Saturday, November 28, 2009
Thursday, November 26, 2009
A patient provides feedback to help doctors to improve
This is a guest post from a patient whom I respect.
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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.
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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.
Wednesday, November 25, 2009
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.
Love,
Alana
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.
Love,
Alana
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 !
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 !
Saturday, November 21, 2009
How your gynecologist can mess up your sex life if you are infertile
All couples know that they need to have sex in order to make a baby. Many infertile couples are worried that may not be having sex at the right time when they fail to get pregnant. They know that they are meant to have sex during the fertile time - but they are often very confused about the details, including: how to calculate their fertile time; how often to have sex; whether it's okay to have sex daily; and what position to have sex in.
Now these are questions most fertile couples never need to think about. Infertile couples, however, start obsessing about sex - and many of them will turn to their fertile friends, to get "advise". After all, couples who've had a baby by having sex must know a lot about baby making sex, so why not ask them ?
Unfortunately, most couples are quite clueless . They end up providing their expertise ( I went to Goa for a holiday and got pregnant, so that's your best option) , without realising that they maybe poorly informed - or that what worked for them may not work for everyone !
This is why many couples turn to their family doctor or gynecologist for advise. Unfortunately, the sad truth is that even many doctors are still very poorly informed about these basics
Thus, many doctors still advise couples to have sex for 3 days before and for 3 days after ovulation. This is bad advise, because a woman cannot get pregnant if she has sex after she has ovulated. After ovulation, the cervical mucus , which is now under the influence of the progesterone hormone , will not allow the sperm to swim up through it. This means a woman is relatively infertile after ovulation - a fact many doctors still do not know.
Similarly, most doctors do not bother to teach women how they can track their cervical mucus to monitor their fertile time.
One of the commonest misconceptions is with regards to what the optimal frequency of intercourse is, in order to maximise fertility. Many doctors advise couples to have sex every alternate day; while others advise couples to "save up" their sperm ( by abstaining from sex for 3-5 days) and then to have sex on the day they ovulate. This is wrong advise - but because it comes from the "expert", many couples religiously follow this. Timing sex like this actually reduces fertility - and often causes the husband and wife to start fighting with each other, because the wife insists that they only have sex at the time "recommended" by the doctor.
Actually, the best prescription to improve your fertility is to have sex as often as possible. As long as you are depositing the sperm inside the vagina, you will not run out of sperm, and they will find their way to the egg. Daily sex has been actually shown to improve fertility. While it is true that the volume of the ejaculate does drop with frequent sex, as does the total sperm count, the ejaculated sperm are "fresher" and of better quality. Saving up sperm for the "fertile time" just increases the number of dead or tired old sperm in the semen !
Some doctors advise couples to use K-Y jelly to help facilitate sex. While K-Y jelly is a good lubricant and can facilitate sex, it is also great at killing sperm - a fact very few doctors know !
Older doctors still advise women to keep pillows under their hips and to rest for 10 min after sex, to prevent the semen from failling out ! Semen always leaks out after sex - this is completely normal, and can be safely ignored . It's actually a good sign - it just means that the semen is being properly deposited in the vagina, and because it is of high volume, the extra seminal fluid leaks out !
So the good news is that you don't need to worry about "fertile times" or your sexual frequency or position. Having sex as often as possible is your best ( and simplest) option ! I guess this makes sense from an evolutionary perspective as well - man was designed to transmit his genes, and frequent sex maximises your ability to do so !
Now these are questions most fertile couples never need to think about. Infertile couples, however, start obsessing about sex - and many of them will turn to their fertile friends, to get "advise". After all, couples who've had a baby by having sex must know a lot about baby making sex, so why not ask them ?
Unfortunately, most couples are quite clueless . They end up providing their expertise ( I went to Goa for a holiday and got pregnant, so that's your best option) , without realising that they maybe poorly informed - or that what worked for them may not work for everyone !
This is why many couples turn to their family doctor or gynecologist for advise. Unfortunately, the sad truth is that even many doctors are still very poorly informed about these basics
Thus, many doctors still advise couples to have sex for 3 days before and for 3 days after ovulation. This is bad advise, because a woman cannot get pregnant if she has sex after she has ovulated. After ovulation, the cervical mucus , which is now under the influence of the progesterone hormone , will not allow the sperm to swim up through it. This means a woman is relatively infertile after ovulation - a fact many doctors still do not know.
Similarly, most doctors do not bother to teach women how they can track their cervical mucus to monitor their fertile time.
One of the commonest misconceptions is with regards to what the optimal frequency of intercourse is, in order to maximise fertility. Many doctors advise couples to have sex every alternate day; while others advise couples to "save up" their sperm ( by abstaining from sex for 3-5 days) and then to have sex on the day they ovulate. This is wrong advise - but because it comes from the "expert", many couples religiously follow this. Timing sex like this actually reduces fertility - and often causes the husband and wife to start fighting with each other, because the wife insists that they only have sex at the time "recommended" by the doctor.
Actually, the best prescription to improve your fertility is to have sex as often as possible. As long as you are depositing the sperm inside the vagina, you will not run out of sperm, and they will find their way to the egg. Daily sex has been actually shown to improve fertility. While it is true that the volume of the ejaculate does drop with frequent sex, as does the total sperm count, the ejaculated sperm are "fresher" and of better quality. Saving up sperm for the "fertile time" just increases the number of dead or tired old sperm in the semen !
Some doctors advise couples to use K-Y jelly to help facilitate sex. While K-Y jelly is a good lubricant and can facilitate sex, it is also great at killing sperm - a fact very few doctors know !
Older doctors still advise women to keep pillows under their hips and to rest for 10 min after sex, to prevent the semen from failling out ! Semen always leaks out after sex - this is completely normal, and can be safely ignored . It's actually a good sign - it just means that the semen is being properly deposited in the vagina, and because it is of high volume, the extra seminal fluid leaks out !
So the good news is that you don't need to worry about "fertile times" or your sexual frequency or position. Having sex as often as possible is your best ( and simplest) option ! I guess this makes sense from an evolutionary perspective as well - man was designed to transmit his genes, and frequent sex maximises your ability to do so !
What patients want from their IVF doctor !
Here's an email I received recently from a patient from the US. She has a baby after taking IVF treatment from our clinic 4 years ago, and is now looking to complete her family. She is in the US and is finding it hard to travel to India again because of her job .
Dear Doctor Malpani, I need your advise.....
I went to the doctor here for ICSI and it did not work.....I developed just 8 good eggs, 6 embryos, 2 were good and 1 was just OK, 3 of them were transferred on a day 3 (they were not good enough to transfer on day 5), and I am not pregnant.....
That was a reality check for me since I was positive that it will work for me again. I have to tell you..., whats a different between doctor's attitude here and what i had experienced in India....I only saw the doctor that I "picked" here twice, once during the first consultation and another time at the egg retrieval The transfer was performed by a different doctor since the doctor #1 was not at that office at that day....To me it is not acceptable but I have a feeling its how it works in US, it's just the way it is; no words of encouragement here, no one cares about the patient....
Now, I was on Gonal-F 1050, Luveris, and Genirelix. It was a very short cycle, it was something around just over a week, I had just about 8 eggs that developed very very quickly and the rest of the eggs that I had were not ready yet....
My first test before IVF was: FSH 11.4 mlU/ml and E2 37.6, I sent you e-mail about it earlier;
I had another test today and its: FSH 7.2 and E2 39.2 .....
I do not know if he dosed the medication wrong (since I had a few eggs, just some of them were ready and some of them were not there yet), or they may be messed up the test at the first time, or i am getting older, or all together.....
Any way, If I'll decide to do it again the doctor here suggested to try Lupron and birth control pills (something called micro dose...). However, he cannot tell me what I need , he basically said " you can repeat the ganirelix protocol or try Lupron micro dose with birth control pills; however, if you are not comfortable with Lupron, you can pick Ganirelix again".....that's basically our conversation.....
About embryos, we transferred 10c,10c, and 6 c, I have no idea about the thickness and actually do not know if I can find it out since I have no way of talking directly to the doctor, I am not even talking about communicating with the embryologist whom I only saw once by the way, which is what upset me the most.....all communications are done through the nurses who do not have any information, they are like translators between doctor and patient.
I requested the copy of all my records that will be mailed to me and I'll probably get it next week. I have a picture of embryos that were given to me prior the transfer but its not digital so I'll have to scan it first and then e-mail it to you.
The thing that really puts me down at this moment is not even the fact that I did not get pregnant, i understand that there is no 100% guarantee but the fact that I feel that the doctor did not try hard enough to even take me seriously or spend extra minute to think what might would work better for me. I do not need a doctor who puts me on "what ever" to see if it will work or not, or a doctor who will do what I'll tell him to do. I need a doctor who will tell me what I need to do and I believe its the case with the most patients. I know that not all doctors are the same here and I believe that there are many great doctors here in US but who knows where to find them and where is guarantee that the next doctor will not fall in to the same category.......
Dear Doctor Malpani, I need your advise.....
I went to the doctor here for ICSI and it did not work.....I developed just 8 good eggs, 6 embryos, 2 were good and 1 was just OK, 3 of them were transferred on a day 3 (they were not good enough to transfer on day 5), and I am not pregnant.....
That was a reality check for me since I was positive that it will work for me again. I have to tell you..., whats a different between doctor's attitude here and what i had experienced in India....I only saw the doctor that I "picked" here twice, once during the first consultation and another time at the egg retrieval The transfer was performed by a different doctor since the doctor #1 was not at that office at that day....To me it is not acceptable but I have a feeling its how it works in US, it's just the way it is; no words of encouragement here, no one cares about the patient....
Now, I was on Gonal-F 1050, Luveris, and Genirelix. It was a very short cycle, it was something around just over a week, I had just about 8 eggs that developed very very quickly and the rest of the eggs that I had were not ready yet....
My first test before IVF was: FSH 11.4 mlU/ml and E2 37.6, I sent you e-mail about it earlier;
I had another test today and its: FSH 7.2 and E2 39.2 .....
I do not know if he dosed the medication wrong (since I had a few eggs, just some of them were ready and some of them were not there yet), or they may be messed up the test at the first time, or i am getting older, or all together.....
Any way, If I'll decide to do it again the doctor here suggested to try Lupron and birth control pills (something called micro dose...). However, he cannot tell me what I need , he basically said " you can repeat the ganirelix protocol or try Lupron micro dose with birth control pills; however, if you are not comfortable with Lupron, you can pick Ganirelix again".....that's basically our conversation.....
About embryos, we transferred 10c,10c, and 6 c, I have no idea about the thickness and actually do not know if I can find it out since I have no way of talking directly to the doctor, I am not even talking about communicating with the embryologist whom I only saw once by the way, which is what upset me the most.....all communications are done through the nurses who do not have any information, they are like translators between doctor and patient.
I requested the copy of all my records that will be mailed to me and I'll probably get it next week. I have a picture of embryos that were given to me prior the transfer but its not digital so I'll have to scan it first and then e-mail it to you.
The thing that really puts me down at this moment is not even the fact that I did not get pregnant, i understand that there is no 100% guarantee but the fact that I feel that the doctor did not try hard enough to even take me seriously or spend extra minute to think what might would work better for me. I do not need a doctor who puts me on "what ever" to see if it will work or not, or a doctor who will do what I'll tell him to do. I need a doctor who will tell me what I need to do and I believe its the case with the most patients. I know that not all doctors are the same here and I believe that there are many great doctors here in US but who knows where to find them and where is guarantee that the next doctor will not fall in to the same category.......
Wednesday, November 18, 2009
Successful IVF for Bangladeshi couple
Here is another success story from one of our patients ! This is one of the reasons I love being a doctor - there is no other job which can provide so much personal satisfaction and happiness !
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We are a couple from Bangladesh. I am 29, and my husband is 31 y. We got married 5 years ago and since then we were trying to have a baby. I had certain drawback; I lost my one ovary with malignant cyst and had gone under chemotherapy almost 9 years ago. So from the very beginning we both have understanding about the root of our problem and we knew that we had to take expertise help.
And we sought help from everyone and knocked at all possible doors , both inside and outside of the country. Each of the visits to the infertility clinics was like an illusive ray of hope which ultimately turns to a shadow of trauma. The thought of never becoming a parent was painful to us – and also impacted all our relationships with others. You cannot discuss with everyone about your own problem, but you also cannot make them stop from asking… “So when are you going to give us some good news ? What is going to be your next step?” . As I did not have one ovary, my major problem was not having good eggs. We had to depend on the donor who is very unavailable at Bangladesh and moreover I do not have any sister who could be helpful. One of my good friends extended her help and we tried IVF first at Dhaka, at end of July 2008 . We had do this in a hush-hush manner, because we had to hide from the people around us - and ultimately we faced a failure story. The cycle was unsuccessful. My husband was always like Robert Bruce, and firmly believes in never give up strategy. However I had already faced several operations, medication, discussion, heard hopeful and hopeless comment and advice from the medical persons. So I decided not to take any further medical advice until or unless my mind demanded it. I was totally shattered and dejected. We even did not get any help from Kolkata clinics, which I visited regularly for the last 9 years.
At 2009 February, in the morning, just surfing on the infertility clinics of India and the heading of Malpani Infertility Clinic seemed a bit interesting to me. I clicked on the page and saw how easy it was to get a second opinion. Immediately I uploaded the information asked on the second opinion questionnaire and then sent it. I wondered if I would ever get a response. To my amazement, I got a response from Dr. Malpani himself in one day. Then we exchanged few more mails to decide what to do with my problem and what could be the possible solution , how to execute it , time duration and expenditure. My husband and I continue communicating with him and what helped to me to have confidence on him is the way he approached the problem. Not only like a Doctor but also like a well wisher. Anyone who has gone through infertility problem must admit that a doctor’s attitude, words and hope mean so much to you. Finally we decided to reach Mumbai soon after the communication, and then the problem of accommodation arose. The treatment itself is expensive, and staying at Mumbai costs a lot. And Dr. Malpani sorted out this problem too. The clinic has arrangement with a rest house where we can reside and have our meals. Finally we reached Mumbai with a 19 days plan.
The first word from Dr. at his clinic on our first meeting was “So you finally made it”. Then he described all the emotional upheaval infertile couples go through, and I was wondering how this person can give so much quality time with treatment and in right words! He made us believe that as you have a good uterus, the treatment will do the maximum for you to get pregnant, rest of the things are upon God. Our treatment started. The donor’s superovulation was started at the same time. Then we stayed and took medicines with occasional USG. Everything appeared normal. Days passed and my hope started to rise high. At particular time sperm was collected. Finally at 14th day we were told to come to the clinic. After we reached, Dr. informed us that 24 eggs were collected and among them 22 were fertile. All of them were of excellent condition. The red letter day of my life came up at 13th October- the transfer day. Before transferring , Dr Sai, the embryologist, showed us all the embryos and explained the steps. I was barely able to hold my emotions. At the time of transfer I was rather panicked because last time I was having pain under this situation. But this time the whole team and the Dr. were dealing this so delicately, keeping me busy with conversation that I did not concentrate on what was going on - rather , I was just was praying. I was told about every single step while transferring. It was so clear that you hardly have any question in your mind. We left Mumbai 2 days after the transfer with high hopes. I had IVF before and you will have to wait 14 longest days on the planet before you get to know the output.
With three embryos in my womb , I was waiting for the most life-changing news. In the mean time I had few problems, I immediately mailed to Dr. Malpani and he responded with what should be done, always telling me not to have stress and tension. At 13th day I did a home urine test.…and ..OMG..it was positive.! I was screaming like anything. And we were so happy that we cannot wait for a blood test. We did blood test of Beta HCG at 15th day and repeated after 3 days later. It was quite viable and showing a Positive Pregnancy. We did an ultrasound scan at 20th day and the radiologist showed me TWINS on the screen. Our joys knew no bounds. We still have contact with Dr. Malpani for any need or medical advice and he happily responds on those mails. Now I am 8 weeks pregnant and expecting our children at July 2010.
Infertility is becoming increasingly important and people need to learn a lot to discuss these issues openly. After returning home, many of our friends and relatives wanted advice from us. We have informed them all about Malpani Infertility Clinic. I always do remember one line of Dr. Malpani that, “have faith on god, whatever he did, is for our best and try to accept what you cannot change.” Thanks Dr. for all of your support and make things clear to me. We wish all the good luck to the clinic, Dr., and the staffs of the clinic.
-------------------------------------------------------------------------------------
We are a couple from Bangladesh. I am 29, and my husband is 31 y. We got married 5 years ago and since then we were trying to have a baby. I had certain drawback; I lost my one ovary with malignant cyst and had gone under chemotherapy almost 9 years ago. So from the very beginning we both have understanding about the root of our problem and we knew that we had to take expertise help.
And we sought help from everyone and knocked at all possible doors , both inside and outside of the country. Each of the visits to the infertility clinics was like an illusive ray of hope which ultimately turns to a shadow of trauma. The thought of never becoming a parent was painful to us – and also impacted all our relationships with others. You cannot discuss with everyone about your own problem, but you also cannot make them stop from asking… “So when are you going to give us some good news ? What is going to be your next step?” . As I did not have one ovary, my major problem was not having good eggs. We had to depend on the donor who is very unavailable at Bangladesh and moreover I do not have any sister who could be helpful. One of my good friends extended her help and we tried IVF first at Dhaka, at end of July 2008 . We had do this in a hush-hush manner, because we had to hide from the people around us - and ultimately we faced a failure story. The cycle was unsuccessful. My husband was always like Robert Bruce, and firmly believes in never give up strategy. However I had already faced several operations, medication, discussion, heard hopeful and hopeless comment and advice from the medical persons. So I decided not to take any further medical advice until or unless my mind demanded it. I was totally shattered and dejected. We even did not get any help from Kolkata clinics, which I visited regularly for the last 9 years.
At 2009 February, in the morning, just surfing on the infertility clinics of India and the heading of Malpani Infertility Clinic seemed a bit interesting to me. I clicked on the page and saw how easy it was to get a second opinion. Immediately I uploaded the information asked on the second opinion questionnaire and then sent it. I wondered if I would ever get a response. To my amazement, I got a response from Dr. Malpani himself in one day. Then we exchanged few more mails to decide what to do with my problem and what could be the possible solution , how to execute it , time duration and expenditure. My husband and I continue communicating with him and what helped to me to have confidence on him is the way he approached the problem. Not only like a Doctor but also like a well wisher. Anyone who has gone through infertility problem must admit that a doctor’s attitude, words and hope mean so much to you. Finally we decided to reach Mumbai soon after the communication, and then the problem of accommodation arose. The treatment itself is expensive, and staying at Mumbai costs a lot. And Dr. Malpani sorted out this problem too. The clinic has arrangement with a rest house where we can reside and have our meals. Finally we reached Mumbai with a 19 days plan.
The first word from Dr. at his clinic on our first meeting was “So you finally made it”. Then he described all the emotional upheaval infertile couples go through, and I was wondering how this person can give so much quality time with treatment and in right words! He made us believe that as you have a good uterus, the treatment will do the maximum for you to get pregnant, rest of the things are upon God. Our treatment started. The donor’s superovulation was started at the same time. Then we stayed and took medicines with occasional USG. Everything appeared normal. Days passed and my hope started to rise high. At particular time sperm was collected. Finally at 14th day we were told to come to the clinic. After we reached, Dr. informed us that 24 eggs were collected and among them 22 were fertile. All of them were of excellent condition. The red letter day of my life came up at 13th October- the transfer day. Before transferring , Dr Sai, the embryologist, showed us all the embryos and explained the steps. I was barely able to hold my emotions. At the time of transfer I was rather panicked because last time I was having pain under this situation. But this time the whole team and the Dr. were dealing this so delicately, keeping me busy with conversation that I did not concentrate on what was going on - rather , I was just was praying. I was told about every single step while transferring. It was so clear that you hardly have any question in your mind. We left Mumbai 2 days after the transfer with high hopes. I had IVF before and you will have to wait 14 longest days on the planet before you get to know the output.
With three embryos in my womb , I was waiting for the most life-changing news. In the mean time I had few problems, I immediately mailed to Dr. Malpani and he responded with what should be done, always telling me not to have stress and tension. At 13th day I did a home urine test.…and ..OMG..it was positive.! I was screaming like anything. And we were so happy that we cannot wait for a blood test. We did blood test of Beta HCG at 15th day and repeated after 3 days later. It was quite viable and showing a Positive Pregnancy. We did an ultrasound scan at 20th day and the radiologist showed me TWINS on the screen. Our joys knew no bounds. We still have contact with Dr. Malpani for any need or medical advice and he happily responds on those mails. Now I am 8 weeks pregnant and expecting our children at July 2010.
Infertility is becoming increasingly important and people need to learn a lot to discuss these issues openly. After returning home, many of our friends and relatives wanted advice from us. We have informed them all about Malpani Infertility Clinic. I always do remember one line of Dr. Malpani that, “have faith on god, whatever he did, is for our best and try to accept what you cannot change.” Thanks Dr. for all of your support and make things clear to me. We wish all the good luck to the clinic, Dr., and the staffs of the clinic.
Tuesday, November 17, 2009
Horror stories from IVF patients !
I recently got this tragic email from a doctor.
My heart breaks when I read about such poor quality treatment . If a doctor is treated like this, I wonder what happens to the other poor patients ! Why do patients put up with this kind of shoddy medical care ?
I underwent IVF at ...clinic at Kolkata in April but failed to conceive.Since both my husband and I are busy doctors, the loss of time and emotional energy was a difficult one for us . Since we both run a clinic together , our absence athe same time makes it difficult for our patients as well , and we have to think a lot before going for IVF again.I have decided to come to your centre in Feb 2010.
My experience in the previous cycle was harrowing.I got to meet the doc only once.The rest was handled by his secretary who was not even a medical person ! The follicular monitoring was done by different sonologists on different days. The ovum collection was done under deep sedation with fentanyl .I had terrible post -op hallucinations and vomiting .I was informed that four eggs were retrieved and 3 embryos were subsequently transferred. I was told to fill my bladder for the embryo transfer . I was then told to lie down with the full bladder for 30 min . I was having intolerable pain in my pelvis and I requested the doc to relieve me with a catheter.However trivial it may sound , but this was my worst experience . Could this have had adversely affected the outcome ?
My heart breaks when I read about such poor quality treatment . If a doctor is treated like this, I wonder what happens to the other poor patients ! Why do patients put up with this kind of shoddy medical care ?
Monday, November 16, 2009
AHFS Consumer Medication Information -- NCBI Bookshelf
AHFS Consumer Medication Information -- NCBI Bookshelf: " This resource contains useful information on more than 1000 drugs, from 'Abacavir' to 'Zonisamide'. You can find out why a particular medication is prescribed, how the medication should be taken, and be advised what to do if you have missed a dose. Side effects, both common and rare, are also listed.
AHFS Consumer Medication Information is a product of the American Society of Health-System Pharmacists (ASHP). ASHP is the 30,000-member national professional association that represents pharmacists who practice in hospitals, health maintenance organizations, long-term care facilities, home care, and other components of health care systems. ASHP, which has a long history of medication-error prevention efforts, believes that the mission of pharmacists is to help people make the best use of medicines. Assisting pharmacists in fulfilling this mission is ASHP's primary objective."
AHFS Consumer Medication Information is a product of the American Society of Health-System Pharmacists (ASHP). ASHP is the 30,000-member national professional association that represents pharmacists who practice in hospitals, health maintenance organizations, long-term care facilities, home care, and other components of health care systems. ASHP, which has a long history of medication-error prevention efforts, believes that the mission of pharmacists is to help people make the best use of medicines. Assisting pharmacists in fulfilling this mission is ASHP's primary objective."
Sunday, November 15, 2009
Top 10 mistakes that Doctors make in choosing medical software
This is a guest post from Aditya Patkar, Marketing Director of Plus91, a company in which I am an angel investor.
Choosing which program to buy to run your medical practice has never been easy. Earlier , it was because there were very few programs available. Today, ironically, it is because there are too many ! Doctors are very confused as to which program they should buy – sometimes, too much choice can be as bad as too little !
Doctors have some special character traits which software producers need to be aware of ! To be able to treat a patient and be confident that your decision is right requires tremendous self confidence, which means doctors often have a big ego. Many take the approach that they are always right - even in a field like computer technology ! However, sometimes a little knowledge can be dangerous , and often what doctors know about computers and software leaves a lot to be desired. Also, doctors are pressed for time, and hence their decisions are based on the fact that “anything that does not gel with me is going to hamper me”. Rather than try to improve their workflow with the help of computers, they’d rather stick to their old dysfunctional habits, even if this hampers their efficiency.
Doctors who wish to enhance their practice and provide better care and service to their patients by using technology are on the right track. Unfortunately, they don’t always go about it the right way. Some of the important mistakes doctors make are highlighted below.
1. Wanting too many bells and whistles.
Some doctors want their software to do everything for them - even pay their taxes (Just joking ! ). Sometimes putting too many things in your software tends to delay its deployment and make it too complicated to use . Often, some doctors will end up not buying any program at all, because it does not have everything which they want – which means they deprive themselves of a great opportunity of improving their efficiency in 80% of their practice. For example , some doctors want the entire drug database of 15000 drugs in their software! Now you know you will never use even 1/100th of these. There are enough online resources to give you these details when you do require this esoteric information. Why load this redundant data in your software and make it slow by cramming it with stuff you will never use ? It’s much more sensible to have a small efficient intelligent drug database which you can grow over time. That’s what we recommend at Plus91. Stick to the basics - your aim is to improve your practice - not to solve the world healthcare crises.
2. Acting like a bania.
It’s a simple fact of life that investment reaps rich rewards. Why haggle over a few rupees and try to find the cheapest option ? Negotiating is great, but choosing quality, support and peace of mind is far more important than trying a save a few bucks. Sad to say , this mentality is very prevalent amongst Indian doctors . It’s easy to get a local company to make a simple, unsupported database for you to manage your patient’s addresses. However, in the long run it makes more sense to invest a little more in good software – preferably from a company which is completely focused on the healthcare space. Medical practice is a complex domain , and an software engineer who doesn’t spend time understanding this cannot make a good product. This is why the early successful packages were created by doctors because they did have the right idea. However, they did not have the savvy to remain uptodate with the latest technology. Please stop acting like a bania in choosing a package. Every doctor I know earns enough to invest in a good package which will enhance his practice. Choose your vendor carefully – after all, you want them to be your partners for life, and for this, they need to make enough profit .
3. Thinking someone else understand your business.
A lot of doctors tend to put too much trust in what their software vendor is doing for them. They feel he is the computer expert, and know what he is doing ! If a custom built package is being made, unless you provide the vendor with adequate knowledge on your processes, templates , wants and need, the program will never do what you want it to. Garbage In, Garbage Out. I know doctors who just give a brief outline of what they want and leave it at that. Now the vendor is left scratching his head because he does not really understand what is required of him . He muddles through – but what he produces is not what the doctor wanted, which means a lot of time, money and energy is wasted – and the cycle needs to be repeated again. If you want a custom built solution, you need to be very closely involved. You cannot delegate this. You need to provide all the information required personally. More importantly , you need to review and ask for updates from time to time. Often, the project gets needlessly delayed because the doctor realizes that this was not what he wanted only after the complete package is delivered to him.
4. Losing sight of the basics – KISS.
Your primary aim is to improve your productivity, and you should always keep this in mind ! Anything else should come later. For example, we have clients who request Tally integration in their software. Now, this is a great idea and Plus91 is working on it and is confident about delivering it. But delaying an order or cancelling an order based on just this one feature is unjustified. Nice to have is not the same as “essential” – and adding too many features just results in “bloatware”. It is a mistake to want your software to do too many things right from the start. Get what is essential , and build from there.
5. Waiting for something better.
Doctors often keep on waiting for something better to come along. Unless you don’t jump in the water, you aren’t going to learn how to swim ! Some of the best run private hospitals have been early adopters of technology. Today they might still be using legacy systems , but they are much better run than non IT friendly setups. It’s true that software will evolve over time, but you cannot wait for perfection. At Plus91, we evolve and add cool new features daily – after all, software is always a work in progress, which gets improved and polished incrementally. However, just because you want a Mercedes does not mean you should continue driving a cycle to work ! It is a mistake to wait when you can always upgrade if you want to later on !
6. Thinking your staff shares your vision.
Many good doctors buy the perfect software and then find that it does not help them manage their practice at all . Often they blame the software for being unfriendly or useless . Most doctors fail to understand that their staff is one of the key stake holders in this process. Unless the staff uses the software, it is bound to fail. The software may be the best in the world, but if it is not used properly , it isn’t living upto its potential. Doctors need to be firm and to share their vision for the software with their staff. It is a mistake to assume that software will be easily adopted by support staff, nurses and fellow doctors. Provide lots of training – and if some members refuse to use this, you need to take them to task.
7. Not nurturing innovation.
Today Indian healthcare IT is a nascent stage. The biggest stake holders in this industry are the doctors. It is important for them to nurture innovation. Sometimes it is valuable to take a risk or allow a software company to go that extra mile in providing a feature which will change the process flow of your clinic. Doctors who refuse to try out products which provide extra features or new age ideas because they do not understand its utility are closing the door on innovation. A doctor who asks me to block some modules to save money because he feels he will not use them is basically closing his own mind to the potential of using new processes to improve his practise . Do not buy the module in the beginning, but keep an open mind. Even when doctors do not ask for the SMS or Email Plug-in , we still leave it on the User Interface, because just seeing that button there will make them wish it was active when they want to send out a report or reading instantly. Once they see the value, they can always buy the module later on.
8. Underestimating the complexity of your needs.
Running a clinic is like running a small business. It’s a complex enterprise, and often doctors overerestimate their ability to do a good job. Ideally, you should be focused on taking care of your patients, so your staff can run the clinic. If you find you are spending time on routine administrative tasks, this means you are wasting your time and money. There are only 24 hours is your day – learn to use them sensibly. A good software program will help you to improve your productivity and that of your staff, if you use it to its fullest extent. An integrated program will allow you to do all the tasks needed to ensure your clinic runs smoothly - manage appointments, accounts, inventory, medical records and referrals. Don’t get stuck buying a cheap program which was designed for a small shop – you will end up being unhappy and dissatisfied.
9. Delaying decisions.
The single biggest mistake a doctor makes in buying software is when he delays his decisions – whether it is thinking about his needs; talking to the vendor; spelling out his requirement; installing the program ; or getting training for his staff. As a result, the vendor is frustrated; the doctor is confused ; the staff is anxious ; and patients continue to remain unhappy. Start small – but start today !
10. Disregarding the hardware.
Hardware always complements your software. As much as the software vendor may try to make his solution lithe (for example, Plus91 products can run on any Windows and Unix system, and even an AMD netbook processor) , if you want the best results, invest in good hardware. Do not be afraid to upgrade your hardware to help enhance the productivity of your medical software – PCs have become very inexpensive these days !
11. Not providing enough time for training.
While doctors understand that learning a new medical procedure can take time, unfortunately, they are not willing to invest the same time in training their staff – and themselves – in learning how to use the softare properly. This can cause a lot of frustration and when this happens, many doctors just give up on the idea of using any software at all, because they feel their staff is too stupid. Good companies like Plus91 provide lots of training – and all this is free online !
Choosing which program to buy to run your medical practice has never been easy. Earlier , it was because there were very few programs available. Today, ironically, it is because there are too many ! Doctors are very confused as to which program they should buy – sometimes, too much choice can be as bad as too little !
Doctors have some special character traits which software producers need to be aware of ! To be able to treat a patient and be confident that your decision is right requires tremendous self confidence, which means doctors often have a big ego. Many take the approach that they are always right - even in a field like computer technology ! However, sometimes a little knowledge can be dangerous , and often what doctors know about computers and software leaves a lot to be desired. Also, doctors are pressed for time, and hence their decisions are based on the fact that “anything that does not gel with me is going to hamper me”. Rather than try to improve their workflow with the help of computers, they’d rather stick to their old dysfunctional habits, even if this hampers their efficiency.
Doctors who wish to enhance their practice and provide better care and service to their patients by using technology are on the right track. Unfortunately, they don’t always go about it the right way. Some of the important mistakes doctors make are highlighted below.
1. Wanting too many bells and whistles.
Some doctors want their software to do everything for them - even pay their taxes (Just joking ! ). Sometimes putting too many things in your software tends to delay its deployment and make it too complicated to use . Often, some doctors will end up not buying any program at all, because it does not have everything which they want – which means they deprive themselves of a great opportunity of improving their efficiency in 80% of their practice. For example , some doctors want the entire drug database of 15000 drugs in their software! Now you know you will never use even 1/100th of these. There are enough online resources to give you these details when you do require this esoteric information. Why load this redundant data in your software and make it slow by cramming it with stuff you will never use ? It’s much more sensible to have a small efficient intelligent drug database which you can grow over time. That’s what we recommend at Plus91. Stick to the basics - your aim is to improve your practice - not to solve the world healthcare crises.
2. Acting like a bania.
It’s a simple fact of life that investment reaps rich rewards. Why haggle over a few rupees and try to find the cheapest option ? Negotiating is great, but choosing quality, support and peace of mind is far more important than trying a save a few bucks. Sad to say , this mentality is very prevalent amongst Indian doctors . It’s easy to get a local company to make a simple, unsupported database for you to manage your patient’s addresses. However, in the long run it makes more sense to invest a little more in good software – preferably from a company which is completely focused on the healthcare space. Medical practice is a complex domain , and an software engineer who doesn’t spend time understanding this cannot make a good product. This is why the early successful packages were created by doctors because they did have the right idea. However, they did not have the savvy to remain uptodate with the latest technology. Please stop acting like a bania in choosing a package. Every doctor I know earns enough to invest in a good package which will enhance his practice. Choose your vendor carefully – after all, you want them to be your partners for life, and for this, they need to make enough profit .
3. Thinking someone else understand your business.
A lot of doctors tend to put too much trust in what their software vendor is doing for them. They feel he is the computer expert, and know what he is doing ! If a custom built package is being made, unless you provide the vendor with adequate knowledge on your processes, templates , wants and need, the program will never do what you want it to. Garbage In, Garbage Out. I know doctors who just give a brief outline of what they want and leave it at that. Now the vendor is left scratching his head because he does not really understand what is required of him . He muddles through – but what he produces is not what the doctor wanted, which means a lot of time, money and energy is wasted – and the cycle needs to be repeated again. If you want a custom built solution, you need to be very closely involved. You cannot delegate this. You need to provide all the information required personally. More importantly , you need to review and ask for updates from time to time. Often, the project gets needlessly delayed because the doctor realizes that this was not what he wanted only after the complete package is delivered to him.
4. Losing sight of the basics – KISS.
Your primary aim is to improve your productivity, and you should always keep this in mind ! Anything else should come later. For example, we have clients who request Tally integration in their software. Now, this is a great idea and Plus91 is working on it and is confident about delivering it. But delaying an order or cancelling an order based on just this one feature is unjustified. Nice to have is not the same as “essential” – and adding too many features just results in “bloatware”. It is a mistake to want your software to do too many things right from the start. Get what is essential , and build from there.
5. Waiting for something better.
Doctors often keep on waiting for something better to come along. Unless you don’t jump in the water, you aren’t going to learn how to swim ! Some of the best run private hospitals have been early adopters of technology. Today they might still be using legacy systems , but they are much better run than non IT friendly setups. It’s true that software will evolve over time, but you cannot wait for perfection. At Plus91, we evolve and add cool new features daily – after all, software is always a work in progress, which gets improved and polished incrementally. However, just because you want a Mercedes does not mean you should continue driving a cycle to work ! It is a mistake to wait when you can always upgrade if you want to later on !
6. Thinking your staff shares your vision.
Many good doctors buy the perfect software and then find that it does not help them manage their practice at all . Often they blame the software for being unfriendly or useless . Most doctors fail to understand that their staff is one of the key stake holders in this process. Unless the staff uses the software, it is bound to fail. The software may be the best in the world, but if it is not used properly , it isn’t living upto its potential. Doctors need to be firm and to share their vision for the software with their staff. It is a mistake to assume that software will be easily adopted by support staff, nurses and fellow doctors. Provide lots of training – and if some members refuse to use this, you need to take them to task.
7. Not nurturing innovation.
Today Indian healthcare IT is a nascent stage. The biggest stake holders in this industry are the doctors. It is important for them to nurture innovation. Sometimes it is valuable to take a risk or allow a software company to go that extra mile in providing a feature which will change the process flow of your clinic. Doctors who refuse to try out products which provide extra features or new age ideas because they do not understand its utility are closing the door on innovation. A doctor who asks me to block some modules to save money because he feels he will not use them is basically closing his own mind to the potential of using new processes to improve his practise . Do not buy the module in the beginning, but keep an open mind. Even when doctors do not ask for the SMS or Email Plug-in , we still leave it on the User Interface, because just seeing that button there will make them wish it was active when they want to send out a report or reading instantly. Once they see the value, they can always buy the module later on.
8. Underestimating the complexity of your needs.
Running a clinic is like running a small business. It’s a complex enterprise, and often doctors overerestimate their ability to do a good job. Ideally, you should be focused on taking care of your patients, so your staff can run the clinic. If you find you are spending time on routine administrative tasks, this means you are wasting your time and money. There are only 24 hours is your day – learn to use them sensibly. A good software program will help you to improve your productivity and that of your staff, if you use it to its fullest extent. An integrated program will allow you to do all the tasks needed to ensure your clinic runs smoothly - manage appointments, accounts, inventory, medical records and referrals. Don’t get stuck buying a cheap program which was designed for a small shop – you will end up being unhappy and dissatisfied.
9. Delaying decisions.
The single biggest mistake a doctor makes in buying software is when he delays his decisions – whether it is thinking about his needs; talking to the vendor; spelling out his requirement; installing the program ; or getting training for his staff. As a result, the vendor is frustrated; the doctor is confused ; the staff is anxious ; and patients continue to remain unhappy. Start small – but start today !
10. Disregarding the hardware.
Hardware always complements your software. As much as the software vendor may try to make his solution lithe (for example, Plus91 products can run on any Windows and Unix system, and even an AMD netbook processor) , if you want the best results, invest in good hardware. Do not be afraid to upgrade your hardware to help enhance the productivity of your medical software – PCs have become very inexpensive these days !
11. Not providing enough time for training.
While doctors understand that learning a new medical procedure can take time, unfortunately, they are not willing to invest the same time in training their staff – and themselves – in learning how to use the softare properly. This can cause a lot of frustration and when this happens, many doctors just give up on the idea of using any software at all, because they feel their staff is too stupid. Good companies like Plus91 provide lots of training – and all this is free online !
Saturday, November 14, 2009
What doctors want from EMR software
What doctors want from EMR software "Three fundamental themes dominated:
* Physicians will not adopt technology that compromises their productivity,
* They will not become data entry clerks, and
* They will not jeopardize the physician-patient relationship.
No financial incentives or penalties will persuade these physicians to take actions they deem detrimental, or not valuable, to their practices."
Physicians are smart and will respond to the right incentives - just like everyone else !
* Physicians will not adopt technology that compromises their productivity,
* They will not become data entry clerks, and
* They will not jeopardize the physician-patient relationship.
No financial incentives or penalties will persuade these physicians to take actions they deem detrimental, or not valuable, to their practices."
Physicians are smart and will respond to the right incentives - just like everyone else !
Friday, November 13, 2009
An Invitation to Doctors to Join the Expert Panel at HELP
HELP, the Health Education Library for People is India's first Consumer Health Education Resource Center, and one of the world's largest consumer health libraries (as determined by the Medical Library Association, USA). We are a registered charitable trust and a non-profit organization.
We would like to invite doctors to join Expert@HELP – a panel of experts on India’s most frequented health website , www.helpforhealth.org .
Our goal is to empower people by providing them with the information they need to promote their health, and prevent and treat medical problems in the family in partnership with their doctor .
Expert@HELP will give you an opportunity to share your profile and information about your practice with millions of visitors to our website – all over the world. You will have a page dedicated to you on our website - free of cost !
A number of leading doctors have agreed to join our panel - and I am sure this will grow quickly soon ! These include Dr.Y.Matcheswalla, Dr.Nina Madnani , Dr.Dilip Nadkarni, Dr.P.Talwalkar and Dr.Cyrus Mehta.
Please send us your confirmation/queries and we will get in touch with you. We’re just a click away: [email protected].
We would like to invite doctors to join Expert@HELP – a panel of experts on India’s most frequented health website , www.helpforhealth.org .
Our goal is to empower people by providing them with the information they need to promote their health, and prevent and treat medical problems in the family in partnership with their doctor .
Expert@HELP will give you an opportunity to share your profile and information about your practice with millions of visitors to our website – all over the world. You will have a page dedicated to you on our website - free of cost !
A number of leading doctors have agreed to join our panel - and I am sure this will grow quickly soon ! These include Dr.Y.Matcheswalla, Dr.Nina Madnani , Dr.Dilip Nadkarni, Dr.P.Talwalkar and Dr.Cyrus Mehta.
Please send us your confirmation/queries and we will get in touch with you. We’re just a click away: [email protected].
Thursday, November 12, 2009
How to succeed at IVF !
We're called the fairer sex, but then, being a woman is not easy at times, especially when it comes to fertility and its related problems. When a woman is unable to conceive, it plays havoc with every other aspect of her life. Becoming pregnant takes precedence over everything else and you become obsessed with it. The ironic aspect of this is that the more you despair over having a baby, the higher your stress levels become and the less your chances of success.
If you’re unable to have a baby because of medical reasons, then IVF maximises your chances of success . With the embryo being developed in vitro in the lab , all you need for success in an IVF cycle is a lot of luck and a healthy uterus to carry the baby to term. The procedure has a 30 to 45 percent success rate, if you’re healthy and young enough.
I know a friend who went through three IVF cycles, each of which failed. She was finally too tired mentally and physically to continue which is when she said - enough is enough. Why do IVF cycles fail, especially after you’ve spent so much time and money investing in the process and the embryo has developed and is in your uterus? Why is the process of implantation so uncertain?
My friend was very depressed after the failure of the first cycle; she blamed herself for the failure and kept obsessing about what she was doing wrong and how she could have done more to ensure success. It was only after she had a heart to heart with her doctor that she realized that all the mother could do to try to conceive after an IVF cycle is to stay calm, be happy, do as the doctor instructs, and surround yourself with emotional support from family and loved ones. Beyond this, the technique depends on science, the skill and dedication of your team, and various other factors that are beyond the control of the woman.
So if you’re preparing for an IVF cycle, go into it with a positive frame of mind. Try not to be too nervous and continue with your life throughout the treatment instead of obsessing over the fact that you’re preparing for a baby. Being prepared mentally improves your chance of success, so think good for good to happen.
This guest article was written by Jennifer Johnson, who regularly writes on the topic of nurse practitioner school . Jennifer welcomes your comments and questions at her email address: [email protected]
If you’re unable to have a baby because of medical reasons, then IVF maximises your chances of success . With the embryo being developed in vitro in the lab , all you need for success in an IVF cycle is a lot of luck and a healthy uterus to carry the baby to term. The procedure has a 30 to 45 percent success rate, if you’re healthy and young enough.
I know a friend who went through three IVF cycles, each of which failed. She was finally too tired mentally and physically to continue which is when she said - enough is enough. Why do IVF cycles fail, especially after you’ve spent so much time and money investing in the process and the embryo has developed and is in your uterus? Why is the process of implantation so uncertain?
My friend was very depressed after the failure of the first cycle; she blamed herself for the failure and kept obsessing about what she was doing wrong and how she could have done more to ensure success. It was only after she had a heart to heart with her doctor that she realized that all the mother could do to try to conceive after an IVF cycle is to stay calm, be happy, do as the doctor instructs, and surround yourself with emotional support from family and loved ones. Beyond this, the technique depends on science, the skill and dedication of your team, and various other factors that are beyond the control of the woman.
So if you’re preparing for an IVF cycle, go into it with a positive frame of mind. Try not to be too nervous and continue with your life throughout the treatment instead of obsessing over the fact that you’re preparing for a baby. Being prepared mentally improves your chance of success, so think good for good to happen.
This guest article was written by Jennifer Johnson, who regularly writes on the topic of nurse practitioner school . Jennifer welcomes your comments and questions at her email address: [email protected]
Wednesday, November 11, 2009
Creating a comic strip for patient education
This is a guest post from our comic book artist, Syanne Djaenal, an extremely enthusiastic student now studying in the USA.
Having worked for Dr Malpani for about a year and a half, I pretty much get the gist of making something that most people find complicated and mundane into something more entertaining. The most important thing is simplicity. As a designer, it's sometimes a challenge to make something simple and easy to understand out of quite a heavy topic, but it's actually quite a fun journey!
Since I'm working on my own, my Mac and my pen tablet became my best assistants and tools. I actually bought my Mac computer just last summer to do projects like these, and of course for school as well. It's one of the best computer for a designer to have and also not forgetting my pen tablet. It has changed my life ever since I started using it instead of a mouse. You can practically draw or color straight in your computer and have no worries about hurting your wrist from working too much with the mouse. Many people think it's expensive, and there are a lot of expensive ones, but now you can just get a decent one for under $100 which works just as well as the $300 ones!
I've also been using Adobe Photoshop to do my comic layout and a new software I purchased recently to create 'Baby Chase' which is called 'Manga Studio Debut'. It's a software that allows you to create comic books painlessly. They have many different speech bubbles, background patterns, and more. This is a must have for those of you who's thinking of making a comic, it makes life a lot easier :)
and it's cheap too!
One tip is to always have your reader's best interest in mind. Remember who your target audience is ! This is why I have a lot of pastel colors and tones in my work since my readers are mainly female. Also , learn how to simplify your work so it's easy to understand for the readers. When it comes to designing, sometimes less is more. I've also learned a lot from working with Dr Malpani, even designing stuff! Such as to make bigger fonts, and put more effective graphics. The most important thing however, is that if you love what you do, you'll never feel as if you're working, and every time you get paid, you'll say to yourself that you can't believe that someone is actually paying you to do this!
Tuesday, November 10, 2009
Why do doctors do IUI treatment ?
I saw a patient today who was fed up and frustrated. She had unexplained infertility and had done 6 IUI ( intrauterine insemination) treatment cycles with various doctors.
I reviewed her records and advised her that IVF would be her best option.
I explained that while IUI had only a 10% pregnancy rate, IVF had a pregnancy rate of over 45% and would maximise her chances of conceiving quickly.
She agreed that this made sense. Before leaving, she asked me an interesting question - Why do doctors do IUI at all ? Why don't they just do IVF for everyone ?
This is a good point and in fact studies have shown that IVF is more cost effective than IUI treatment. The cost per baby born is less for IVF than it is for IUI, because IVF has a higher success rate.
So if IVF has a higher success rate and saves the patient so much time and mental agony, then why does anyone do IUI at all ?
The problem is that IVF is more expensive, which is why most doctors will advise IUI first. However , if money is not a limiting factor, and if you'd rather save time and move on with your life rather than make multiple trips to the doctor's clinic, then it makes much more sense to do IVF rather than IUI.
If I had a choice, I would defintely do IVF for everyone ! After all, why would I want to do a treatment which has a 10% success rate , when I know I have a better treatment which has a 45% success rate ? After all, I want my patients to get pregnant as quickly as possible - and then refer lots of other patients to me !
Would a cardiac surgeon do an inferior operation which had a higher mortality rate just because it was cheaper ? They why do infertile patients have to put up with less successful treatment options, purely for financial reasons ?
I reviewed her records and advised her that IVF would be her best option.
I explained that while IUI had only a 10% pregnancy rate, IVF had a pregnancy rate of over 45% and would maximise her chances of conceiving quickly.
She agreed that this made sense. Before leaving, she asked me an interesting question - Why do doctors do IUI at all ? Why don't they just do IVF for everyone ?
This is a good point and in fact studies have shown that IVF is more cost effective than IUI treatment. The cost per baby born is less for IVF than it is for IUI, because IVF has a higher success rate.
So if IVF has a higher success rate and saves the patient so much time and mental agony, then why does anyone do IUI at all ?
The problem is that IVF is more expensive, which is why most doctors will advise IUI first. However , if money is not a limiting factor, and if you'd rather save time and move on with your life rather than make multiple trips to the doctor's clinic, then it makes much more sense to do IVF rather than IUI.
If I had a choice, I would defintely do IVF for everyone ! After all, why would I want to do a treatment which has a 10% success rate , when I know I have a better treatment which has a 45% success rate ? After all, I want my patients to get pregnant as quickly as possible - and then refer lots of other patients to me !
Would a cardiac surgeon do an inferior operation which had a higher mortality rate just because it was cheaper ? They why do infertile patients have to put up with less successful treatment options, purely for financial reasons ?
Monday, November 09, 2009
A delighted couple and their baby from the UK
A delighted couple and their baby from the UK: "Dr Malpani(s) are fantastic, from the word go full of positive vibes, I quote Dr Malpani in one of the very first email's he sent me 'a female of your age, I would say has got a 80% chance of getting pregnant within 3 attempts of IVF' What can I say - He was right! They know their job, better than most, topped with this is a non-stressful environment in the clinic. Caring staff, who will go the extra mile for you.
India is a fantastic Country, Mumbai is amazing, have a holiday at the same time has your IVF cycle, with people who care !
I will be going back for baby number 2, 3 & hopefully 4 if I do not get too old!
Take good care of yourself, and pray, and your prayers and dreams will come true."
India is a fantastic Country, Mumbai is amazing, have a holiday at the same time has your IVF cycle, with people who care !
I will be going back for baby number 2, 3 & hopefully 4 if I do not get too old!
Take good care of yourself, and pray, and your prayers and dreams will come true."
Sunday, November 08, 2009
Friday, November 06, 2009
How do we take care of your eggs and embryos in the IVF Lab
How do we take care of your eggs and embryos in the IVF Lab ? : This is a photo essay by Dr Sai, Senior Embryologist, Malpani Infertility Clinic.
" We pamper your sperms, eggs and embryos in the IVF lab as carefully as you take care of your newborn baby ! In the IVF Lab, we provide everything that’s required to nourish your eggs and embryos."
" We pamper your sperms, eggs and embryos in the IVF lab as carefully as you take care of your newborn baby ! In the IVF Lab, we provide everything that’s required to nourish your eggs and embryos."
Essay: A Doctor Discovers How to Talk to a Doctor
Essay: A Doctor Discovers How to Talk to a Doctor: "As a physician, I have found a few other patient behaviors to be particularly helpful. People who spend some time before their doctor's appointment thinking about their symptoms and their concerns create a much more efficient, and mutually satisfactory doctor-patient interaction. It is even worth considering jotting down questions so they are not forgotten in the fast-paced hustle and bustle of modern medical care.
Another suggestion to consider is taking a family member or close friend to the appointment. This other person can act as an advocate, especially if the patient is not feeling well. Family members often remember things that patients, because of illness or nervousness, do not. They can also keep track of what was said more easily than the patient."
Patients often complain that their doctors don't talk properly to them. However, if patients took the time and trouble to do their "homework" prior to their visit to the clinic, the doctor will be able to do a much better job !
Another suggestion to consider is taking a family member or close friend to the appointment. This other person can act as an advocate, especially if the patient is not feeling well. Family members often remember things that patients, because of illness or nervousness, do not. They can also keep track of what was said more easily than the patient."
Patients often complain that their doctors don't talk properly to them. However, if patients took the time and trouble to do their "homework" prior to their visit to the clinic, the doctor will be able to do a much better job !
Charting the doctor-patient relationship
Charting the doctor-patient relationship: "What can patients do?
Know how to tell your illness story. Many patients tend to start with interpretation, “I think I have bronchitis” rather than plain facts, “I’ve been coughing for two weeks.” Brief, focused facts will usually get the doctor on the right track, Dr. Lown believes. He also recommends developing a clear description of the symptoms before the visit, not during.
Use concrete examples to explain how illness affects your daily life. For example, “I’m getting worse” is less helpful than “We’ve buying milk in quarts because I can’t lift gallons anymore.” Everyday details also help the doctor understand how the medical data translates into real life."
Know how to tell your illness story. Many patients tend to start with interpretation, “I think I have bronchitis” rather than plain facts, “I’ve been coughing for two weeks.” Brief, focused facts will usually get the doctor on the right track, Dr. Lown believes. He also recommends developing a clear description of the symptoms before the visit, not during.
Use concrete examples to explain how illness affects your daily life. For example, “I’m getting worse” is less helpful than “We’ve buying milk in quarts because I can’t lift gallons anymore.” Everyday details also help the doctor understand how the medical data translates into real life."
Will this embryo become a baby ?
Embryo transfer is often the high point of an IVF cycle. It represents the outcome of all the hard work the clinic does - and many doctors are quite proud of the embryos they create for you.
Good clinics will routinely give you a photo of your embryos for your records, as this documents that you have received high quality care.
Seeing your embryos is a very emotional moment for patients as well, many of whom start thinking of these as their "babies" ( and call them embies affectionately).
Here's what a beautiful Day 5 embryo ( called a blastocyst) looks like.
While the embryologist is likely to be very happy with this embryo, and give it a top grade ( Grade 4AA according to the Gardner rating system for blastocysts), what the patient wants to know is - Will this embryo become a baby ?
The honest truth is that we simply do not know !
While this is a gorgeous embryo, which will gladden an embryologist's heart, we still don't know if it will implant after it is transferred into the uterus.
Why is this so ? Remember that implantation is a complex biological process which we cannot really influence. Human reproduction is an inefficient enterprise - whether it's being attempted in the bedroom or in the IVF lab, and there are still limits to what the technology can do.
After all, we are inserting a microscopic ball of cells into the uterus. How can we possibly track its fate or monitor its health ?
Even a superb blastocyst can have genetic problems which we cannot diagnose with today's technology . In fact, we do know that more than 50% of excellent blastocysts will have a genetic problem.
At the end of the day, all we can say is that implantation is affected by multiple factors - and no matter how beautiful your embryos , how healthy your uterus and how good the IVF lab , you still need a little bit of luck !
Good clinics will routinely give you a photo of your embryos for your records, as this documents that you have received high quality care.
Seeing your embryos is a very emotional moment for patients as well, many of whom start thinking of these as their "babies" ( and call them embies affectionately).
Here's what a beautiful Day 5 embryo ( called a blastocyst) looks like.
While the embryologist is likely to be very happy with this embryo, and give it a top grade ( Grade 4AA according to the Gardner rating system for blastocysts), what the patient wants to know is - Will this embryo become a baby ?
The honest truth is that we simply do not know !
While this is a gorgeous embryo, which will gladden an embryologist's heart, we still don't know if it will implant after it is transferred into the uterus.
Why is this so ? Remember that implantation is a complex biological process which we cannot really influence. Human reproduction is an inefficient enterprise - whether it's being attempted in the bedroom or in the IVF lab, and there are still limits to what the technology can do.
After all, we are inserting a microscopic ball of cells into the uterus. How can we possibly track its fate or monitor its health ?
Even a superb blastocyst can have genetic problems which we cannot diagnose with today's technology . In fact, we do know that more than 50% of excellent blastocysts will have a genetic problem.
At the end of the day, all we can say is that implantation is affected by multiple factors - and no matter how beautiful your embryos , how healthy your uterus and how good the IVF lab , you still need a little bit of luck !
Thursday, November 05, 2009
Coming to India to make a baby !
Travelling to India from the US is often a difficult decision for most patients - especially for those who have never been to India earlier !
This is what one of our patients had to say about her experience.
"The Drs. Malpani and their staff were an incredible asset on our journey to parenthood. They helped us conceive after a couple of years of expensive, frustrating, and ultimately, disheartening fertility treatments at the biggest and best-known fertility clinics in the US. We are a young couple and infertility at our age was a shock to our lives and marriage. We showed up at the Malpani clinic prepared, had done our research, and in the right frame of mind, leaving our ultimate chance of success in the hands of the doctors and fate. The clinic's non-hospital atmosphere was private and welcoming. The nurses on staff were unfailingly kind. Everything was arranged quickly and since the doctors and nurses are always available on site, the stress factor was mitigated. Dr. Malpani went out of his way to counsel us and spent a good deal of time talking with us as a couple. I was unafraid while being treated, and felt very comfortable with my doctors.
I chose Dr. Malpani based on extensive research I conducted on the best IVF clinics in India. I liked the media coverage and the interviews I read where I was
The Malpani facility was different in the level of personalized care we received, we were not seen by different doctors on each visit, our action plan was crafted quickly and efficiently, and the atmosphere was not clinical or impersonal.
A culture shock might be likely for those who have never been to India as the apartment-like setting is different from hospital settings. The level of service is actually just as professional, but more personalized.
We ultimately did conceive after our first round of treatment by Drs Malpani, and we could not be happier with our three beautiful babies. Although we did travel from the US, the distance, time and effort to get to the Malpani Clinic was well worth it, and one of the best decisions we ever made".
This is what one of our patients had to say about her experience.
"The Drs. Malpani and their staff were an incredible asset on our journey to parenthood. They helped us conceive after a couple of years of expensive, frustrating, and ultimately, disheartening fertility treatments at the biggest and best-known fertility clinics in the US. We are a young couple and infertility at our age was a shock to our lives and marriage. We showed up at the Malpani clinic prepared, had done our research, and in the right frame of mind, leaving our ultimate chance of success in the hands of the doctors and fate. The clinic's non-hospital atmosphere was private and welcoming. The nurses on staff were unfailingly kind. Everything was arranged quickly and since the doctors and nurses are always available on site, the stress factor was mitigated. Dr. Malpani went out of his way to counsel us and spent a good deal of time talking with us as a couple. I was unafraid while being treated, and felt very comfortable with my doctors.
I chose Dr. Malpani based on extensive research I conducted on the best IVF clinics in India. I liked the media coverage and the interviews I read where I was
The Malpani facility was different in the level of personalized care we received, we were not seen by different doctors on each visit, our action plan was crafted quickly and efficiently, and the atmosphere was not clinical or impersonal.
A culture shock might be likely for those who have never been to India as the apartment-like setting is different from hospital settings. The level of service is actually just as professional, but more personalized.
We ultimately did conceive after our first round of treatment by Drs Malpani, and we could not be happier with our three beautiful babies. Although we did travel from the US, the distance, time and effort to get to the Malpani Clinic was well worth it, and one of the best decisions we ever made".
Monday, November 02, 2009
Why don't patients ask for their medical records ?
We all know that our medical records contain important information about our health . Just like you own your body, you own these records as well, because they are about your body !
This is why I feel patients should routinely ask for doctors for a copy of their medical records. After all, bad things can happen to your records. Clinics can close down; doctors can die; you can move town; you may need your medical records in an emergency when the doctor is on a holiday ; and files can get lost. No one will take better care of your medical records than you will, which is why you must have a copy !
Keeping a copy will ensure that your records are safe; and that they are available when you need them. Equally importantly, going through them will help you get better medical care, because you are likely to become a better patient . As you study them and try to take the effort to decipher the jargon and make sense of what is happening to your body , you will become better informed , so that you doctor will find it easier to form an intelligent partnership with you. Keeping them will also help you get a second opinion; save money ( because you will not have to repeat tests in case you go to a new consultant); and also prevent errors ( which are surprisingly common !)
In the USA and the UK, your records are traditionally kept with the clinic. You should still insist on a copy - this is your legal right !
In India, most doctors are happy to give you a copy and this needs to be stored carefully.
A good clinic will always be happy to give you a copy - and a good doctor will discuss what your record contains, so you can make sense of it. If a clinic refuses to give you a copy of your records, you should smell a rat and ask for a copy in writing. It is illegal for them to refuse to give you a copy ( though they can charge you for this).
The good news is that EMRs ( Electronic medical records) become popular, it will become easier for patients to maintain their own PHR ( Personal health records), because it will be easy to import your data from the clinic's EMR into your PHR.
This is why I feel patients should routinely ask for doctors for a copy of their medical records. After all, bad things can happen to your records. Clinics can close down; doctors can die; you can move town; you may need your medical records in an emergency when the doctor is on a holiday ; and files can get lost. No one will take better care of your medical records than you will, which is why you must have a copy !
Keeping a copy will ensure that your records are safe; and that they are available when you need them. Equally importantly, going through them will help you get better medical care, because you are likely to become a better patient . As you study them and try to take the effort to decipher the jargon and make sense of what is happening to your body , you will become better informed , so that you doctor will find it easier to form an intelligent partnership with you. Keeping them will also help you get a second opinion; save money ( because you will not have to repeat tests in case you go to a new consultant); and also prevent errors ( which are surprisingly common !)
In the USA and the UK, your records are traditionally kept with the clinic. You should still insist on a copy - this is your legal right !
In India, most doctors are happy to give you a copy and this needs to be stored carefully.
A good clinic will always be happy to give you a copy - and a good doctor will discuss what your record contains, so you can make sense of it. If a clinic refuses to give you a copy of your records, you should smell a rat and ask for a copy in writing. It is illegal for them to refuse to give you a copy ( though they can charge you for this).
The good news is that EMRs ( Electronic medical records) become popular, it will become easier for patients to maintain their own PHR ( Personal health records), because it will be easy to import your data from the clinic's EMR into your PHR.
Sunday, November 01, 2009
Ten reasons why you should use a computer in your practice
This is a guest entry from Aditya Patkar, Marketing Director of Plus91. Plus91 produces inexpensive EMR and practise management solutions for doctors in India.
As a doctor, you routinely have to capture a large amount of information about your patient in order to provide good medical care ( and to collect your fees ) . Medicine is a pen and paper intensive domain, where clinical history, examination findings, lab reports, scans, appointments , messages and bills - all happen on paper. What is the downside to all this paper work ? After all, you’ve been doing it for donkey’s years and are happy with this , so why bother to change ? The truth is that managing paper is always hard to do . Papers get lost, stolen, misplaced - and writing can be hard work ! IT can help you manage your paperwork much more efficiently !
Have you ever lost your temper because your patient has lost his medical records, and does not know what medications he is taking ? Are you fed up of having to write the same prescription again and again ? Aren’t you impressed by other doctors who give their patients crisp, professional word-processed medical summary sheets ? How are you going to compete with corporate hospitals who can access their patient’s medical records at the click of a button ? The good news is that the same technology is now easily and inexpensively available for you to use in your own clinic ! IT can help you improve your documentation and storage ; and actually increase your productivity and efficiency, by allowing you easy access instantly to all your patient’s medical records, no matter where you are !
Here are the top 10 reasons why you should use a computer in your practice !
1. Impress your patients by having all their information available at your finger tips. Your patient expects you to remember exactly what medicines you prescribed and what surgery you did when she comes to see you, no matter how busy you are. Unfortunately, many of us cannot even remember the patient’s name, forget about the medical details ! Having an EMR with the patient’s photo and clinical details means you are well-prepared to talk to your patient ! If you cannot do so because you cannot find the patient’s medical record, you are going to lose the patient’s confidence – and the patient as well ! If you store all this information on the PC, you can find it immediately, and this helps immensely in creating lifelong patient loyalty !
2. Impress your colleages and consultants : Communication is becoming the cornerstone of society today . Once you have all your patient records stored digitally, you can share them with your colleagues. The referring doctor or consultant will be very impressed when he gets an SMS and an email automatically from you, when you see his patient ! This will help you stand out from the rest of the crowd !
3. Save time: You can retrieve stored data much faster on your PC then from a filing cabinet. Why waste time and money hunting for records, when you can instantly find what you need on your PC !
4. Save on storage space. Real estate costs money while digital space is cheap ! You can store thousands of medical records on a hard disk – and as your practice grows, you need to think about the future.
5. Reduce chaos: A large clinic is often drowning in paper – and it’s very frustrating when you cannot find the record you need. With an electronic medical record, there’s no clutter – and much more work gets done efficiently when time is not being wasted in finding lab reports and scans.
6. Increase productivity: A faster records access, storage and retrieval system gives you and your staff more time. It increases efficiency , allowing you to spend more time with your patients. As patients are wowed by how efficient you can access their medical history, they will refer even more patients to you !
7. Improve your clinical skills and practice evidence based medicine: Even though Indian doctors are very busy, our research output is pathetic, because we do not bother to keep medical records properly. Documentation is poor, and most of a senior doctor’s wisdom is primarily anecdotal, since it is not based on a stringent analysis of stored clinical data. For example, most orthopedic surgeons don’t even know the exact number of hip replacements they have done ; or which type of artificial hip works best in their hands. They cannot analyse their complication rate reliably, and depend primarily on their selective clinical memory, which is often deeply flawed ! Digital information allows you to do much more with the patient data you have. You can easily analyse your clinical data and produce informative research reports based on your years of clinical experience. Analysing paper records is a painful chore. Why work so hard when your PC can do the work for you in seconds ?
8. Look cool: A computerized clinic which runs state of the art software creates a lot of confidence in your patients. They will be much more faithful to you, because they know you are well-organised , effective and efficient !
9.Improve your business processes by automating administrative tasks. Because all the data is stored electronically, it’s much easier for you to fill in all the forms and papers everyone else needs – your CA; the IT officer; the TPAs and insurance companies !
10. Empowering patients. Because you now have a state of the art digital office, you can communicate electronically with your patients. You can send them alerts and reminders through SMSes and emails – and this can create a Wow ! experience which will help you to leap ahead of the competition.
As a doctor, you routinely have to capture a large amount of information about your patient in order to provide good medical care ( and to collect your fees ) . Medicine is a pen and paper intensive domain, where clinical history, examination findings, lab reports, scans, appointments , messages and bills - all happen on paper. What is the downside to all this paper work ? After all, you’ve been doing it for donkey’s years and are happy with this , so why bother to change ? The truth is that managing paper is always hard to do . Papers get lost, stolen, misplaced - and writing can be hard work ! IT can help you manage your paperwork much more efficiently !
Have you ever lost your temper because your patient has lost his medical records, and does not know what medications he is taking ? Are you fed up of having to write the same prescription again and again ? Aren’t you impressed by other doctors who give their patients crisp, professional word-processed medical summary sheets ? How are you going to compete with corporate hospitals who can access their patient’s medical records at the click of a button ? The good news is that the same technology is now easily and inexpensively available for you to use in your own clinic ! IT can help you improve your documentation and storage ; and actually increase your productivity and efficiency, by allowing you easy access instantly to all your patient’s medical records, no matter where you are !
Here are the top 10 reasons why you should use a computer in your practice !
1. Impress your patients by having all their information available at your finger tips. Your patient expects you to remember exactly what medicines you prescribed and what surgery you did when she comes to see you, no matter how busy you are. Unfortunately, many of us cannot even remember the patient’s name, forget about the medical details ! Having an EMR with the patient’s photo and clinical details means you are well-prepared to talk to your patient ! If you cannot do so because you cannot find the patient’s medical record, you are going to lose the patient’s confidence – and the patient as well ! If you store all this information on the PC, you can find it immediately, and this helps immensely in creating lifelong patient loyalty !
2. Impress your colleages and consultants : Communication is becoming the cornerstone of society today . Once you have all your patient records stored digitally, you can share them with your colleagues. The referring doctor or consultant will be very impressed when he gets an SMS and an email automatically from you, when you see his patient ! This will help you stand out from the rest of the crowd !
3. Save time: You can retrieve stored data much faster on your PC then from a filing cabinet. Why waste time and money hunting for records, when you can instantly find what you need on your PC !
4. Save on storage space. Real estate costs money while digital space is cheap ! You can store thousands of medical records on a hard disk – and as your practice grows, you need to think about the future.
5. Reduce chaos: A large clinic is often drowning in paper – and it’s very frustrating when you cannot find the record you need. With an electronic medical record, there’s no clutter – and much more work gets done efficiently when time is not being wasted in finding lab reports and scans.
6. Increase productivity: A faster records access, storage and retrieval system gives you and your staff more time. It increases efficiency , allowing you to spend more time with your patients. As patients are wowed by how efficient you can access their medical history, they will refer even more patients to you !
7. Improve your clinical skills and practice evidence based medicine: Even though Indian doctors are very busy, our research output is pathetic, because we do not bother to keep medical records properly. Documentation is poor, and most of a senior doctor’s wisdom is primarily anecdotal, since it is not based on a stringent analysis of stored clinical data. For example, most orthopedic surgeons don’t even know the exact number of hip replacements they have done ; or which type of artificial hip works best in their hands. They cannot analyse their complication rate reliably, and depend primarily on their selective clinical memory, which is often deeply flawed ! Digital information allows you to do much more with the patient data you have. You can easily analyse your clinical data and produce informative research reports based on your years of clinical experience. Analysing paper records is a painful chore. Why work so hard when your PC can do the work for you in seconds ?
8. Look cool: A computerized clinic which runs state of the art software creates a lot of confidence in your patients. They will be much more faithful to you, because they know you are well-organised , effective and efficient !
9.Improve your business processes by automating administrative tasks. Because all the data is stored electronically, it’s much easier for you to fill in all the forms and papers everyone else needs – your CA; the IT officer; the TPAs and insurance companies !
10. Empowering patients. Because you now have a state of the art digital office, you can communicate electronically with your patients. You can send them alerts and reminders through SMSes and emails – and this can create a Wow ! experience which will help you to leap ahead of the competition.
Patients Know Best
Patients Know Best: "Policy makers are freezing or shrinking health care budgets. They simply cannot sustain the increases in spending of the last decade and instead they are demanding that providers of care do more with less. So your institution has to become more efficient.
At the same time, patients are increasing their demands for control. The switch from paternalistic medicine – where clinicians decided and patients obeyed – to participatory medicine – where clinician and patient decide together how to improve the patient’s health – means big changes in the culture of health care.
But putting patients in control is the key to increasing efficiency. In retail, banking, travel and other industries putting the customer in control improved the quality and the costs of serving the customer. And so it will be in health care. The organisations that help the patient to help themselves will be the ones that succeed."
At the same time, patients are increasing their demands for control. The switch from paternalistic medicine – where clinicians decided and patients obeyed – to participatory medicine – where clinician and patient decide together how to improve the patient’s health – means big changes in the culture of health care.
But putting patients in control is the key to increasing efficiency. In retail, banking, travel and other industries putting the customer in control improved the quality and the costs of serving the customer. And so it will be in health care. The organisations that help the patient to help themselves will be the ones that succeed."
Has the medical profession sold itself out ?
I sometimes despair when I look at the sad state in which the medical profession finds itself today.
Physicians used to be highly respected and the medical profession was held in high regard. The tragedy is that doctors seem to have sold themselves for a pittance . This is why we are no longer considered to be patient advocates . Businessmen treat us as skilled knowledge workers who can be paid a salary to take care of patients in their corporate hospitals . Managed care bureaucrats lay down the rules as to what treatment is allowed and what is not, and we have to toe the line. Government officials have a low opinion of doctors, because they feel they are willing to compromise their standards in order to curry favours to get a promotion. Pharmaceutical representatives bad-mouth doctors in private, because they know it's so easy to manipulate them for a few freebies and trinkets. The public feels that we have become too commercial in our pursuit of profits, as a result of which doctors have become soft targets for angry patients who beat up doctors and burn down hospitals.
This is why social activists and NGOs feel free to criticise all doctors. They routinely get away with this, because they have usurped the moral high ground which has been conceded to them by doctors. Even though it's doctors who work hard daily in the trenches, taking care of their patients who come to them seeking solace in their time of distress , they are easily tarred as being mercenary and money-hungry by every " social worker " who wants to do so. A very good example of this is the PNDT Act, which treats every doctor with a sonography machine as a potential criminal, who is out to abort female fetuses for the right financial consideration !
Concepts like the loyalty of the doctor to the patient seem to be archaic. The doctor patient relationship has morphed from being a covenant to a contract.
Even doctors themselves no longer respect their own leaders. Many do not feel that the physician community can regulate itself or uphold its high ethical standards . In fact, the word ethics itself seems to have become archaic for most doctors.
Why have thing come to such a sad pass ? Where has the medical profession gone wrong ? Are we so busy taking care of our patients in our clinics that we have lost sight of the big picture ? Isn't it sad that few doctors want their children to become doctors, because it's not considered to be a respected or respectable profession any more ? Who will take care of us when we fall ill and need the healing ministrations of a capable doctor ? If sociaty cannot trust the medical profession, how can we trust our personal doctor to look after us when we become sick ?
Physicians used to be highly respected and the medical profession was held in high regard. The tragedy is that doctors seem to have sold themselves for a pittance . This is why we are no longer considered to be patient advocates . Businessmen treat us as skilled knowledge workers who can be paid a salary to take care of patients in their corporate hospitals . Managed care bureaucrats lay down the rules as to what treatment is allowed and what is not, and we have to toe the line. Government officials have a low opinion of doctors, because they feel they are willing to compromise their standards in order to curry favours to get a promotion. Pharmaceutical representatives bad-mouth doctors in private, because they know it's so easy to manipulate them for a few freebies and trinkets. The public feels that we have become too commercial in our pursuit of profits, as a result of which doctors have become soft targets for angry patients who beat up doctors and burn down hospitals.
This is why social activists and NGOs feel free to criticise all doctors. They routinely get away with this, because they have usurped the moral high ground which has been conceded to them by doctors. Even though it's doctors who work hard daily in the trenches, taking care of their patients who come to them seeking solace in their time of distress , they are easily tarred as being mercenary and money-hungry by every " social worker " who wants to do so. A very good example of this is the PNDT Act, which treats every doctor with a sonography machine as a potential criminal, who is out to abort female fetuses for the right financial consideration !
Concepts like the loyalty of the doctor to the patient seem to be archaic. The doctor patient relationship has morphed from being a covenant to a contract.
Even doctors themselves no longer respect their own leaders. Many do not feel that the physician community can regulate itself or uphold its high ethical standards . In fact, the word ethics itself seems to have become archaic for most doctors.
Why have thing come to such a sad pass ? Where has the medical profession gone wrong ? Are we so busy taking care of our patients in our clinics that we have lost sight of the big picture ? Isn't it sad that few doctors want their children to become doctors, because it's not considered to be a respected or respectable profession any more ? Who will take care of us when we fall ill and need the healing ministrations of a capable doctor ? If sociaty cannot trust the medical profession, how can we trust our personal doctor to look after us when we become sick ?
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