.
1. There are many different regional languages
2. Many people are still illiterate
3. Few patient educational materials have been published in India so far

Actually, this represents a major opportunity !

Producing high quality educational materials in India is easy, given the wealth of medical talent we have; as well as a huge pool of talented English writers. They just need to be married together, to be able to work as a team !
Translating the materials into regional languages is relatively easy, once they have been produced.
Innovative formats such as animated graphics can be used intelligently, to reach out to illiterates and semi-literates.
All this material can be sold; and also given away for free through the internet, so it can reach out to anyone who wants to access it. This will mean that the distribution costs are virtually zero - it's only the production costs which will need to be incurred.

A national network of patient education resource centers can provide the "real-world" underpinning to patient education, by acting as a reference center; and training patient educators and doctors. Ideally, every hospital should have its own patient education library - and this could be as simple and basic as a librarian or nurse, armed with a computer connected to the internet, who can help to answer patients' queries.

We have all the resources and manpower we need - now all we need is the desire to do so !

The title of this blog

My daughter asked me why this blog was titled The Patient's Doctor. " Aren't all doctors patient's doctors ? " Good question ! Actually, the title is a play on the term, "The Doctor's Doctor." This refers to the "super-doc" who takes care of other doctors; and to whom other doctors turn to for advise when they are stumped ! My blog is for doctors who understand that the sole purpose of their practise is to serve their patients - everything else comes afterwards !

When patients are ignorant - stop blaming the doctor !

I sometimes cringe when I see how little patients who have gone through an IVF cycle know about their own treatment. When I ask them simple questions like - " How many eggs did they collect ? What was the grade of your embryos ?" , the stock reply is - " We don't know, because the doctor never told us !" I feel there's little point in blaming the doctor. It would be far more constructive to say - " We don't know because we didn't ask !"
There's no point in criticising anyone - you cannot control anyone else's behaviour. However, you are responsible for your own actions - it's far more constructive to imporove your own behaviour !

Wednesday, November 16, 2005

Why do patients have such a low opinion of their own intelligence ?

Most patients are in awe of their doctors. They feel doctors are extremely intelligent, hard working experts, who are the fountainhead of all medical wisdom. This is why they often fail to cross-question their doctor; and I often get the impression ( when I review my patients' files ) that they seem to leave their common-sense and brains at home when they go to the doctor's clinic ! Why do patients have such a major inferiority complex ? Most of them seem to take it for granted that what the doctor tells them will "go over their head"; and asking their doctor questions is rude ! I tell my patients, " If you don't understand what I am telling you, the fault is mine - I am not doing a good job explaining." Remember, that nothing is so complex that it cannot be explained ! And if you don't understand what your doctor is saying, this does not mean he is smarter than you - it just means that he is not a good communicator, and needs to polish his professional skills !

The top 10 preventable health risk factors globally

The top 10 preventable health risk factors globally

A report from the World Health Organization (WHO), Comparative Quantification of Health Risks, which estimates deaths and disability from preventable causes of major diseases , compares the impact of 26 major risk factors, and lists the top 10 globally as:

* Childhood and maternal underweight.
* Unsafe sex.
* High blood pressure.
* Tobacco use.
* Alcohol.
* Unsafe water, poor sanitation and hygiene.
* High cholesterol.
* Indoor smoke from solid fuels.
* Iron deficiency.
* Overweight/obesity.

It's a sobering thought, but most efforts which would help to improve health globally have little to do with what the doctor can do in the clinic ! Doctors take a lot of the credit for the health of their patients, but we need to realise that we can have a much greater impact if we take a more holistic approach. Doctors are supposed to be the "health specialists", but a good engineer who can provide clean drinking water to a village ; or a clever marketing expert who can making smoking "uncool" for teens; or an entrepreneur who can provide white LEDs to illuminate rural homes instead of unsafe paraffin lamps can do far more good to improve the health of the community !

Phreesia - Changing the Patient Experience in the doctor's clinic

Phreesia - Changing the Patient Experience This is worth checking out ! " Phreesia installs Wireless enabled WebPads in the clinic's waiting areas. They provide everything the doctor needs, including the hardware and the wireless network. Their WebPads tie into their securely hosted Medical History application. Patients enter the cause of their visit and are prompted with a series of questions based on an elaborate decision tree. A report is then produced and sent to the physician with enough information to begin a focused patient interview, saving valuable physician time." Sounds cool - and instead of wasting their time being patient in the waiting room, patients can actually learn about their medical problems , since the computer can direct them to targetted websites ( based on their symptoms) which provide them with information which is relevant to their needs. And this is all free ! So what's the catch ? Read on...
All this is being sponsored by "Big Pharma" ! Thus, when patients input a description of their medical problem into the wireless laptop computer, based on their symptoms, the laptop displays a page with relevant health news items. The custom-built device not only allows drug companies to sponsor the health news offerings ( "Ask your doctor to prescribe this drug for you !") , it also sends a summary of the patient's complaint back to Phreesia's central server to be examined by its drug company clients ! Most people consider their medical records to be confidential, but Phreesia views them as market research. It hopes to sell the information to pharmaceutical firms looking to hone their drug rep sales calls and future ad campaigns.
What a shame that clever technology is being misused and manipulated for marketing purposes...

Tuesday, November 15, 2005

The Patient's Home: The New Healthcare Hub

The Patient's Home: The New Healthcare Hub" The Patient's Home: The New Healthcare Hub, a December 6, 2005 audio conference, will examine how healthcare organizations are using home monitoring technologies to improve care management and reduce healthcare costs.

Healthcare quality and access can be improved and healthcare costs reduced by moving care management functions away from provider offices and institutions and to the patient's home. Home monitoring technologies move care management processes away from costly centers of care. "

This will reduce costs - and also make medical care much more convenient for patients ! Medical care will truly become more patient-centric !

Leveraging technology to make doctors more productive

Everyone agrees that the healthcare industry in the US is a mess. This is a major multi-billion dollar opportunity and India can provide a solution , if we learn how to leverage technology intelligently to make our doctors more productive. Indian doctors are world- class; as is the Indian IT industry. If we marry these cleverly, we can significantly improve patient care all over the world. In the past, we helped to support healthcare in the US and the UK by exporting our doctors ( the "brain-drain"). We can now export our services instead.

Today, the major bottle neck for efficient healthcare delivery in the US are doctors. Doctors are few and far between, and are an expensive resource ( after all, it takes a lot of time and money to train a doctor) . How can we make better use of this scarce resource ?

Today, unfortunately, most of their time and energy is spent on paperwork (“documentation” ); and talking to insurance and HMO clerks for authorization. This creates a lose-lose situation. Doctors are unhappy and frustrated; and patients are angry because they perceive their doctors as being uncaring and rushed ; and are frustrated over the long waits for appointments. For example, it can take an infertile patient over 3 months to see a consultant in the UK today !

The solution I'd like to propose is the use of technology to leverage a doctor’s productivity. ( This would not apply for emergency situations, but for medical care for cold “elective” problems, such as fever, diarrhea, and chronic illnesses such as arthritis and asthma, which constitute about 90% of all medical care episodes.)

We need to change the model of the consultation – the entry point into the healthcare system. At present, a consultation is inefficient and time-consuming. Traditionally, this has been “ face to face “, but this is an archaic model. It’s time for a makeover ! After all, communication technology has changed everything else – why not this too ? Businessmen conduct conferences and meetings efficiently online – why can’t doctors and patients ?

We need to replace the consultation with a better alternative ! I agree this may cause a certain degree of discomfort , because the visit to the doctor is still the “holy cow” of medicine, because medicine is based on “doctor patient contact “. However, is this really needed ? Isn’t there a better alternative ?

Telephone diagnosis is now routine for many specialties , and has been proven to be safe and effective. This confirms that options to the traditional real world consultation are viable alternatives we need to actively explore.

I am going to offer my solution based on my personal experience. As an infertility specialist, I am a resource in scare supply. It takes me about 60 min to do a consultation, and I can manage to do about 4 consultations a day . I am in private practice, and have a wait list of 2 weeks. It also takes the patient a total of 3 hours of their time ( to commute to the clinic and to wait for their turn) to come for a consultation. How can we make this more efficient ?

What do I do in a consult ? Primarily, like most specialists, I take a history; review the records; and then formulate a treatment plan. I don’t need to do a physical examination for the vast majority of patients. ( Many studies have shown that over 80% of medical diagnoses can be made based on the history !)

I have therefore designed a structured questionnaire on our website ,which anyone anywhere in the world can fill up online and email to me . I can review it and reply by email and it takes me an average of about 5 minutes to reply to each query. I know what the key points on the form are; so that I can quickly look for these; and then guide them accordingly. Most problems are ones I have encountered before ( after all, I am an expert !); and most questions are ones I have answered before, which means I can reply much more efficiently

This is actually a better model than a face to face consultation ! In fact, a personal consultation may not be the most effective or efficient way of providing the doctor with medical information ! I know this may be iconoclastic, but patients are often confused, disorganized, or embarrassed. By subjecting them to the discipline of filling up a structured form when they have the time to do so , they can provide the key bits of information the doctor needs much more intelligently !

I can also provide reasons for my recommendations , and additional references if needed. Patients are much less stressed out ( studies have shown patients forget half of what their doctor tells them during a consultation) when they email me, which means they remember and retain a lot more of what I tell them, because it’s all in writing. Moreover, this can be an iterative process, because they can ask more pointed queries , which I can reply to.

It’s much easier for me too, because I can reply in my pajamas; and for complex problems, I can refer to my medial journals ! I can also “refer “ patients to online information resources, so they become better informed about their problems.

It’s also much easier for my patients because they can ask me queries at their convenience; and they have a written record of what their options are . Patients can also think about their queries; discuss their options with family members; organize their medical records; and structure their thoughts. I now “see” 25 patients in the virtual world ! I find these patients are much better informed and have more realistic expectations, which makes treating them in the real world much easier. This model would work well for all chronic illnesses, such as diabetes , arthritis, hypertension.

One of the limitations of this model is that no personal physical examination is possible, but this is not essential for solving problems in many specialties today. Not only can a history provide a lot of useful information; the record of the primary doctor’s physical examination notes; as well as the results of imaging studies can be very valuable, which often means that a personal physical examination is not even required in the first place.

Medical experts in world class hospitals have been providing second opinions to patients from halfway across the world ( without examining or seeing them) for many years. Doctors are also used to providing useful medical advise on the telephone. Why can’t we use these models to improve the doctor’s efficiency ?

US doctors have become so petrified by the possibility of being sued anytime they write anything down, that they have got paralysed into inactivity ! They can no longer think of innovative ways of providing medical care, because they are so worried about possible medicolegal liabilities . There’s no reason why Indian doctors should allow this irrational and misplaced fear to immobilize them ! We need to capitalise on this opportunity !

We can use this model intelligently and “extend” it using physician extenders. Using a “ learned intermediary” ( who could be a nurse , community social worker , family member or caregiver) can help to extend the utility of this model. Maybe a “targeted “ physical exam can be done by a trained physician assistant or nurse, who can make house calls and video conference with the doctor ? This could also be done by “expert patients” or peers, for example. I agree that the “human touch” is important; and that an online consultation can be impersonal, but this is no reason to throw out the baby with the bath water.

Doctors have a lot of expertise –we need to tap this intelligently. Many attempts were made in the past which attempted to use “artificial intelligence” to help the doctor to make the right diagnosis. Most of these failed, because I feel their goal was misplaced. Rather than try to use technology to replace human expertise, it would make more sense to use it so that to multiply its efficiency. Amazon’s Mechanical Turk was developed to help solve specific internal data processing problems that required human judgment and intelligence.

It's a clever marriage of information technology and human intelligence. India has lots of medical intelligence, and we can leverage this...

The key would be structured questionnaires designed for each specialty which the patient would need to fill up. The concept could easily be extended to allow family doctors to seek a medical opinion from specialists.

Every specialist need a core of critical information on the patient, based on which he formulates a treatment plan using his expertise and experience. While it may not be possible to capture his experience, reasoning skills or experience, by providing him with the core information he needs efficiently, his expertise can be used much more productively !

This business model would allow expert doctors ( even those who have retired and are no longer in active practice ) to generate more revenue; and also allow patients easier access to medical expertise inexpensively ( because they would no longer be compelled by geographic constraints to going to expensive doctors in the US; or to wait for months and months on a NHS waiting list). This may even galvanize doctors in the US to reduce their expenses; and force them to become more efficient and patient-responsive ! The benefits for insurance companies are also enormous, because these consultant doctors would provide objective evidence based advise, with no vested interests ( since they are not going to be actually treating the patient).

Sunday, November 13, 2005

Questions to ask and things to take with you when you go to the hospital.

Here's a useful list from the BBC website.

Questions to ask when you go to the hospital.

Questions:

What's the name of the ward/ room number?

What's the name of the nurse looking after you?

What's the name of my consultant?

What are the names of the other doctors, therapists etc. looking after me?

When are visiting times?

Where's the toilet?

When are meals served and how do I choose what I'd like?

Can I leave the ward to go for a walk, go to the shop/chapel etc?

Is there a phone I can use?

When do the doctors do their rounds?


Things to take with you when you go to the hospital.


* Contact details of your next of kin
* Contact details of family and friends
* Regular medicines
* Night clothing
* Toiletries
* Books, magazines, puzzles
* Pen and paper
* Food snacks
* Personal radio/stereo (if allowed)

Saturday, November 12, 2005

Doctors leam how to say sorry - in the US !

In Colorado, the state’s largest malpractice insurer, COPIC, has enrolled 1,800 physicians since 2000 in a disclosure program called the “3Rs” for “Recognize, Respond, and Resolve” . Under the program, physicians immediately express remorse, apologize to patients, and describe in detail what went wrong in the wake of an error.
Traditionally, lawyers have advised doctors never to "say sorry". Medical errors were covered up, leaving patients in the dark, because of the fear of litigation. ( For most lawyers , "Just Say No !" is the commonest defense they propose !)
If doctors re-learn the 3 Rs, this will be much healthier - for them, and for their patients ! ( The lawyers are going to cry all the way to the poorhouse if this works out well !) Honesty is always the best policy, and telling the patients the truth is much better for everyone involved.

Friday, November 11, 2005

Why is medical care so disproportionately expensive in the US ?

The US is considered to be a model of capitalism; and most other countries strive to emulate the prosperity of the US. However, why is the healthcre system in the US such a mess ? Why is the care so disproportionately expensive ? Why does an IUI treatment cycle which costs about US $ 100 in India cost about US $ 2000 in the US ? Using purchasing power parity, one would expect it to be about US $ 500. What can account for the nearly 200%-400% markup in medical treatment costs ? Is it greed ? inefficiency ? pharmaceutical clout ?

Thursday, November 10, 2005

WSJ Examines Increased Use of Telemedicine To Reduce Costs

WSJ Examines Increased Use of Telemedicine To Reduce Costs
The Wall Street Journal on Thursday examined how telemedicine has begun to move 'into the policy mainstream' as governments and technology companies are 'investing heavily to tap its potential for sharply reducing health care costs for a growing elderly population.' "
If Mohammed will not go the mountain, then the mountain needs to go to Mohammed ! Are we seeing the return of the "home-visit" ( with the only difference that it will be a "virtual" visit, so it'll cost much less !

Wednesday, November 09, 2005

The DigitalTransformations of Healthcare in the 21st Century

The Digital Transformation of Healthcare in the 21st Century: "Digitized healthcare".
The complete digitization of healthcare (both clinical and administrative) will lead to a number of profound changes.

* Hundreds of millions of medical records (shorn of personal identifiers) combine into a massive n-dimensional, queriable, retrospective database, allowing, for the first time, the emergence of true evidence-based medicine.
* “Just In Time Knowledge” systems bring the physician clinical and diagnostic information that she does not yet know that she needs — based on the patterns of information that she is putting into the system
* These systems, and other fail-safe mechanisms built into software, occasion a large-scale drop in medical mistakes and malpractice litigation.
* CEOs and other chief officers can access financial information in real-time in a “virtual close” accounting system
* Procurement “bots,” as well as real-time online market-making in supplies, financing, and drugs replace most of the procurement mechanisms we use today."

Reinventing healthcare - the very "big" picture

Reinventing healthcare - dream big ! " In this system, every individual has a lifetime health care account. Into this account and through it, money flows electronically from a variety of sources: insurance companies, government, employers, personal earnings and charitable institutions. Funds are fully invested, yet they are accessible for health care at times or for purposes determined by the account holder.

The funds are accessed by an electronic transaction device acceptable at any qualified provider of health care service or products. Each transaction is instantly authorized prior to performance of services, and payment is made electronically when the service is rendered--at a cost of less than two pennies per transaction. The system provides insurers and funders an immense variety of data, allowing them to custom-design authorization procedures to balance costs, losses and the level of service they wish to provide in competition with other providers.

The same system simultaneously carries an immense amount of individual, institutional and community health data. Each provider of health care services has electronic equipment custom-designed for its practice compatible with the overall information structure. Thus, 95 percent of the system is incrementally owned and operated by tens of thousands of health care providers and vendors in free and open competition with one another, yet it functions as a unified whole through common standards, along with a few, central, cooperatively owned elements, such as a central switch everyone has access to. The few paper documents required are now produced automatically and instantly at any point in the system.

The system has complete data on the costs, performance and capabilities of every health care provider, and this is readily available to every consumer. Each consumer has complete freedom to select the provider of his or her health care. An ever increasing amount of health information and care is provided through inexpensive, interactive voice-data-video equipment in the home and at countless community locations open to the public.

The medical history of each individual is encoded in machine-readable format in a health care transaction device, encrypted so that it is not available without consent. However, emergency vehicles and facilities are equipped to override the encryption in the event an individual is incapacitated. With consent, the card can be electronically read to produce all necessary medical history or to create patient records in any format desired by the health-care provider.

Government retains the authority to tax and redistribute income or otherwise set public policy to ensure a minimum level of care to each person, but it is not involved as a direct provider, owner or controller of the system.

Individuals control their own health and health care, as well as the money for it. They initiate all transactions. It is a customer-driven system. Perhaps the most interesting feature is that if individuals can maintain excellent health, a portion of the funds in their accounts eventually reverts to them as capital--so they have great incentive to avoid health risks and obtain the best, moderately priced service."

This is a truly "disruptive innovation". Can we make it happen ? Why not ?

Designing a better hospital

What If: The Experience Economy: "'Think of patients as guests,' says founder Dr. Alan Pierrot. 'If you make that leap, you provide a significantly different service, and you view the people differently. The typical hospital room, by its very design, says, 'We don't care about you. We value something else more, whether it's JCAHO technical indicators, or state regulations, or our own rules, not your spiritual and human comfort. We want a correct diagnosis and a good outcome. How much you enjoyed the ride is not particularly an issue for us.'"

Improving healthcare by listening to the patient

What If: The Experience Economy: "This philosophy - 'Give people what they want and the patients will come' - has its roots in Griffin's 1987 experience designing a new child-birth center." So why is this so hard for doctors to do ?

Conversations In Care -Web-book for doctors

Conversations In Care Web-book " The issues surrounding physician/patient communications are many. Anxiety, fear and embarrassment can all impact the way a patient communicates with his/her doctor, and make it difficult to articulate concerns and participate effectively in their treatment. A physician is no less likely to feel anxiety from trying to meet both the psychosocial as well as the medical needs of a patient, or fear at having to break traumatic news." Here's a very wise book which teaches physicians how to communicate with their patients. It should be compulsory reading for all medical students, residents and doctors ! Just learning how to operate is not enough - this book teacces the basis of how to develop a better bedside manner.

S-P-I-K-E-S Makes Breaking Bad News Easier

When you have to break bad news, think S-P-I-K-E-S!

" S SETTING
Set the scene by ensuring the privacy of your conversation. Select a quiet and private place in which to break the bad news. Greet your patients warmly, with a smile and make eye contact. Ensure there are no physical barriers between you and your patients.

P PERCEPTION
Assess patients' perceptions of their illnesses by asking open-ended questions. Remember the vocabulary that the patient uses and repeat their choice of words when you break the news.

I INVITATION
Invitation to impart medical information should come from your patients. The vast majority of your patients will want to know the details of their illness, but to respect those who don't, be sure to ask their preference.

K KNOWLEDGE
Knowledge should be shared with your patients by replicating their vocabulary. Give your patients small chunks of information, making sure that they understand the content after each chunk.

E EMPATHY
Empathic and exploratory responses should be used when responding to your patients' emotions on hearing the bad news. Validate their feelings.

S STRATEGY AND SUMMARY
Strategizing and summarizing will give you a chance to reiterate what has just been discussed, and provides the opportunity to raise important issues that should be covered immediately. Create a strategy so the patient knows what will happen next. "

I love clever acronyms - they help mentally overloaded physicians to remember key information better !

Tuesday, November 08, 2005

Will Disruptive Innovations Cure Health Care?

Will Disruptive Innovations Cure Health Care?
" It's no secret that health care delivery is convoluted, expensive, and often deeply dissatisfying to consumers. But what is less obvious is that a way out of this crisis exists. Just as the PC replaced the mainframe and the telephone replaced the telegraph operator, disruptive innovations are changing the landscape of health care. Nurse practitioners, general practitioners, and even patients can do things in less-expensive, decentralized settings that could once be performed only by expensive specialists in centralized, inconvenient locations. But established institutions are fighting these innovations tooth and nail. Not only is this at the root of consumer dissatisfaction with the present system, it sows the seeds of its own destruction. The history of disruptive innovations tells us that incumbent institutions will be replaced with ones whose business models are appropriate to the new technologies and markets. Instead of working to preserve the existing systems, regulators, physicians, and pharmaceutical companies need to ask how they can enable more disruptive innovations to emerge. If the natural process of disruption is allowed to proceed, the result will be higher quality, lower cost, more convenient health care for everyone. " So true ! The trouble is that by the time you become a doctor, all the initiative and enthusiasm has been drained out of you !

Monday, November 07, 2005

Who is the lowest paid worker in the doctor's clinic ?

" You already know that the physician is a practice’s most expensive worker, but can you identify your lowest paid workers? Don’t bother looking in the file room or reception. Your least expensive workers are your patients ! Without compromising excellent service, your patients can help reduce your busy staffers’ administrative hassles by completing the registration information in advance, and online. Many physicians mail registration forms to new patients to fill them out before coming into the office. Now a few have started offering online registration for new patients—either as a form they can print right off the Web page, or a true on-screen registration form. Of course, your front-office staff must still review and approve any completed form. That’s because inaccurate form-fillers cause more problems at registration than do inadequate forms. "

This nugget was adapted from Improve Your Productivity, from Advisory Publications, a division of HCPro, Inc.

Now I would not have put it this way, but I am glad someone realises that patients can be a very useful healthcare resource , if they are tapped intelligently - and respectfully !

Sunday, November 06, 2005

Where There is No Doctor

Where there is No Doctor This is one of the most useful books I have ever read. The title suggests that it's useful only for people living in remote areas, but the impact of this book is far greater. For one thing, it's an excellent model of clear wiriting and teaching - I wish all books were written so well ! Secondly, it can empower all of us to learn to take care of our own medical problems ( most of which are minor and self-limited), rather than run to the doctor for every cough, cold and fever. This book can teach all of us the basics of medical self-care - please bookmark it !

Healing the Healer

Healing the HealerHere's a very useful guide which teaches medical students how to take care of their own health. Patients can learn from what their future doctors are learning now ! "Mark Twain once said, "The physician who knows only medicine, knows not even medicine." In order to be skillful in the art of health and healing we need to start with ourselves. Your first patient is you. If you continuously explore how you define your own health, you will be more present and successful in helping your patients do the same. And more importantly, you will be more happy and fulfilled in your life's work."

Health Hint: Using Journaling to Aid Health

Keeping a journal or diary provides an avenue for expressing stressful emotions and thoughts that may have a tendency to worsen physical symptoms.

Studies have found that if we express feelings about a time in our lives that was very traumatic or stressful, our immune function strengthens, we become more relaxed and our health may improve. Writing about these processes helps us organize our thoughts and create closure to an event that our minds have a tendency to want to suppress or hide. This can be done in the privacy of the home and requires only pen and paper. No one but the individual needs to read what is written. The most benefit comes from writing the document and the words can even be destroyed if so desired.

This process can bring back into conscious some frightening events that would best be handled with the help of a licensed therapist. These services should be sought out if needed.
How to Journal

* Write about an upsetting or troubling experience in your life. Something that has affected you deeply and that you have not discussed at length with others.
* First describe the event in detail. Write about the situation, surroundings and sensations that you remember.
* Then describe your deepest feeling regarding the event. Let go and allow the emotions to run freely in your writing. Describe how you felt about the event then and now.
* Write continuously. Do not worry about grammar, spelling or sentence structure. If you come to a block, simply repeat what you have already written.
* Before finishing, write about what you may have learned or how you may have grown from the event.
* Write for 20 minutes for at least four days. You can write about different traumas or reflect on the same one each day.
* Consider keeping a regular journal if the process proves helpful.

Rakel, DP. Shapiro D, Mind Body Medicine, Textbook of Family Practice. 6th ed. Saunders.

An excellent resource for more information on this subject can be found in a book titled, Opening up: The healing power of expressing emotions by James Pennebaker, PhD. Guilford Press, 1997.

How to motivate yourself to change

Need to improve your behaviour ? Get rid of a bad habit ?
Motivational interviewing can help - and you can do it yourself !
Directions for the Motivational Interviewing Worsksheet:

* Download the Motivational Interviewing Worksheet (PDF)
* Choose a behavior or habit that you have that you would like to change.
* Write down the positive things about this behavior.
* Write down the not so positive things about the behavior.
* After making the two lists above, take some time and look at what you have written in each section. Contemplate on how each of these may influence your decision to continue this behavior.
* Then list one or more goals that you would like to work for in the future. These goals should match those things in your life that fill your cup and support your sense of meaning and purpose.
* Take time and review what you have written and then ask yourself how this behavior may help or hinder your ability to reach these goals.
* Is this a behavior that you want to continue? It is your decision!

Saturday, November 05, 2005

Medical Seminars In Ancient India

Medical Seminars In Ancient India Medical seminars and symposia are not a new phenomena ! They existed in ancient India where indeed there were codified rules of debate and discussion. Dr B S Mehta illustratively discusses a few important medical seminars that were held in ancient India. Given the scholarly tenor of the debates, he writes, these deserve to be included in medical encyclopaedias. Indian medicine has a long tradition and a history we can be proud of. Unfortunately, most of it is very poorly documented. This series of articles on the history of Indian medicine from the magazine, HouseCalls, is a treasure trove of valuable detail , based on painstaking research, which deserves a wider audience. I hope someone publishes these articles in a book, which all Indians can be proud of !

Housecallsindia.com

Housecallsindia.com: "“There weren’t that many drugs then, and often treatment would involve just talking nicely to the patient,” says Dr Nilima Kshirsagar, head of the pharmacology department at Seth GS Medical College & KEM Hospital, Mumbai, who is incidentally also its current dean. She takes time off to talk to Nilufer Fernandes on pharmacology, the drug trials her department is involved in, and the ethics of such human trials that are sometimes conducted on unknowing patients in India". If you'd like to find out more about medicine in India, this is a great site to go to ! It's an extremely well-produced magazine, and packed with information you will never find anywhere else !

Thursday, November 03, 2005

Talking about our mistakes- good advise for doctors

Talking about our mistakes - good advise for doctors
" Most lawyers and insurance companies advise physicians never to discuss potential litigation with their patients, and never to admit to a patient that they made a mistake. Similarly, most lawyers advise patients, who have been injured medically or surgically, never to discuss the matter with their physician. With all due respect to the legal profession, I still maintain that a doctor's office should be the first place a patient goes to express concern about the healthcare received. I also maintain that physicians should encourage dialogue with their patients and discuss problems in an honest and open manner." Patients can be very forgiving if they know (1) that their doctor cares; and (2) has done his best.

Community-Based Health Financing

Community-Based Health Financing What is a Community-Based Health Financing Scheme ? A CBHF Scheme is any scheme managed and operated by an organization, other than government or a private for-profit company, that provides risk pooling to cover the costs (or part thereof) of health care services. The scheme is voluntary in nature but could be owned by a variety of organizations and covers a variety of benefit packages.
I am amazed no one in the US has considered using this model as a cost-effective way of providing healthcare. If it works well in developing countries, why can't it be made to work in the US ?

MHOs vs HMOs - what Ghana can teach the US

Most people know what HMOs are. Health Maintenance Oraganisations are profit making bodies in the US which "manage health care" for large groups of citizens. They often do a bad job, and there is a lot of unhappiness with the services they provide. MHOs may be a much more sensible model we should be looking at instead !

MHOs ( Mutual Health Organizations ) are autonomous, non-profit community or enterprise-based health financing schemes based on the up-front contributions of many people for the health care costs of a few. Contributions are rated on a community basis as opposed to an individual basis. MHOs attempt to maintain democratic accountability to their members and promote solidarity and mutual aid between members. MHOs are common in Ghana.

Consumer-directed healthcare is the currently fashionable wave in the US Healthcare industry. Maybe it can learn from Ghana !

Paying in potatoes: community-based health insurance for the rural and informal sector

Paying in potatoes: community-based health insurance for the rural and informal sector" Imagine a health centre where the community contributes to the running costs with their labour. Each family provides seed potatoes and agricultural labour throughout the year to cultivate and harvest the crop in return for free access to health services. The profits from the potatoes are used to pay for essential drug stocks and bonuses of health staff. A local committee manage the scheme and, owing to their lobbying, government funds for the public services increase five-fold within 2 years. The example above, the “Caja de seguro de salud campesino Tiwanaku”, exists in the highlands of Bolivia, a country that has struggled to improve the health of its rural communities. What is remarkable is that such an arrangement is not unique. It is one of a growing number of community-based health insurance schemes in the developing world. This term describes voluntary insurance schemes based on a system of risk sharing between community members. Unlike simple payments for services, the healthy and sick contribute. In return, members receive protection from the risks of health costs should they become sick. Too many people fall into the poverty trap when ill health strikes, losing their income and exhausting their assets to pay for health care. Community-based health insurance schemes aim to prevent this." Healthcare is too important to leave upto the government. Here's an excellent example of what even poor communities can do toimprove their own health, once they decide to. All they need is the will to do so !

Wednesday, November 02, 2005

Revolutionising healthcare

Revolutionising healthcare"It's the largest industry in the country, and almost everybody is unhappy with it," he says. "Consumers feel disenfranchised. They feel like somebody else is making the decisions." Here's how AOL's Steve Case is planning to fix the problem.

A unique healthcare insurance package for the poor - for 11 cents per month !

A unique healthcare insurance package for the poor - for 11 cents per month !: "Even as India propels into an era of prosperity and technological advancements like never before, we still lack an efficient healthcare delivery system for the masses. A scenario that is prevalent especially among the marginalized and the rural population of India. Healthcare experts, both in India and the world over, unanimously agree that the main causes of pain and suffering in villages are lack of quality hospitals, qualified doctors, and medical equipment. We too, for a long time believed in these facts until studies proved us wrong." Here's a success story where the rest of the world can learn from India how healthcare can be provided to the poor !

The Perfect Vision of Dr. V.

The Perfect Vision of Dr. V.: "'If Coca-Cola can sell billions of sodas and McDonald's can sell billions of burgers,' asks Dr. V., 'why can't Aravind sell millions of sight-restoring operations, and, eventually, the belief in human perfection? With sight, people could be freed from hunger, fear, and poverty. You could perfect the body, then perfect the mind and the soul, and raise people's level of thinking and acting.'"
Here's a really inspiring true-life story of one of my medical heroes - a doctor who is changing the way millions of poor Indians receive medical care for their eyes !

Tuesday, November 01, 2005

How to talk to your doctor SAFEly

Violence against doctors

A recent Times of India article( Bereaved and Angry, 27 Oct, 2005) has documented the increasing violence against doctors , and I read this article with great dismay . There used to be a time when doctors were held in high regard, but it is becoming increasingly commonplace today for doctors to get beaten up because patients' relatives perceive they are getting poor medical care. This is leading to a breakdown of the doctor-patient relationship, and doctors are feeling victimised and threatened.

Everyone agrees that the best way of resolving this problem is by improving doctor-patient communication. However, they seem to have got hold of the wrong end of the stick, which is why the situation continues to deteriorate. The problem is that trying to teach doctors to improve is futile. Good doctors don't need to be taught; and bad doctors will never improve.

This is why focussing on patient education is so important ! A well-informed patient understands what the doctor is doing and why; has realistic expectations; and also understands that a doctor is not God, and complications and mishaps can occur.

While it may be true that not all doctors are good communicators, we also need to remember that doctor-patient communication is a two-way street. It is the patient’s right to get accurate medical information – but it is also his responsibility to do so !

The easiest solution to improve doctor-patient communication given the limited amount of time doctors have to spend with each patient, is to teach doctors how to “ prescribe information “ . They can do this either by providing patients with educational handouts, by putting up their own websites, or referring them to health libraries . Patients will then learn to have realistic expectations of what their doctor can do for them . An information prescription is the best way of healing the doctor-patient communication gap today !
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