Sunday, August 30, 2009

Using technology to improve appointments for doctors

Q for Doctor is a clever system which uses the now-ubiquitous mobile to help doctors to schedule their appointments , so that patients don't have to wait for ever. This is a clever idea, because it addresses the biggest pain point of patients - the fact that they have to wait and wait ( which is why they are called patients, according to a friend of mine !)

This is a great "proof of concept" model which shows how technology can be used to improve healthcare delivery - but I have my own doubts as to how well it will work in practise . I have learnt from personal experience that patients don't always admire efficient doctors . Most patients in India are worried when there are very few patients in the waiting room. They feel that a "busy doctor" who makes them wait for hours must be a good doctor, because he is so busy ( though I feel this just means that he does not respect his patients can cannot manage his time well !)


This system is "Doctor driven" so doctors go ahead and be a part of the revolutionary system and change the way you are conducting your appointments forever. Give the most desired facility to your patients at no extra cost.
Without you registering in this system your patients can not take advantage of it. So go ahead, register and give your patients "Appointments on Finger Tips."

What I learned from IVF

2. Don't put all your eggs (and sperm) in one basket

Don't count on your first cycle working. Sure, it could; plenty of people hit the jackpot on IVF #1. Statistically speaking, however, it's likely that you'll need more than one try, and it's best to be prepared for that from the very outset.

Our doctor encouraged us to think of our first cycle in terms of a diagnostic run, a chance to see how my body would respond to the drugs, and how our embryos would develop in the dish, giving us information that would help optimize any further treatment if necessary. This excellent advice helped us face a bad outcome without destroying our future hopes. So when you're making a treatment plan, save enough money, time, and stamina for a second cycle, and perhaps beyond. There's no down side to being prepared. And, hey, maybe you will hit the jackpot. After all, you can't win if you don't play.


All patients considering IVF should read this post - it's full of hard-earned
wisdom !

Friday, August 28, 2009

What is AIDET: Five Fundamentals of Patient Communication?

What is AIDET: Five Fundamentals of Patient Communication?

1. A - Acknowledge:
Whether you acknowledge patients by name or with a friendly smile, patients know that you have connected with them. Acknowledgment includes putting down paperwork and making the patient your focus. Eye contact, a pat on the shoulder, and a smile are all non-verbal ways of acknowledging a patient or family member.
2. I - Introduce:
Introduce yourself by name, state your department, and describe what you are going to do. "Good morning, Mr. Jones. My name is Mary, and I am here to start your IV. I am part of the special IV team at the hospital, and I will do everything to make this as comfortable as possible for you."
3. D - Duration:
Give an estimate of the time it will take to complete the procedure. "It should take me only about 15 minutes to register you." "The chest X-ray should take only about 10 minutes. However, I would ask that you stay here in the room so I can run the film through processing and make sure that I got a good, clear picture. That should add about another 20 minutes and then you should be able to go. We will have the results to your physician's office by three this afternoon."
4. E - Explanation:
Explain what you are going to do to or for the patient. Ask if the patient has ever had this X-ray done before or lab work drawn before. Ask if the patient has any concerns or questions before you start or any information that may make the testing easier. Explain, explain, explain-all along the way. As the technologist, you may do this procedure many times a day. For the patient it may be the only time he or she has ever experienced it. If it is going to hurt, let the patient know. We also can integrate patient safety into the discussion. For example, before drawing blood, the phlebotomist can say, "For your safety, I am going to check the test label against your ID wrist band."
5. T-Thank You:
Thank the patient for choosing your hospital to have the test or treatment done. If the patient is an inpatient ask, "Is there anything else I can do for you?" or, "Do you have any questions I can answer?"

Wednesday, August 26, 2009

The surrogacy racket

I received the following email from a distraught patient.

This is inform you that an ex surrogate from Dr X’s clinic, AB has now started a racket in which she is duping innocent couples emotionally and financially. Few months back she got VD w/o SD to Delhi to make her as surrogate for us. VD is staying at Baroda and AB has a setup in Anand (it seems!! not sure if she has any).

She did not let us visit us saying that before 3 months, the surrogate would catch evil's eye. But when we forced her after 4 months we came to know that the surrogate was never pregnant. AB has duped many people like us in Delhi, Mumbai , Hyderabad and Ludhiana.

She is proclaiming to be a doctor to everyone but we searched on the internet and found the following links on her background.

http://www.foxnews.com/story/0,2933,319106,00.html

http://economictimes.indiatimes.com/articleshow/2661740.cms

http://news.bbc.co.uk/1/hi/world/south_asia/7202043.stm

http://www.dailymail.co.uk/news/article-500601/Wombs-rent-Childless-British-couples-pay-Indian-women-carry-babies.html

http://theindiansurrogate.com/luq/?p=29

http://www.surrogacyissuesblog.com/2007/08/

Please discourage your patients from falling in her trap and get her police verification done before proceeding further

Thanks

N



It's very easy to fool patients because they are desperate. And because the surrogacy treatment involves fudging a name on the baby's birth certificate, most clinics do the treatment on the sly. This lack of transparency makes it very easy for them to exploit vulnerable infertile couples !

Monday, August 24, 2009

Study places EHRs at core of saving cardiac patients' lives | Healthcare IT News

Study places EHRs at core of saving cardiac patients' lives | Healthcare IT News: "An EHR program that cut cardiac deaths by 73 percent has also kept patients healthy two years later, according to a new study.

The Kaiser Permanente program in Denver linked coronary artery disease patients and teams of pharmacists, nurses, primary care doctors and cardiologists with an electronic health record to help keep the patients healthy two years after they left the program by keeping them in touch with their caregivers electronically, according to a randomized study.

The study, which was funded by the American College of Clinical Pharmacy, is published in The American Journal of Managed Care this month. It is the first randomized study to evaluate a follow-up system for patients discharged from a cardiovascular risk reduction service, researchers said.

The Clinical Pharmacy Cardiac Risk Service at Kaiser Permanente Colorado combines Kaiser Permanente's HealthConnect EHR with patient outreach, education, lifestyle adjustments and medication management.

The two-year randomized trial of 421 patients found that patients discharged from the program kept their lipid and blood pressure levels at controlled, healthy levels by receiving electronic reminders."

Improving Health in India: Putting People First

Chronic diseases are soon going to become the No 1 killer in India and just building more hospitals and training more doctors will never help us to tackle this growing menace. The only long-term solution is to rely on the one resource which is almost inexhaustible—the people themselves. Within its one billion people lie India’s greatest untapped resource for combating the rise in chronic disease and for reducing its burden.

This proposal presents a sustainable plan to engage millions of at-risk individuals in the state of Maharashtra (population 100 million, capital: Mumbai/Bombay) to adopt prevention, monitoring and self-management behaviors which will significantly reduce the burden of chronic disease in India .

The Goals and Objectives

Patients should be the true experts on their own chronic diseases and expert patients are those who are able to take more control over their illness by understanding and managing their disease, leading to an improved quality of life. Unfortunately, even though Information Therapy – providing the right information to the right patient at the right time – can be powerful medicine, patient education has been sadly neglected completely in India .

We plan to set up a network of ten consumer health resource centers established at hospitals and retail malls will provide a real-world cluster for the program. We will use these as a showcase for the program; a place to evaluate its impact on patients; and a place to influence medical students , doctors and policy makers on the importance of chronic disease self-management.


The Plan

Over the next 3 years, we will set up 5 hospital-based patient education resource centers in Bombay and Pune. Hospitals have a captive population of patients and their family-members, who are highly motivated to seek information about medical problems.

We will partner with corporate and government hospitals to do so. Hospitals will provide us the space; and we will offer them a free value-add service which would help them to attract more patients and improve the quality of care their provide to their patients. Each library would have a core collection of about 1000 books; and a network of 5 computers connected to the internet to help patients search for information. Each library would have trained staff to help people look for information relevant to their needs ( librarian-mediated information therapy). We will also setup 5 mini-libraries at a chain of health and wellness centers located in malls , in partnership with retail health chains . This will help us to attract a large number of footfalls and spread awareness in the community about our activities.
This cluster of libraries will serve as the real-world hub of our activities. They will be used to empower patients to form self-help groups; and will also serve as reliable sources of information on chronic diseases for journalists and media.

In order to be useful, information needs to be provided at the “point of use”. We will develop a health knowledgebase ; translate this into Hindi and Marathi; and develop innovative methods to deliver this to patients in their homes, through the mobile and the web. We will provide patients with a free PHR ( personal health record) developed by our partner, YosCare ( www.yoscare.in). Patients who suffer from the same illness can form online communities and interact with each other using Web 2.0 social networking tools. The PHR will also help patients with a chronic illness to get second opinions and remote consultations ( for example, if the patient develops a complication and needs an expert re-assessment), thus making more effective use of limited specialized medical resources. We will use the mobile phone to provide real-time information and feedback to patients to support improved medication adherence.

We will also publish patient educational materials in the major Indian languages in multiple formats, including: books; leaflets and CDs and DVDs. Multimedia materials would be developed by our partners, Infoseek Media ( some of these videos are online at http://www.drmalpani.com/health-videos/.)


Working with the Government

Since we offer our basic services free of cost , it will be easy to forge partnerships with the Health Department of the Bombay Municipal Corporation and the Maharashtra State Government . We would set up additional mini-libraries in Government Hospitals, at no cost to the government ; and also provide the government with authoritative patient educational materials in Hindi and Marathi.


The Policy Model

o The Government has agreed to champion public-private initiatives in order to improve healthcare services to Indians, and our proposal fits in very well with their model
o Support from the media. HELP has a tie-up with the Times of India Foundation, the publisher of the world’s largest English newspaper, and this will help us achieve the needed publicity
o Support from health insurers. Health insurance has recently become privatised in India ; and this is a huge market which needs to be addressed. We will partner with health insurance companies to help their clients to manage their diseases better.
o Support from retail chains. With the opening of the retail industry in India, many large players are now setting up specialty health and fitness stores to sell fitness products and healthcare services and we will use this platform to reach out to the community
o Well-informed patients will demand better healthcare services ; and this will act as a catalyst to improve the quality of care the healthcare industry provides them

Sunday, August 23, 2009

Why Julie from UK is over the moon

Hello.

If you have stumbled across this site than you must be considering IVF and at Dr Malpani's clinic. You can of course jump to the bottom and read how excited I am being PREGNANT!!!

My name is Julie aged 41 and I am married to Tim aged 29, yes my husband is younger than me. I was previously married and have two girls who have now flown the nest and doing their own thing. I met my now husband quite a few years ago, as there was an age gap we decided to talk about having children as time was not on my side, so we started trying, and I didn't think I would have any problems at all , having had two girls. I fell pregnant quite quickly only to be told that was an ectopic pregnancy ( that means my baby was growing in my fallopian tube) , I was so upset.

I had treatment that lasted over 6 weeks and still ended up in hospital, it was quite an ordeal to say the least. We were told because of the treatment we had we could not try again for another 6 months, so we waited and after 6 months past we decided to try again, it took a while to get pregnant this time but we got there in the end. We were overjoyed. I felt everything was ok until I had that 6 week scan, yes I was told it was ectopic again ! I was devastated as this was in the other tube , which meant both my tubes where damaged. I could not stop crying.

After a lengthy hospital stay and the removal of the ectopic and recovery time we took a deep breath, sat and had a chat about where we go from here as conceiving normally was out of the question and the NHS in England won’t help us because of my age. Hence we decided to have IVF outside the UK.

We were travelling to Bangkok in the Feb and decided to check out a hospital for an IVF Dr there. We booked an appointment in this all-singing all-dancing hospital and had an appointment to discuss our treatment. There are not many hospitals where you can eat sushi in the waiting rooms, and it was a splendid place, however when we met our Dr I just kept getting this overwhelming feeling that the whole thing was a money spinner. He was very keen for Tim to hand over a sperm sample and his lack of eye contact with me was appalling. It seemed that all this hospital was about was MONEY, so I declined Tim handing over his sperm and we left.

Well, that didn't put me off, and as soon as we got back I hit the Internet again, and I came across Dr Malpani's clinic. I have travelled India quite a lot so I knew what India was about, yes it’s classed as a third world country and is very hectic and you have to take everything in your stride. That aside, I contacted Dr Malpani and sat back and waited, I didn't think I would hear from him and was amazed at how quickly he got back to me - within 24 hours !

Dr Malpani’s web site was the best that I had come across explaining everything that you need to no, even a novice like me and my husband who didn't really know what IVF entailed understood what we would be going through, it was such an easy process. I couldn't wait to go. So we booked an appointment in 03 July 09 where we met with Dr Malpani who I might add is a really lovely Dr I wish he was my Dr at home, he explained everything to us so we knew what we were going to go through, and we then started our treatment on 06 July 09.

OOO the jabs for superovulation, I won’t lie to you they hurt, but not when given - just at night my hips would be a little sore. I kept telling myself the end result would be worth it all. I found the staff nurses just so lovely and helpful, the language barrier was a little difficult at times but we knew the Secretary spoke good English who we would borrow now and then if we needed something explained , she was funny and didn't mind... Mrs Dr Malpani (yes husband and wife) was such a warm caring person, I felt at ease whenever my scan dates came around, we would talk about things to do in Mumbai etc but at the same time she would explain her finding of my growing eggs to me and my husband, it’s very exciting to see them on the ultrasound scans and know that all is going to plan.

My egg retrieval day came, off I went, upon my return my husband was there waiting for me, And one of the clinic helpers who never said a word just made sure you where ok, I referred to her as a little angel, she didn't speak English but she would give me a little blessing I knew she was rooting for me. I found out that I had grown 11 eggs, I was over the moon, we then waited to find out how many had fertilised and was told 7, this was just great news, we were just so excited, I almost felt that I should sit next to the incubator in the lab and read nursery stories to my wonderful growing babies. I couldn't wait to have my embryos put back, the day came and as discussed we decided to have 4 good ones out back, the day came and we had the 4 best ones put back, now all we had to do is wait, we had 2 days rest, before our flight on the 3rd day home, I was so going to miss everyone at the clinic, I had seen them almost every day for nearly a month, we went into the clinic for the last time and bought a box of hand picked chocolates from the shop across he road and a bunch of flowers to say thank you, a small token really for what they had done for us.

Well, upon our return home we have been told to wait 2 weeks before we do a pregnancy test, that was a long long wait, then my husband got a call from work 4 days before the 2 weeks before our pregnancy test time, he works away and was being called back so we bought one of those clear blue tests that states you can test up to 4 days early, I wasn't holding my breath, my husband wanted to take charge of the stick, It stated that if you test early you have to use the first urine of the morning, sadly for the house hold I woke up at 5am and had to use that, so I woke my husband and presented him with my little jar of my very early morning pee. He did the rest, and there before us was a positive PREGNANCY test yes POSITIVE, ok, I am now thinking that as its an early one and only has a 96% accuracy I will do some more, my husband flew off that day knowing I was pregnant, it was so nice, I bought some more tests and started testing everyday sometimes twice a day as I still couldn't believe it, that little faint line on the stick just got darker and darker . It was fantastic. I still couldn't believe it.

We had our 6 week scan yesterday and there was 1 baby growing the rest have been naturally dissolved within me, however we are still not ruling them out completely as we won’t know for sure until our 12 week scan. My husband and I are just over the moon. This was our first attempt at IVF and I would have no issues at all going back to India which is a wonderful country to explore and for IVF at the Dr Malpani's clinic.

Thank you to everyone for your care and your help in making all this possible. You will always be in our thoughts.

Julie and Tim Jillians

I would be happy to discuss my experience with anyone who is considering IVF in India at this Clinic. Please contact me Julie Jillians [juliejillians@yahoo.co.uk]

Friday, August 21, 2009

Doctors-patients :: Parents:children

The doctor-patient relationship has a lot in common with the parent-child relationship. Doctors, like parents, have the knowledge and power; while patients, like children, trust that their doctors will do what is best for them.

To carry the analogy further, good doctors, like good parents will set boundaries - but within these limits, they will allow their patients a lot of freedom to choose what is right for themselves ! This is an approach which I find very effective. I allow my patients a lot of flexibility ; and do my best to accommodate their requests, even when I may not agree with them. I try to be non-judgmental and provide guidance and advise. However, if they make requests which I feel will harm their interests, I do put my foot down and tell them I cannot comply - after giving them my reasons for my decision.

Most patients are quite happy to be treated as intelligent adults - which is the way all good parents treat their children !

Why doctors should learn to ask their patients for help

I am always amazed by how poorly most doctors utilise the intelligence and creativity of their patients. While doctors will devote extra special attention to their " VIP patients" ( such as politicians and rich industrialists) in the hope of getting favours, most still seriously underestimate the wealth of knowledge locked in their "ordinary " patients.

Patients can be an excellent resource. They have skills and strengths which most doctors are unaware of - and therefore fail to tap. Just talking to your patients can open your eyes to what is happening in the world outside the four walls of your hospital. You just need to be curious and interested !

Many doctors are very hide-bound and stuck in the daily grind. By refreshing contrast, patients who work in creative fields such as advertising and marketing can help you look at your own practise with new eyes.

Similarly, most doctors are not very technologically adept. However, patients working in IT can offer all sorts of clever solutions to your daily problems, to help you improve the services you offer to your patients !

I ask my patients for help all the time. Most of them are happy to do so - and I am always pleasantly surprised by the results of their efforts ! I learn a lot thanks to them, which allows me to remain young - and they are happy that I use their help to improve the services we provide to other patients !

Thursday, August 20, 2009

Doctor, please don't treat me like an idiot

Many doctors take a very patronising attitude towards their patients. Because they have spent 10 years getting an MD degree ; know lots of Latin terms describing the body's innards ; and are experts in medical trivia, they feel they are smarter than their patients, who will not be able to understand anything about their illness.

This is a shame, because patients can be the best teaching tools for doctors. They are highly motivated; and often have lots of time to dig deep and find out tons of information about their illness.

Smart doctors learn to use their patients as research assistants ( unpaid !) to help them keep abreast of medical advances !

Wednesday, August 19, 2009

Slidepedia for Information Therapy

Patients are hungry for information and many routinely use the Internet in order to find out more about their diseases and the treatment options. Most patients trust the opinion of “expert patients” who have “ been there and done that”.

Also, health information needs to be "local" - so that diabetic patients in Pune need to know about treatment options ( such as the local chemists, supplies and specialists) available in Pune, rather than about treatments available at Mayo Clinic.

We also know that collaborative tools such as wikis work very well; and that most people find it much easier to absorb information when it is presented in a graphic format rather than in a text format.

This is why we need to set up Slidepedia, a collaborative platform where users can exchange information using slides rather than using text.

The initial presentation can be uploaded by an expert patient or by a doctor. This can then be edited and modified by any interested user, so that these presentations can be translated ; localized ( to make the information more useful ) and improved
( by updating information or adding alternative points of view). There can potentially be many different "versions" of the same presentation, so that it's useful for many more people

IUI versus IVF versus laparoscopy

If your diagnosis is unexplained infertility, it can often be difficult to decide as to what your next action step should be. This is because there are multiple options, and patients often have a hard time choosing which one is right for them.
Often the advise you will get from a gynecologist will be completely different from that which you get from an infertility specialist , and this makes a bad situation even worse because patients don’t know whom to trust.

In the past, a diagnostic laparoscopy used to be a standard part of the infertility workup. By introducing a telescope into the abdomen , the gynecologist could inspect the pelvis ; confirm the fallopian tubes were open ; make a diagnosis of endometriosis ; and remove peritubal adhesions. Not only did laparoscopy allow the gynecologist to make an accurate visual diagnosis , it also allowed him to treat certain problems at the same time, such as peritubal lesions and endometriosis.

Since this was minimally invasive surgery , it was quite easy to convince patients to signup for it; and since it was an operative procedure , gynecologists could charge high fees for doing it. In fact , for many gynecologists, laparoscopy is the most frequently performed surgery they do.

However , in my personal opinion , a laparoscopy is often overused and misused. Most infertility specialists use this procedure very sparingly today, because even though it may be “ minor surgery “ , it is still far more invasive than the other modern options which are available today. Doing a diagnostic laparoscopy to establish tubal patency is overkill, because this can be done as reliably with a simple hysterosalpingogram. While an operative laparoscopy can remove peritubal adhesions and treat endometriosis , it is still unclear whether these operative procedures actually help to improve the patient's fertility. While some patients may conceive after a laparoscopy, for which the gynecologist takes the credit, the pregnancy may not be because of the laparoscopy itself.

What about choosing between IUI and IVF ? Both have advantages and disadvantages, and should not be thought of as being competitive procedures, but rather as being complementary procedures. An IUI is much simpler to do and is much less expensive , but also has a lower pregnancy rate, and patients need to weigh the risks and benefits before choosing between the two. As a useful rule of thumb , for young patients, IUI would be the first option. However if three IUIs fail, then it's time to move on to IVF.

If you are confused because you are receiving contradictory advise, you need to formulate your own treatment plan, which takes into consideration your own personal preferences as well as your medical problems.

Tuesday, August 18, 2009

Health Headlines - Making Sense of medical stories in the News

What’s Plan B ?

Before starting an IVF cycle , I always ask my patients – What is Plan B ? While it is true that the success rates in our clinic are very high , it is also true that the chances of failure in one IVF cycle are higher than the chances of success.

While it’s easy to deal with success , one also equally needs to prepare for failure.
I tell patients to prepare a contingency plan, so that they are not shattered in case the IVF cycle fails. While most patients are realistic and understand the importance of having a backup plan in place , other take offense and feel I have an unnecessarily pessimistic attitude . The truth is that I am an optimist – but it is my job as a professional to present both sides of the coin. After all, the sad reality is that not all IVF cycles have a fairy-tale ending where everyone lives happily ever after !

I tell patients to prepare a list of options, so that intellectually they know what their possible courses of action are, in case the treatment fails. I feel doing so provides patients a certain degree of emotional stability, which helps them to cope better when confronted with the IVF emotional roller coaster ride . It's very hard for patients to think straight when they find out that their beta HCG result is negative and their embryos have failed to implant. This is the worst time to start asking – What do I do next ? If patient's are both mentally and rationally prepared for failure , they will find it much easier to accept this , in case the cycle fails.

Unfortunately, some patients get so paralysed by fear and anxiety when they think about the possibility of failure, that they just cannot start an IVF cycle. For these patients, just acknowledging the fact that the cycle can fail and preparing for this eventuality can help them to move ahead with their treatment. After all, what is the worst which can happen in an IVF cycle? Yes, the cycle may fail and you may not get pregnant. But you will be no worse off than before you started – and life does not end with the failure –there are still additional options which can be explored !

So what are the other possible options ? Often the best option is to repeat the cycle again. This is particularly true if the cycle was a textbook cycle , with good-quality embryos , a receptive endometrium , and an easy embryo transfer. If there were technical difficulties , these can be identified and then corrected in the next cycle. However , sometimes it's necessary to think of third party options, and this could include using donor eggs, donor sperm , donor embryos or surrogacy. Adoption is always an option which should be carefully evaluated; as is the decision to remain childfree. If you are not happy with the quality of medical care or emotional support you have received , your best option may be to change your IVF clinic.

I still find that many patients refuse the entertain the possibility of failure. They use denial as a protective mechanism, but this can be counterproductive and can actually backfire. Not having a Plan B is in one sense the worst plan , because this means they are not willing to accept reality. These patients need much more counseling and hand-holding, so that they can move on with their lives.

Monday, August 17, 2009

Why I like treating older patients

Everyone knows that IVF success rates drop as a woman becomes older. This is why many IVF clinic refuse to treat older women. Treating older women reduces the overall success rates of the clinic; and because it's become so important to rank high in the IVF success rate league tables (after all, IVF is a competitive business !) most IVF clinics do not want to jeopardize their statistics. They will either refuse to treat these women ; or recommended that they consider using donor eggs.
In our clinic , we are actually very happy to treat older women, for two reasons. For one thing, these women present a medical challenge ; and it can be quite professionally fulfilling when you can get a woman pregnant , when other IVF clinics have refused to treat her.

Secondly , because these women are older, they are often much more mature and well-informed and have realistic expectations of the treatment . They are willing to form a partnership with their doctor, so it is very personally satisfying when we can help them to achieve their goal. Very importantly, they have seen much more of life, and we enjoy learning from them and their life experiences.

Finally, when they do get pregnant, they are very grateful - and they make excellent parents as well !

So while young IVF patients are always welcome , because it so easy to get them pregnant , we look forward to working with the more challenging older ones, because they keep us on our toes, and we learn so much from them every day !

Sunday, August 16, 2009

Twin Babies Born in Tanzania

We are writing this letter to express our great thanks to our Almighty God who gave a great profession to our Doctors ANIRUDHA and ANJALI MALPANI as they are only Doctors who achieved to wipe out our tears of about 8 years of childless and brought us to a rejoice Family of Father and Mother of TWIN BABIES.

Dear Doctors Anirudha and Anjali Malpani, before we came to you our life was at all time difficult and unhappy. Thank you for giving us peace of mind and our freedom to think without stress like we had in last 8 years. Thanks to you & your entire team. We are thankful everyday that we were able to get treatments from you.
SHORT STORY ABOUT OUR INFERTILITY.

I and my wife married each other about 8 years ago. Since then, we were trying for a baby without any success. After trying for some years without conceiving, we went to the Hospital to find out the problem. Oh! My God! We were so much shocked by the results of low sperm count. I was given some pills to take for three months, after three months I went for test but there was no improvement. I was again given different pills but also there was no any improvement. Here my dreams of fathering my own baby started to disappear. One day while was browsing to some sites in internet, my mind took me to yahoo web search. I told myself! Let me write here and search “Best Infertility Clinic in India” the first site displayed was MALPANI CLINIC. Here my dreams of fathering my own child took place as was passing through pages of the book of Dr. Malpani’s called “HOW TO HAVE A BABY”

You know what? There is word in a certain page of Malpani’s book written, “ Any Man can father his own child” To me I can read it like this, “Through the skills of Doctors Malpani, any Man can father his own children’’. Yes, for the grace of God who gave great skills to Doctors Malpani, we are now have two healthy children after ICSI treatment we got from Malpani’s Clinic.

Again we are so thankful to Doctors Malpani & their entire team. You are the best doctor ever. We are recommending Drs Malpani to all infertile couples.
Once again thank you Doctors Malpani, we wish your clinic a very successful future in helping couples to achieve their dreams.

Now we are so happy and this happiness is given by you Dr. Anirudha and Anjali Malpani. Our experience at Malpani's clinic was excellent and we would like to share our experience with everyone. We are ready to advice, direct, and answer some quetions from infertile couples what we know about infertility and how to get the best treatments. Also as we know swahili language, any one can ask in swahili. Tupo tayari kujibu maswali na kutoa ushauri kwa lugha ya kiswahili.

Mr. & Mrs Jason,
Mwanza-Tanzania..
Email: yosanjason@yahoo.com

Saturday, August 15, 2009

Comic books are a great resource to teach patients !

This is a guest entry from our very talented comic book, artist, Syanne.

I'm originally from Jakarta, Indonesia. I've worked with Dr Malpani as a freelance designer since last summer, which makes this summer our first anniversary working together. Although my major in school (Academy of Art University, San Francisco, California) is advertising, I've always had a passion in illustrations. That's why I took the job on creating a comic book for 'How to Have a Baby' right on the spot. That was surely a learning experience for both Dr Malpani and me. I've never created a comic book before and neither has he. There was some struggle and definitely excitements. I've learned about more that I had ever knew I could about pregnancy ( which would be a pretty great conversations at dinner parties among friends and family :P).

After that project was finished, I was thrilled that he offered me to do a second comic book, which is the 'How to Have the Best Medical Care'. I have to admit that most people would probably shy away from reading thick medical books because they might think that it's too hard for them, but making in in the form of comic book certainly have narrows the gap. So far I've had a lot of fun working with Dr Malpani because of his professionalism and kindness. His patients might be feeling lucky to have a doctor like him and me as well by getting a great client like him. It shows that no matter who you're dealing with, your personality and professionalism knows no boundary.

I have to say that the new 'Baby Chase' comic book is the most exciting and the one that needs the most creative juice. It contains mostly of drawings and graphic artwork, but the thing that I love about it the most is that now people can relate closely to what an infertile couple is going through. What more is that like the other books, it's free, so it's for everyone who wishes to know more about this issue to read. This project has portrays my best artwork to date. I kept on trying to find new things and techniques to learn so I could do the best that I can for Dr Malpani. You know what they say, a happy worker is a productive worker, and Dr Malpani has certainly tried to keep that true!

In short, working with Dr Malpani has been a tremendously rewarding experience. Not only did I get to do what I love, I also get to catch a glimpse of what he loves to do as well, for a living, I'm certainly trying everyday to become a better artist and designer so i can continue producing great work for him.

Thursday, August 13, 2009

HELP Library catalog is now online !

HELP, Health Education Library for People, is the world's largest free patient education library !

You can now search the HELP collection online at http://www.smartpatient.in/w21/w21simplesearch.aspx

Gynecologists versus IVF specialists

Many gynecologists are critical of IVF specialists. They feel that they advise IVF for practically all the infertile couples who come to them, and end up overtreating many couples who could have got pregnant with much simpler treatment, just to make more money.

I think there is some truth in this crticism. A man with a hammer tends to see only nails; and some IVF doctors do overtreat infertile couples.

I just saw an example today, and hence this post. This was a young 29 year old woman who had been trying to have a baby for just 6 months. She went to her gynecologist who tried to reassure her; and told her to get ovulation scans done to document that she was ovulating.

The scans confirmed that she did ovulate from the right ovary - but the ultrasonographer also noted that the left ovary was "small".

She was worried that this meant that her egg quality was poor, which is why she met a leading IVF specialist. This doctor did an ultrasound scan in her office ; told her that her ovaries were "small" - and then advised her to do IVF, without telling her what her antral follicle count was or what her ovarian volume was. There was absolutely no documentation - she did not even provide an image of her scan or bother to test her AMH levels or FSH levels to confirm this diagnosis.

She came to me for a second opinion, and I had to spend 30 min trying to reassure her that this was half-baked advise.

Infertile couples are emotionally vulnerable - and it's easy to play on their feelings and prey on them. Many small abnormalities are highlighted - and
simple anatomic variants of no clinical importance are treated as "diseases" which need to be treated !

While this is the kind of patient who will contribute to the IVF clinic's success rates and bottom line ( because she never needed IVF in the first place), overtreating infertile couples will give all IVF specialists a bad reputation.
Patients need to learn to protect themselves by doing their own homework and ensuring that they are not being taken for a ride !

Making a bad situation worse - the press and swine flu

I feel the biggest problem with the swine flu has not been the virus, but the press. With all the media hype and the constant bombardment of pictures of hospital beds and sick patients on TV channels 24/7, most people are scared out of their wits about getting swine flu. Public gullibility is high - and rumours spread like wild fire. Unfortunately, no one is willing to listen to the voice of reason. Sensible doctors provide sensible opinions, but these are ignored - and poorly informed politicians decide to close down schools and shut down malls, adding fuel to the fire ! These silly measures hurt the economy and make everyone even more miserable, without helping the situation even one bit ! Swine flu is a self-limited viral infection, which is contagious, but not very virulent, which means that most people who get it do get better on their own, without needing any medical intervention. I wish responsible doctors had a better way of being able to reassure the public at large, so they would not waste their money buying masks or hiding at home !

Wednesday, August 12, 2009

Why does the infertile man get such poor quality treatment ?

As an IVF specialist , I have noticed that infertile men often get very poor quality treatment. There are many of reasons for this.

The first is the infertile couple themselves. Having a baby is usually considered to be the woman's problem , and she is the one who seeks medical attention which means she usually goes to her gynecologist. Many men have a fragile ego, and while some refuse to go for sperm testing , others postpone this, because they are worried they will find that they have a problem. Many men still blissfully resume that if their libido is normal , this automatically means that their fertility is fine , and that they do not need to check their sperm count.

By default, it is usually the gynecologist who then becomes the primary care physician for infertile couples. Unfortunately, most gynecologists are clueless about male infertility. Many have never examined a man in their entire professional career . They usually ask for a semen analysis; and if this is abnormal, they refer the man to a urologist. However , sometimes they do not interpret the semen analysis report properly , and this causes its own set of problems. For example some gynecologists still believe that a count of less than 60 million is abnormal - which means that men with a completely normal semen report are overtreated with medication , wasting valuable time.

To make a bad problem worse, most laboratories don't even know how to do a basic semen analysis properly. Because it is an inexpensive test, it's often done badly. This causes a lot of heartburn and confusion, as sperm counts vary widely all the time, and patients cannot make sense of what their problem is !

What happens when the infertile man is referred to the urologist ? While the urologist is a specialist , many of them do not have a special interest in treating the infertile man; and there are very few specialised andrologists ( male infertility specialists). This is why many urologists continue to provide many ineffective tests and treatments for the infertile man. They will often try empiric medical therapy to improve a low sperm count; and because this rarely works, patients get fed up and frustrated. The trigger happy urologists diagnose a varicocele for practically all men referred to them, by doing a color Doppler ultrasound scan. Once they find a varicocele , they are happy to treat it - and when this doesn't help to improve the patient's fertility status, they throw up their hands and say – Sorry – there is nothing else we can do ! The other problem with a referral to a urologist is that the care of the infertile couple gets fragmented. Often the gynecologist has no idea what the urologist is doing , and vice versa, which means the couple is not treated as a unit. This often causes them to lose confidence in medical treatment.

Another weak link in the medical system is the fact that many laboratories do not know how to perform a semen analysis properly. Since it is such a cheap test, they often do it badly, resulting in wrong reports - and therefore , the wrong treatment.

Compounding this problem is the underlying fact that the basic sciences understand very little about male infertility. We really still don't know enough about normal sperm production; and since we cannot pinpoint what the problem in sperm production is in the infertile man , there is very little effective treatment we can offer him. This is why the standard treatment for a man with a low sperm count today is ICSI
( intracytoplasmic sperm injection )
– a treatment which is conceptually crude, but works amazingly efficiently. We still do not have good tests for analyzing sperm function, so that a lot of our treatment consists of bypassing problems , rather than identifying them and solving them. This is a sad testimony to the fact that the infertile man has been relatively neglected !

About 15 years ago , it was felt that strict morphology testing using Kruger criteria would help us to identify which infertile men had functionally competent sperm. Unfortunately , we now realize that these criteria are not always reliable. The new generation of sperm function tests are supposed to check for DNA integrity. Unfortunately , these are equally unreliable, even though they are presently very fashionable. This is because while they do generate valuable information in research studies, they are not very good at providing clinically useful information for the individual patient. Thus , while we know in general that infertile men will have higher sperm DNA fragmentation levels than fertile men, there is no number at which we can tell the infertile man whether or not his sperm are capable of fertilizing his wife's eggs.

This sad truth is that male infertility treatment still leaves a lot to be desired. And this is why , ironically , the most effective treatment for the infertile man it to treat his fertile partner !

Tuesday, August 11, 2009

Baby Chase - Chapter 6 of the comic book story of how one infertile couple built their family

Why aren't patients better informed about their own problems ?

I always cringe when I see how poorly informed patients are about their own medical problems. Even infertile couples who have been through an IVF cycle know very little about simple basic facts, such as how many eggs were collected; or how many embryo were formed; or what the quality of the embryos were.

Some patients take perverse pride in their ignorance. They feel that IVF is too technical or complex to understand- and don't even make the effort to do so. A common justification is - I could never make any sense of biology even in school, so all this goes " over my head". Others justify their stance by saying - A little knowledge can be dangerous and I don't want to become a half-baked doctor" !

Others believe that doing the IVF is the doctor's job - so why should they bother about all these medical minutiae ?

In some cases, it is the doctor who is to blame. Many doctors are very selective about releasing information; and many IVF clinics still refuse to give patients their medical records. ( This always make me wonder as to what they have to hide !)

Some very rich patients take the attitude - " I am paying to go to the best,so why should I bother about all this silly medical stuff. I have more important things to worry about !"

Unfortunately, ignorance is not bliss. Patients cannot afford to take a "hands off" approach. Biological systems are unpredicatable - and the outcome of any medical treatment will always be uncertain. Patients just cannot afford to leave everything upto God - or upto the doctor anymore !

The good news is that there is now a lot of information available on the internet for infertile couples, so even if your doctor is uncommunicative, you cannot use this as a pretext for remaining ignorant ! After all, it takes two to tango - and you cannot shirk off your responsibility by blaming your doctor anymore.

For example, our book, How to Have a Baby - A Guide for the Infertile Couple is now available online - free of charge. It is available in 4 different languages - and is also available in a comic book format and as a video !

Doing your homework does not mean trying to become a doctor - it just means you are trying to form a partnership with your doctor. You should trust your doctor - but you should also verify independently that he deserves your trust !

If you aren't well-informed, there's a real risk that an unscrupulous doctor may take advantage of your ignorance. If this happens, then all your confidence in the medical profession is lost - and you will never be able to trust another doctor again in your life. Rather than be passive and allow such a calamity to occur, you can use Information Therapy to immunise yourself against bad doctors.

Thursday, August 06, 2009

Why women are luckier than men

I just finished reading a book called - Knock Yourself Up by Louise Sloan. The sub-title is A Tell-All Guide to Becoming a Single Mom .


On the same day, I got this touching email from a man.


" I have always desired to be a parent and a husband Dr. Malpani. I am 42 and stable in many ways mentally, spiritually, and financially. You get to the point where if you have not yet been able to become a parent and you are a woman you bring a friend over for dinner and can get pregnant. A man when faced in the same situation must plan a different path than having a friend over for dinner. I wish I had better luck with a woman who desired to be a parent as much as I have but thus far 2 who I have known seriously if life have taken the path of not wanting a child. So I find myself in this position of where if something is going to happen I might have to go forward on my own. I am happy there are people out there like you who can help those who wish to have their own family. God bless and thanks for you help."


Many women resent the fact that men have so many more privileges than they do - and quite a few would rather be a man in a man's world.Sometimes they need to be reminded of their blessings !


Wednesday, August 05, 2009

Top 10 Reasons Docs Order Expensive Tests | RangelMD.com

Top 10 Reasons Docs Order Expensive Tests | RangelMD.com: " CAT scans, MRIs, PET scans, colonoscopies, ultrasounds, biopsies, stress tests, electromyography, can cost several hundred to several thousand each. Some doctors order many more of these than other doctors. Why?"

Our angel - a gift from Malpani Infertility Clinic

Life was not so beautiful as it is today

For we are holding our angel in our arms today

Thanks you Lord for giving us this gift

Thank you lord for showing the way

.... to Malpani Clinic

We are a couple from West Sussex, UK. We got married in 2006 and decided to have a baby straight away. We tried but nothing was happening. After a year we decided to visit our GP who advised us to undergo some tests to find out the problem if they were any.

After having a long discussion with the GP he advised us that he needs some tests to be done to find out if any problem exists. Firstly he requested my husband to provide them with a sample of his semen to conduct some test. The result showed that my husband semen sample had no sperms in other words it medical term it was called Azoospermia. We were shattered and heart broken and felt we never will be able to have a baby of our own.

We met our GP with our reports to see what other options are available for us to be parents. Our GP advised us that we need to meet a specialist with our report and he will fix an appointment with a specialist to see us. After a wait of 45 days we had an appointment with specialist. We were anxious and worried if the specialist says we may never have a baby of our own.

After discussion and examination by the specialist they explained us what is Azoospermia and what all options are available for us to have a baby of our own. They said first they need to have a surgery on my husband’s testes to find out if there was any blockage and if there were any they would try to fix it if possible during surgery. They also advised us that they would also have a biopsy on my husband testes to find if they are producing any sperms.

We waited for an appointment for the surgery on NHS as it takes time but due to our luck we got an appointment for surgery within 2 weeks. The Surgery was done and then we had to wait for a couple of weeks for an appointment with the specialist to discuss the findings of the surgery. All this waiting was painstaking as well as we were getting more worried and anxious.

We had an appointment with the Specialist and they advised us that they have both good and bad news for us. The bad news was that there was a blockage, which was blocking the flow of sperms, and they were not able to fix it during the surgery. The good news was that my husband testes was producing sperms so we could have our own baby through IVF (ICSI) treatment.

We enquired whether we could do the IVF treatment through NHS in UK but due to age factor we had to wait for 5 years to do the IVF treatment with NHS. We enquired with private clinic the cost was too high and success rate was very low.

Then we started doing our research on the net to find out different infertility clinic in India for the treatment. We short listed some clinic but still were worried, as we were not aware much about IVF treatment and how it functions in India.

We browsed through the website of the short listed clinic and found Malpani clinic website more informative, detailed and organized and we got all the information required for our treatment that is when we decided to do our treatment with Malpani infertility clinic.

We sent an email to Dr. Anirudh Malpani with all our details, copy of Semen Sample Analysis Report and the Biopsy report. Within 6 hours we received a reply from Dr. Malpani advising us about the treatment, Cost, and all requested information. We are quiet impressed with the professionalism and prompt response.

Then we planned our trip to Mumbai and met Dr Anirudh Malpani. After meeting Dr Anirudh Malpani whatever little doubts we had with regards to treatment and expertise had disappeared. We found Dr Anirudh Malpani friendlier, and his relationship with his patients is more of a human than a doctor -patient relationship. We at last were happy that we made a right decision and felt we are in safe hands.

Then we started our IVF cycle and all went as planned eggs were collected and embryos were transferred. Dr Anirudh Malpani advised me to have a pregnancy test after 2 weeks. We waited for 2weeks and when we received the pregnancy report we were shattered as it was negative. Dr Malpani called me and he spoke to me, consoled and advised me which made me feel better.

We met Dr Anirudh Malpani before we went back to UK and informed him that we will be going through another IVF cycle and we will do the treatment through Malpani Clinic as we were happy with the treatment and were confident the second time will be a success because Dr Anirudh Malpani always said to us “ unless you try you don’t get”.

We did our second IVF treatment in October 2008 and when my wife did her pregnancy test it was positive. We were so happy there was no limit for our happiness.

On 31/07/2009 my wife delivered a healthy baby girl.

We thank you Dr Anirudh and Anjali Malpani without your help this would not have been possible. We pray to God to give you both good health to carry on this good work by putting back smile on childless couple.

I also like to thank all the staff at the clinic that helped us during our treatment. They were very helpful and supportive. Thank you all and God Bless.

Couple from UK

Sunday, August 02, 2009

The Physician as Learner - Medical Education

The Physician as Learner - Medical Education: "Research into the physician as a learner indicates that:

* Physicians learn best when the learning is in the context of patient care, answers their questions about patient care issues, is directly applicable to their work and does not take up too much of their time.
* Physicians learn in response to clinical problems. They scan their environment for potential problems, and once a problem has been identified decide to act on it by learning the things they need to know to solve the problem. They then apply this knowledge to the problem. (Slotnick)
* Physician learning is unique in that there is a high inclination towards autonomy and self-directed learning. (Amin)


When designing continuing professional opportunities for physicians it is, therefore, important that the characteristics of learner-centred education be incorporated. These characteristics include:

* The learners are self-directing, but may need some guidance to reach that point.
* The learners have an extensive experiential base that can serve as a resource or foundation for learning.
* The learners tend to have a life, task or problem-centred orientation to learning.
* The learners’ motivation is internal rather than external, but both motivations can apply."

I wish everyone who designed CME ( continuing medical education) programs for doctors would read this !

Saturday, August 01, 2009

Learning How to Learn - A Guide for Indian Doctors

Why it's good for everyone when doctors make money !

Why it's good for everyone when doctors make money !: "The Business of Medicine is a vital dynamic chunk of our economy. So let's call it what it is (a business*), let's stop fighting and, instead, find a way to work together so everyone can profit - whether it be in dollars (or whatever your currency) or in oodles of good health."

How doctors can make teaching videos easily and for free !

How doctors can make teaching videos easily and for free !: "Imagine you wanted to make a teaching point.
About reading food labels, or showing patients how to find the best-rated websites for health, or using a new piece of equipment, or teaching your staff how to perform various tasks in your EMR.

You could do all of these, with the tools I mentioned above (and with the addition of a Flip video camera like my model, to capture yourself or others speaking and demonstrating something).

And I bet you'll be placing yourself and your business or practice head and shoulders above the competition."

Doctors have so much to teach. They need to use all these clever tools to reach out to many more people than they can face-to-face !
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