Friday, August 15, 2008

I believe .. patient power can heal a sick healthcare system


The Indian healthcare system has become sick. In the private sector, doctors are no longer held in high regard; the doctor-patient relationship has deteriorated; and patients believe that the medical profession has become commercialized. The dismal state of the government’s healthcare services for the poor and the middle-class has also been extensively documented. The knee-jerk reflex has been to train more doctors ; set up more hospitals; and force corporate hospitals and doctors to provide subsidised medical care. This is simply a form of " band-aid medicine". The only effective solution will be to rely on the one resource which is almost inexhaustible—the people themselves. The principle is simple – teach them so they can manage their own health problems.

The reason that India is shining today is that we are in a demographic “sweet spot.” India’s major strength is its middle-class, with its millions of educated young adults , and protecting their health should be a high priority. Unfortunately , healthcare remains a neglected area , because of which millions of working years ( and billions of rupees ) are wasted on preventable illnesses . Medical absenteeism exacts a huge toll , but because it is hidden from public view, we have not addressed this problem effectively.

This is a daunting task, and the challenges are enormous. However, the biggest mistake we make is to assume that people are incapable of tackling their own medical problems; and that we need to look to doctors for solutions. We need to change our focus. Instead of trying to provide sophisticated healthcare services ( blindly imported from the West) , which need expensive technology, fancy machines and highly trained specialists, we need to tap the people themselves. People are smart and motivated , and are capable of remaining healthy, if we give them the right tools and teach them how to use them.

Doctors are illness experts – and not healthcare experts. Healthcare needs to learn from the revolution which has occurred in microfinancing. When given money and the freedom to use it as they see fit , even very poor people have come up with remarkably innovative ideas which could never have been planned, designed or anticipated by the traditional experts - bankers!

Information Therapy - the right information at the right time for the right person - can be powerful medicine ! Ideally, every clinic , hospital, pharmacy and diagnostic center should have a patient education resource center, where people can find information on their health problem .

The key is to develop patient-friendly materials which people will want to watch and can learn from. Most of us are visual learners, so this should be in graphic format. Modern technology has made creating and sharing visuals easy, so each community can build its own customised health video libraries with ease ! A simple example would be to find an articulate doctor with excellent communication skills, and to record a doctor-patient consultation with her about the top ten common clinical problems. A library of such videos could then be published online as "open source content" ; and patients and doctors could download and dub these in local languages . This version can again be uploaded to the web and shared with other patients from all over the country. Web 2.0 technology empowers patients to form support groups and communities where expert patients can help others. As the technology improves, it will soon be possible to deliver this graphic educational content on the third screen which is quickly becoming universal - the cellphone. This means information will be available 24/7 , free of cost, whenever you need it ! Patients will make use of these videos, since they are in their own language; deal with their immediate personal concerns; use local characters they can identify with; and provide local solutions which they are familiar with .

Information Therapy enhances patient autonomy by putting patients first; promotes patient-centered healthcare; respects the fact that the patient is the expert on himself; emphasizes personal responsibility for health; reduces the risks of medical errors; improves patient compliance with therapy; reduces the risk of litigation, because the patient has realistic expectations of the treatment; empowers patients to make their own decisions; and allows the intelligent use of integrative medicine, ( such as yoga , homeopathy and ayurveda) , so people can explore what works best for them. It creates expert patients and allows patients and doctors to form a healthy partnership, by improving doctor-patient communication. Finally, it saves money on medical care , both by promoting self-care (thus encouraging patients to do as much for themselves as they can, and not become dependent on doctors) ; and helping them with veto power, so they can refuse medical care they don’t need, thus preventing overtesting and unnecessary surgery .

Is educating people about their health and medical issues too expensive ? In fact, it's too expensive not to do it ! Human capital is India's most precious resource and we cannot afford to squander it. Information Therapy is free ; has no side effects ; and provides a terrific return on investment. We should insist that doctors dispense information therapy every time they do a consultation; advise a lab test; or prescribe medicines. In fact, both the government and insurance companies can make prescribing information compulsory . Knowledge is power, and Information Therapy can be powerful medicine – let’s make the most of it !

This is an article I wrote for the Times of India I Believe supplement for the 15th of August - India's Independence Day.

1 comment:

  1. Hi Dr Aniruddha,

    I read the same article in Times o India Independence Day special issue, and wanted to appreciate you for coming up with such innovative ideas. Luckily I could connect with you through your blog.

    Yes, 'information is power', and many people talk about empowering without delivering the information. Especially healthcare sector is highly neglected in this area. We try to educate people when the crisis reaches its edge, as it is happening with HIV/AIDS awareness.

    Indians should be educated through various tools, online and interpersonal, about how they can take better care of their health and avoid serious health issues.

    As it is said, 'prevention is better than cure', and it is the primary responsibility of everyone of us.

    Mohan Krishna

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