Monday, February 27, 2006

"Please educate me " - said the doctor to the patient . A new model for patient education

Traditionally, patient education has always meant that the doctor ( or healthcare provider) provides information to the patient in order to educate the patient. Actually, I think this is too limiting a definition. I feel patient education should also include all those times when the patient educates the doctor ! ( In the term "patient education", the patient can be the subject as well as the object !)
All good doctors will agree that their best teachers are their patients - and a well-informed articulate patient can teach a doctor ( who is open-minded) a lot!
Patients have a lot of time to explore the medical literature and their treatment options; and if we give them the tools to do so, they will use them intelligently in order to ensure they get the best medical care possible. ( For example, it's interesting to note that the vast majority of Medline searches done today are done by patients - and not doctors, even though the Medline database is an index of the medical literature, and was originally developed and designed for doctors !)
If you are stumped by a difficult diagnosis, why not offer patients access to a differential diagnosis toolbox ( such as Isabel or Dxplain) so they can explore more diagnostic possibilities ?
After all, patients are the experts on their illness - why not treat them accordingly ?
Communication is a two-way process; and just like doctors can teach their patients, patients too, can teach their doctors. How can we make this easier for patients ?
I think the first thing we need to do is to change our perception of patients - and their own perception of themselves ! Treat tham as experts, and lots of them will behave as experts.
In my own practise, I give my patients a prescription for information. I tell them - fill it up. These are the topics you need to find out more about - and these are the resources you may find helpful. I suggest books, websites and the public library - and encourage them to explore for themselves. I then tell them to come back and share the results of their information search with me, so they can educate me .
This is a win-win process. Patients feel empowered and comfortable, and are happy to be treated as intelligent adults ! While I may not learn much new medical information from them ( I feel I am well-informed and well-read !), every once in a while a patient unearths a priceless nugget which I would have otherwise missed.
It also allows me to establish a more personal relationship with them, as one of equals. It encourages questions; allows me to clear doubts; and enables patients to give a much more "informed consent".
Most importantly, my patients educate me about their own personal feelings; and the techniques they use to cope with their illness. Since I am not infertile myself, this helps me to empathise with my patients. It also helps me to grow as a person, as I learn a lot about life; and about how people cope with stress and distress.
This is one of the best forms of CME ( continuing medical education ) I have ever come across - and I highly recommend it to everyone !


  1. Anonymous6:42 PM

    Dr Malpani,I was your patient once and I am a regular reader of your blogs. I remember you having asked me on my second cycle of treatment Do you remember last time's prescription? Can you say it? Well, rightly said, a doctor needs to treat the patient as an intellect and give him/her an opportunity to explore and involve himself in the treatment procedure.

    I underwent a fibrod surgery in India and they found I had endometriosis. I was given some tablets and asked to take them. For several months I did not get my periods. I panicked, went from doctor to doctor, they did all kinds of tests(including a pregnancy test). Finally one asked me if I am under some kind of medication. I told them I was taking Danazol(I think that was it). The doctor laughed and said that is the reason. I called the doctor in India from US, he took it so causually and said that was to treat endometriosis and the only way to do that was to stop the periods for a couple of months!!!Wish he had told me that the day he presribed the medication!

    From that day, whenever I get a prescription, I make it a point to research and also ask question about the prescription.

    I am glad that we have doctors like you in India who dont treat patients as dumb people and try to involve them in the treatment!


  2. Wow. You have the perfect attitude. Your patients are lucky.


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