Friday, July 28, 2006
This is how and why the web can be so powerful in improving healthcare delivery in India !
Thursday, July 27, 2006
Beta HCG ( beta) is a key pregnancy hormone ; and its levels are serially mesaured to confirm the pregnancy is progressing well.
I am impressed with this site ! This is a great example of how infertile women are using technology to empower themselves with information !
It's important that you stop thinking of yourself as a pawn. You are the Queen of your life, and are very capable of charting your own life's course. The best way of regaining control is by arming yourself with the information you need; and exploring all the options, so that you have peace of mind you did your best !
The amount of media attention which surrogacy attracts is huge, but it is completely disproportionate to its utility in real life. Surrogacy stories are full of human interest, which is why they are so popular, but what I find very disappointing is the fact that the media does not provide the right perspective while covering this topic. I feel the failing is because of innumeracy - of not realising how uncommonly this particular treatment is needed in the first place !
We need to remember that surrogacy is useful for only a very small group of women. For example, a busy IVF clinic which performs about 300 IVF cycles every year will see only about 3 patients who medically need surrogacy. Medically, the indications for surrogacy are few and far between, and most infertile patients can be helped with much simpler and easier treatment options. The commonest reason is a woman who has no uterus. The uterus may be absent from birth (Mullerian agenesis, MRKH syndrome); or may have been removed surgically (hysterectomy for life-saving reasons, such as excessive bleeding during a caesarean). Other women who may wish to explore surrogacy include those whose uterus is irreparably damaged because of uterine tuberculosis or Ashermann's s syndrome.
However, in real-life, when we we analyse the medical histories of women who opt for surrogacy, we find that the vast majority of the time it is usually infertile couples who either :
1. have had multiple miscarriages; or
2. who have failed repeated IVF attempts for unexplained reasons.
While these can be reasonable indications for surrogacy, the fact is that it is often done because the patient is fed up and frustrated with repeated IVF treatment failures or miscarriages; and is looking for alternative options. In a market economy, supply rises to meet demand, and there are many clinics who are happy to oblige these desperate couples - for the right price, of course !
However, the fact is that many of these couples do not need surrogacy at all ! They have a perfectly normal uterus; and would be better of opting for donor eggs or donor embryos, rather than surrogacy. Unfortunately, they fail to realise this, partly because these options are not adequately highlighted in the media; and because some doctors prefer "pushing" the more lucrative surrogacy treatment option ( as this means more bucks for them !)
Unfortunately, it's hard for patients to think straight when they are desperate, which often means they opt for surrogacy rather than egg donation - a choice which is much more complex , because of all the legal, emotional and social issues involved - and also needlessly expensive .
Let's look at the real-life problems involved in surrogacy. Firstly, finding a surrogate can be extremely difficult ! If you have a friend or relative who agrees to be your surrogate, then your best option is altruistic surrogacy. Not only is this much less expensive, the risk of this going sour is much less. Commercial surrogacy is much trickier, because you then need to take extensive steps to protect your interests, and ensure that the surrogate will hand over the child to you after birth. Finding a reliable clinic, an honest surrogate and a good lawyer can be hard work - it is also very expensive !
If the surrogate is anonymous and confidential, then you need to trust the clinic 100% - and this can be a big mistake . When there is so much money at stake, many doctors are tempted to cut corners , partly because it's so easy to do so - and it's so hard to check their actions ! It's easy to fool vulnerable patients . For example, clinics or agencies may take an advance fee and promise to find a suitable surrogate - who then backs out at the last minute because of a faked "personal or medical emergency". Some clinics take the money ; claim to perform the treatment ; and inform the patient that the surrogate is pregnant. They then add to the lie by saying that the surrogate unfortunately miscarried, with the result that all the money has been poured down the drain ( or into the clinic's coffers). Since there is no way of verifying any of this, the patient is completely at the doctor's mercy - and woe betide the patient who falls into the hands of an unscrupulous doctor ! Since many surrogates who act as surrogates for purely financial considerations are poor and malnourished, the babies they give birth too are often low-birth weight as well.
Many patients also have unrealistic expectations of surrogacy treatment. They think that it is a 100% sure-shot affair , while in reality the pregnancy rate is still only 50% per cycle.
Of course, the major problems with surrogacy arise after birth. However, desperate patients refuse to think so far ahead, and plan to "cross the bridge" when they get to it - without thinking clearly through the real-life hurdles they will encounter at this time.
Let's look at this closely and assume the treatment has been successful; the pregnancy has been uneventful; and the child is now born in an Indian clinic. Whose name is going to appear on the birth certificate ? How will the infertile couple claim parenthood ? How will they take the child back with them to their home country after the birth ? And what happens if the surrogate ( or her husband) changes her mind and refuses to hand over the baby ? Or blackmails you for custody ?
While many clinics talk about the " Indian Council of Medical Research ( ICMR ) guidelines for surrogacy"; and about how they make the surrogate sign an agreement to protect the infertile couple, what they do not tell the patient is that the guidelines are just a piece of paper which have no legal validity whatsoever !
The Indian legal system today only recognises the birth mother. There is no concept of DNA testing for establishing paternity as far as the Indian legal system goes, which means that the name on the child's birth certificate has to be that of the birth mother and her husband ! Many couples naively plan to adopt the child and then take it back with them. What they fail to realise is that adoption in India is a long and convoluted process which can only be performed by a recognized adoption agency - and you cannot select a particular child for adoption !
Hopefully, the Indian parliament will soon pass a law which regulates IVF and related assisted reproductive technologies which may provide some legal protection for infertile couples when they go in for surrogacy treatment. However, no matter what laws are passed and what contracts are signed, remember that real-life can be very messy; and if the surrogate chooses to dispute the contract after birth, then the infertile couple is likely to find themselves embroiled in a legal quagmire - and knowing the way the Indian judiciary work, the child will be about 10 years old before the problem is solved ! King Solomon's wisdom is hard to come by in this day and age !
In my opinion, the real danger with surrogacy in India today is that it is being overused and misused today. Without a safe legal framework to operate in, patients are being misled and misguided.
The biggest tragedy is that it is being used for women who do not need it in the first place - women who can be successfully treated with much simpler ( and less expensive) treatment options ! These are women who have had repeated IVF failures; or recurrent miscarriages. They feel that their uterus is defective, because it is "rejecting" the fetus, which is why they opt to go in for surrogacy. They feel that if they use a healthy woman's uterus to grow the embryo, their problems will be solved.
Actually, this is a misconception. The commonest reason for recurrent unexplained miscarriages or repeated IVF failures is NOT a defective uterus - it is usually poor quality eggs. Extensive research has shown that embryos fail to implant ( and miscarriages occur ) because of a genetic problem in the embryos . It has been documented that these problems become commoner as the eggs age, because older eggs have a higher chance of being genetically abnormal. The
solution to this problem is not surrogacy, because replacing a normal uterus with another woman's normal uterus does not correct the underlying problem !
Not only is egg donation much easier and less expensive; it also bypasses all the social and legal problems associated with surrogacy. Once the donor donates her eggs, she relinquishes all rights to them; and since it's the infertile woman who gives birth to the baby, it's her name which appears on the birth certificate, thus preventing any problems in the future. It's also much more satisfying for women, because she is the one who experiences the pregnancy; can bond prenatally to her baby; and gives birth to her baby !
However, unless patients become better informed, many of them will continue to opt for surrogacy, when in fact the right answer to their problem would be using donor eggs !
Applied commonsense !
Clever article, which every clinic manager and doctor should read.
Wednesday, July 26, 2006
Simplify everything—The core of improvement need not be complex. Set aims, track results, find great ideas, and change something every day to find the better ways. Involve everyone you can, and do not assume that the rules of today must be the rules of tomorrow. I find elegance in the simplicity of approach that people who have little to waste have a knack for. Complexity is waste.
Take teams seriously—Improvement is about cooperation, and no one should trump the team. Uncooperativeness is waste.
Be pragmatic about measurement—Information technology is nice but not the point at all. Use the least measuring that helps, not the most that you can think of. Too much counting is waste.
Strip the support system for improvement to a minimum—Flatten the organisation. Consultants should make it their job to become unnecessary as fast as they can. Dependency is a form of waste.
Manage the political interface wisely—It is wiser to use it than to change it. Naivety is waste.
Help patients become advocates for change—Their stake is the highest, and their voices count the most. Keeping patients silent is waste.
Go quickly. Start now—Delay is waste.
Make spread a system—Find the latent structures, the channels along which change can flow, and use them from the start. Go, as Tver, from 5 to 50 to all, then to the neighbours, and then to their neighbours. Isolation is waste.
And finally, don't complain—I have visited settings in Rwanda, Mozambique, Peru, and Palestine where every person I met had 100 times more reasons to complain than I do. And none did. Complaint is waste."
This is an inspiring paper - please read it !
* The care team
* Patient activation
* Clinical information system
I personally prefer email as everything is in writing and is documented. It also saves me time - and my patients prefer it too, because it allows them to get better organised and ask intelligent questions.
Happy patients also make happy doctors !
1. Strong visionary leadership
2. Patient centered
3. Strong support for physician-patient relationship
4. Strong group, team, and standardization orientation
5. Extensive involvement and engagement of all physicians and staff
6. Highly organized change management
8. Strong change and improvement orientation
9. Broad physician sense of ownership and responsibility
10. Market driven
11. Data-based, transparent, and accountable
12. Pride and joy"
Excellent model - and it's possible to replicate it. However, I don't think it's one which it's possible to scale up. I believe medical care is a very personal service, which is best provided in the setting of a small medical practise.
What a great business opportunity for whoever can provide a clever solution to this problem !
This article is a great guide for doctors, to help them discuss the risks of medical treatment with their patients.
He discusses the 5 key dimensions of risk.
1. What Are the Unwanted Outcomes ( risks) ?
2. How Permanent Is the Unwanted Outcome? ( risk) ?
3. When Will the Unwanted Outcome Occur?
4. How Likely Is the Unwanted Outcome?
5. How Much Does the Unwanted Outcome Matter to the Patient?
Tuesday, July 25, 2006
This is especially true for infertile couples who are paralysed into inactivity when past treatments have failed. Because they have invested so much time, money and energy in their current doctor, they are very reluctant to consider switching. This can be a major mistake - and since getting a second opinion from an expert has become so easy, I just cannot understand why more patients don't do this routinely. It's important to start with a clean slate - and move on !
* Mutually Exclusive (each idea is distinct and separate; overlap represents muddled thinking) and
* Collectively Exhaustive (you've covered all the possibilities; you've thought of everything."
McKinsey is one of the world's leading consultant firms, and you can apply their MECE technique when you need to make a decision about a medical problem.
For example, for patients who are infertile, the MECE list would include:
1. child-free living
3. medical treatment
Of course, you would then need to learn more about each of these options by researching them, till you find the one that's right for you !
Monday, July 24, 2006
This makes so much sense ! Actually, hospitals are a relatively new invention - just about 100 years old. The home is the best place to get healthcare !
Sunday, July 23, 2006
Firstly, it allows me me to peek into the mind of an infertile couple ( because they share their worries and concerns with me, and email allows them to unburden
themselves ) . This allows me to be more empathetic and considerate with my real-life patients ( who usually have the same doubts but maybe hesitant about voicing them) !
Secondly, it allows me to track what services other doctors offer their patients. For example , I got an email from a lawyer today, who was advised to have a " laparoscopy, endoscopy and hysteroscopy " performed by a high-profile leading doctor in New Delhi; who had told her it would cost 2 Lakh. " Not only was this doctor taking her patient for a ride by advising surgery which the patient did not need - she was also charging her at least 4 times the standard rate , just because she was well off ! This was a valuable learning lesson for me, because I now know ( from first-hand experience in one sense), how this doctor treats her patients. I am never going to refer a patient to her again !
Thirdly, it makes me feel good about the service I offer. Not only have I saved this patient a large sum of money; I have also saved her unnecessary surgery - and this did not cost either my patient or me any money !
I feel health insurance companies can use the power of the internet to offer such a service to their clients. Not only will this prevent unnecessary surgery; it will help to keep doctors honest; and also help to reduce the claim payouts of health insurance plans and save them money ! Maybe retired doctors ( who have no axe to grind and have a lot of experience) can offer this service - all they would need is a computer to do so !
Saturday, July 22, 2006
As a stimulant to broaden the health care delivery dialogue, Gesundheit! Institute's mission is to build a hospital/healing community and provide care based on these priciples:
* All the healing arts are welcome
* All patients are treated as friends
* There is no charge for health services
* No third party reimbursement is accepted
* The health care experience is infused with fun
* No malpractice insurance is carried by the Institute
* The health of the staff is valued equally with the health of the patients
* The health of an individual is nested in the health of family, community, society and the natural environment"
Wow ! This is a big, original audacious dream - hats off to them !
Friday, July 21, 2006
The goal, WellPoint said, is to arm people with information about their own health histories. For instance, a man seeing a cardiologist for the first time could share his personal record with that doctor so the physician would have a more complete picture of that patient's medications and medical history.
In another example, a pregnant woman could use 360 Health to research information on proper nutrition during pregnancy. Or that mom-to-be could look up names of doctors and hospitals that specialize in high-risk pregnancies or register to have a dedicated nurse to have phone consultations with throughout the pregnancy.
WellPoint said much of 360 Health is packaging together information and services already available to its members. But some experts said the personalized health record stood out to them as an innovative approach to better using health information.
'I think it is an important step to make an effort to use their data to put it at the fingertips of patients and doctors where they can access it day or night,' said Dr. Brad Doebbeling, a professor of internal medicine at Indiana University and director of IU's Center for Health Services and Outcomes Research at the Regenstrief Institute.
The concept for 360 Health was developed by New York-based insurer WellChoice, which WellPoint acquired last year. WellPoint said nearly $100 million has gone into developing the program."
This is a win-win situation and I am sure lots of other health plans will provide the same services to their customers soon.
Thursday, July 20, 2006
This will help to demystify a lot of what doctors and nurses do. Valuable skills to add to your armamentarium - all presented in a very simplified format - a bit like the Dummy's Guide to Home Nursing.
Tuesday, July 18, 2006
background, history of diagnoses and procedures, test results and medications, and diet and
exercise habits is essential to managing health, assessing problems, and preventing medical
error. Today medical information is scattered among the many health care providers people
see throughout their lives. It is stored in individual memories, on scraps of paper and in
spreadsheets on personal computers. Some doctors and hospitals keep computerized
medical records, but most personal health information is stored in thick paper files that line
office walls. There is no coordinated system, no standardized, private and secure way to
integrate an individual’s health information in one place. A visit to a new doctor means new
forms to complete, new tests to run and new conversations reviewing your personal medical
history -- conversations that depend almost entirely on memory alone. People need effective tools to help them manage their health and their healthcare.
Here's a clever solution to a common problem !
Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, And Costs
A one-word summary of the article would be - Yes !
In 2004-2005, health insurance premium collections amounted to Rs 2,000 crore which, in comparison with the total health care spend at around Rs 60,000 crore, pales into insignificance. Health cover premiums, however, account for less than 1 per cent of total premiums for life insurers and 10 per cent for general insurers of total premiums but it is an idea whose time seems to have come. Per capita health care spend in India is just $32 as against $5,365 in the US and $3,036 in the UK in 2004."
Someone is going to be making a lot of money by tapping this segment - let's hope they provide good value for money !
How will doctors ever improve if you don't given them feedback ?
1. To earn $20,000 so that we can become parents. And if we earn more than that, and all of our medical expenses have been covered, then we'll donate the additional money to another couple.
2. We hope it will serve as a positive, and personal window, into the IVF process- this includes keeping you updated on our experiences, a running total of money earned, a detailed breakdown of every penny spent and resources we've found useful in educating ourselves- giving another couple in our position a first-hand account of the process and better prepare them for their journey."
I am glad to see this website from this clever infertile couple who are taking matters into their own hands !
Sunday, July 16, 2006
I tell patients that if the technology was perfect, we would transfer 2 embryos for every patient ( most infertile couples are very happy to have twins so they can complete their family at one stroke); or just 1 for the minority who wanted to have only one baby. However, because the technology is still not perfect, deciding how many embryos to transfer is always a heart-wrenching decision.
As is usual with most of life's decisions, there is a price you pay for every decision you make - and every couple needs to weigh the risks and benefits of this tough choice. ( In countries which allow doctors to transfer only 2 embryos by law, the decision is much simpler, because there is no choice available !)
We know that the chances of pregnancy are proportional to the number of embryos we transfer - the more the number of embryos transferred, the greater the chances. However, just as the chances of success rise, so does the risk of multiple pregnancy. High order multiple births can be a major complication, because of the risks of prematurity, so we would like to select the optimal number of embryos to transfer , which would ensure a pregnancy, without risking a high-order multiple birth.
Since the chances of implantation depend upon a number of biological variables which are hard to quanitfy, we use the following guidelines to help our patients make this difficult decision.
The variables we need to consider include:
1. Age of the woman and ovarian reserve
2. Quality of the embryos ( Grade)
3. Day of transfer ( Day 2, 3 or 5)
4. Number of failed IVF attempts
5. Fertility history
6. Endometrial receptivity
7. Financial and real-life constraints
8. Patient preference
9. Use of donor eggs/ donor embryos
10. Quality of the clinic ( overall success rate)
Such a large list of variables ( many of which are "soft" and subjective")explains why this is such a difficult decision.
This is how we approach this problem in our clinic.
For young patients ( less than 30) , who are doing their first IVF cycle, we suggest they transfer 2 embryos if these are Grade A embryos on Day 3. If the patient is between 30-38, we add one more, so we transfer 3. For patients more than 38, we suggest 4, as the risk of a multiple pregnancy decreases as a woman gets older. For women more than 40, we are happy to transfer as many embryos as they get.( Of course, if they are using donor eggs or donor embryos , then we need to re-do the calculations). If the embryo quality is poor ( Grade C or less) , we add one more. If the endometrium is poor, we add one more embryo ( as the chances of implantation go down if the uterine lining is poor). For patients who have failed IVF cycles elsewhere, we transfer one more embryo. If the patient opts for a Day 5 ( blastocyst ) transfer, we reduce the number by one. This algorithm gives us a rough rule of thumb as to how may embryos to transfer, which tries to factor in all the key variable which can affect embryo implantation. What I like about it is that it allows us to choose a number which is individually tailored for each patient,
However, we always let the patient make the final decision. For example, if a patient says that it's her last IVF cycle, because of financial constraints, and she wants to transfer more embryos, we will do this.
In the final analysis, we feel that the patient should make their own decision, since they suffer the consequences of whatever decision they make. I suggest to patients that they take what I call the "path of least regret". It's often a question of choosing between the lesser of two evils : not getting pregnant; or having a high order multiple. Many patients prefer transferring more embryos, and are willing to consider the option of selective fetal reduction in case they have a high order multiple. In this sense, a high order pregnancy is a "manageable complication" . Others would start a fresh cycle rather than countenance a reduction. Since this is such a personal decision, it's best if couples make it for themselves, so that they have peace of mind they did their best.
Most of the time, this system works well and we have a high pregnancy rate and many satisfied patients. However, whenever a patient does not get pregnant, we always wonder - Maybe if I had transferred one more embryo, she might have conceived ? And conversely, when she has a triplet pregnancy, we kick ourselves for transferring too many embryos ! Being an IVF specialist can be stressful !
This was my reply.
" Yes, you are right. Unexplained infertility is simply a confession of our ignorance, and means that our technology is not good enough to be able to identify the problem. For example, a semen analysis can show that your sperm count is normal. However, it tells us nothing about the functional competence of the sperm - whether they are able to fertilise the egg or not ! In any case, I feel the question should NOT be "Why am I not getting pregnant ? " Rather, it should be - What can I do in order to get pregnant ?" After all, no one cares about problems - we only care about results - about having a baby ! Fortunately, our technology for solving problems ( by bypassing them in the IVF lab !) is much better than our technology for identifying them - and perhaps this is just as well ! This means that rather than waste time trying to pinpoint the problem, we can just bypass it altogether ! "
This is a clever idea, and will help infertile couples to fight for their rights !
Friday, July 14, 2006
The Indian health insurance market is hotting up ! Health insurance plans can serve as important catalysts in improving healthcare services for the population.
You scan the information and realize that you don't remember when you had your tonsils out or the name of the medicine that caused you to break out in hives five years ago. You soldier on, filling in the blanks as best you can, hoping that your memory lapses won't come back to haunt you. Having complete and accurate records for everyone in your family isn't just a nice thing to have, it's essential."
This is why a web-based PHR ( personal health record) makes so much sense ! ( And if your family members have their own PHRs, then it's that much easier to complete your own family medical history reliably.)
'This is costing us,' said Dr. Catherine DeAngelis, JAMA's editor-in-chief. 'It's costing us really good articles and God knows what it's costing us in ads.'"
I find it fascinating that the editor of USA's leading medical journal is worried about the impact of her policies on her revenue ! Things have come to a sad pass when academic journals need to worry about keeping their advertisers happy ! I guess it's a sad reflection of our times that editors have to worry more about their ad revenue, than about their reader; or their product's reliability and integrity. However, once they lose this, then who will want to read their journal - forget about advertising in it !
Improve care by building better relationships with your doctors - Nashville, Tennessee - Tuesday, 07/11/06 - Tennessean.com
As with any two-way street, good doctors are skilled at getting patients to open up !
Thursday, July 13, 2006
In USA, it's all about money ! Unfortunately, healthcare does not respond to bottom-line concerns, and we need to think of cleverer ( and more humane) ways of providing better medical care.
Wednesday, July 12, 2006
First, we define the problem: Healthcare expenditures in America continue to escalate out of control as quality (safety, effectiveness, efficiency, affordability, timeliness, and availability) suffers.
Second, we examine proposed solutions: Debates now focus on what models should replace the failed financial strategies of the past.
Third, we propose a unique and sensible model to solve our country’s healthcare problems."
This is an extremely comprehensive and optimistic view of how we can use existing technology to heal a sick healthcare system.
If Google is setting up a health portal, this confirms that this is a "hot" area and there is money to be made. Anyone who customises a portal for Indian health consumers will do very well. The chase is afoot, Dr Watson !
( Of course, one doctor's advocate could be another doctor's pest :)
For the ideal combination, mix an informed patient with an inquiring physician. Arthur Caplan, chairman of the medical ethics department at the University of Pennsylvania, likes to cite a quote attributed to the ancient Greek physician Galen: "The best physician is something of a philosopher." Such a physician does more than "pose questions," says Caplan. He "isn't afraid to have them asked. The process of questioning can lead to understanding and patient satisfaction."
And doctor satisfaction as well. It's much more fun ( and intellectually stimulating) to treat a well-informed patient who does his homework and asks questions ! Smart patients can teach their doctor a lot !
Tuesday, July 11, 2006
Just like ATMs revolutionised the banking industry, maybe this model will change the face of healthcare delivery by making it more easily available and affordable. Instead of patients having to come to doctor, what's wrong with doctors going to where the patients are ?
This makes so much more sense, and is a great win-win solution ! However, few corporates are willing to invest in even something so simple as a health education program for their employees. While they are happy to pay lip-service to the slogan - "Our people are our most valuable assets", few put their money where their mouth is !
Doctors are sickness specialists - not wellness specialists ! While I won't say that more doctors = more illness, it is true that more doctors does not mean more health !
Saturday, July 08, 2006
Every clinical facility should have a patient education recource center. This could be as simple as a computer with an internet connection - but it should be easily accessible and freely available !
I like the emphasis placed on the importance of the patient's active participation in minimising medical mistakes.
Misdiagnosis does not occur equally for all conditions but follows certain patterns. Some conditions are inherently more difficult to diagnose, whereas common familiar conditions are less commonly misdiagnosed. Some diseases are over-diagnosed whereas other conditions are more commonly under-diagnosed or overlooked."
A misdisgnosis can be a doctor's nightmare - and a patient's as well. This is a very well-written review on the common causes for misdiagnosis; and what you can do to protect yourself !
At the Bombay Hospital we have been serving vegetarian food from the inception of this institution and now we feel that the time has come to offer scientific justification for this. Not only on religious or moral grounds is this justifiable, but also on scientific grounds vegetarian food seems the more suitable diet for human beings. More scientific work has been done on vegetarianism in the last two decades than in the entire previous history of the world. Therefore, we felt that we should take the lead and bring to the fore all that there is to know on vegetarianism from the scientific angle and thereby justity the use of vegetarianism in health and in disease."
Excellent scientific review by leading doctors as to why vegetarian food is good for you !
Makes sense. Specialised courts for specialised problems, so patients don't have to wait forever and ever to get a fair hearing and redressal.
Thursday, July 06, 2006
This process of looking at the state of the evidence before making a decision is called evidence-based medicine or evidence-based health care. It means based on scientific evidence or supported by proof. It means not relying only on the views of experts, but on the most objective knowledge as well. The goal is to help patients get the most appropriate treatment for them. After considering the evidence and the person's own values and judgment about their options, a patient and experienced doctor can come to a better decision. The best health care is not necessarily where 'everything” is done for the patient, but rather, the most appropriate. This can protect people from harmful and useless treatments. What's more, it is only when we know what the limits of knowledge are, that we can know what needs to be done in the future to fill the gaps in what is known."
Evidence-based medicine ( EBM) is one of medicine's current buzzwords. This is a very useful guide, which explains what EBM Means in clear English .
Is this fair on the patients ? Not always, but this is the occupation hazard of being a patient in a teaching hospital. Fortunately, the "errors" are often easily corrected, and don't result in any lasting harm.
Excellent primer on medical laboratory testing ! Every well-informed patient needs to know these basics. Check this before you go for your next test.
Wednesday, July 05, 2006
We need to also address the needs of the 200 million middle class Indian citizens who can pay for health insurance - but who are not being adequately served at present.
breakdown of public expenditure (0.9%); private expenditure (4.0%). The private expenditure can be further classified as out-of-pocket (OOP) expenditure (3.6%) and employees/community financing (0.4%). It is thus evident that public health investment has been comparatively low. In fact as a percentage of GDP it has declined from 1.3% in 1990 to 0.9% as at present.
Furthermore, the central budgetary allocation for health (as a percentage of the total Central budget) has been stagnant at 1.3% while in the states it has
declined from 7.0% to 5.5%."
This actually represents a huge business opportunity. Anyone who taps this underserved market intelligently will do very well - as well as doing a lot of good !
Monday, July 03, 2006
Reading this great book can inspire you - listen to this lecture to get an idea of what an unusual man Dr Farmer is !
Are they making a comeback ? Is this a new business opportunity ?
Sunday, July 02, 2006
Great site ! Unfortunately, you won't get an Master of Public Health degree ( MPH ) by studying this course online - but you will learn a lot !
On average, Miller has found in a new paper, a woman in her 20s will increase her lifetime earnings by 10 percent if she delays the birth of her first child by a year. Part of that is because she'll earn higher wages—about 3 percent higher—for the rest of her life; the rest is because she'll work longer hours. For college-educated women, the effects are even bigger. For professional women, the effects are bigger yet—for these women, the wage hike is not 3 percent, but 4.7 percent.
So, if you have your first child at 24 instead of 25, you're giving up 10 percent of your lifetime earnings. The wage hit comes in two pieces. There's an immediate drop, followed by a slower rate of growth—right up to the day you retire. So, a 34-year-old woman with a 10-year-old child will (again on average) get smaller percentage raises on a smaller base salary than an otherwise identical woman with a 9-year-old. Each year of delayed childbirth compounds these benefits, at least for women in their 20s."
No wonder women ( and their husbands) agonise over when to start their family. Career versus Baby ?
If I had a choice, I would have liked to be born with genes which allowed me to be more athletic and more intelligent !
This is why "brain drain" is NOT a bad thing and should be encouraged. Think of it as exporting skilled manpower to the USA !
I am glad for once someone focussed on the fact that the doctor was providing a useful service to his patients ! Unfortunately, it's easy to paint doctors as villains and bash them up - and unfortunately, when they are down and out, no one comes to their aid !
Which is not to say the search for a solid doctor is hopeless—just that the guidebook approach has made the task more complicated than it needs to be. Below is my simple one-two-three approach. It's even in glossy-magazine format.
1) Trust your instincts: There are lots of rotten doctors, really really lousy ones, wretched souls you wouldn't want to know as people, much less trust with your health. But they aren't any harder to suss out than the schmucks you meet in everyday life. If your gut says run, then run.
2) Don't trust your instincts if a scalpel is involved: Subjective impression is meaningless when selecting a surgeon. Craft should trump your desire to like them; in fact, it's OK to hate your surgeon. You simply need him to cut and sew very intelligently. So always select the surgeon who has already done the most iterations of whatever procedure you need. Stated in Zagat-ian terms: Which restaurant do you want to go to—the one with the line or the one that sits empty?
3) Shop around: Diagnosticians, sensitive (and craftless) souls that we are, succeed only if we connect. A doctor who is beloved by one person can be a disaster for the next. Think of who ended up marrying whom—there simply is no accounting for taste. So look before you buy. Yes, it takes time, it takes money, it is humiliating and ridiculous and maybe just a sinister plot to give doctors more business. Do it anyway, and do it when you are well."
Excellent advise from a doctor who appears on a Top-10 list. You can use it for everything - including looking for a wife; or a college !
Saturday, July 01, 2006
One of the biggest challenges to the General Insurance Company’s in India has been the penetration of individual health insurance product. Figures quoted by various sources reveal that only 2-5% of the population buys a health insurance product. The figure is incongruent in today’s context where concerns regarding health care are dominant across various segments of the population. There is a growing distress among all sets of individuals regarding rising health care costs.
Inspite of this concern, health insurance has failed to penetrate in India. We have done a consumer research through Quantum Market Research, India’s leading qualitative Market Research agency on this issue. The research revealed that consumers are reluctant to accept health insurance because of the complex procedures that need to be followed for buying a health insurance product. The premium to be paid for health insurance for the entire family is also perceived to be very high especially when the consumer is buying something, which he believes could be unlikely, or an unforeseen situation.
The issue is further compounded by the fact that the insurance agent does not find it lucrative enough to sell health Insurance as the commission amount does not commensurate with the effort that it takes to convince a potential customer to go through a complex procedure and buy a health insurance product.
Aiming to address the above concerns, we intend to bring in quite a few initiatives in our individual health product portfolio. Direct marketing to the vast untapped middle income groups is one of our priorities. We would be giving various price point options for the customer to choose and offer premium payment options through installments to eliminate the entry barriers."
The other reason is that health insurance in India was a monopoly, and health insurance cover was provided only by government insurance agencies. This was seen to be a social service; and this segment always incurred major losses, which is why it was neglected. Once health insurance gets de-tariffed, many more private players will enter; and along with competition will come a lot more innovative efforts to provide cost-effective health insurance cover.
I feel the entry of private health insurance companies into India will mark a dramatic change in the way healthcare is delivered. Their entry will be a major catalyst towards the adoption of EMRs ( electronic medical records) and PHRs
( personal health records), which make a lot of business sense !
Diseases such as cancer and cardiac conditions are likely to account for nearly 30% of ailments and HIV infections are also expected to rise significantly during this period.
Meanwhile, the four public sector insurers and the country's largest private insurer ICICI Lombard have submitted their bids for a number of State Government-sponsored health insurance schemes. The State Government's plans are part of the Central Government's initiative to increase public spending on health to 2% of the GDP by 2009 and provide health insurance to people below the poverty line."
To mark the day, HELP is providing the book ‘Successful Medical Practice - Winning Strategies for Doctors’ at a subsidised price of Rs 100 (regular price Rs 250) to all doctors who come to the library. The message of this book is simple - ‘Love your patients. Doctors who take good care of their patients will have a flourishing practice!’
Doctor’s day makes you aware of the role of doctors in your lives so that you can express your gratitude for their compassion and commitment towards health care and wellness of the society. Says Dr Kapoor, “This day is an opportunity for patients to express their gratitude to their doctors for the medical assistance and solace they may have received in their time of emergency.”
Panacea Biotec has come up with a novel idea wherein, the company will deliver a bouquet to the doorsteps of the doctors of the first 1,000 people who log on to their website. The campaign aims at encouraging every person to thank their doctor for the latter’s invaluable services.
“It’s a pleasure to encounter a thoughtful patient who just takes the time to say ‘Thank you!’ This patient makes the doctor’s day. The best gift a doctor can receive is the referral of another patient - an ultimate accolade any professional can be awarded,” concludes Dr Malpani.
I find his basic message is worth emphasising - you can no longer trust what you read in the press. Unfortunately, the media has got so good at "dumbing down" all of us, that with our reduced attention spans and constant need for stimulating "sound bites", we have become so addicted to "sweet, short and simple" messages, that we find it hard to think critically; or separate the wheat from the chaff. Let the reader beware !
What this means is that you really can't trust your doctor to prescribe what's best for you ! Even if he is honest, he may have been brainwashed by the pharmaceutical industry's propaganda into prescribing drugs which may not be very good for you.
Many people are so fed up of Big Medicine, that they prefer using alternative medicine as their treatment of first choice. However, the field of alternative medicine is even murkier. While the misinformation in Big Medicine is systematised and cleverly oiled, quackery flourishes in the arena of alternative medicine, because there is no regulation or supervision. Your best weapon is information - but you have to be very careful where you source your information from. There's too much information out there - and lots of it is unreliable or biased.
This is why information produced by independent organisations such as Healthwise is worth its weight in gold !