Saturday, October 20, 2007

Why don't hospitals invest in patient education libraries ?

" Although apparently it may seem antagonistic to profit making for hospitals, the model of putting health education units in hospitals actually makes great business sense where hospitals can make real good money by properly distributing materials, tailored patient care settings, and educating patients. A prominent example of the success of your type of business model is Nicotrol CQ the nicotine substitution with controlled quitting for smokers. It took the pharmaceutical companies years to realize the worth of patient education, but once they got the hang of it, it changed the way medicines were brought to people. Think of insulin and Novartis campaigns to educate patients.

Unfortunately, you cannot change the "perceptions" of hospital administrators, but you can hope to change practices. Medicine is information science, and those in the medical profession who take it as business than a profession, play the following game, that's characteristic of any business transaction --

a) you should have an information advantage over your client (or patient), and

b) you should scare your client/patient/patient-party and then you let them decide what's best for them.

QED, system-wise, in areas and times when the practice is slow, the number and frequency of surgeries/cesarian sections/expensive intervention goes up. Hospital administrators too take advantage of this asymmetry of information and therefore create imposing structures in the names of hospitals, as if hospitals are factories where the "sick" are made better.

Your concept is aimed at tipping the scale at the other end, empowering the patient. If I were you, I'd not bother messing with the hospital administrators, they are not our audience. I'd focus on the patient (or people at risk) and then go for tailoring messages to the segment of population that matter. Information presentation is the crucial key here. In presenting the information, revert the two points we alluded to above:

c) the patient should now have an information advantage (one, he or she already has, his or her personal physical problem, that he or she knows better than the doctor to start with. The physician, on the other hand, is an expert with the technical knowledge as to what works). Educate the patient so well that she knows what's the problem and the physician then will be able to fine tune the diagnosis and the treatment process. That means creating evidence based literature and translating that in the language of a class Eight pass idiot. Can we the doctors, do it? With similes, stories, comparisons, parables, comics, graphic novels, games, etc?

d) Information, if properly tailored, should minimize irrational fear in the mind of the patient.

Some of the best doctors with whom I got trained, without exception, I found all these "best"/great doctors were extremely polite and teacherlike with their patients, even in their most busy schedules. It's purely my personal opinion and therefore it's of little worth, but I must share this with you -- I found that the technically most incompetent doctors also tend to be very rough and ruthless with their patients. Sorry for this long post, and I will sign off with these two aphorisms by Don Berwick

e) from the perspective of patients, the aphorism is -- "Nothing about me without me": in other words, patients should be clearly explained why some diagnostic procedures or treatments were offered
f) from the perspective of the doctors -- "Every patient is the only patient" -- self explanatory. "

Dr. Arin Basu MD MPH
Allan Smith's Research Group
1950 Addison Street
Berkeley, CA 94704
United States

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