Friday, November 28, 2008

Preventing Post-Traumatic Stress Disorder after the Mumbai terror attacks

The recent terror attacks have devastated Mumbai. While Mumbaikars are resilient and the city will bounce back to normal soon , this is the sort of event which shakes everyone up because it reminds us of our own mortality. Many south Mumbai citizens visit hotels like the Taj and the Oberoi frequently . It could easily have been you or me ( or one of our family members or friends) trapped in the hotel. “ There, but for the grace of God, go I” is what many of us are likely to experience.

In the past, this sort of traumatic event would be experienced by a few hundred people and others would only learn about it second-hand, through the newspapers. Today, however, thanks to the electronic media, this sort of event affects all of us much more directly . All of us have been glued to our TV screens and have been watching scenes of the gore being replayed 24/7. This has a direct visceral impact and can cause fear, helplessness or horror . In some people, this emotional impact can result in a type of anxiety disorder, called PTSD or post-traumatic stress disorder.

Most people who witness such events have a brief period of difficulty adjusting and coping after which they bounce back to normal and life carries on as usual. In some cases, though, the symptoms can get worse or last for months or even years. This is called post-traumatic stress disorder.

It's normal to have a wide range of feelings after such an event, and these include fear and anxiety, a lack of focus, sadness, changes in sleeping or eating patterns, or bouts of crying that come easily. You may have recurrent nightmares or thoughts about the event. This doesn't mean you have post-traumatic stress disorder. But if you have these disturbing feelings for more than a month, if they're severe or if you feel you're having trouble getting your life back under control, consider talking to your doctor .

The diagnosis is based on a thorough psychological evaluation; and you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association . Treatment of post-traumatic stress disorder usually includes both medications and psychotherapy and will help you regain a sense of control over your life.

Getting support and help – either from friends, relatives , spiritual leaders or your doctor can help prevent normal stress reactions from getting worse and developing into post-traumatic stress disorder.

Self-management. Yoga and meditation can help you manage your feelings much better. These are useful skills to learn !
Take care of yourself. Get enough rest, eat a balanced diet, exercise and take time to relax. Avoid caffeine and nicotine, which can worsen anxiety.
Don't self-medicate. Turning to alcohol or drugs to numb your feelings isn't healthy, even though it may be a tempting way to cope. It can lead to more problems down the road and prevent real healing.
Break the cycle. When you feel anxious, take a brisk walk or find a hobby to immerse yourself in.
Talk to someone. Stay connected with supportive and caring family, friends, or your guru. Just sharing time with loved ones can offer healing and comfort.

If you’d like to learn more about PTSD and what you can do to help yourself, please do come to HELP ( Health Education Library for People, Excelsior Business Center, National Insurance Building, Ground Floor, Near Excelsior Cinema, 206, Dr.D.N Road, Mumbai 400001 Tel. No.:65952393/65952394, www.healthlibrary.com). We have lots of very useful information on PTSD and how to prevent this !

Thursday, November 27, 2008

The Mumbai terror attacks - How vulnerable we all are

The recent Mumbai terror attacks have shaken up the whole country, and we have received numerous messages and emails from concerned patients from all over world. Fortunately, the clinic, our staff and our patients are all safe and sound.

"Ask not for whom the bells toll - they toll for thee." Today it was Mumbai's turn - who knows where they will strike tomorrow ?

It's hard to make sense of such meaningless carnage. I think it just emphasises how vulnerable we all are - and that the only way we can fight this menace it to tackle it collectively.

May the souls of the innocent victims and the brave police officers rest in peace - and may God give their family members courage to deal with this trying time.

"There, but for the grace of God, go I" is what I feel. We eat out frequently at the Taj and the Oberoi - and it could easily have been us trapped in the hotel yesterday...

Some of our US patients are worried about how safe it is to come to India for treatment. In one sense, no place in the world can ever be safe ( a lesson we learned from the 9/11 blasts). However, after this incident, security is extremely tight in Bombay, which makes it a very safe place now !
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Monday, November 24, 2008

Healthcare I.T. News EU - Atos Origin picked to implement German electronic health card

Healthcare I.T. News EU - Atos Origin picked to implement German electronic health card: " Atos Worldline, an Atos Origin Company, has signed a five-year contract with leading German health Insurance Company, Gmünder ErsatzKasse (GEK), to implement and operate the issuing and management of the new German electronic health card (eHC).

In 2009, GEK plans to issue 30,000 cards per day to provide its 1.7 million members in Germany with the new card. One of the German public authorities' most important IT projects, the eHealth card is an important step in the modernisation of European health systems. It is designed to guarantee the simple and secure exchange of data between insured parties, doctors, pharmacists and health insurance companies.

The introduction of the new electronic health card helps to connect together people, pharmacists, doctors, hospitals as well as the private and statutory health insurance companies, and aims at simplifying and accelerating exchanges, thereby doing away with any paperwork."

SmartCards are all set to change the way medical paperwork is processed !

Friday, November 21, 2008

A Whole Lot of Infertility Blogging--Brought to You Sorted and Filed

A Whole Lot of Infertility Blogging--Brought to You Sorted and Filed: "This list brings together anyone in the infertility/pregnancy loss/assisted conception/adoption/pregnant or parenting after infertility or loss community. From those who were shocked by their diagnosis to those who are utilizing assisted conception because they are single parents by choice. Gay or straight, male or female, every race and religion--all are welcome here. From the newly diagnosed to the oldest vets to those who finished their family building via ART years ago."

Tuesday, November 18, 2008

Autopathography: the patient's tale

Autopathography: the patient's tale : " The case history was invented by Hippocrates. Since then medical practice has been straitjacketed by its artificiality, to the detriment of the patient's own narrative. But patients have found ways of expressing themselves other than by talking to their doctors. Over the past two years I have been collecting a bibliography of book length autobiographical medical narratives, each completely or largely devoted to the writer's personal experience of drug use or illness. My growing list currently runs to about 270 titles."

Monday, November 17, 2008

Medical imaging tool launched for Apple iPhone

Medical imaging tool launched for Apple iPhone: "A leading healthcare IT vendor has made its imaging technology available through Apple's iPhone App Store, in a move that looks to capitalize on the growing popularity of smartphones and the need for remote access to medical images.

Merge Healthcare's new Merge Mobile tool provides access to CT, MRI, X-ray and other images via the Apple iPhone and iPod Touch. The vendor is offering a free demo version of the product in the App Store.

iPhone and iPod applications built on Merge Mobile will allow radiologists to view emergency cases, consult with colleagues and securely forward care information to a patient's referring physician."

The Health Care Blog: Confessions of a Physician EMR Champion

The Health Care Blog: Confessions of a Physician EMR Champion: "The broad message is that, to be successful, the adoption of health IT by physicians, nurses, and staff must extend communication and health data exchange beyond the narrow confines inside the four walls of their practice. Health IT needs to empower all providers to act as effective members of a team which includes the patient, medical home, specialists, and ancillary service providers such as pharmacists and lab technicians."

Right now, the problem with healthcare is that it's all about doctors - who decide what to do and when to do it. It needs to be about the patient - and the clever use of IT in health can allow this to happen !

The Health Care Blog: The Technology Hype Cycle: Why bad things happen to good technologies

The Health Care Blog: The Technology Hype Cycle: Why bad things happen to good technologies:

"# Technology Trigger – The initial launch; a new technology reaches public or press attention.
# Peak of Inflated Expectations – A few successful applications of the technology (often by highly selected individuals or organizations) help catalyze unrealistic expectations, often aided and abetted by hype driven by word of mouth, the blogosphere, or vendor spin.
# Trough of Disillusionment – Virtually no technology can live up to its initial PR. As negative experience mounts, the balloon is pricked and air rushes out. The press moves on to cover another “hotter” technology, like a moth flitting to the light (see Phase II).Hypecycle_2
# Slope of Enlightenment – A few hardy individuals and organizations, seeing the technology’s true potential, begin experimenting with it unencumbered by inflated expectations. Assuming that the technology is worthwhile, they begin to see and demonstrate its value.
# Plateau of Productivity – As more organizations ascend the “Slope of Enlightenment,” the benefits of the technology (which by now has improved from its initial clunky phase) become widely demonstrated and accepted. The height of the plateau, of course, depends on the quality of the technology and the size of its market.

You can chart the course of virtually any health information technology on the Hype Cycle curve."
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The Health Care Blog: A patient's perspective

The Health Care Blog: A patient's perspective: "As a customer relations expert and a concerned healthcare observer, I must comment on doctor's turning a deaf ear to patient input.

Two things to remember:

-You don't have to read an entire stack of articles that a 'patient customer' brings you. To minimize how often this happens, give them more *undivided attention when you see them, more empathy, and much more clear updates on their condition. If they are bringing you a stack of articles, it is one sign that you have not earned their trust yet. Else they would more likely just ask you if you were familiar with xyz info.

-Turning a deaf ear to patient customer is disrespectful and breeds long term mistrust of the entire medical community. Mistrustful customers are tougher to deal with next time. Many doctors (not all) like to be in control. They frequently present options as must haves. Answer our questions doctors, present options, and make your recommendations -- without the attitude that you have something better to do. The sooner you do it, the sooner you will be free to move on to what is next in your schedule and your life. It takes less time when you give patient customers your focus and your respect -- not more. Listen to the questions and answer them clearly. Then your patient customer will relax."

If doctors remember that both doctor and patient are on the same side ( the patient's !) , life becomes much easier. It's only when we start thinking of patients in an adversarial role; or resent them for taking upo so much of our time, that we start running into trouble.

Reframing your perspective, by thinking of your patients as "research assistants" who will educate you about their problem, can help a lot !
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Saturday, November 15, 2008

Compassionate honesty for infertile couples

Compassionate honesty for infertile couples : "We have found that when ovarian reserve is low, the best course of action for the physician is compassionate honesty. After all, time is precious by the time a couple reaches infertility specialists, so little can be gained by creating false hope or continuing down a fruitless path. Instead, physicians can provide invaluable assistance by helping the couple re-evaluate their parenting needs and determine what, if any, other options they might pursue. In the world of infertility, some doors shut while others open. The door may not reveal what the couple thought they wanted, but for many, it might reveal something that is even better."

Friday, November 14, 2008

The Doctor Is In, but He’s Almost Always Late - Poked & Prodded - Health.com

The Doctor Is In, but He’s Almost Always Late - Poked & Prodded - Health.com: "Most of the time, I’m just happy if I see a doctor within an hour of my scheduled appointment. Over the years of visiting so many waiting rooms, I’ve learned a few tricks:

• Scout out the waiting room. The bigger the waiting room, the more inefficient or overbooked the doctor (for practices, divide the number of chairs by the number of doctors). Make sure there’s only one room.
• Book the earliest morning appointment possible. It usually takes doctors a few appointments to get behind schedule.
• Ask the scheduler to book you on the lightest day of the week.
• Avoid school holidays if your doctor or dentists sees kids.
• Bring your own magazine."

21 Primary Care Time Wasters « Pookiemd’s Weblog

21 Primary Care Time Wasters « Pookiemd’s Weblog: " In my travels as the ExtraMD, I have seen many different practices, different styles and hundreds of ways practices waste time and annoy patients. In my quest to help primary care physicians stay afloat, I will list my observations of time wasters that suck the joy out of medicine. I will also include my incredibly astute suggestions for positive change. Beware, you may even see your practice here."

All doctors can use this information to improve their efficiency !

Good to Great Patients | Medical Practice Business Blog

Good to Great Patients | Medical Practice Business Blog: "These are the commonest complaints from both patients and doctors. Physicians can take steps to address many of the patient’s issues, as well as their own, which will lead to more satisfied physicians and patients, better care and better outcomes. Let’s look at these complaints and how to address them."

The 7 "Cs" of Meaningful Work for Physicians-Nov08 - The Entrepreneurial MD

The 7 "Cs" of Meaningful Work for Physicians-Nov08 - The Entrepreneurial MD: " I often ponder about what makes one's work meaningful. It's a rumination that pops up regularly when I am enjoying navel-gazing time.

Having gone from showing up at work and getting the required job done to passionately engaging in both aspects of my work - coaching clients, and building a business - I now know the difference.

Work that serves a purpose has most if not all of these seven 'C' attribute.

Thursday, November 13, 2008

Pew Internet: Finding Answers Online in Sickness and in Health

Pew Internet: Finding Answers Online in Sickness and in Health: " Recent research from the Pew Internet & American Life Project shows that, as more Americans come online, more rely on the internet for important health information. Many Americans are deepening their connections to the internet, whether for entertainment or to help a loved one through a crisis. And though the audience for the latest DVD may be larger than the audience for clinical trial information, the impact on someone’s life in the latter case may be dramatically different in scale. Fully 58% of those who found the internet to be crucial or important during a loved one’s recent health crisis say the single most important source of information was something they found online."

Pew Internet: The Engaged E-patient Population

Pew Internet: The Engaged E-patient Population: " This latest Pew Internet Project survey confirms that information gathering has become a habit for many Americans, particularly those in the 55% of households with broadband connections. Home broadband has now joined educational attainment, household income and age as the strongest predictors of internet activity. For example, 78% of home broadband users look online for health information, compared with 70% of home dial-up users. Home broadband users are twice as likely as home dial-up users to do health research on a typical day -- 12% vs. 6%.

High-speed, always-on connections enable frequent and in-depth information searches, which is particularly attractive if something important is at stake."

Pew Internet: Recruit doctors. Let e-patients lead. Go mobile.

Pew Internet: Recruit doctors. Let e-patients lead. Go mobile.: "E-patients are at the center of the health care revolution, marching forward with or without the help of industry leaders. They are the worried well using search engines to look up basic advice. They are the chronically ill using discussion forums to trade in-depth knowledge. Or as one e-patient wrote in one of our online surveys, 'we are lab rats tapping out messages on the bars of our cages.' But how will Health 2.0 attract and serve the majority, not just the elite?"

PRE-VISIT PREPARATION PACKETS

PRE-VISIT PREPARATION PACKETS: " Patients who are better prepared for an appointment with their doctor will make better use of their one-on-one time with the doctor. The Stoeckle Center is developing novel approaches to reach out to patients and their families prior to their appointment. Newly designed pre-visit packets will contain basic information specific to each patient’s upcoming appointment, ensuring:

* a better prepared and better educated patient who becomes an active participant in his or her own treatment and prevention plans;
* the patient and physician identify clear objectives for the appointment;
* the groundwork is laid for true shared decision-makingthat patients understand their medications;
* better use of the time that patients and physicians spend together to make informed decisions and plans for care."

What a great idea ! Every physician should give one of these packets to patients prior to their consultation.

Participatory Medicine: Text of Susannah Fox's Keynote Presentation at the Connected Health symposium | e-Patients.net

Participatory Medicine: Text of Susannah Fox's Keynote Presentation at the Connected Health symposium | e-Patients.net: "Going back to the Seven-Word Wisdom contest, the Cancer article might have given us a new set of rules for the Information Age:

Go online. Use common sense. Be skeptical.

That might resonate with people who say we should trust users to find the good stuff and ignore the bad stuff. Indeed, Pew Internet Project surveys show that this ad hoc system has worked pretty well. About one-third of e-patients say they or someone they know has been significantly helped by following medical advice or health information found on the internet. Just 3% of e-patients say they or someone they know has been seriously harmed by following the advice or information they found online. Reviews of the medical literature have also turned up very few cases of bad outcomes related to the internet.

Participatory medicine is a cooperative model of medical care that encourages and expects active participation by all involved parties as an integral part of the full continuum of care.

WellPoint, X Prize launch $10M health care contest - Yahoo! News

WellPoint, X Prize launch $10M health care contest - Yahoo! News: "The companies have announced an open competition to devise solutions that improve health care cost and quality, and they're dangling a prize of at least $10 million for the winner.

'Reinventing and rebooting the U.S. health care system is not to be taken lightly,' said X-Prize Chief Executive Dr. Peter Diamandis. 'Its an audacious task but, we think, very achievable.'"

Wednesday, November 05, 2008

U.S. Hospitals Lag in Patient Satisfaction - Forbes.com

U.S. Hospitals Lag in Patient Satisfaction - Forbes.com: " In the first national survey of patients' experiences, many hospitals were found wanting in key areas such as pain management and discharge instructions. In fact, almost one-third of patients gave low ratings to pain management, and one-fifth gave low ratings to communication at discharge.Patients in many U.S. hospitals are not satisfied with their care, Harvard researchers report.

Jha also puts part of the onus on patients to improve care. 'Patients need to be proactive -- ask questions,' he said. 'The more engaged patients are, the better the care they will receive and the better the care all of us will receive, because they will drive the change for better systems of health care.'"

The Doctor's Office - WSJ.com

The Doctor's Office - WSJ.com: "Did you feel healed the last time you went to the doctor? My bet is no. If you were lucky, maybe you got 10 minutes with the doctor. In not much more time than you might have spent in a fast food drive-thru, the doctor wrote a prescription, ordered a battery of lab tests and sent you off for a thousand dollars worth of imaging studies.

Somewhere along the line too many doctors stopped being healers and became prescribers and technicians.

We became business people and started thinking in terms of relative value units -- the coin of the medical finance realm -- as much as how to make patients better. We took seminars in medical coding, so we could talk the same lingo as the government and the insurance companies.

The changes in medicine are at odds with many of the values that defined the profession I joined."

Doctors, like all humans, respond to incentives. Given the perverse system of incentives which exist today in healthcare , it's hardly surprising that most doctors behave as rational human beings, and focus on maximising their benefits. Rather than preaching, it makes more sense to change the incentive structure, so that doctors are rewarded for being healers, rather than for being technicians. Patients will ultimately get what they pay for !

Tuesday, November 04, 2008

Indian clinics woo "fertility" tourists | Send to NEWS home | News.com.au

Indian clinics woo "fertility" tourists : "'Nearly half of our patients come from overseas. Of them, nearly half are of Indian origin,'' said Aniruddha Malpani, whose IVF clinic in Mumbai is considered among the country's best.

A full IVF cycle at the Malpani clinic costs $US4500 ($6771), including medicines. In the United States, the average cost is $US12,400, according to the American Society for Reproductive Medicine. "
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