Tuesday, February 28, 2006

The most powerful patient communication tool you can use

The most powerful patient communication tool you can use : "Dr. Albert Schweitzer once said, “Patients carry their own doctor inside. They come to us not knowing that truth. We are at our best when we give the physician who resides within each patient a chance to go to work.”"
Wise words, quoted in a wise article which every doctor should read. I like her idea that the role of the doctor is that of a facilitator. Facilitation bridges the gaps between what we know about medicine , what our clients ( ? patients) know about themselves, and the choices they have to make about their health.

Monday, February 27, 2006

"Please educate me " - said the doctor to the patient . A new model for patient education

Traditionally, patient education has always meant that the doctor ( or healthcare provider) provides information to the patient in order to educate the patient. Actually, I think this is too limiting a definition. I feel patient education should also include all those times when the patient educates the doctor ! ( In the term "patient education", the patient can be the subject as well as the object !)
All good doctors will agree that their best teachers are their patients - and a well-informed articulate patient can teach a doctor ( who is open-minded) a lot!
Patients have a lot of time to explore the medical literature and their treatment options; and if we give them the tools to do so, they will use them intelligently in order to ensure they get the best medical care possible. ( For example, it's interesting to note that the vast majority of Medline searches done today are done by patients - and not doctors, even though the Medline database is an index of the medical literature, and was originally developed and designed for doctors !)
If you are stumped by a difficult diagnosis, why not offer patients access to a differential diagnosis toolbox ( such as Isabel or Dxplain) so they can explore more diagnostic possibilities ?
After all, patients are the experts on their illness - why not treat them accordingly ?
Communication is a two-way process; and just like doctors can teach their patients, patients too, can teach their doctors. How can we make this easier for patients ?
I think the first thing we need to do is to change our perception of patients - and their own perception of themselves ! Treat tham as experts, and lots of them will behave as experts.
In my own practise, I give my patients a prescription for information. I tell them - fill it up. These are the topics you need to find out more about - and these are the resources you may find helpful. I suggest books, websites and the public library - and encourage them to explore for themselves. I then tell them to come back and share the results of their information search with me, so they can educate me .
This is a win-win process. Patients feel empowered and comfortable, and are happy to be treated as intelligent adults ! While I may not learn much new medical information from them ( I feel I am well-informed and well-read !), every once in a while a patient unearths a priceless nugget which I would have otherwise missed.
It also allows me to establish a more personal relationship with them, as one of equals. It encourages questions; allows me to clear doubts; and enables patients to give a much more "informed consent".
Most importantly, my patients educate me about their own personal feelings; and the techniques they use to cope with their illness. Since I am not infertile myself, this helps me to empathise with my patients. It also helps me to grow as a person, as I learn a lot about life; and about how people cope with stress and distress.
This is one of the best forms of CME ( continuing medical education ) I have ever come across - and I highly recommend it to everyone !

Sunday, February 26, 2006

Inviting Participation for shaping Health Services

Inviting participation for shaping Health Services: "For decades health services have sought greater openness, accountability and consumer involvement, but have lacked an effective means of achieving it. Values Exchange software satisfies this need in day-to-day health service practice. "
This is a clever way of inviting public participation and expert input , to help people to come to a consensus when dealing with difficult health topics. An excellent example of participative democracy !

Involving patients !

Involving Patients ! : "Patient Opinion is about sharing experiences and opinions of health services.
What can you do with Patient Opinion?
* See what other patients are saying about their health care
* Add your own story so that others can learn from your experience
* Rate the care you received at hospital"
Patient Opinion was founded by Paul Hodgkin, a doctor who wanted to find a way to make the wisdom of patients available to the NHS.
This is a clever use of technology to encourage and invite patient feedback !

Saturday, February 25, 2006

Doctor ? or Healer ?

Most doctors are technically proficient and because they know a lot about medicine, they are good at treating diseases. However, some of them never learn how to deal with humans. They forget that they are not just treating a disease - they are treating a human being who is sick. Patients have illnesses - and they want to get better. They need more than just a doctor - they need a healer - someone whu understands what it's like to be ill; and who can treat them with care and compassion.

Why are patients so passive ?

I saw a patient today who works as an executive in a leading bank. She is smart, clever and well-informed, and is on the fast-track to a high-profile managerial job.
However, the quality of medical care she had received so far left a lot to be desired, and I was quizzing her as to why this was so.
She had had an endometrial curettage done, after having a spontaneous abortion. I felt this was an unnecessary surgical intervention, and was quite surprised that it had been performed. In her case, the curettage had removed part of her normal uterine lining, causing her to form intrauterine adhesions, which were likely to significantly reduce her fertility. When I asked her why the surgery had been performed, her answer was, " Because the doctor told me to do it". This is the stock answer I receive; and I feel this explains the problem. For any operation, it's not just that the doctor does the surgery on the patient - it is also the patient who requests the doctor to do the surgery. The patient is as important in this equation as the doctor - but this is true only if the patient perceives herself to be the decision maker ! If you treat yourself as a passive "victim", you will be treated by your doctor as one too !

Thursday, February 23, 2006

Podcasting for doctors and patients

Podcasting for doctors and patients: "A growing number of health professionals make podcasts and video casts available to their patients. The Arizona Heart Institute and the Cleveland Clinic both offer specific video podcasts for patients and make general podcasts available on their web site. This service provides patients with helpful information as they make health decisions."

Re-centering the Patient in Clinical Education

Re-centering the Patient in Clinical Education: "Reconfiguring the Patient-Doctor Dynamic. Given the general state of upheaval that exists in health care and its effect on hospital practice, solutions for the physician-in-training who has little time or impetus to 'connect' and truly care for patients emotionally and physically seem few and far between. It seems logical that until reforms adjust the current imbalance in health care, residency and early practice will be tough and potentially alienating experiences for physicians looking to engage fully in the care of patients."
Sometimes we need medical students to remind us of how dehumanising modern medical education can be .

The Language of Medicine

The Language of Medicine: " Wits occasionally describe England and the U.S. as two countries separated by a common language. I feel one might say a similar thing about doctor and patient. As a former English major, I spend perhaps more time than most observing the language of this profession. I find myself uneasy at times with the transition I am making, at an almost alarming pace, from viewing medicine through the eyes of a patient to seeing it with those of a physician."
Both doctors and patients can learn a lot from medical students, as they pass from one world ( of the layperson) to another ( that of the medical professional).

Wednesday, February 22, 2006

Making your doctor's life easier

A good way to get good medical care is by being a good patient - and a good patient is one who tries to make their doctor's life as easy as possible. Being a doctor can be stressful - and patients who are disorganised and careless add to this stress.
However, if you are well-organised, your doctor will be in a much better position to take better care of you.
Prepare for your visit by summarising your concerns . Writing them down helps you and the doctor, because it ensures you remember all the details; and it's easier for your doctor to scan through this summary and extract the relevant information.
Good patients make happy doctors - who make happy patients !

Monday, February 20, 2006

An unhappy patient - and an unhappy doctor

I just saw a patient who had a distressing problem. He was a software engineer, and the couple had not been able to consummate the marriage. His problem was premature ejaculation, which was so severe that he would ejaculate before vaginal entry, as a result of which he had not been able to achieve intravaginal ejaculation.
Premature ejaculation is a complex problem to solve, because it is a learned reflex, in which the man cannot control his ejaculation. Psychologic problems always take a long time to resolve, and they wanted a baby quickly, because he was being posted to the UK in one month's time for one year.
He wanted me to perform an artificial insemination to bypass his problem; but I had to explain to him that because Nature was not very efficient at making babies, the pregnancy rate would be only 10% in one month. This was too low for him, and he wanted to explore alternative options.
I explained that it would be far better if they tried to solve their problem for themselves - after all, it was much more fun making a baby in the bedroom than coming to me !
I suggested they buy a book which described treatment options for premature ejaculation, such as the "squeeze technique", so that they could learn to treat themselves. I also told them there were alternative options, such as self-insemination, and we had a detailed description of this on our website at
www.drmalpani.com/selfinsemination.htm.
I felt I was being empathetic, and by trying to empower them to solve their problem for themselves, I was proving the best possible medical care.
For some reason, he was very unhappy with my advise. He expected a quick solution, and resented by suggestions that he do some "homework" and try to become an expert on premature ejaculation, so that he could tackle the problem more efficiently. I was trying to promote his autonomy, rather than making him dependent on medical intervention ( which I felt was uncalled for, since they were young).
We parted on unhappy terms. He felt I was being unhelpful; and I felt that he was too immature to understand that I was trying to look at the "long-term" picture, and just trying to help him to help himself ! I felt my role was that of a teacher, who goads a student into performing better; rather than trying to spoonfeed him so that he can ace the examination. He was focussed on short term results, which meant we ended up talking at cross-purposes.
I guess patients find the doctors they deserve - and that doctors get the patients they deserve. I wish him luck in his quest for a doctor who will pander to his desires - and I hope he will be able to appreciate ( maybe in a few years) that I was just looking after his best interests !

Saturday, February 18, 2006

Bidding for medical care

Auction websites have proven to be very successful, and provide a very healthy marketplace for both buyers and sellers. Why can't they be used to provide medical care at competitive pricing levels ?
Hospitals are expensive institutes to run, and an empty bed is a waste of precious resources. Hospitals which have free beds or operation theater slots can offer them to consultants at a discounted price. Similarly, doctors who have free time on their appointment diary can offer to see patients at discounted rates.
Why not let the marketplace decide a "fair rate" ? Isn't this much better than letting the hospital bed get wasted by allowing it to lie empty ?

Can doctors offer differential pricing ?

A common complaint many patients have about doctors is that it takes very long to get an appointment. No one wants to wait when they are sick - you need to see a doctor pronto to get better ! Unfortunately, doctors are busy people, and it can take upto 2-4 weeks to get an appointment.
I have a suggestion to resolve this impasse.
Doctors should offer differential pricing for their appointments. Let's say your doctor charges US $ 100 for a routine elective visit, when the appointment has been taken 1 month in advance. If you feel you are ill and need to see him urgently, he should offer you a next-day appointment for a premium - say US $ 200. And if you think it's really urgent, he can see you the same day for US $ 400.
Hospitals offer differential pricing at present for many services they offer. For example, an appendectomy costs you much more if you choose to stay in a private deluxe room as compared to a general ward. Why can't doctors use the same principles ? Consumers are used to this model for other services as well ( for example, airline tickets). This model will allow them to exert a certain amount of control over how quickly they want to be seen by their doctor.

Friday, February 17, 2006

Home Semen Analysis Kit

Home Semen Analysis Kit: This website sells a " kit which includes everything you need to confidently do accurate semen analysis." DIY carried to its logical conclusion for couples who are worried about their fertility !
I have mixed feelings about this test. Doing an accurate semen analysis can be technically difficult and challenging, and many laboratory technicians do not do a good job of it. I wonder how well inexperienced patients will perform on their own ? On the other hand, because the patient is doing the test themselves, maybe they'll be much more careful and conscientious when doing it !

Information asymmetry, the doctor and the patient

I have been reading the book, Freakonomics, by Levitt and Dubner, and am thoroughly enjoying it . I admire anyone who can explain difficult concepts so lucidly and entertainingly !
I was struck by the chapter , "The Ku Klux Klan and Real-Estate Agents" , where they introduce the concept of information asymmetry. One of the reasons why experts have the upper hand in encounters with consumers is because they have more information.
A lot of what they say applies to doctors and patients.
" ... a face-to-face encounter with an expert might actually exacerbate the problem of asymmetrical information - situations in which an expert ( read doctor) uses his informational advantage to make us feel stupid or rushed or cheap or ignoble."
As a thoughtful doctor once put it, "The reason doctors are on pedestals is because patients are on their knees !"
" Armed with information, experts can exert a gigantic, if unspoken leverage: fear". Doctors become quite expert at playing on patients' ( and their relatives) fears, and often scare them into performing unnecessary tests and uncalled for surgery.
The best way of overcoming this is with Information Therapy - we need to equalise the playing field, and the internet is a great tool which enables us to do so !

When is a pregnancy not a pregnancy ?

As an IVF specialist, it's very gratifying when patients conceive after IVF treatment. However, like any other pregnancy, 10% of all IVF pregnancies are also destined to have medical problems. The commonest problem is a miscarriage; and in some of these, the reason is because the embryo/fetus does not develop properly. This means that even though the woman is pregnant, and the pregnancy tests are all positive, there is no baby. This is a non-viable pregnancy, and many women get very confused - How can I be pregnant when there is no baby, doctor ?
It's important for the doctor to sit down and explain exactly what the problem is, so that they don't lose hope for the future. A pregnancy consists of two tissues - the embryonic tissue, which gives rise to the baby; and the extraembryonic tissue, which gives rise to the placenta. In these pregnancies, only the tissue from which the placenta arises is formed properly. The tissue which gives rise to the embryo does not develop at all. This appears as an empty gestational sac on ultrasound scanning. This is called a "missed abortion" - presumably because the embryo is missing. The technical term is an anembryonic pregnancy. The commonest reason for this is a genetic problem in the embryo, which prevents it from developing properly. This is a random event, and the risk of recurrence is low, which means patients can be reassured that their chances of having a healthy pregnancy for the future are actually excellent !

Thursday, February 16, 2006

eHealthcare in the developing world

eHealthcare in the developing world: "This paper proposes a model, or framework for analysis, to inform the development of eHealth in developing countries. The framework has five components – the 5Cs. Firstly there is the Context of poverty, meeting the Millennium Development Goals and the role ICT can play to support health workers. Then, there is the Content of health information provided to health workers and how it can be migrated from being paper-based to a digital format. Providing wireless Connectivity within and between health facilities that supports the transmission of health knowledge and management information provides an entry-level health information infrastructure. Over such a health facility-based wireless infrastructure it then becomes possible to build workforce Capacity as well as support Community development, via the delivery of information to enable better individual and community decision-making in health and other development issues." Is ehealthcare "pie in the sky" for developing countries ? Or will it allow us to leapfrog and provide better healthcare for all our citizens ( just like mobiles have allowed millions access to telephones even where there is no electricity ) ?

Sunday, February 12, 2006

Interfering in individual's lives

It always depresses me when I find that people who I think are wise want to interfere in other individual's private lives.
Many women are infertile because of poor egg quality, and they need donor egg IVF in order to conceive. The only source of donor eggs is a young woman who is willing to provide her eggs. This can be done on a commercial basis; or an altruistic basis. Since it's very difficult to find suitable egg donors, most clinics encourage friends, relatives and sisters to donate their eggs to the infertile women, to help her build her family. This model works well, and has an excellent track record of success.
The government of India is now going to pass a law which is going to prohibit women from donating their eggs to their own sisters ! This means that the government, in its wisdom, has decided that adult Indian women will be allowed to donate their eggs to strangers, but not to their own sisters ! The "rationale" for this is that it's being done for the "unborn child's welfare". Apparently, if a child finds out that the biological source of her/his eggs is her aunt, the child will be traumatised and scarred for life ! While I can understand this viewpoint, how can the government apply it universally across all families ? Isn't it being unnecessarily meddlesome to completely take this option away from Indian women ? Aren't they intelligent enough to weigh the pros and cons and decide what the best option ( anonymous egg donor versus eggs from a known egg donor) is for themselves ? What purpose does banning this option possibly serve ?
Incidentally, the ASRM ( American Society for Reproductive Medicine) in the USA discussed the ethical implications, and concluded that egg donation from sisters is safe and ethical.
I am surprised no Indian women's group has challenged this law ! Or do Indian women feel they are really not capable of making this sort of decision for themselves, and that government officials know best ? They better wake up before things get completely out of hand. Why should the government interfere in such personal and private reproductive decisions ?

What psychological self-help will do for you

what psychological self-help will do for you: "This free book reviews all aspects of self-improvement. It provides you with a system for analyzing any problem into its manageable parts and for planning self-change. It invites you to first carefully consider what you value and want to accomplish in life. It summarizes science's best explanations of most human problems. It lists the most promising ways of treating a wide range of unwanted behaviors and emotions. It describes in detail how to use about 100 self-help methods. In short, this book gives you a sound, research-based fund of knowledge about behavior; add to this your own coping experiences and you accumulate a storehouse of general knowledge that will help you understand yourself and gain more control over your life. That is offered; absorbing and applying the knowledge is your job." Once you read this, you'll never need to buy another self-help book again in your life !

Saturday, February 11, 2006

Fertility testing for women

One of the things most doctors dislike having to do it is giving bad news. We just did an IVF treatment cycle for a 32 year old woman, and she grew only 6 eggs, inspite of maximal superovulation. This means that she is a poor ovarian responder - an ill-defined condition, which just means that she does not produce good quality eggs. The term which has been coined to describe this is "oopause" - the 10-year span before a woman reaches the menopause, during which her fertility declines because her ovaries get depleted of eggs ( which die every month as a result of a natural process called atresia). Unfortunately, not too many women know about this condition - and neither do too many doctors. It has no symptoms or signs, and often the only time the women finds out she has reached the oopause is when she goes to a fertility specialist, who determines she has a high FSH level, which is a marker for poor egg quality. It is not easy to explain to a young woman with regular periods that her eggs had become "too old" for her to have a baby with them.
Her first lament was - I wish I had known about this earlier, so I could have planned a baby sooner. Unfortunately, this has become an increasingly prevalent problem amongst young women who would like to pursue a career. It's often hard to balance the stress of the biological clock with the pressures of the executive ladder ! Fortunately, tests have now become availabl which allow women to judge how fast their biological clock is ticking - and how many eggs they have left. This is a simple blood test, to measure the levels of the FSH hormone.
The major killer for men is heart disease , and routine screening for cholesterol has now become institutionalised ( even though we really don't know how useful this is ! ) Unfortunately, since fertility is a woman's problem, routine blood testing for screening ovarian reserve is unlikely to become widespread - women are still second class citizens !

The dangers of overtesting

One of my patients who had conceived after taking IVF treatment at our clinic came to me in tears. She had registered with an obstetrician, who had performed a "routine" "triple marker test" to screen for birth defects. This is a simple blood test, which was first introduced for screening older women who were at increased risk for having a baby with Down's syndrome ( trisomy 21) , and is done at 16 weeks of pregnancy. However, since it's such an easy test to do, many doctors now do it routinely for all their pregnant patients. The blood test measures the levels of 3 hormones - HCG, AFP ( alpha fetoprotein) and estriol. These levels are then mathematically manipulated, to give a risk figure.
She was only 28 years old, which meant that her risk of having a baby with Down's syndrome was very low to begin with - less than 1 in a 1000. It's not a good idea to perform screening tests when the prevalence of the disease being screened for is low, because the chance of getting "false positives" ( abnormal results in a healthy patient) are very high.
When her results came back, her doctor told her that her AFP level was low , which meant that her baby did have a chance of having Down's syndrome, even though this was small; and the only way of ruling this out was by doing a "minor procedure" called an amniocentesis, in which amniotic fluid is sent for genetic testing.
Since patients are so worried about having an "abnormal" baby, most are willing to go to any length to ensure their baby is normal. They are quite happy to blindly follow their doctor's advise - after all, " the doctor knows best " , doesn't she ?
However, she wanted a second opinion, since this was an IVF pregnancy, and came to me for a second opinion. ( Once you become senior, you become a doctor's doctor !)
I sat down with her and explained her results to her. Her HCG and estriol levels were in the normal range and the AFP was marginally lower than normal . The computer calculation showed her levels were well in the normal range, and her re-calculated risk of having Down's syndrome was actually re-computed to be even lower than expected - only 1 in 2000. This should have been very reassuring, and should have set her mind at peace. However, her doctor did not take the trouble to explain the test results to her - and seemed to use the triple test as an excuse to do even more ( expensive and remunerative !) testing.
Don't doctors see the harm they are doing by medicalising pregnancy ? They are converting a healthy event to a "high-stress" medical journey, littered with hazards and risks ! Instead of enjoying her pregnancy, this woman is petrified that her baby is going to be abnormal ! No matter how much I tried, I could not reassure her, and she plans to go ahead with the amniocentesis.
Most probably the procedure will be eventful - and since all's well that end's well, she'll forget all about this. However, the risk of miscarrying a healthy baby after an amniocentesis ( even in the best of hands) is 1% - and I pray that she doesn't fall into that 1% !

Friday, February 10, 2006

What Determines Health?

What Determines Health?:
Doctors are happy to take the credit for the increasing life expectancy most citizens can expect today. However, the truth is that there's little that doctors have done to influence public health. The health of a country - and an individual - is influenced far more by their socio-economic status, than by the quality of medical care they receive. This is one of the reasons why the "AIDS epidemic" which was supposed to decimate the US petered out; and why AIDS continues to be such a big killer in Africa today !


The following story speaks to the complex set of factors or conditions that determine the level of health of every person.

'Why is Jason in the hospital?
Because he has a bad infection in his leg.
But why does he have an infection?
Because he has a cut on his leg and it got infected.
But why does he have a cut on his leg?
Because he was playing in the junk yard next to his apartment building and there was some sharp, jagged steel there that he fell on.
But why was he playing in a junk yard?
Because his neighbourhood is kind of run down. A lot of kids play there and there is no one to supervise them.
But why does he live in that neighbourhood?
Because his parents can't afford a nicer place to live.
But why can't his parents afford a nicer place to live?
Because his Dad is unemployed and his Mom is sick.
But why is his Dad unemployed?
Because he doesn't have much education and he can't find a job.
But why ...?'

The "key determinants of health" include:

1. Income and Social Status
2. Social Support Networks
3. Education and Literacy
4. Employment/Working Conditions
5. Social Environments
6. Physical Environments
7. Personal Health Practices and Coping Skills
8. Healthy Child Development
9. Biology and Genetic Endowment
10. Health Services
11. Gender
12. Culture"

Note that health ( medical care) services ranks tenth on this list !
This just means that while doctors can do little to improve your health, they can do a lot to damage it !

Is google selling out ?

I have always had high regard for google. I have a soft corner for clever technology - especially when it's provided free of charge, and I admired google for building a clever search engine.
However, I am now disheartened and I feel that google is selling out. The advertising industry is pretty low on my list of things I have high regard for, and I feel google is acting like an advertising firm, in order to capitalise on their ability to make money. While money is high on my list I have high regard for ( because of the freedom it gives you to do the things you really want to) , I don't think too highly of people who make their money doing things which are unimportant and inconsequential ( which is what I feel of advertisers, who just act as middlemen).

Thursday, February 09, 2006

Why don't they teach doctors useful stuff ?

When I was in medical school, we were taught all sorts of fascinating and esoteric facts about the human body - and we took pride in memorising these and regurgitating them on demand during the examinations ! However, I ( as I am sure is true of over 99% of doctors) have forgotten over 95% of these - and this does not affect the quality of care my patients receive. Most of what is taught in medical school is irrelevant and meaningless.
This are some of the subjects I feel medical students need to be taught, to help them become better doctors.

1. How to talk to patients
2. How to run a business
3. How to network with colleagues
4. How to manage money ( including learning how to speculate)

These are "real-life" skills - all of which can be taught. Most doctors learn them "on the job" - but some never do !

Wednesday, February 08, 2006

Information Therapy - dispensed at point of use !

Information Therapy - dispensed at point of use ! "Information therapy is the ultimate decision aid because it reaches out to the patient just as he or she must make
a health care decision." This is why Prescribing Information can be so powerful ! It's being dispensed at the "point of purchase" - when it has maximal impact. Patients wnat it - how can we got doctors to routinely prescribe it ?

Tuesday, February 07, 2006

Health information - more is not always better

Health information - more is not always better !
1 More information is not always better;
2 People find ways to simplify complex decision making;
3 Consumer preferences are malleable; and
4 There are different kinds of decision-makers.

For most Americans, it's true that there's too much information out there, and they need help to make sense of it. Most people use their doctor as a filter, to help them sort the wheat from the chaff.
However, the irony is that for most Indians, there's just not enough health information. The information is often not available in Indian regional languages; or is not applicable to Indian local conditions. This is a shame - and a major opportunity !

Monday, February 06, 2006

The Secret Life of the Brain

The Secret Life of the Brain Medicine is a fascinating science - and if you'd like to explore some of the body's secrets, please start here. The human brain is amazing - and you can take a peek into how it works here !

Watch your heart beating !

Watch your heart beating ! This is a very well-designed visual site which is packed with information about the anatomy of the heart. If you want to learn more about how doctors study the heart, this is a great place to start !

National Health Test

National Health Test: "Take 'The National Health Test' Today!" Clever use of technology - using TV and web together. I am sure we'll be seeing a lot more of this type of marriage of web and TV soon !

Free and Open Source Electronic Health Record

Free and Open Source Electronic Health Record: "MirrorMed is a free and open source EHR and practice management system written in PHP. MirrorMed is a web-based application that is capable of running a healthcare practice." Like everyone else, I love stuff which is free - especially open source software for running medical practises. If you want to help improve medical care and are an IT whiz, this is a project you should contribute to !

Consumers in Health Care: The Burden of Choice

Consumers in Health Care: The Burden of Choice: "Consumers in Health Care: The Burden of Choice. Dale Shaller, Shaller Consulting. " As consumers assume greater responsibility for their own health care, they are being asked to make more—and more complex—decisions than ever before. At the same time, the growth of information and increasing customization of health care products and services has ratcheted up the need for understandable information that aids in consumer health care decision-making.

This report distills the latest research on consumer decision-making, explores the methods consumers use to make choices, and looks at what influences affect consumer action. The research suggests important implications for the development of effective information tools for consumers, including the need to:

* Make information relevant and appropriate to specific decisions;
* Use creative ways to help consumers simplify their choices;
* Target information at the right audience;
* Work through trusted advisors and intermediaries;
* Cultivate an image as a trusted source;
* Integrate information to offer the benefit of one stop service; and
* Emphasize benefits, not features."

Thoughts on the Future of Medical Devices at the Point of Care

Thoughts on the Future of Medical Devices at the Point of Care: "Ultimately what will break the market lose will be small innovative vendors who can visualize and create solutions completely from the customer's perspective. The path from today's market to my fantasy of a patient centric world is as yet unknown - blazing that trail will be an adventure." Lots of opportunities here - patients need to speak up so that their voice are heard !

Really Personal PHRs

Really Personal PHRs : "Surely, consumers need to understand why personal health information is important. The only way they'll be persuaded to adopt any PHR, whether paper-based or Quicken-like, is if they are meaningful and connect in a personal way with the individual. " If it's customer-centric and customer-friendly, individuals will be happy to do this. After all, we are all going to be patients some day !

Doctor's Advocate - Fighting back !

Doctor's Advocate - Fighting Back ! : " Simply the threat of being sued hurts doctors and their profession. It is demoralizing to have a lawsuit filed in response to your own alleged negligence, and even more so when it is groundless. The financial burdens are also unbearable, as insurance premiums in many cases have reached hundreds of thousands of dollars. Doctors are feeling the squeeze in many ways, and it shows." Normally, doctors and lawyers are on opposing sides - and in fact, in one city, obstetricians refused to provide obstetric care to a lawyer's wife, because they were so worried about being sued on flimsy grounds. This group has now put the lawyers on the doctor's side, so that doctors can protect themselves !

Storytelling Power - The Everlasting Healing Power of a Story

Storytelling Power - The Everlasting Healing Power of a Story: "To my amazement, the telling was not only therapeutic for me, but to this day, I still have people come up to me and tell me how they remember the story about my son. So many have been touched by cancer, either personally or through friends and family, a true and positive story serves as reassurance. Because I have kept this story alive, others feel a bond with me and have learned that I want to hear their stories too." Sharing your story is good for you - which is why I encourage my patients to keep a diary. A blog would be even better, and I am happy to see many infertile women are starting to do so !

Sunday, February 05, 2006

What does the doctor hear ?

What does the doctor hear ? If you've ever wondered just what it is that your doctor hears when he listens to your heart through his stethoscope, please check out this website ! This clever program allows you to be a medical student, so you can learn all about heart sounds and murmurs !

Saturday, February 04, 2006

Fate of Fat

Fate of Fat: "Fate of Fat - a clever animation which provides an overview of how dietary fat gets digested, packaged, and sent to various tissues for storage or energy".

How to lose weight

How to lose weight "The following are 6 principles upon which any successful weight loss future can be based. Each principle is designed to protect you from those who would confuse, mislead, stymie or prevent you from succeeding either by mistake or by cajoling, flattering, inveigling, lying or distracting you. The six principles are:

1. Avoid Doctors, Fake Doctors, Dietitians and Nutritionists, the Media, Alternative Care Practitioners, Personal Trainers, Special Interest Groups and Philosophers
2. Avoid Exercise
3. Avoid Weight Loss Products
4. Avoid Weight Loss Programs
5. Avoid Government Recommendations
6. Face the Facts"
And if you want to know what the facts are, you need to visit the site ! Please do so - it's well worth it !

Eat Like The Devil-Weight Loss Made Sinfully Simple

Title Page.Eat Like The Devil-Weight Loss Made Sinfully Simple: "Eat Like The Devil: Weight Loss Made Sinfully Simple
(Guaranteed or Your Soul Back!) " Very honest and cleverly written book on how to lose weight - and it's free ! I wonder why anyone would buy another diet book , since this one is available free !

Medical Images

Medical Images: "The Yale Medical Image Teaching Collection is provided pro bono to the wider academic medical community." What a wealth of medical images - available for everyone to use. The internet allows people to share freely, and brings out the altruistic streak in everyone !

Friday, February 03, 2006

Virtual Health Coach

Virtual Health Coach" The Virtual Health Coach project is a groundbreaking research and development initiative to improve the effectiveness and efficiency of information therapy interventions to help people better selfmanage their conditions and improve their health." What a clever idea !

Thursday, February 02, 2006

The Prescription Infrastructure: Are We Ready for ePrescribing? - CHCF.org

The Prescription Infrastructure: Are We Ready for ePrescribing? - CHCF.org: "ePrescribing (eRx) is currently practiced by only 15 percent of physicians . This reports looks at the opportunities it presents to streamline information management and the potential payoffs for both clinicians and pharmacies."
Is this the killer app for e-healthcare ?

Corruption and Health

Corruption and Health : Medicine is supposed to be a "noble profession" - but it's also one of the most corrupt ones as well ! "The GCR 2006 focuses on corruption and health. The book includes expert reports on:
* the risks of corruption in different health care systems
* the scale of the problem: from high-level corruption in Costa Rica to counterfeit medicines in Nigeria to
* health care fraud in the United States
* the costs of corruption in hospital administration and the problem of informal payments for health care
* the impact of corruption at various points of the pharmaceutical chain
* anti-corruption challenges posed by the fight against HIV/AIDS"
You can read it online free - this is quite an eye-opener !

Executive Health Checkups can be hazardous to your health !

Executive Checkups can harm your health ! : Many well-heeled executives take pride in going for an annual "health checkup". This has become a ritual - and their company is happy to foot the bill - after all, they care for their employees, and need to ensure they remain healthy ! After all, isn't it commonsense that prevention is better than cure - and the earlier you identify problems, the easier it is to treat them ? "Many clinics now readily pander to this demand by providing a wide range of 'executive health check-up schemes,' but often these 'schemes' can be more harmful than beneficial ! In fact, routine tests, such as electrocardiograms, chest X-rays and full blood screening, have been found to provide little overall benefit for the healthy individual. " Ironically, the "higher" the executive's post - the more tests the Health Package ( Diamond Packages provide 70 tests, versus Gold Packages which provide 40, for example) offers - and the more dangerous it is ! More is not always better - and in fact, the more the tests performed, the greater the chances that an abnormality will be identified. Unfortunately, in this patient population ( healthy people who are undergoing tests for screening only), the vast majority of abnormalities are unlikely to be of any medical importance - they are the False Positives. However, the result will create a lot of anxiety - and the doctor will then happily order further tests to try to determine the significance of the abnormal test result, often resulting in a Catch 22 situation, where a healthy person has been "converted" into a patient. " Welcome to my parlour, said the spider to the fly" would the best way of describing how the medical system seduces patients with the help of these health checkup schemes.

Helping patients to become better patients

I feel the greatest untapped healthcare resource today is the patient. Patients are smart, curious and intelligent; and will move heaven and earth to get the best medical care when they are ill, if we give them the tools to do so. This is what we hope to accomplish at HELP - the world's largest patient education library. We teach patients to become better patients, by teaching them the skills they need to learn to navigate the healthcare system ( how to select a doctor; how to talk to a doctor; how to look after yourself in a hospital; how to research information about your illness, and so on). The ROI is potentially huge, because this is a such a neglected area. I believe that if we can leverage the capability of patients, we can dramatically improve medical care !

Difficult patients - and difficult physicians

Difficult patients - and difficult physicians: "Webster's dictionary defines difficult as 'hard to manage or deal with.' The medical literature, in discussing difficult patients, has attempted to categorize such persons, whom British authors refer to as 'heartsink' patients. This chapter will briefly review this literature, discussing difficult patients in general, and then looking specifically at three types of difficult patients: (1) those who are manipulative; (2) those who have multiple somatic complaints; (3) those who are addicted to anxiolytics or painkillers. Although I will describe the relationships of these patients with physicians, the discussion applies to all health care providers."

Every complaint is a gift

I often see patients who were unhappy with the medical care they received from their earlier doctor. They are quite voluble in their complaints, and I give them a patient hearing. When I ask them, "Did you tell your doctor that you were unhappy with him - and the reason for your unhappiness ?", they look surprised, as if this were a completely alien concept.
I encourage patients to give their doctors feedback - after all, if you don't tell us what you like about us, and what you dislike, how will we ever improve ?
Is the doctor likely to get upset if you complain ? This depends. Bad doctors may get defensive and try to brush you off. If this happens, this is a sign your doctor is not a good doctor, and you should be happy to leave him. A good doctor understands that a complaint is a gift, and will do his best to resolve it. After all, every problem he solves helps him to improve the quality of the service he provides !

Wednesday, February 01, 2006

Cutting out the middleman

It's a sad fact of life that a lot of consultants who practise in Bombay offer kickbacks as incentives to general practitioners ( family physicians) in order to solicit patient referrals. We've never done this, and this means we rarely get referrals from family physicians ( who would rather refer patients to the IVF clinics which do offer them a kickback). What's amazing is that we have managed to flourish, even though we don't toe the standard line. I feel the reason for this is our high pregnancy rates and the excellent standards of patient-care we offer - but this would not be enough . Today, thanks to the internet and our website at www.drmalpani.com, most of our patients come to us directly. What I love about the internet is that it allows patients to compare clinics from all over the world - and they are now no longer dependent upon their family doctor for a referral - they can search for the best clinic for themselves ! This is why many of our patients are doctors or nurses - who are capable , confident and competent enough to decide for themselves !

Doctors suffer when their patient suffers

Doctors suffer when their patients suffer: "Similarly, doctors and patients sometimes engage in parallel suffering. Both patient and doctor suffer, but their suffering is isolated from one another. As a consequence, the suffering of both patient and doctor is needlessly intensified. Not uncommonly, the doctor or the patient is blamed for the suffering of the other. The isolation, wordlessness, and blame of parallel suffering hurt all who are involved: the doctor, the nurse, the patient, the family, and all who must witness the pain of any of the participants." Suffering is the one thing all human beings share. If we share the suffering, this helps to relieve it !
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