Thursday, December 31, 2009

Health gets personal in the cloud - O'Reilly Radar

Health gets personal in the cloud - O'Reilly Radar: "Healthcare is one of the biggest industries in the world. The United States spends over 17% of its GDP on healthcare and the issue of the industry's future is being hotly debated in Congress. Whatever happens to other elements of health reform, health information technology will play a key role in moving us towards the goal of bending the cost curve and improving quality and clinical outcomes. A Personal Health Record (PHR) is one way that patients can have some control of their own health data, while providing an interoperable platform for sharing relevant clinical data between providers. Healthcare is changing rapidly and there are some important trends worth watching.

Healthcare in the near future will be quite different than it is today. Web enabled technology is already changing the way medicine is practiced. As the digital nation comes of age we will see new opportunities, and new challenges, bringing healthcare in America into the 21st century. Health consumers will come to expect they will have control over their own health data. Having secure, interoperable access to clinical data will allow patients to partner with their care providers in new ways incorporating Web 2.0 principles.

For example, Google announced at the Health 2.0 conference that they have entered into a partnership to provide telehealth services through their Google Health platform using MDLiveCare. With the integration of MDLiveCare technology, Google can provide a service that offers patients access to doctors from remote locations, via webcam or telephone, into its personal health record offering. This will be particularly valuable for those who are caring for their loved ones from far away. My family is scattered around the country and caring for our mother with advanced stage Alzheimer's was quite a challenge that would have benefited from this type of service."

How it Works - MDLiveCare

How it Works - MDLiveCare: " MDLiveCare is the newest and most advanced healthcare delivery system in America where you will engage in real time interactive consultations with healthcare providers over the Internet with the use of a webcam and your computer, or telephone.

Using MdLivecare is easy as 1-2-3:
1) Create an account
2) Make an appointment
3) See a healthcare professional.

You will see and speak to a physician live and face-to-face. Create your account and see a healthcare professional right now!"

This is an innovative disruption . You don't need to drive down to your doctor's clinic or wait for a days for an appointment ! They guarantee access to a doctor within 2 hours - or the consultation is free. For patients who don't have a family physician with whom they have a longstanding relationship , this is a very valuable alternative. "Busy" doctors will not be able to hold patients to ransom anymore !

Wednesday, December 30, 2009

Healthcare sites may see a funding boost - Corporate News -

Healthcare sites may see a funding boost - Corporate News - "The nascent healthcare portals industry is up for a funding boost, given its attractiveness for private equity, or PE, and venture capital, or VC, investors, as well as the Unique Identification Number, or UID, project that will collate digital data on the nation’s population.

“The holy grail in this space would be personal medical records,” says Alok Mittal, managing director at VC firm Canaan Advisors Pvt. Ltd, referring to the automation of hospital records, a possibility through the UID project."

Finally, the Indian healthcare industry is maturing ! Given the fact that we do not have any legacy issues, and that we are an IT powerhouse, this is a huge opportunity !

Sunday, December 27, 2009

Why patients are unhappy with doctors - and what we can do about this

One of the commonest reasons for unhappiness is a mismatch between expectations and reality.

This is equally true for a doctor-patient interaction. The patient expects that:
1. the doctor is an expert on everything to do with medicine
2. the doctor will do whatever is needed to make him better
3. the doctor has all the time and money and power to do so

Unfortunately, in today's day and age, its very rare for doctors to be able to satisfy all three conditions . Doctors operate under multiple constraints - personal; intellectual; and financial.
Even if they wanted to do everything for their patient, they are often constrained by reality, and cannot do so, no matter what their personal desires may be.

Ironically, it is patients ( through their lawmakers) who set the constraints as to what doctors are allowed to do and what they are not. However, when this constraint affects their personal care, patients are not likely to be charitable, and dump their anger and bitterness on their personal physician, who becomes a soft target for all the patient's resentment.

The only way to prevent this problem is to ensure that patients have a realistic and intelligent understanding of what the doctor is allowed to do - and what he is not. It's far better for doctors to be transparent, so patients know what the doctor's limitations are. Equally importantly, patients need to do their own homework, so they have a better understanding of reality, rather than leave everything upto their doctor - who is not omniscient or omnipotent !

Monday, December 21, 2009

Three IVF Attempts Double Chances of Live Birth

Just one in three women gives birth after a single IVF attempt, but the cumulative chance of a live birth increases with each cycle -- where women are offered three cycles nearly two thirds go on to have babies, reveals a thesis from the Sahlgrenska Academy at the University of Gothenburg in Sweden.

The study followed almost a thousand women during their IVF treatment at Sahlgrenska University Hospital . The probability of having a baby was 35 per cent after one treatment, 52 per cent after two treatments and 63 per cent after three treatments. It was slightly higher for women under the age of 35.

Half of the couples who did not have a baby dropped out of IVF before three attempts. The most common reasons were that the treatment was felt to be too psychologically stressful, and that the chances of having a baby were considered to be very slim.

"My conclusion is that we need to get better at looking after patients' mental welfare during treatment," says Olivius. "A greater sense of wellbeing among patients would not only benefit them psychologically, but could also mean that fewer abandon treatment, which in turn could result in more couples having babies."

Patients need to have realistic expectations of IVF treatment; and doctors need to prepare a plan of action, which includes the possibility of failure. Otherwise, the treatment can become an emotional roller-coaster ride, causing patients to lose heart and give up prematurely, thus depriving themselves of their best chance of having a baby !

Grant to provide Free Websites for Indian Doctors

There are now millions of Indian patients online, looking for medical information . Unfortunately, most of what they find comes from places like . We need Indian doctors to establish their own web presence, so that information about Indian healthcare services is easy to find.

Even though Indian doctors understand the importance of having their own website, very few actually have one. This is because : it is expensive; they don’t understand the technology; and because web designers do not have the medical background needed to provide high quality medical information on medical websites . With the help of our unique offer, we hope to correct all these problems !

We feel we can leverage Indian IT skills and Indian medical expertise. This combination can allow Indian to become a global medical powerhouse and promote medical tourism.

Plus91 , a healthcare technology company at, normally charges Rs 5995 for a professional website for doctors . HELP will offer this website free for hundred doctors.

We hope these grants will help young doctors to showcase their talents, and help them to grow their practice ethically. This will help patients as well , who will become aware of what medical facilities are available in India. The transparency which the web imposes will help to improve the doctor-patient relationship, by allowing much more open communication between doctor and patient, and cutting out the middleman. Interacting with patients online will help doctors to become more patient-centric and empathetic.

Information Therapy - the right information at the right time for the right person - can be powerful medicine ! Ideally, every doctor and clinic should have an online patient education resource center, where people can find information on their health problem . This will create a positive virtuous cycle.

Please email me and explain why you feel you should be awarded this free website. Include your resume; what your present online activities are; details of your publications; how you expect to grow your website. I will shortlist 100 doctors and Plus91 will get in touch with you so they can publish your website. Doctors who are young ( less than 35); are specialists; have an academic interest; and practice in cities will be given first preference.

Plus91 will provide all the technological support needed, including:
Registering the unique personalized domain name you choose – for example,
Hosting your website
Uploading the initial content, so your website is live in 2 days
Submitting the content to search engines
Refreshing the content so it is fresh
You will also be able to publish your own content , using the easy OneClick WebPublish Content Management System, which allows you to become your own webmaster
You can publish as many pages as you like – there is no page limit !
You will also get your own personalized email – [email protected]

Sunday, December 20, 2009

Visiting Your Doctor Online Is a Virtual Reality - US News and World Report

Visiting Your Doctor Online Is a Virtual Reality - US News and World Report: "Gano and Harper are surfing a new wave of patient-friendly, relatively inexpensive, Web-based healthcare. A recent partnership between American Well and OptumHealth, a division of UnitedHealth Group, will take Online Care nationwide to all consumers, regardless of insurance provider. Then there is MDLiveCare, a national service with more than 100,000 members who may or may not be covered by a healthcare plan and who pay a flat $35 per online visit to consult with primary-care providers, specialists, and therapists in the network.

Virtual doctor visits are in real time and don't have to adhere to office hours. In Hawaii, some of the most remote patients now have 24-7 access to basic healthcare.

Such services offer more than convenience, however. An online encounter often is a substitute for an expensive trip to the ER. It's also likely to be cheaper than an office visit, plus it confers nearly instant access to a patient's choice of available doctors and—a boon for employers—may trim the number of workdays missed for minor maladies. Ninety-five percent of Harper's patients using the Hawaii service can be managed without a face-to-face visit, says the physician."

Is your IVF doctor taking you for a ride ?

Selecting the right doctor is one of the most difficult decisions an infertile couple needs to make. Most people use a hit and miss approach towards finding that doctor. They will ask friends for recommendations; family members who are in the medical profession for referrals; or go to the doctor whose name appeared in the latest newspaper article. Unfortunately , none of these are reliable methods for choosing the right doctor – and woe betide the poor infertile couple who stuck with the wrong doctor !

Even though there is no easy formula which works for everyone ,it always amazes me how patients continue going to a clinic even when they are not happy with it ! This is partly because patients perceive they are helpless; and partly because they underestimate their ability to judge the technical proficiency of a doctor.

Deciding which doctor to go is perhaps the only major medical decision which is under your control. Since this has such a huge impact on the outcome of your treatment, it is too important to leave this up to chance . You need to follow a systematic process , so you have peace of mind you made the right decision.
Here are some simple suggestions which will help you to make sure that the IVF doctor you select is not taking you for a ride.

The first visit will give you a lot of valuable information. Unfortunately patients are often so anxious and apprehensive during this visit, that they often fail to make the most of it. The first consultation is not just an opportunity for the doctor to make a diagnosis and formulate a treatment plan for you - it is also an occasion for you to judge whether this clinic is the right clinic for you.

First impressions are valuable –please learn to trust your gut feelings. Does the doctor make you wait for ever and ever before seeing you ? Do you get a chance to talk to the doctor or are you stuck speaking to his assistants ? Is the staff respectful towards you ? Do they appreciate that your time is valuable ? Are they empathetic ? Remember that the doctor’s personality rubs off onto his staff – and if his staff is rude and uncaring, it is quite likely that the doctor will be rude as well !

When you are a new patient, you are likely to be treated extremely well , because the doctor wants you to become his patient. Repeat visits are likely to be mirror images of the first visit. If the clinic is badly organized; if you are made to wait aimlessly without rhyme or reason; and if you get to talk to the doctor for only 4-5 minutes, these are all red flags which should alert you that you are in the wrong place. Yes, doctors can be extremely busy, but if they are so busy that they do not even have time to talk politely to you , then what value are such busy doctors to you ?

Does the doctor formulate a treatment plan for you ? Does he have a well -organized systematic approach , so that you know exactly what is happening ? Does he take the time and trouble to educate and inform you , so that that you are empowered to make your own decisions ? Is he empathetic ? Or does he talk down to you and interrupt you ? Does he take phone calls when doing a consultation ? Or does he give you his undivided attention ? How the doctor behaves during this first visit is going to be pretty much exactly how he is going to behave in all future visits - and if you are not happy with his personality or bedside manner please find another doctor.

The one thing which always perplexes me is why patients sign up to do a second IVF cycle in the same clinic even when they are not happy with the doctor ! Remember that no doctor has a monopoly. You are spending your hard earned money , and the least you can expect is good quality service . On the other hand, if your doctor provides poor quality services and you are willing to put up with it , then you really should not complain when this is what you get !

A lot of patients complain about the lack of transparency on the part of the doctor. They say that the doctor refuses to provide them with their medical records ; or to share information with them. I think any patient who accepts this behavior from their doctor deserves what he gets. You have a legal right to your medical records , and your doctor is obliged to give these to you . However , you may need to ask ! It takes two hands to clap - and if you do not ask , you are not likely to get what you want ! Blaming the doctor cannot justify your lack of initiative .

A good clinic will routinely provide you with a treatment summary of your IVF procedure ; as well as photographic documentation of your embryos . This is a tangible endpoint, which demonstrates the technical proficiency of the clinic, and assures you that the clinic is medically competent. If your doctor refuses to give you a treatment summary even when you request him for one, this is a major black mark against your doctor, and you need to be on your guard. Do not get fobbed off by silly excuses – for example, “ It is our clinic policy not to provide you with your records ! “ You have a legal right to your medical records , and your doctor is obliged to give these to you – he has no choice in the matter !

The other common excuse patients provide for putting up with poor quality treatment is – But I am not an expert ! What do I understand about the treatment ? I just believe everything the doctor tells me ! Unfortunately , ignorance is not bliss , and you cannot afford to take such a hands-off approach. While you don't need to become an IVF specialist yourself, you must take the time and trouble to become well informed about what your treatment involves. I feel enormous pity for patients who have been through an IVF cycle, and who do not even know how many cells their embryos had or what their quality was . If you allow your doctor to leave you in an information void, then why should you complain when he does so ?

Does this mean that you should be suspicious about your doctor and not trust him at all ? Of course not ! What it means is that you should trust your doctor - but only after you have determined that he deserves your trust. Trust is too important for you to just give away – your doctor needs to earn it !

In the final analysis, I feel patients get the doctors they deserve. The more the effort you put into selecting the right doctor, the better your chances are of finding the best doctor !

Saturday, December 19, 2009

Doctor, don't you get tired ?

I often work till late at night, and many patients ask me - Don't you get tired seeing so many patients daily ?

The truth is that seeing patients actually energizes me ! I enjoy seeing them - and helping them to complete their families ! Helping a fellow human to cope with the pain of infertility; explaining to a husband what he needs to do to empathise with his wife when she gets her period ; helping them to understand what IVF can do for them - and what it cannot; counselling a patient who has just had a miscarriage that this tragedy actually means that she has a good chance of having a baby in the future; watching patients admire their embryos ; listening to the joy in their voice when they get a positive HCG result; and watching them dote over their babies - how can life get any better than this ?

So don't feel sorry for your doctor when he has lots of patients to see - it might be more appropriate to feel sorry for him if he doesn't have patients to see !

Why are doctors' clinics so poorly organised ?

While most doctors are very good at providing good quality medical care, most of them organise their clinics very inefficiently. Patient flow is disorganised; patients are made to wait for hours on end; phone calls are not returned; and medical records are hard to track down. This creates a lot of unhappiness and frustration - for both patients and doctors.

The reason is historical. Doctors are never taught practise management skills in medical college; and some never pick these up. When they start practise as solo practitioners, they single-handedly run the clinic. In the early days, this is fine, because there are few patients, and the doctor can do everything himself. However, as he starts becoming busier, he starts having to hire staff to help him manage his clinic. Unfortunately, most clinic staff is untrained and because they are part-time, they are not very motivated in learning the complex skills involved in running a clinic. Also, the doctor is not very good at teaching them, because he does everything by " the seat of his pants". As time goes by, his attitudes harden,and he continues using the same old archaic inefficient systems, because these are the ones he has been using his entire life. Unfortunately, as his practise becomes busier, his "systems" can no longer cope, and most busy doctors today run clinics which are extremely inefficient, because they don't know how to fix the problem. They continue to get away with this inefficiency because they are the "experts" in the field, and patients are willing to put up with lots of incoveniences to see them - but this is a problem which causes a lot of stress for both doctors and their patients. Conscientious doctors are unhappy that they have to make their patients wait for so long, but they don't know what to do about this. Others take a perverse pride in how long their patients are willing to wait to see them - and boast about how hard they work long hours into the night ! Unfortunately, being busy is not the same as being efficient or effective !

Friday, December 18, 2009

Free CD for Indian Doctors

Plus 91 offers a free CD for doctors ! This CD is full of computer application and information to help doctors to improve their practise. Please send an email to [email protected] stating your name, specialization, clinic name, address, phone number, mobile number and email ID. For doctors within Pune and Mumbai , no courier charges will be applicable. For doctors outside these two cities , courier charges of Rs 45 are applicable.

You can see what is on the CD here !

Wednesday, December 16, 2009

Designing Clinical Templates for the EMR

This is a guest post from Aditya Patkar, Marketing Director at Plus91.

The working of a clinic can be divided into two parts. The administrative portion deals with the business part of a medical practice , such as accounting, insurance, billing , and inventory management. The scale and complexity will depend on the size of the clinic, and is much simpler for single physician clinics, as compared to group practices, for example. The other part is the clinical aspect , where the data captured is clinical in nature. Reports can be created using both these types of data.

Traditionally, clinics have focussed only on the administrative uses of medical software, using primarily the appointment and billing modules to help schedule patients and collect payments. The ability of the computer to improve the clinical care of the patient has never been explored properly in India so far.

Why is it so challenging to develop software which a doctor will find clinically useful ? This is because doctors are not able to write their own software – and most software programmers don’t have enough domain expertise in medicine to be able to understand a doctor’s thought processes or a clinic’s work flow.

How hard can it be to convert the doctor’s paper form into an eletronic template ? This can be quite a challenge for many reasons ! For one reasons, there is little standardisation in clinical record keeping. Each doctor loves to develop and design his own medical forms. Doctors take pride in their clinical skills, and each of them does things in their own idiosyncratic fashion. Trying to provide this kind of customisation is very difficult for a programmer, because it means spending a lot of time understanding the doctor’s needs, and then implementing them in the program. Not only is this expensive, it’s also very time consuming, because doctors are often too busy to spare the time needed to sit down with the programmer. Even worse, many doctors are not articulate enough to explain to the programmer exactly what it is they want the program to do. This is because they have often not analysed their own work flows and clinical thought processes, and are quite hazy about these. While they are good at doing what they do, they often are not analytic enough to be able to describe this in writing. Thus, while they are very good at finding faults with the program, they are often not articulate enough to be able to provide solutions ! This often ends up causing a lot of frustration for both doctor and programmer !
This is why we have developed a clever model which provides prefilled generic templates; and allows the doctor to customise these to suit his own needs, so that he does not need to call on us for making any changes he many need !

A doctor who needs an EMR should understand the following basic rules, so that it’s easy for us to convert his paper forms into electronic templates painlessly.

1. How many forms he uses ( for example, an orthopedic surgeon may have a special form for each joint)

2. Whether this form will need to be modified for followup visits

3. Because electronic templates are much more flexible than paper forms, they can be designed much more cleverly. A good doctor will help the computer programmer to design easy to use templates. Thus, those parts of the form which are used most often should be brought to the top; while those which are not essential can be relegated to the bottom.

4. Elecronic forms can be “intelligent”, so make use of this. For example, if the answer to : Swelling Present ? is: No, then no further fields related to this question will be displayed. However, if it is Yes, then additional fields reqeusting more information about the swelling will be shown.

5. Remember your question flow when designing the template . This will help you to get used to it quicker and will allow you to pay attention to your patient even while you are capturing data . A good computer program will follow your process, allowing you to become more productive.

6. Finalise your templates and stop tweaking and modifying them all the time – this just wastes time. Some doctors keep on changing their templates, and I still haven’t been able to install their program for them !

7. Unlike a paper form, which only allows you to enter information in a linear sequential format, electronic forms have lots of clever options, such as drop down menus. Not only do these minimise your writing, they also ensure that you remember to collect all the information you need from the patient !

Plus91 has a whole range of templates , individually designed for each specialty, using inputs from its panel of doctors. Your best option would be to start with this; and then change it, depending upon your personal preferences. Plus91 technology is flexible, and allows you to make these changes for yourself ! Of course, we can also do this customisation for you, if you’d prefer us doing so.

At Plus91 , we focus on improving both your practise management and clinical workflow processes in an integrated manner. This means that all the data collected, whether it be in the administrative section or the clinical templates , is captured in the same seamless workflow, cutting down time and effort.

Happy patients make for happy doctors !

Here's an email I received from a patient whose IVF cycle we needed to postpone


Hi Drs Aniruddha and Anjali Malpani

We would like to thank you once more for the wonderful treatment and care we received when we attended your clinic in April this year.

To be fair, when we agreed to come come to India to your clinic we weren't initially sure what to expect. We however grew more confident with each email correspondence we had with you (and there were so many of them!) and our several visits to your highly informative website such that by the time we boarded our flight to India we were certain we had made the right choice.

The care and attention we received at the clinic was first rate. The staff (from the receptionist to the nurses) were very friendly and courteous and made us feel at home. And our investigation/treatment started without any fuss. We felt comfortable because you guys encouraged us to ask questions and helped explain each step of the IVF procedure.

We were impressed by the professional, though compassionate, assessment of how our treatment was progressing and why you had to suspend the procedure as a result of over stimulation observed after a scan. We really appreciated your very clear explanation of the cause of the over stimulation. We are also grateful for your offer to immediately refund the IVF cost or if we chose, use it against a fresh procedure at a later date. The gesture gave us further reassurance thaat we are indeed in the right hands.

May God reward you abundantly for this.

We intend to come to India in the third week of January 2010.We hope you would be able to schedule an appointment around that period. We would keep you updated of our travel plans and dates.

Managing difficult IVF patients - a guide for infertility specialists

Tuesday, December 15, 2009

The vicious cycle of unhappy doctors and unhappy patients

A patient just sent me this email.

Dear Dr. Malpani, I would like to congratulate you on your very informative website. I am a Kenyan lady , 39 years old, married to a German. We live in Uganda. I have had 2 unsuccessful IVF-ICSI treatments in Germany. My experience at the clinic was quite painful. The doctors are all stressed and do not take time for their patients. My doctor never even bothered to say hello or even explain anything. I was stupid to go back to the same clinic for a second attempt. But anyways i have learnt from my mistakes. What caught my attention on you website was your emphasis on patient care. I believe the chances of success also greatly have to do with how the patient is feeling during treatment and also the doctor/patient relationship. I am seriously considering your clinic as an option.


She has expressed the anguish which patients feel when they have to deal with ultra-busy doctors very well. It's not as if these doctors don't care about their patients. Unfortunately, they are so burdened with administrative tasks and paperwork, that most of them forget even their basic manners. While it's doctors who have to dear the brunt of the daily thankless grind, in the long run it will be patients who suffer when they fall ill ! This is one of the reasons why alternative medicine doctors do a much better job at hand-holding their patients ! They don't have to worry about filling in forms and watching the clock !

How doctors in India are getting squeezed !

Consultants practising in Mumbai have a hard time getting patients.

It has now become practially compulsory for all new young specialists to have to give the family physicians who refer patients to them a hefty proportion of their fees as a commision for sending patients to them . While corporate hospitals are more refined and refer to this fee as a referral fee, the fact remains that this is a kickback - and can be as high as 50% ! Not only does this make the practise of medicine unethical, it causes young doctors to become cynical and disillusioned. They are often forced to toe the family doctor's line , and in order to generate more revenue for themselves, resort to unnecessary medical testing and surgery. The tragedy is that this corruption has spread throughout most Indian cities and is now rampant. Since the most corrupt doctors win, even the honest and straightforward ones soon fall into line very quickly, when they see what their seniors and peers are doing.

However, this is not the only area where doctors take a beating. Government rules are becoming increasingly onerous - and like any bureaucracy, the government only understands paperwork. As long as this is done properly, nothing else matters. The problem is that doctors then end up spending more time on the paperwork, rather than their patients !

Corporate hospitals are another major source of concern. These are large for-profit institutes, who have excellent marketing skills and huge budgets. Most doctors are defenceless against this kind of corporate competition, and quickly end up losing patients to these hospitals. Just like the Walmarts drove the mom-and-pop corner store out of business, these hospitals skim off the cream of patients, and will drive many independent young consultants out of business.

Finally , the last straw seems to be the entry of medical insurance into India. Medical insurance companies are hard bargainers - and today, if you want to be on the medical panel of an insurance company, you need to bribe the TPA ( Third Party Administrator) to allow you to serve on their panel ! If you don't do this, all the patients who have medical insurance will go to your competitor down the street !

Who ends up paying for all these kickbacks and the bribes ? You , the patient, that's who. The doctor simply builds in all these "costs of doing business" into the medical bill which he presents to you !

The only solution for the consultant who wants to survive is to cut out all these middlemen ! It's only when specialists will be able to reach out to patients directly that all this rubbish will stop. While senior consultants do not have a problem, thanks to their reputation, and the fact that most of their patients come to them through word of mouth, what is the junior consultant who is full of ideals going to do ?

He will have to use the web to reach out to patients directly ! This is the most cost effective medium to practise medicine ethically - and it will soon become an essential tool for most specialists !

Does google make you stupid ?

The great thing about the internet and clever search engines like google means that it's possible to get reliable information on practically any topic under the sun. This is great news, because you don't need to clog your head with tons of facts, when it's so easy to look them up ! Or is this such a good thing ? After all, isn't it important to acquire a core store of information which resides in your brain, rather than on a PC ? Is google making all of us stupid because we no longer bother to retain information ?

I agree that search engines will make the acquisition and retention of facts much less important. While this is a valuable skill, cramming and memorising is a low-level cognitive skill which a computer can do much more efficiently and reliably than humans can. The easy access to information means you can then free up your brain's computing power and use this for high-level tasks, such as creating unique viewpoints and looking at knowledge with a new perspective. These are high level skills, which are uniquely human, and can add much more value.

Also, this easy access to information means that non-specialists also have access to information which was originally available to professionals only. This "outsider" viewpoint can provide a great way of encouraging disruptive innovation !

A lot of my patients will unearth valuable nuggets of information on the net, which they then sbring to may attention. They act as my personal research assistants, stimulate my thinking and keep me on my toes !

Friday, December 11, 2009

How Smart Cards can improve hospital productivity in India

HELP needs help with Youtube uploads !

HELP has daily health talks which we upload to youtube. You can see the HELP Talks channel at

These are talks about Indian medicine with a local flavor !

However , right now we have to cut them up into 10 min segments because of Youtube rules. We’d like to become a YouTube partner so we can upload the entire talk.

However, unfortunately, they don’t seem to be accepting applications from India as yet . Can anyone help ?

Coping with IVF failures

Being infertile is bed enough, but failing an IVF cycle is often a hundred times worse. Often, the IVF cycle is the "last ditch" attempt at getting pregnant. Lots of hopes are riding on the cycle - as well as lots of money ! When the cycle fails, lots of patients despair of ever being able to have a baby, and it can be very hard for them to cope with the failure. They often feel that their bodies are flawed, because they have "rejected" their embryos; and they feel guilty because of all the money which has been spent and wasted.

Unfortunately, human reproduction is not an efficient enterprise - and the possibility of failure will remain an integral part of each IVF cycle.

While you may not be able to influence the outcome, how you deal with the failure is something you can learn to do well !

There are always two variables in any event: external; and internal. While you may not be able to do anything about the externalities ( such as your age), how you respond is an internality you can control !

It's amazing how very differently patients respond to failure. Some curse themselves and blame the doctor - while others bounce back quickly, analyse what they learnt from the failure, remember to thank God for giving them the opportunity to at least try IVF - and then move on with their lives. The failure could be an unhappy part of your life - or a positive one, because it gives you peace of mind that at least you gave it your best shot !

Financial Planning for Doctors

Financial Planning for Doctors : " Indian doctors are top notch but sometimes it is this very quality of being knowledgeable and intelligent in medicine and general affairs that makes doctors commit a lot of financial mistakes. It normally takes a personal financial disaster, introspection or peer feedback that makes a doctor realize that he needs help.

Doctors generally take a rudimentary or a product centric approach when it comes to making prudent choices about money. Very rarely does a doctor take a holistic view of his financial situation. Most doctors think of financial planning as investment planning or tax planning. This book is an attempt to help doctors understand the different areas of financial planning and to help doctors make smart and informed choices about money."

Books like this will help doctors to manage their finances better - and successful doctors are likely to be better doctors , because they do not have to worry about financial worries !

How smart patients keep fit ! An Expert Patient's first person account

This is a guest post from a friend, Amit Goela.


Dear Doctor Malpani,

The following is a fairly detailed account of all that has transpired over the last three months. I will tell you a little bit about health and habits first and then try to give as many details as possible of the events since September.

I have had high BP for almost 12 years but it was always controlled with a small dose of Atenol. I have also been over weight, have been a heavy smoker (about 10/12 cigarettes a day) for almost twenty years and would have drinks a couple of times a week but in very moderate quantities. The only thing I was addicted to was smoking and had a sweet tooth. While in Reliance, Mr Ambani inspired me to run and I started doing it fairly regularly. One thing led to another, and soon I found myself participating in the Mumbai Half marathon for the first time in 2007. While my running did change some habits of mine, I continued smoking and in fact became more careless about my food as I felt I had earned the right to finally eat whatever I wanted. The reason being I was burning the calories. However, as time passed my running became a little irregular till October 2008, when I decided to climb Mount Kilimanjaro. This motivated me to get back into a routine of exercise and running and culminated in me running the half marathon in January 2008 and climbing Kilimanjaro in Feb 2008. I think this went to my head and after March 2008, it was a steady decline. I kept falling sick every few months and almost stopped all exercise. Food habits became bad and on hind sight the daily routine was quite sickening. I put on some more weight and would generally feel extremely lethargic and sluggish. One thing led to another and I finally went for a health check up.

I remember the day distinctly. I had just returned from Kolkata where I had to get my parents to call a doctor home for acute stomach pain and general ill feeling. He checked my blood pressure and found it around 160 and then asked if I was a habitual drinker. It was extraordinarily embarrassing to be grilled in front of your old parents like that and I said to myself I will get a proper check up as soon as I return to Mumbai. Went for a health check up on Saturday ....... to Health 360. By the end of the day I had started feeling something was not right and in the evening went to Dr Kirti Punamiya who is my neighbor as well as a good friend. I told him everything and he also took the BP which came at 170 odd. He said to come and meet him as soon as the reports were ready.

I collected the reports on Monday, the 2nd September around 5 and went to his house around 9.30 pm with my wife. After, going through the reports, Dr Kirti started by saying there is a problem. He then went on the explain that my cholesterol was not right, lipid profile was not right, BP was out of control and the CT angio showed stenosis in the right artery. He said that an angio may be required. I was completely devastated and all kinds of morbid thoughts went through my head. Was I a ticking time bomb waiting to get a heart attack ?

I think the next twenty five minutes will turn out to be among the most important twenty five minutes of my life. Kirti first explained to me the physical implications of the problems in the report as well the long term consequences of my current life style. He then laid out the treatment plan, both immediate and medium term as well as the life style changes I need to make. Finally, he said that everything is in my hands and mind. By the time he finished, my mind was in turmoil and almost in a state of shock. I guess I said all the right things to Kirti and then came home. On the way up the stairs I promised Anju my wife, that I will smoke one last cigarette once I get home and that would be it. She looked at me and just said I have heard it many times ..... you had to be there to see how disgusted she was with that statement of mine.

Anyway, I came home, immediately went to the Balcony and had the Cigarette and that was it. I have not smoked since that day and now it is almost 95 days. While I hardly slept that night, I made a promise to myself that come what may, I will fix myself ..... at least I will do everything I can to remedy the situation and leave the rest to Kirti and the almighty.

I came to office the next day and around noon, went and told the entire situation to Rakeshji. Along with that , I requested for a week off , to which he readily agreed. He told me to take care and call him in case I need anything or any help. I have to say that after that he completely left me alone for almost one full week .... not one call was made regarding any work or official matter. He only called to enquire how I was doing and his silent encouragement was one of the major reasons why I have been able to accomplish so much over the last three months. After speaking to him, I called the research team and back office boys and explained to them my health situation and that I will not be coming for the next 7 days. I took care of some housekeeping and then I was home. The urge to smoke was at its peak by then and I was almost ready to explode. I managed to survive the first day and then the next two days. I just kept to myself and whatever little talking I did was like a dog barking. I don't know what Anju and Roshni , my daughter, went through those days but they did whatever they could to make things easy for me. The three days were extraordinarily difficult and it took everything I had both in physical and mental terms to get over the urge to smoke.

From the fourth day, things became a little easier and I started feeling a little better. The new medication prescribed by Kirti must have also started having some effect. I met Kirti in the evening and he encouraged me big time to hang in there. The next day, was almost normal except that I started feeling a little bit more confident. I had a long chat with my wife, then opened the net and started reading about Blood Pressure. I must have spent the entire afternoon and evening reading all kinds of articles on BP as well as some stories about individuals. Later that night, armed with a little knowledge but lots of enthusiasm and confidence, I went to Kirti's house again. I told him, I am ready to do everything that can be done to fix the problem but I needed a game plan and some handholding. The fact that I had stopped smoking conveyed my seriousness to him and he explained the next steps to me. The initial focus was on diet and life style. He said that he will tackle the exercise part after the Thallium stress test which he said I need to take after the blood pressure stabilizes a little. So my next step was to focus on my food. It may sound simple or like a fairy tale but I actually did it ... I just cut out all the salt and sugar from my food ... period. The only little salt I was having was in dal or sabji. The surprising part was that I did not miss salt or sugar a lot because by then I had almost started feeling a little different. I started feeling that I suddenly had a lot more energy and generally felt lighter on my feet.( Even today my lunch comes from Raju Bhaiyas house and I eat the same salt free diet which he has ) Meanwhile, the BP had started coming down and Kirti who was kind enough to check me almost every third day said it is time for the Thallium Stress Test. So the next mental battle became conquering the stress test. I asked Kirti if I could start stretching a little and go for long walks which he agreed to. Finally I went for the stress test with a huge amount of apprehension but the reaction of the doctors was completely different than the day of the CT Angio. Somehow I had a pleasant feeling and the reports confirmed it the next day. You cannot imagine how happy and elated I was when Kirti saw the Stress test report and said no Angio was required. Anju also must have smiled for the first time in three weeks.

Meanwhile you had also given me the books on hypertension. I started with Dr Stephen Sinatra's book because it had a remedy within 8 weeks on its cover. The book really helped in getting a better understanding of Hypertension and the fact that it can be conquered. So between Kirti, the books and the net, I had picked up some rudimentary knowledge of Hypertension and some of the things I could do to get myself out of the hole I had dug myself in.
I had started following a routine of some sort with extreme focus on the right kind of food and some attention to exercise. A week after the stress test, I was chatting with Kirti when he mentioned about a program called ATS training ....... it is a weight loss and stamina building program conducted at the QI Gym. He explained to me that it involved intense exercise in a simulated high altitude environment which is achieved by controlling the oxygen levels. My excitement kept mounting as I listened to him and then asked him if I could do it. He said Yes with some checks and balances , which he would explain to the Gym staff as he was also going there every day. So the very next day, i walked into Qi and set up a time to meet the lady , Kainaz Doctor who runs the program. If you want to meet one tough person who will not compromise on anything it is her ..... she and her staff are amazingly demanding but the program they run changes your life. This week is my ninth week and you have seen the difference....... Now I can run almost non- stop for 90 minutes at a simulated height of almost 2200-2300 hundred meteres !

This is what I have done since September 2nd and it has paid off big time for me ...... and I am determined not to slide back. I think what will help me keep this going is how much better I feel both physically and mentally.

While being a little immodest, the reason I feel confident that I will not slide back is because I have discovered the magic formula .....The most amazing thing I have discovered over the last twelve weeks is that it is not all that difficult to say "no" if wants to say "no". I have said 'no' to so many things over the last twelve weeks that I have lost count , but nobody seems to mind’s okay to say 'no" when you want to take care of your health !

You might feel that I have made it sound too easy , but believe me it was..... once I was clear in my mind why it needs to be done and the fact that I was doing it for myself and the people who love me and depend on me and not for the doctor, it fell in place....... The one place where I lucked out was in terms of people..... starting with Kirti who was available whenever I wanted, my family, Rakeshji and office colleagues who knew what I was trying to do and made as few demands on my time as possible, the interest you took , the books you gave me to read, as well as all my friends who excused all my absence from almost all social occasions.

Want more information ? Amit's email is [email protected]

Plus91 Online-EMR for Indian doctors-

Plus91 Online-EMR for Indian doctors: " As a doctor, you have been trained to take good care of your patients and you enjoy doing this. However, since you are in private practice, you also need to be a businessman and have to learn how to manage your clinic and your staff. Unfortunately, administration is one of those things few doctors enjoy doing, which is why most of them do it badly.

Plus91 can help you do a better job . We use advanced technology to help you streamline your practice management skills, allowing you to see more patients more efficiently.

Our clever customized electronic medical record software offers many customized templates, designed for your particular specialty. We can also easily tailor this to suit your requirements, so no extra cost!

Finally, we also allow you to take your practice to the web, by integrating your EMR with a custom-made website!"

I am an investor in this startup which is using clever technology to provide Indian doctors with an affordable EMR and practise management software which the doctor can customise to suit his own clinic. Because the software can be downloaded and installed online without requiring any human intervention, Plus91 can service doctors all over India !

Tuesday, December 08, 2009

13 weeks pregnant after egg donor IVF at Malpani Infertility Clinic in India, Mumbai

I love publishing our success stories !

Here is another one !


Despite a series of expensive consultations, investigations and treatments in the UK, we ended up with 2 failed IVFs and emotional and financial strain. Compounding the situation was when we were eventually told that IVF was no longer an option for us because my egg reserve was too low and that the only option we had to make our dream of having a baby come true, was through egg donation. For about a year I struggled to get an egg donor. What made it more difficult was that we actually needed a Black donor because I am Black and my husband is White. We contacted the UK National Gamete Donation Trust and our plea for an egg donor was placed on their data base but the response from most licensed fertility clinics was that there was a shortage of egg donors particularly of the ethnic minority group. It became evident that we had to broaden our fertility horizons and this led to correspondence with various individuals and egg donation services abroad. Whilst in this maze, I came across a 2nd Opinion Infertility doctor at Malpani Infertility Clinic in India and I thought it won’t cause any harm for me to get a 2nd opinion regarding my fertility problem. Within the very same day I received a response from Dr Malpani who confirmed that he could help. He answered all my questions promptly and honestly and even advised my GP to do a Clomid Challenge test and based on the results and considering my age (45yrs), we agreed to do egg donor IVF. From the beginning he was transparent with regards to his fees, type and duration of my treatment, and he gave me various detailed information about infertility and IVF on his website: This was extremely useful and reassuring. Dr Malpani is a man of integrity and is highly professional.

Within a month, not years, we were in a position to decide on a date for starting my treatment at the same time with my anonymous egg donor. We were given an opportunity to choose our egg donor from a list provided. This was quite helpful because I chose the donor that best suite my descriptions and interest.

I could not believe it when I eventually flew to India but due to work commitments, my husband joined me after a week. When we worked out the expenditures, it worked out far more cheap for us to do the IVF in India compared to the UK, all including airfare, cost of living and accommodation, entertainment. Because it was the first time we visited India and we needed a conducive environment for us to concentrate on our treatment, safe accommodation was an important area hence we appreciated the assistance that Dr Malpani offered in helping us find a suitable and inexpensive accommodation.

India is much different from Africa and the UK in that despite the fact that it is densely populated and there is extreme poverty, the rate of crime is very low. People are humble and very warm.

Anyway, a day after I arrived in India, Dr Malpani did some few tests and I started with my clearly defined treatment plan. I visited the clinic almost on weekly and the effect of the treatment was monitored very closely. I need not go anywhere else as everything, the laboratory, scan room was in the same clinic. The staff were excellent and very supportive. I felt at home as I seemed to have developed a very close and open relationship with the nursing staff and Dr Malpani. I felt comfortable asking any question and always got good, honest responses. I remember at some point I was a little anxious and was asking lots of questions and Dr Malpani reassuringly said to me: “Nozipho, leave the worrying up to me. I will do what is humanly possible to make your treatment a success but once I have transferred the embryos into your uterus, I would have done my job to the best of my abilities, and all will be in the hands of God. ” I could not have expected more than such an honest and comforting response like that. That clearly showed that Dr Malpani is a specialist in infertility treatment and had confidence that he will carry out my treatment with exceptional expertise up until he had to hand over to Mother Nature and that is: God’s Divine intervention which resulted in a pregnancy.

I had weekly scans to closely monitor my progress and response to treatment, which went very well. My husband joined me a week before he had to submit his sperm, as a result we were able to explore Mumbai and other interesting places before our return.

I guess my anonymous egg donor was undergoing treatment at the same time with me and thank God I never had to know her. I however, would always appreciate the precious gift that woman gave me by giving me a chance to be a mother. More so, I don’t have any obligation to humiliate my child by explaining that I am not his/her biological mother, as it would have been the case in the UK. The Malpani had done the appropriate screening of my egg donor and I trust their judgment. My egg donor produced 10 good embryos and we had agreed that 3 best ones will be transferred into my uterus.

On the scheduled day, I attended the clinic for my embryo transfer. Prior to the procedure, Dr Malpani and the embryologist showed us the embryos. It was amazing to see that they looked just like the embryos I had seen in the IVF text books. The fact that my husband’s sperms successfully produced those beautiful embryos was awesome. The transfer procedure itself was painless. Within few minutes, without me noticing, Dr Aniruddha Malpani had skilfully and successfully transferred the embryos into my uterus. After 2 hour’s rest at the clinic I went back to my hotel room and spent 3 days on bed rest before I flew back home.

The waiting period following the IVF was nerve wrecking. I remember going to the doctor for pregnancy test 14 days following the egg transfer. I could not believe it when he congratulated me and said that I was pregnant. I immediately went to the pharmacy and bought some few pregnancy test kits. It took some days before my pregnancy miracle could sink in as I tested my urine daily. I still have the strips safely kept in my drawer. My husband was over the moon to get the good news.
Although 3 embryos were transferred, only one implanted. Whatever this outcome, I am grateful. I have recently graduated to the 2nd Trimester of my pregnancy and seeing my baby through the scan lying peacefully in my uterus is overwhelming and remains a miracle.

I cannot thank Dr Aniruddha and Anjali Malpani and their Team enough for doing such an excellent job. I wish I had known about the Malpani Infertility Clinic long ago as I would probably have had a dozen kids, considering my age. Anyway, God send me his way just at the right time, for a reason.

Anyone who needs any more information about my experience at the Malpani Infertility Clinic in India can feel free to contact me at [email protected]

Monday, December 07, 2009

RELATE - The Baptist Leadership Group

RELATE - The Baptist Leadership Group: "What we developed through our research is an evidence-based model for consistent two-way patient and family communication: RELATE™ (Reassure, Explain, Listen, Answer, Take action and Express appreciation). This is a simple model that does not take any extra time to do, but ensures consistent, impactful communication with every patient, every encounter (from pre-registration to discharge)."

Such a simple way of helping to improve doctor-patient communication !

Portable inexpensive ultrasound for Indian villages

Portable inexpensive ultrasound for Indian villages : "InNovaSound is the first complete Ultrasound imaging system built into a USB-compatible probe. The system uses B-mode imaging and weighs just 7.5 ounces. This breakthrough in analog to digital miniaturizations allows all of the electronics to be built in to the probe. The probe then sends this data to PC for display and processing. The software provides integrated training video clips and guides clinicians to ultrasound controls or the specific scan protocol."

What this means is that even a laptop can now be used for ultrasound scanning !

Free fertility calculator with free email reminders

One of the reasons infertility is on the rise is the fact that couples are often not able to have sex during their fertile days. Especially in cities, where both the husband and wife are working, often on different shifts; or because they have to travel frequently because of their job commitments, it’s not possible for them to time baby making sex during their “fertile period”.

To make a bad situation worse, many couples are completely clueless about their fertile time and how to calculate it. While most women know that the fertile time is related to their ovulation and that women with a 28 day cycle ovulate on Day 14, they often do not know how to apply this generic information to their own cycles !

For example, if they have a 33 day cycle, then what is their fertile time ? And how often should they have sex during this time ? Should they try to save up the sperm ? Does the position matter ? It’s hard to ask busy doctors all these questions, which means that old wife’s tales and myths and misconceptions are still very prevalent.

Sadly, many doctors are also poorly informed. I remember a 28 year old woman who came to me. She had a regular 25 day cycle and her gynecologist had advised to have sex exactly on Day 14 to maximise her chances of having a baby. She had been juggling her work schedule and forcing her husband to have sex on Day 14 by the calendar religiously for the last 6 months, but had not got pregnant, which is why she came to me for IVF treatment.

I explained to her that by following her doctor’s advise, she was actually making herself infertile ! Women with a 25 days cycle ovulate on Day 11 – which means they are infertile by Day 12 ! She was angry and upset when she realised how much valuable time she had wasted. I explained to her that she did not need IVF; and advised her to continue trying in her own bedroom, after explaining to her what her fertile time was. She conceived promptly in the second month and still invites me to her daughter’s birthday every year !

This is when I realized that many educated women are very confused about their natural fertility cycles. In order to clear this confusion, we setup a website ,, with technology being provided by Plus91. This free “ Egg Tracker” service allows women to print out their fertile calendar – and we even send them reminder email alerts, free of charge. We also provide SMS alerts on their mobile( for couples in India only), for a small fee.

While there are other fertility calculators available online, MyFertileTime is the first to offer email and SMS alerts, making it extremely useful for modern couples who want to enhance their fertility.

IVF News - World Health Organisation recognises infertility as a disease

IVF News - World Health Organisation recognises infertility as a disease: " The World Health Organisation (WHO), in conjuntion with the International Committee for Monitoring Assisted Reproductive Technologies (ICMART), has formally recognised infertility as a disease in its new international glossary of Assistive Reproductive Technologies (ART) terminology. The jointly-prepared glossary appeared simultaneously in journals Fertility and Sterility and Human Reproduction.

According to the glossary, infertility is 'a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse'.

The move was described as 'a significant milestone for the condition' by the American Society of Reproductive Medicine (ASRM). 'We applaud the WHO for leading this important effort and for being so clear about the disease status of infertility', said Dr William Gibbons, ASRM President. He added: 'For too long those suffering from infertility have had their condition slighted or even ignored. Insurance companies don't pay to treat it, governments don't put adequate resources to study it and consequently patients suffer. We hope that this international recognition that infertility is, in fact, a disease will allow it to be treated like other diseases'."

Sunday, December 06, 2009

Baby through donor egg IVF

Here's another success story !

We are a young healthy couple and have been married for over 7 years and without children. The wait has been very painful with all our relatives and well wishers commenting on our childlessness. The psychological trauma of this resulted in our not frequenting social and family functions and brought depression and anxiety into our lives.

Initially, we decided to plan to not have any children for 2 years. We gradually started thinking about raising a family and initiated studies and process. We were surprised, that in-spite of our best efforts we did not succeed. Thus, began our fight against infertility over 4 years ago. We initially opted for regular assisted pregnancy techniques and failed for over 10 cycles. During this process, doctors also advised us a routine Laparoscopy to check whether the ovaries and fallopian tubes were clear and healthy. The results indicated that there was absolutely nothing of concern.

Subsequently, we graduated to IUI which we opted for 8 cycles and failed. We consulted multiple specialist doctors and the doctors gave us no reasons for our failures and told us to keep trying. There were times during our struggle, when we were tired of fighting against the demon titled as infertility and took a break of a few months. But, then we were back at it again with renewed courage to face failure at every attempt.

As a god send, we scouted the internet for any further approaches we can try upon. We came through Dr.Aniruddha Malpani’s website and read through the success stories. We suddenly realised that we were not alone in this battle against infertility and the success stories posted on the site helped us to ease our anxiety and we found ourselves picking up our confidence to approach Dr. Malpani for a discussion. The doctor was immensely approachable and co-operative. We discussed at length over mail communications and we finally were advised to carry out a cycle of IVF as all other methods had been tried upon earlier. The clinic has a very positive atmosphere with the support staff providing all the assistance that you would need.

During this process, came a challenge which we did not expect at all, in our wildest of dreams. The egg quality was not upto the mark and hence fertilisation did not occur. The doctor told us that this is very rare for young healthy couples and failure stared us on the face yet again. We did not succeed in our 1st IVF attempt as well. This was very disappointing, But, on the brighter side, after our prolonged battle we now knew the reason why we were failing in our attempts. The anxiety continued and we took a break of some months to think about our way ahead. We read through the donor egg programs and opted for this way out. So, there we were trying out our 2nd IVF cycle along with donor egg program under the very capable guidance of Dr. Aniruddha Malpani. We had a positive feeling as always and we were in luck this time as the Beta HCG result confirmed a twin pregnancy. As the saying goes, when luck smiles, it does smile in pairs. We are now extremely delighted as we have won our fight against Infertility under the guidance of Dr.Aniruddha Malpani.

We strongly recommend other similar couples in the world to not lose hope and seek his advise and guidance.

All the Best.

Saturday, December 05, 2009

Taking IVF patients for a ride

I just got this email .


My name is Mrs. AB. I am writing this mail on behalf of my elder sister - Mrs. DP who is undergoing IVF treatment. Kindly guide me whether she can continue with her IVF treatment further and what would be her success chances based on the latest IVF cycle details which she has undertaken recently. The details are as mentioned below:-

Her LMP was on 27th Oct 2009. Pick - up date was 7th Nov 2009.
1st Beta HCG was done on 17th Nov 2009. The value was 22.
2nd Beta HCG was done on 21st Nov 2009. The value was 10.
3rd Beta HCG was done on 26th Nov 2009. The value was 12.
Injection Beta HCG was given on 26th Nov 2009 night.
4th Beta HCG was given on 30th Nov 2009. Value was 70.
5th Beta HCG was given on 2nd Dec 2009. Value was 12.


I was surprised when I saw this. Why had the doctor done so many HCG tests for the poor patient ? The HCG level of 10mIU/ml on 21 Nov ( 14 days after the transfer) had confirmed that the cycle had failed and that the embryos had not implanted. Why did he make her do so many more tests ?

I guess doctors do not want to tell patients the bitter truth, so they keep them hanging onto false hopes by repeating the tests and calling them "positive". A HCG level of less than 10 mIU/ml is negative, and there's no point in repeating it again.
However, some doctors will choose to interpret anything more than 5 as a "positive" because the normal range in the printed report is 0-5.

Patients are willing to be deluded - and because they do not get their periods, they feel they must be pregnant. The reason for the delayed period is all the hormonal support ( estrogens and progesterone) which is provided after the embryos transfer, so that just missing a period means nothing whatsoever !

To add insult the injury, the doctor then gave her an HCG injection on 26 Nov to "support the pregnancy" ! Giving anyone a HCG injection ( even the husband !) will result in a positive blood test for beta HCG - and this a common technique which many doctors use to fool ignorant patients. Incidentally, this is why the first HCG level on 17 Nov was 22 ( it was more than 10, which means it was positive). It was a result of the HCG left in the body after the HCG trigger shot given prior to egg collection.

Patients need to be well-informed to ensure their doctor does not take them for a ride ! If the HCG level does not rise, this means you are not pregnant - period. There is unfortunately nothing anyone can do about this. You need to accept the bitter truth and move on.

However, unscrupulous doctors point to the "positive" HCG result and claim that the cycle succeeded ; and the fact that the levels dropped afterwards means the patient miscarried. If the patient gets hoodwinked, she is hooked onto doing another cycle with the same doctor - after all, if the cycle succeeded in getting her pregnant, this means the doctor is a good doctor, and she has a good chance at getting pregnant if she continues trying again. After all, the fact she had a miscarriage must mean she had done something wrong, so why blame the doctor for her failure !

Doctors can fool patients once. However, once patients find out the truth - as they will, sooner or later - this kind of jugglery will backfire !

Why are doctors so penny wise and pound foolish ?

Here's a guest post from Aditya Patkar, Marketing Director of Plus91, who still cannot understand why doctors are not willing to invest in good quality medical software to help improve their productivity ! Are doctors being very short-sighted ? Or have they just got so used to getting freebies from pharma companies they they refuse to spend their own money ?

The sheer number of times that I have had to think about refusing to talk to a doctor because he is too uptight about spending money makes me wonder whether doctors are at all worried about quality.

I think a there was a wide schism between requirement and delivery in a lot of earlier versions of medical programs in India , leading to a fear amongst doctors about being taken for a ride when purchasing a new IT product. But there is a limit to which this excuse can be used to bargain .

Any doctor wanting to make his clinic IT savvy needs to get the right solution . Otherwise , it is going to be a dead investment, and there is no salvaging either the product or the doctor's interest in using IT to improve their practise. So, why do doctor's tend to bargain like they live hand to mouth when it comes to IT products ? This is a very different trend from the big hospitals, who may bargain and call tenders but are never penny wise and pound foolish.

I think it stems from a few reasons:

a. Because there are no standard suppliers for these products in the medical retail segment (read clinics, medical centers, small hospitals) , there is no real price benchmark.

b. Making a software is a simple enough affair , which is why you get a lot of 2-bit players, pharma company sponsored software, a relative who is an engineer or a local company which makes a HIS system among its entire range, so there are many cheap alternatives out there - much like a cheap imitation watch market. Unfortunately , doctors are not IT savvy enough to be able to differentiate between the good, bad and ugly ! Remember that if you pay peanuts, you are likely to get stuff which is useful only for monkeys !
c. Today , as we make a transition from the old to the new, software hasn't yet become a high priority for the older generation, so they are very sceptical about its utility, and refuse to spend on it.
d. Doctors have this fascination with getting things cheaper, because of the pharma companies.
e. Doctors are still very financially naive, and do not think in terms of "life cycle costs" or productivity benefits.

So what has been the effect of all this?

Doctors end up arguing with me about a cost of Rs 2000-3000 , even though they run practices with a turnover of many crores and our medical practise management software can help them to improve their efficiency by over 10% ! Some doctors still take shortcuts in their software , cutting out essential modules because they may save a buck or two.

If doctors are willing to spend big bucks in buying the best quality medical equipment , why aren't they willing to invest in good quality medical software ? After all, this will help them in making the most of their expensive equipment, so they can provide the best quality medical care to their patients !

Aditya Patkar
Plus91 Technologies Pvt Ltd

Friday, December 04, 2009

Another IVF sucess story from the UK

After close to eight years of moving from one doctor to another trying to conceive, we were advised by our gynecologist to try assisted conception. Our search on the Internet led us to the Malpanis. I surveyed their website, reading people’s stories on the special care they received at the clinic. I then decided to contact Dr Aniruddha Malpani for a second opinion, for which he recommended IVF treatment as earlier suggested by our doctor. I will always remember these words from Dr Malpani “When you are 50 years old and looking back at your life, you should never have any regrets that you left any stone unturned and didn't give yourself the best shot at fertility treatment”. This sent us thinking and saving and after three months of planning we went to Mumbai for the treatment. At the clinic we got lots of support and encouragement from the staff during our visit. The treatment was a smooth procedure and after three weeks we were good to come back home. After two weeks, we got a faint two lines on a home urine pregnancy test. The ensuing tests every after a few days also confirmed this initial test. We were ecstatic!! Having our first IVF cycle being successful, we can never stop thanking God for this. However the first few months were not easy; I was hospitalized and put on bed rest for two months. Our baby was delivered through an emergence c-section at 32 weeks due to ruptured membranes and a scan that revealed that the cord was around her neck. But for a pre-term baby she was doing well and could breathe on her own. We were discharged after 10 days with strict instructions on how to look after her. She is now four months and continues to amaze us. We thank God for this gift after a long period of waiting. We also thank Him for using the Malpanis as a channel of blessing to us and many other families like us. We pray a blessing upon the Malpanis and the people they work with.

HELP on All India Radio !

You can listen to this audio podcast about HELP on AIR !

You can also hear this in Hindi !

Wny every IVF patient should insist on photos of their embryos

Every IVF patient knows that the skill and the expertise of the IVF clinic plays a big role in their chances of getting pregnant.

Unfortunately , most patients are completely clueless as to how to judge the competence of an IVF clinic. Many of them select a clinic based on its "word of mouth" reputation or how busy it is. Unfortunately, this is a very poor criterion.

For example, one of India's busiest clinics is run by a skin specialist ! Why is it so busy ? Because the clinic offers cheap IVF, they attract a lot of young infertile couples, who don't even need IVF in the first place ! Because they do IVF for all these couples, they have a success rate which appears to be high - and a very busy and crowded clinic, even though their IVF lab is of very poor quality !

Unfortunately, patients confuse marketing skills with clinical competence !

This is also why "success rates" are not always a good method for judging an IVF clinic's competence.

One of the best methods is to ask for photographic documentation of your embryos. The key skill of the IVF clinic is to produce embryos. Whether or not the embryos will implant to become a baby is a variable which depends on factors outside the clinic's control, a good clinic should be proud to show you your embryos.

This is important for many reasons

1. This reinforces the technical competence of the clinic
2. It ensures they are transparent
3. It allows you to get a second opinion , in case the cycle fails
4. It's a tangible end point, which confirms that you can make good embryos in the laboratory ! Making a baby is then just a next step away !

If a clinic refuses to provides you photos, this is a major black mark against them.

What are they hiding and why ? And if they don't even have the equipment to photograph your embryos, this means their equipment is sub-standard - enough reason for you to look for another clinic !

Tuesday, December 01, 2009

BioNews - New EU rules could cause IVF costs to escalate

BioNews - New EU rules could cause IVF costs to escalate : All patients undergoing assisted reproductive treatments may be screened for diseases between each cycle, potentially leading to massive cost implications, under a new interpretation of European Union rules on tissue and cell donation proposed by the European Commission.

Currently couples are screened for diseases like HIV and hepatitis before their first treatment cycle and, once completed, are considered virus-free for the remainder of the course of their treatment. However, in a meeting on 19-20 October, the Commission stated that, under the European Union Tissues and Cells Directive (EUTCD; EC/2004/23), all patients must be tested for HIV, hepatitis, Human T-lymphotropic virus, and syphilis prior to each treatment and that this is not open for national interpretation."

This is what happens when rules and regulations are mindlessly applied to medical treatment. Patients continue to suffer !

Thursday, November 26, 2009

A patient provides feedback to help doctors to improve

This is a guest post from a patient whom I respect.


I am writing in about something that happened with me and my gynecologist in Chennai. I know that you write a great deal about positive doctor-patient relationships. I am not writing in to complain, crib or even ruin this doctor's reputation but a lot about what she said and did left a lot to be desired.

My parents live in Chennai and I spent my first trimester with them, because my husband was traveling a great deal and he did not want me to be alone in Mumbai. In Chennai, I went to a very well-known gynecologist. She was quite approachable and friendly in person, so I had no reason to expect the volte face that I saw today.

For my second trimester, I am back in Mumbai, because my husband is back. I plan to go back to Chennai for my third trimester, because my husband might have to travel again then. The Chennai gynecologist asked me to call her in case of doubts and queries. To be honest, this is the first time that I am even calling her ever, because she does not check her mail regularly and she is very busy so I did not want to trouble her with calls. I had done a urine analysis and wanted a clarification about the report, which said that the PH level was very high (the normal range was given in the report and my PH level was 8.5). This part was the only highlighted part of the report.

I am no doctor but as a patient, I did have a doubt about this and wanted to ask the doctor. In fact, it is precisely the fact that we patients do not know what is important and what is not in a report that prompts us to ask these questions, which may seem silly or irritating to a doctor but like doctors, we are human after all and it is my body, which we do not want to take for granted just because we are afraid to ask stupid questions.

I asked the doctor about the PH level and she told me that I had not gone to a medical school and that my knowledge of other things may be great but I knew nothing about medicine, so I had no right to second guess a doctor by using a piece of paper. First off, I was not trying to second guess her. I merely wanted to *clarify* something in a report and I did so with humility about my ignorance and faith in her judgment. She then asked me what PH was, as if I was a student in a class, and when I said that I did not know, she told me that I had no right to ask such questions as if I knew everything about medicine. She continued to grill me about what PH was with sarcasm and malice. Finally she asked me to drink a lot of water and said that I will be fine. She also said that I should not dabble in anything I had no knowledge about, although my knowledge in other things might be 'great'. She is right, of course. My knowledge of manners is far superior to hers.

When I proceeded to ask her about hair loss during pregnancy, she said that that was an intelligent and 'valid' question. I felt like I was back in school, dealing with a malicious teacher who was pulling me up for asking the 'wrong' questions, whatever those may be.

I know that we patients can get on doctors' nerves. We have a tendency to think that we know it all or we want to know it all. We want answers for everything when in fact, things are a bit more complicated than they appear. We know that doctors work very hard and I know that it is next to impossible to be patient with us.

However, the fact is, I know that I know nothing about medicine, let alone pregnancy, but this does not mean that we are empty mugs to be filled. It is my body and I do have a right to ask questions. If I do ask questions, it does not mean that I think I know more than the doctor does. I have met doctors who have snapped at, chided or pulled me up for being stupidly worried about trivial things and they were right in being upset but they were never malicious, personal or sarcastic in their anger.

All I want to stress on is that patients are possibly ignorant about many things but it is our body. And it is my child. My husband and I did conceive with a certain amount of difficulty, and the child is all the more precious to us. I know that our struggle is nothing compared to couples who try so many years and so many attempts before they get successful. I can only imagine how gynecologists are to them. In no way did I adopt a superior tone to this gynecologist. In fact, I was so taken aback by her behavior that I did not even react strongly to it. I was, however, extremely upset and saddened. My husband has written a polite but firm email to her. I simply do not want to write or communicate with her again because the relationship has obviously soured to a point that it is not fair to the doctor that the patient dislikes her but still goes to her.

I thank you for your time in hearing me out. Hopefully, I will, as a patient, be one step closer to understanding the doctor-patient relationship. I do respect it a great deal and the challenges that miscommunication poses. We have known some truly wonderful doctors - Dr KK Raja who performed my dental surgery, Dr VC Bose who performed two hip resurfacing surgeries on my husband, Dr Ananthapadmanabahan our GP in Chennai, Dr Prathima Reddy my gynaecologist in Bangalore for over three years, and of course, you, doctor.

Tuesday, November 24, 2009

A single woman's viewpoint about having a baby

This is a guest post from a very articulate patient of ours ! It's an open letter from her to her friends and family.

Dear friends,

I’ve greatly appreciated your offers of help and support during what has become an extended struggle with fertility. This infertility treatment stuff can be awfully isolating for a single girl, and I’m grateful to have supportive friends and family to help carry me through. I know that you are sincere in your caring, and I imagine it’s tricky for you to know “what to do”, so I’ve put together a few thoughts to help you understand what I’m going through, and how you can best support me during this time:

1. The choices I’ve made and am making are among the most difficult and deeply personal that most individuals face. I’ve shared my situation with you because I trust you and need your support. You may have opinions and judgments relating to my situation; sharing these with me at this point is not helpful. In general, I find folks feel much more free to ask judgmental questions or pass along critical comments to a single woman than they might if I were married. Please consider whether you really need to tell me about your thoughts on the selfishness of single motherhood, why God doesn’t want women having careers, how adoption is the only ethical reproductive choice, how overpopulated the world is, etc. I don’t want to push people away, but I’m vulnerable right now, so I have become protective of myself, avoiding situations and people who are negative or judgmental.

2. I’ve spent many, many hours researching every aspect of fertility and every option available to me. Although I know you’re well intentioned, I find it a little frustrating when friends insist on offering a barrage of insights along the lines of: “You probably didn’t know that a woman’s most fertile days are…” or “Have you considered resting with your legs raised after the insemination?” My personal hot button comment is “If you’d just relax…” Please note that blaming me neither helps me relax, nor offers me any insight. Unless you happen to be a reproductive endocrinologist, chances are I’ve read the study, researched the rumour, tried the miracle vitamin, and visited the new-age practitioner you heard could get a rock pregnant.

3. Know that you don’t have to have all, or any, of the answers. I’m so grateful for the calls, emails, check-ins, and long cups of coffee. You can’t imagine how relieved I have felt after a good conversation with a friend. Just listening is a wonderful gift of sharing of yourself.

4. I’ve been truly blessed by all your offers of support. Sometimes, it can be a little difficult for me to talk about what’s going on. I’m not embarrassed or ashamed about my current situation, but I do get awfully emotional about it. I know we’re all hoping that each month is the last; It may be just too much for me to talk to you after every “non-success”. When things do look promising (like a positive pregnancy test), what is a source of joy for most women trying to conceive, carries with it a further level of anxiety for me. I don’t want to share good news and then have to choke down my tears to report a disappointment. Let’s agree that I’ll call if and when there’s good news I’m ready to share.

5. I want to be a good friend, sister, neighbour, and colleague. I am truly excited to hear about your little bundles of joy. Don’t stop sharing your good news! It’s inspiring to me! I usually enjoy being around your children; I love kids and yours are an inspiration. Sometimes though, I need to be in a world without babies, just for a little while. Please forgive me if I send a card and a gift rather than a personal appearance at a shower, or if I’d rather go to a movie geared towards adults than family cartoon where there are likely a million beautiful little ones running around.

6. So much of my life revolves around medical appointments, charts, tests, and hormonal fluctuations, that I’m thrilled about any activity that takes me out of myself. I do appreciate your openness to listening, being able to talk about all this is a godsend. I also appreciate the opportunity to get out and socialize, go hiking, or canoeing, or out to a party; in short, do all the stuff we did before I started down this road. Normalcy is great! Let’s talk about what’s going on in your life too.

I’m looking forward to being done with all this; in the meantime, you can’t know how grateful I am for all your help and support. I look forward to sharing good news with you soon.



Monday, November 23, 2009

Teaching doctors how to write

Most doctors are very inhibited about writing. Since they are science students, writing is often not their forte. Unfortunately, this means they cannot share their expertise with the rest of the world and many will take their lifetime’s clinical wisdom with them to the grave.

What can we do to prevent this ?

In the past, doctors did not have much opportunity to publish or write about their clinical experience. Most doctors would write only for medical journals, which had a very rigid format and limited space, which means most never ever managed to get a single article in print. This was a big problem especially for Indian doctors , because most medical journals were published in the West.

The good news is that thanks to the web, anyone who wants to write can do so . I feel doctors have an obligation to share their wisdom – and the best way to do so is by publishing online. There are many ways of doing so – including: writing a blog; creating a website; podcasting for those who’d rather not write; or even videocasting on youtube !

The best way is to start small – and the trick is to start right now ! You can start by doing just one blog post daily, for example. Setting up a blog is easy – and free !

What can you write about ? The good thing about being a doctor is that you hear stories daily ! Because you see interesting patients ( what doctors call “cases”) daily, you have lots of stories. Instead of just discussing these with other doctors in the hospital cafeteria, why not share these with everyone through your blog ?

Just write about the most memorable patient you saw today. Every patient has an interesting story to tell – you just need to hear it and re-tell it ! As a doctor, you write every day. Most of it is your patient’s history, when you fill in his medical records. All you need to do is to re-tell the story in a more entertaining style for others ! Good writing is just a conversation with the reader – and since you talk all day long, all you need to do is to capture your conversation in words !

Doctors are busy and it can be hard to find the time to write. This is why discipline is so important – and it’s a good idea to plan to do a post on your blog daily. The oftener you do it, the easier it will become !

If you are unsure, you might want to dictate and then ask your secretary to type this out for you. The other option is to hire a ghost writer for one or two weeks , to help you get kick started !

Try asking yourself these simple questions - Who ? What ? Why ? When ? Where ? Why not ? Answer these, one paragraph at a time – and hey presto – you have a complete article ! It’s also very helpful to draw a mindmap, as this is a very useful way of providing new ideas. Keep each article short – try to cover only one idea at one time.

Let’s try this for this particular article. This could be seen to be a series of answers to the following questions !
Why should doctors write ?
Why don’t they ?
How can they do this ?
What technique should they use ?
Where should they write ?
When ?
( Go back and read the article, and you’ll see that each paragraph is an answer to these questions !)

What about the mechanics of actually writing ? This is amazingly easy, once you start ! Start with a blank sheet, and just keep or writing. This is the equivalent of a verbal diarrhea – don’t stop, until you have run out of ideas. Don’t worry about spelling or grammar or logic – you are just trying to capture all your thoughts, then they are fresh.

Then, the actual process of writing starts. Start converting your ideas into sentences , so that they make sense and are complete.

Put this away for 24 hours, and then look at it again. You are now ready to rewrite, so that it becomes more coherent. Don't aim for perfection and try not to be critical.

Finally, read it once more after another day, and start editing it. This can be hard work, because having to delete your beautifully crafted prose can be heart-breaking – but this is what will make you a good writer. As Thomas Sowell says, “ The only way I know to become a good writer is to be a bad writer and keep on improving. “

Do you get brain freeze when you see a blank page ? Then an easy option is to download the wikipedia article on this topic, and modify it. Rewriting what someone else has written is often easier than starting from scratch !

Is English a foreign language for you ? Are you diffident about your English skills. This is even better - write in your local language ! There’s very little competition, so your chances of being able to stand out and shine are even better !

Finally, I agree writing can be hard work, but it's well worth the effort ! It will become easier with time - I promise !

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