Monday, June 30, 2008
For patients to become platforms, we need more tools and capabilities that are native to the patient. All of us need to be able to walk around the world with the ability to jack into any health care system and drive it. How? I don't know yet. I'm still new to this. But I do know that these are capabilities we need to add to ourselves, as independent drivers of health care services. And that these must be based on free and open standards and code.
The new health care infrastructure must be built on independent and autonomous patients, not on systems that surround and subordinate patients. Once it is, the systems will be vastly improved, and far more profitable for all."
Healthcare should be about the patient !
Sunday, June 29, 2008
Progressive companies in the USA recognize that unhealthy employees are a financial burden and that wellness programs can provide an effective solution. Instituting wellness programs that help employees adopt healthier behaviors can be an important way to decrease illness, absenteeism, turnover, medical claims; and increase productivity and create a healthier bottom line.
How can Corporate India help to improve the health of Indians ? Traditionally, most companies just pay for their employees’ medical insurance policies, which means they provide financial cover in case of illness. I feel they need to take a more proactive approach and prevent illness ! At present, HR ( Human Resources ) departments think of themselves simply as dispensers of health care entitlements . If an employee falls ill and submits a claim, they feel that their job is to process the claim so that the costs of the medical care are reimbursed. This is very short-sighted !
In the US, employee health management (EHM) programs have been around since the 1970s. However, when employers simply offer free EHM programs and do not offer incentives for participation in them, the uptake of such wellness programs is poor. They attract only those employees who already committed to personal health and fitness, while those most needing to improve these dimensions ignored the opportunity. However, by providing incentives, participation rates of as high as 95% have become possible.
Instead of focusing solely on healthcare and disability claims costs, these programs look at absenteeism reductionism and presenteeism as desired outcomes. They look at employees who have “productivity impairment” behaviors and conditions, including emotional/behavioral problems, inadequate sleep, stress, and similar debilitating factors, many of which are epidemic in call centers and BPOs today, and provide holistic solutions.
Results have been far more positive than earlier EHM investments that focused just on healthcare cost reduction. Productivity “recovery” often increases total economic benefit to employers by two to five times, compared to healthcare cost reduction alone. Progressive companies allow employees to design their own EHM goals, and this has been very helpful since it is the employees’ own personal efforts that make EHM successful.
The good news is that progressive companies in India are now following the US trend. Many companies provide gymnasiums and fitness centers in their campuses; technology companies use the internet to provide their employees with online counseling programs; others offer their employees a free PHR ( Personal Health Record) to help them manage their own health; while others are gifting free copies of the Healthwise Handbook to help their employees to remain healthy.
What’s your company doing to improve the health of its employees ?
NB I wrote this article for Times Wellness, where it was first published.
Friday, June 27, 2008
conversations - this is an occupational hazard !)
He used evolutionary psychology ( aka sociobiology) to explain his thesis. When man first started having sex, " quickies " were far safer than prolonged intercourse, which meant evolution favoured premature ejaculators for many reasons.
1. They could have sex with more women, this winning the "sperm wars".
2. Having sex in the open left the couple vulnerable to dangers from predators. Men who completed intercourse faster reduced their exposure to danger.
3. There was little privacy in primitive times, and having sex in front of other men meant that they would get sexually aroused by watching the act , and would want to have sex with his partner . Premature ejaculators could have sex more quickly and quietly, and thus were less likely to create competition with the other males.
Does this make sense ?
Wednesday, June 25, 2008
I am in the prime of my professional career as an IVF specialist and have been very pleased with the way life has treated me. However, I have major misgivings about what the next generation of Indian doctors are going to have to deal with.
Here’s a sampling of some of the woes medical students and residents in India have to battle with today.
There’s an apparently never-ending series of examinations to clear before you can get a license to practice . For some specialties, it can take upto 10 years before you get a degree which means that doctors are over 30 years old by the time they start seeing patients independently.
The government changes the medical college rules when it so fancies. When some politician decides that doctors need to do more for the poor, medical colleges make new rules and decide that rural service is compulsory , so that hapless medical students are stuck for another year in a village, in a hopeless job where they learn nothing, and have no facilities or supplies to be able to do any good to anyone.
There are limited seats and openings for certain specialties which means that many young doctors never get a chance to practice the specialty they want to. Not only are there very few seats, but most of these are blocked as a result of the pernicious reservation policy. Imagine the heartburn a bright young doctor who has set his mind on becoming a heart surgeon goes through when the only seat available for MCh cardiothoracic surgery goes to a candidate who has only 50% of his marks, just because he belongs to a backward class.
Doctors are a soft target and easy to beat up on. The Indian press enjoys doctor-bashing and does it with predictable regularity. A few black sheep tar the image of the entire profession so that hard working upright doctors who have devoted their lives to taking care of patients are treated with disrespect. Doctors are considered to be dishonest money-hungry professionals – and the law ( PNDT Act) now forces ultrasound clinics to put up signs which effectively
say – “ We will not perform illegal activities” ! Society no longer trusts doctors - it's that simple !
The government has failed miserably at providing primary health care to citizens , but does its best to interfere with the running of efficient corporate hospitals , just because they make a profit.
Individually, we all respect our personal doctor and go running to him when we fall ill . However, we tend to view the medical profession as a whole with a jaundiced eye ! Why is there such a major discrepancy in the way most of view the medical profession vis-a-vis our own doctor ?
Doctors are usually excellent in the clinic. They are very good at helping their patients, one at a time, because this is what they have been trained to do , and they do this very well. Ironically, this is what hurts them ! They are not very good as a group because they have poor political skills and cannot band together . They often end up fighting with each other because of petty personal rivalry and compete with each other for patients and prestige. They are so focussed on trying to get more of the slice of the patient population for themselves that they don't realise that their cake is fast shrinking ! There is strength in unity, but the Medical Associations do not stand up for individual doctors who are helpless and vulnerable. The profession has lost its autonomy, and is regulated by bureaucrats and outsiders, who have little understanding of the realities of providing medical care.
The role which doctors used to play in guiding society to provide health care for the community has been usurped by health activists , who are supposed to represent the interests of patients. Unfortunately, many of these live in ivory towers and have never taken care of a patient in their lives. They provide excellent solutions on paper which never get implemented because they are unrealistic and impractical.
What can we do to redress the problem ?
Doctors have a lot of individual clout and they should learn to use it for the sake of the profession. This is difficult to do in the hurly-burly of daily medical practice, but senior doctors who have retired can perform this role very efficiently. Doctors are meant to be patient advocates – and senior retired doctors should be invited to represent the interests of patients and doctors . They have spent a lifetime studying medicine and healthcare and are aware of ground realities.
It’s a fact that the medical profession has lost its charm and the future looks even gloomier. Doctors have lost their moral authority and their professional prestige. We seem to be headed the US route, where the doctor-patient relationship has been tarnished because of commercialism.
If this negative vicious cycle continues, not only is it going be sad for the next generation of doctors but it’s going to be even worse for the next generation of patients ! Angry, unhappy and frustrated doctors provide poor quality care – and it is their patients who will suffer !
"# Module 1. INTRO: What is evidence-based healthcare and why is it important? (45 minutes)
# Module 2. ASK: The importance of research questions in evidence based healthcare. (40 minutes)
# Module 3. ALIGN: Research design, bias and levels of evidence. (1 hour)
# Module 4. ACQUIRE: Searching for healthcare information. Assessing harms and benefits. (1 hour 10 minutes)
# Module 5. APPRAISE: Behind the numbers: Understanding healthcare statistics. Science, speed and the search for best evidence. (1 hour 20 minutes)
# Module 6: APPLY: Critical appraisal and making better decisions for evidence-based healthcare, Determining causality. (1 hour)"
Tuesday, June 24, 2008
Very inspiring story of a doctor who has used technology cleverly to help him to take better care of his patients ! It's a model which has stood the test of time !
Sunday, June 22, 2008
There is no “wisdom of the market” with regard to health care. Consumers, i.e. patients, are not wise. They are frightened, sick, and confused. That’s what happens to human beings when they are sick or injured. Patients are irrational consumers, and no amount of arm bending, medical websites, or cajoling on the behalf of medical economists is going to change that.
I would suggest that the medical economists who are also parents are just as irrational when their children are ill as any other human being.
Great Britain’s NHS lacks the competition that drives innovation. As a consequence it is greatly inefficient.
America’s unfettered free market lacks the rational “market wisdom” necessary for a demand side to direct the competition of the supply side. Patients are by definition irrational. There is no market wisdom in a health care system run according to the tenets of an unfettered free market. The supply side competes for profit alone, unfettered by any restraints."
During the visit, a team led by Virginia Mason's chief of medicine met with a Toyota guru, a sensei who had absorbed the Toyota approach into his very marrow. Examining a layout of the hospital, the sensei learned that there were waiting rooms scattered across the campus.
'Who waits there?' the sensei asked.
'Patients,' said the chief of medicine.
'What are they waiting for?'
The sensei was told there might be a hundred or so such waiting rooms and that patients wait about 45 minutes on average.
"You have a hundred waiting areas where patients wait an average of 45 minutes for a doctor?" He paused and let the question hang in the air. "Aren't you ashamed?"
Many doctors seem to take perverse pride in how full their waiting rooms are; and how many weeks in advance their appointments are booked. To me, this just spells poor time management ! But as long as patients feel they are helpless and need to be patient, doctors will continue ill-treating patients.
1. Avoid Reliance on Memory
2. Simplify Tasks
3. Standardize Procedures and Equipment
4. Use Constraints and Forcing Functions
5. Use Protocols and Checklists Wisely
will move medicine out of its cottage industry practices into the modern world of systems design."
Millennial Patients: How Your Practice Will Change as You Prepare to Care for the Next Generation of Patients
David S. Sobel, MD, MPH, Medical Director of Patient Education and Health Promotion for The Permanente Medical Group at Kaiser Permanente, is responsible for 3.3 million members who interact with the Kaiser system and has a simple mantra for success: “Keep the patients healthy, happy, and at home.” Beyond the trite saying is a powerful philosophy about patient empowerment. Namely, Sobel considers his patients as providers and collaborators in the care process. “Patients are most often viewed as consumers of healthcare, and health professionals are seen as the primary healthcare providers” Sobel says. “In fact, 70 to 90% of all symptoms are self-diagnosed and self-treated".
Health eTouch Pad is a 10-inch touch-screen computer that asks questions about health and behavior while patients are waiting to see a doctor.
The gadget, developed by Children's researchers, serves as a screening device, allowing doctors to ask questions that might be rushed or forgotten in an exam. The information is sent to a control site, where it is summarized and flagged to indicate concerns. Doctors could receive reports right away, to discuss in the exam, or days later."
Most IVF patients are excellent candidates, which is why we see so many of them in our clinic.
Mode 1 refers to 'arm's length' services that are typically found online: The provider and the user of services do not have to be in physical proximity. Mode 2 relates to patients going to doctors elsewhere. Mode 3 refers mainly to creating and staffing hospitals in other countries. Mode 4 encompasses doctors and other medical personnel going to where the patients are. All modes promise varying, and substantial, cost savings."
That's why we created Trusera, an online health network where you can find and share real-world experiences. By connecting with others, you can find valuable insights that help you take control of your health. At Trusera, you get relevant, credible and useful health information and insight from others who’ve been there."
But there were rewards. For decades, doctors earned hefty paychecks, had autonomy and respect. But those benefits are fading, and as a result, so is the number of doctors. Within the next 15 years, the United States will experience a shortage of between 90,000 to 200,000 physicians, according to the recently published Will the Last Physician in America Please Turn Off the Lights: A Look at America's Looming Doctor Shortage.
The American Medical Association recognizes there are shortages in certain geographic areas and in certain specialties. Part of that is due to the aging population and a stagnant number of medical-school applicants.
But there are other significant reasons. They include the increasing costs of medical malpractice coverage, higher practice costs, lower insurance reimbursement rates and insurance-company restrictions resulting in less autonomy over how patients are cared for."
McKinsey Quarterly released an interesting study this week under the moniker, “What Consumers Want in Health Care.' The central theme of the publication was the large and growing opportunity for a new type of health care “infomediaries” (who traffic in the flow, enhancement, and interconnectivity of information) to have a large and sustained impact in the transformation of our current system to a next-generation system required to meet the health needs of the future.
A few relevant quotes:
* Retail health consumers constitute a market worth hundreds of billions of dollars annually.
* Currently 116 million consumers have a choice of health insurance (expected to be 151M by 2011).
* Most consumers still do not “shop” for insurance -- 74 percent will like purchase from current health insurer.
* People who do “shop” do so during moments of considerable change -- and a full 41 percent either considered or changed insurance.
* Most people need additional guidance, education, and advice to make decisions."
Looks like people will pay for Information Therapy !
“The fact that you can engage in a Web video chat with a provider is a nice exercise, but it’s not the fundamental offering of the system,” is how he put it in a recent conversation.
The company’s big idea is more ambitious: A patient who wants an online doctor consult can log on and get something approaching a complete doctor visit, often without waiting. The doc can review the patient’s record, make a diagnosis, write a prescription and make a referral, all online. Patients without a webcam can talk to the doctor on the phone.
The company’s business model is to partner with insurers, who agree to reimburse in-network doctors for patient e-visits. Docs who choose to work with American Well can sign on whenever they want and see patients who are looking for an online visit
The visits are reimbursed through relatively new standardized billing codes that allow docs to get paid for electronic visits. The insurer pays the doc, and American Well takes a cut. The company also charges an up-front licensing fee.
Doctors make about $40 for a 10 minute consult. The rate can vary — specialists may cost more, and the price may rise after hours or if a patient wants an immediate consult rather than wait a few hours. It’s up to the insurer to set the parameters on what’s reimbursed and what the patient pays out of pocket, but the basic idea is for patients to be on the hook for their regular co-pay."
Saturday, June 21, 2008
Thursday, June 19, 2008
And it is not just managed care. Stories of patients armed with medical knowledge gleaned from the Internet demanding antibiotics for viral illnesses or M.R.I. scans for routine symptoms are rife in doctors’ lounges. Malpractice worries also remain at the forefront of many physicians’ minds, compounded by increasing liability premiums that have forced many into early retirement.
In surveys, increasing numbers of doctors attest to diminishing enthusiasm for medicine and say they would discourage a friend or family member from going into the profession."
Unhappy doctors will lead to unhappy patients - leading to a negative vicious cycle.
Fortunately, this has now changed thanks to the efforts of Girish Mohata, a bright entrepreneur who has developed and released a medical practice management software designed for Indian doctors , called EasyClinic.
I requested Girish to write about EasyClinic - and here's his guest entry.
" We have spent over 3 years in designing and developing Easy Clinic to seamlessly fit with an Indian doctor’s workflow. Most clinical software focuses around better patient care as the primary objective. We consider that to be a by-product. Easy Clinic focuses on the doctor. It is designed to assist the doctor and automatically leads to delivery of better patient care by the doctor. This makes a huge difference in the adoption and usability of Easy Clinic. It enables a doctor to maintain electronic medical records and manage his practice better without being slowed down as a result of using a computer program.
Each aspect of a doctor’s workflow has been thoroughly researched and there are many customisation options in Easy Clinic. For example , ordering investigations and prescribing drugs can be done in less than 10 seconds; clinical notes can be written quickly using self defined shortcuts; and bills to patients can be recorded with a single click .
The drugs database in Easy Clinic has been licensed through CIMS India and is updated quarterly. This provides the doctor with the latest drug information at the click of a mouse. It also reduces medical errors by automatically warning about drug interactions and allergies
Practice management features such as accounting have been designed to suit a doctor rather than an accountant. They are extremely simple and intuitive. For example a doctor can bill a patient with a single click and record expenses using simple voucher entries. Easy Clinic automatically generates their day book, form 3C and other financial reports.
Easy Clinic records and presents data intelligently which enables informed decision making; automates routine tasks; provides prompts on clinical activities ; and provides quick hassle-free accounting , thus making the doctor’s day much more organised . The doctor will be able to see a substantial improvement in the management of patient medical records ; and will be able to run the practice more efficiently as a business. Patients will also be much happier, as a result of the sense of professionalism EasyClinic provides to the practice ."
Here's a request I got by email
" I am interested in the following:
- Egg donation from a young Caucasian woman (in her 20’s) who is has both intelligence and beautiful with the following physical characteristics:
- Caucasian (white) race
- Light skin complexion
- Light colored hair
- Blue eyes
- Height: 5 feet 5 inches to 5 feet 8 inches
- Slender build
- Very attractive (beauty)
This may not be available in India so I have some questions and ask your advice:
- If I obtain the egg donor, is it best to bring her to India?
- Is it possible for her to donate here in the US and have the cells transported to your facility?
- Would freezing be utilized?
- What do you advise as the best approach for success?
- IVF at your facility using all donated egg cells and my sperm cells making me the genetic father.
- Three of the fertilized cell would then be split and re-split to produce 3 sets of up to 6 identical fertilized cells. This is a step seldom used. The purpose is this step is to create the potential for identical twins (3 to 5 identical individuals). All eggs cell might be frozen at this step. But I will discuss and ask for your technical advice.
- Surrogate mothers: I wish to have you arrange up to 4 surrogate mothers who will each have 2 to 3 of the fertilized cells implanted (or a number you may recommend). I will look to you for your advice and technical knowledge on the best approach for this aspect.
- Prenatal care of the mothers and related medical care at birth. "
Is this a reasonable wish list ? Who is to decide ? Is it something doctors should agree to do ? Are doctors just technicians ? Are there limits to respecting patient autonomy and fulfilling patient's personal desires ? If a patients understands and is willing to pay, when should doctors say No ? And why ?
Patient-Centered Health Information Technology (PCHIT) Blog » Patient AND Family Centered, using the PHR to connect with everyone
What I do, then, is use the After Visit Summary to compose a letter to that person or people, with the patient helping me write it. The “letter” is printed out on the hard copy, and then permanently stored for viewing on the PHR of course."
This is a great idea - write a summary letter not just to the family physician, but to the caregiver as well !
That skill: talking to doctors.
'The old technique of having a conversation is 99% of what a successful doctor's visit is about,' says Peter Salgo, a professor of medicine and anesthesiology at Columbia University in New York and host of the PBS medical series Second Opinion.
We hear a lot, of course, about doctors who don't listen, don't answer questions or don't remember their manners.
But communication is a two-way endeavor. And sometimes it's patients who fail Communication 101."
I particularly liked Joe’s closing slide on the disconnect between chronic care management today and consumers’ values (particularly the values of baby boomer women–who Joe says make on the order of 90% of the health care decisions in the US…that seems a little bit high to me, but his point is well taken). I think I’ve gotten most of this right–if I’ve mistaken anything, I hope Joe can correct me. The today is first and the consumer values are second in each dichotomy below.
* Data intensive vs. Useful knowledge
* Empower physicians vs. Empower consumers
* Trust authority vs. Trust experience
* Populations based vs. Personalized services
* Physician-patient-centric vs. Social networks
* Hospital & home focus vs. Ubiquitous
* Deliberate speed vs. Internet time
* Disease & illness care vs. Proactive vitality (wellness)"
Tuesday, June 17, 2008
Monday, June 16, 2008
* As the industry shifts from a wholesale to a retail model, a new market of consumers is demanding clearer information and personalized support. A company that pays careful attention to their needs, desires, and habits stands to gain a significant advantage over its competitors in this quickly burgeoning market."
Collection and use of ODL ( observations of daily living) information – which includes information on such activities and experiences as sleep, diet, exercise, mood and adherence to medication regimens – is one area that is genuinely user-directed, both in the kind of information that is contained in the record and the health-related activities that stem from it.
No one wants to fall ill , but when you do, the last thing you want to worry about is the doctor’s bills. This is why it’s a good idea to take a health insurance policy to protect yourself against the financial losses caused by a medical problem. Medical care can be expensive and a health insurance policy can provide financial protection and ensure you can afford the best medical care.
The traditional form of health insurance is called indemnity insurance (also known as fee-for-service ) , in which the insurer pays for the cost of covered health care services after they have been provided. In most indemnity insurance plans the patient is free to choose his own doctor or hospital.
In the past, the health insurance business was a monopoly, so the only medical insurance policy available for most of us was MediClaim, through the subsidiaries of the General Insurance Corporation (GIC). Today, with increasing liberalization, the insurance business in India has been opened to the private sector, and there are now many more options to choose from. While this extra choice is great, because companies are competing with one another to offer customers the best deal, having so many options can be confusing ! Also, not all the changes are for the best , and you need to use your judgment when deciding which policy to select for your family. Since the cost of medical treatment is rising faster than the rate of inflation, premiums are likely to increase sharply each year. Also, as you get older, the likelihood of your making a claim increases, which means premiums may jump even more dramatically.
What do customers want from a health insurance policy ? Your basic needs are: protection from financial loss because of hospital bills ; free access to doctors and hospitals you want to go to; no fine print for exclusions; reasonable costs; convenience at the time of hospitalization so you don’t have to pay first and then claim the money from the company ( what is called a “ cashless” transaction);prompt payment of medical claims; quick processing of claims; minimal paperwork; and friendly customer service.
Today, because there are so many companies competing for your business, they all have great marketing campaigns and are happy to sign you up because they want to increase their market share and they know that once signed up, most customers usually stay for life. However, most Indian health insurance companies are still stuck in the past when their only role was limited to paying the hospital bills. All they seem to do collect your premium every year and pay your medical bills in case you fall sick and need hospitalization.
This is shortsighted. Remember that this is a health insurance policy , which should not just provide illness care , but also help us to remain well ! In the USA, which has the most evolved health insurance market, things are different. Insurance companies have realized that spending on medical care after a person falls ill is expensive for them . It’s much more cost-effective to invest money in educating, counseling and motivating people to remain well, so they do not fall ill in the first place - after all, prevention is better than cure ! In fact, in ancient India, this was a well-accepted principle and the doctor ( whose job was to keep the family in good health) was paid only as long as everyone was healthy. If anyone fell ill, the payments stopped, until they recovered. It would be interesting to see if an innovative health insurance company could come up with a modern version of this model !
There are many options now available to insurance companies which they can use to help their customers remain healthy. These include tools for counseling; lifestyle improvement; weight loss; and smoking cessation programs. Many of these can be provided online on the web, which makes them inexpensive to deliver. They can also offer discounted memberships to gyms , spas, yoga classes, meditation retreats and counseling sessions, to help their customers take a proactive approach in managing stress and fighting off disease.
Similar tools can be used to help patients with a chronic illness manage their disease better so they don’t need hospitalization. Hospital care becomes very expensive – and teaching patients to take care of themselves is a powerful therapeutic intervention. This is called “disease management” – and has been applied abroad for a wide range of diseases, ranging from asthma to hypertension to diabetes.
These programs are cost-effective for the insurance company to offer – and don’t need them to spend too much either . An excellent example is the recent study from Partners Health Initiative (PHI) in Anderson, South Carolina which showed they saved an estimated $34.5 million in 30 months—thanks to simply gifting a copy of the world’s largest selling patient education book, the Healthwise Handbook, to all their customers !
The lesson is clear - not only is there a business case for health insurance companies to be investing in patient education , it’s also a great way of helping them win more customers and keeping their customers happy. Enlightened customers should ask health insurance companies for tools to promote their health !
Sunday, June 15, 2008
Medical care during emergencies in India leaves a lot to be desired. Those of us who watch medical shows on TV ( such as ER) are very impressed with the high quality of care Emergency Rooms in the US provide. If there is an accident, someone phones 911, and within a few minutes an ambulance is promptly dispatched and succor provided. In India, unfortunately, the reality is far grimmer. If there is an accident, most of us prefer not to get involved and turn a blind eye. What’s worse, is that if we do try to help the victim by rushing them to the nearest local hospital, the doctor there may refuse to treat the patient – and tell us to transfer them to a government hospital. What is tragic is that many victims die because of simple medical problems ( such as bleeding) which could have been treated and their lives saved if medical care was provided to them promptly during the emergency.
Doctors know that during a medical emergency ( for example, a traffic accident or a heart attack), there is a “golden hour” which can literally spell the difference between life and death. If effective medical care is promptly delivered efficiently during this critical period, many lives could be saved. However, traffic accidents remain a distressingly common cause of preventable death in India. Given the state of our roads and our civic sense, this problem is going to keep on increasing unless we tackle it efficiently.
What should you do if you see an accident and the driver is bleeding profusely ? The first human instinct is to rush the patient to the local hospital for emergency medical care; or call for an ambulance. However, the nearest medical facility could be your local nursing home or hospital, many of which will refuse to admit these patients. Patients are then shunted off from pillar to post – losing valuable time – and possibly their lives, in the process. Not that large private hospitals are much better. Many do not even have a well-equipped Casualty ( ER): and even if they do, they refuse to take on the patient, until payment is made first.
It’s true that doctors have an ethical obligation to treat any patient – especially during an emergency. However, many refuse to do so. This is not because they are wicked or uncaring , but the sad truth is that many often don’t have the expertise or equipment to do so. What makes a bad situation worse, is that others refuse to do so because they are worried about the police hassles . Accident and emergency cases are often medicolegal cases , and these entail the burden of a lot of paperwork. While some are worried about who will pay for this medical care ( which can be expensive), others are fearful that if they try to help and the patient dies, the mob will vent their anger on the doctor and beat him up. It’s often much easier for the doctor not to do nothing, because they do not want to stick their neck out.
This is a sad situation , but it’s really no different from the approach most of us take when we see an accident. We prefer turning a blind eye and carrying on with our lives and are quite happy to let “someone else” provide succor because it’s not really our problem. Unfortunately, it is our problem. Ask not for whom the bell tolls – it tolls for thee ! Tomorrow , it could be your turn – or mine .
Shouldn’t doctors be held to a higher standard ? Haven’t they sworn a Hippocratic Oath to save lives ? Isn’t there a law which compels them to provide emergency assistance ? How can they refuse to help and transfer the patient ? Isn’t this illegal ?
The truth is that it’s impossible to compel doctors to provide emergency medical care. While most good doctors will do this on moral ground, they cannot be forced to do so – and in any case, this is hardly an effective solution. There are observations made by Supreme Court judges about the importance of doctors providing medical care expeditiously, but these are unlikely to be legally binding – and are very hard to implement in the absence of the needed infrastructure.
Following the Supreme Court Judgement in 1989 ( Pt. Parmanand Katara vs Union of India AIR 1989) , the Motor Vehicles Act was amended in 1994 and under section 134, it was made mandatory for the driver and the owner of the vehicle to take the accident victim to the nearest doctor and for the doctor to treat the victim without waiting for any formality. But, even after all this, the situation has not improved.
I think we cannot fix this problem on an individual basis – and passing a law is unlikely to help. “ Good samaritan” guidelines from the Mumbai Police encourage bystanders to provide assistance in an emergency by reassuring people that the police will not harass them. What can we do to improve the medical care provided during emergencies. ?
This is a societal problem , which needs to be addressed by the government. Unfortunately, there is no 911 service in Bombay – India’s prima urbis ! Most leading Mumbaikars are more focused on earning more money, rather than trying to improve these basic services. This is very short-sighted, as emergencies and accidents can strike anyone at any time !
The good news is that the EMRI ( Emergency Management and Research Institute, www.emri.in), a non-profit organization started by Mr.B.Ramalinga Raju (founder and Chairman, Satyam Computers) in Hyderabad, has implemented a very effective free medical emergency service in Andhra Pradesh called 108. This is a public-private partnership ; and is a shining example of what socially responsible Indians are capable of doing, when they put their mind to it.
We need similar services in Bombay and Maharashtra – and all over the country ! I do hope citizens will put pressure on the government to make this a reality. Once this happens, then we will no longer need to worry about proving effective emergency medical care !
Thursday, June 12, 2008
A. Aspirin and antianginal drugs
B. Blood pressure and beta-blockers
C. Cholesterol and cigarettes;
D. Diet and diabetes;
E. Exercise and education."
I love clever acronyms !
From physicians to nursing assistants, health care providers play a critical role in supporting patient self-management. However, this can be difficult for primary care practices, particularly if providers are unfamiliar with behavior change strategies. Patient self-management also fundamentally challenges the traditional authority of providers and transforms the patient-provider relationship into a collaborative partnership.
To support health care providers in promoting patient self-management, CHCF has produced a short training video called 'Techniques for Effective Patient Self-Management.' The 33-minute presentation provides strategies and tools that busy clinicians can use to help patients adopt healthy behaviors."
The Internet has evolved from the information-retrieval of “Web 1.0” to “Web 2.0,” which allows people who are not necessarily technologically savvy to generate and share content. The collective wisdom harnessed by social media can yield insights well beyond the knowledge of any single patient or physician, writes report author Jane Sarasohn-Kahn. The outcome of this development is “Health 2.0” -- a new movement that challenges the notion that health care happens only between a single patient and doctor in an exam room.
Using examples, this report describes how the Web is becoming a platform for convening people with shared concerns and creating health information that is more relevant to consumers. Social networks, ranging from MySpace to specific disease-oriented sites, are proliferating so rapidly that new services are already under development to help health consumers navigate through the networks."
Achapter titled The Cost of Zero Cost, seems to imply that if anything is offered free, then people will flock to get it.
However, even though we provide unique services which are useful and which are not available anywhere else in the city ( which has a population of over 15 million people) we only get about 50 visitors per day, even though we are located in the heart of the city. This is what I felt too when
This is what I felt too whenwe setup HELP 10 years ago. HELP, the Health Education Library for People is India's first Consumer Health Education Resource Center. We kept entry to HELP free with the hope that more people would make use of our services because there were being provided at no cost.
An alternative point of view is that people do not use our services because they are free. The belief is that people do not value anything which is given away free because they perceive that it has no value.
Who is right ? What should we do ? Should we charge a nominal amount for our services ( so that people will realise the value we provide) ? Or should we continue to give them away free ?
Wednesday, June 11, 2008
Sunday, June 08, 2008
* Empowering Consumers with actionable, real-time health information that is personalized and not generic
* Intelligently identifying recommended preventions, followup, and therapies for existing conditions
* Detecting potentially harmful drug therapies, and medications to avoid
* Identifying safety-checked medication alternatives which are covered by a specific insurer with real-time financial comparison capabilities
* Delivering physician-labeled internet search queries using the highest-quality sources
The one thing that you can control is getting your physician to be emotionally compelled to help you. This may come in the form of that special connection you have to him. Or perhaps because you have a mutual friend or colleague. Or perhaps because you brought him a gift and he remembers you as the patient who brings gifts.
Whatever your method, I do recommend that patients try and do something to curry favor with their physician. If you are in a position of influence, don’t be shy to let your doctor know that you can refer other patients to him."
This is good advise - and is true when dealing with any professional . You need to try to stand out from the crowd, so you get more personalised attention and care !