Monday, October 31, 2011

Creating patient educational materials in India - challenges and opportunites

Mr Parag Vora is the CEO of PEAS, which is the market leader in producing patient educational materials in India.

He provides a real-life demo of a new app called Jugaad, which helps doctors take a medical history from illiterate patients using a simple smart phone app !

He presented this talk at the 2nd HELP Conference on Using Information Therapy to Put Patients First !

Saturday, October 29, 2011

Why the Indian Government needs to promote Information Therapy

Dr Rajendra Gupta is one of the few experts in India who have a holistic perspective on how we can tackle India's burgeoning healthcare problems by using Information Therapy. He is India's No 1 health policy wonk ; and presents his case as to why the government needs to tap into India's enormous patient power !

He presented this talk at the 2nd HELP Conference on Using Information Therapy to Put Patients First !

Friday, October 28, 2011

How Dr Chatterjee, CEO, Hiranandani Hospital promotes Information Therapy in Mumbai, India

Dr Sujit Chatterjee is the perfect hospital CEO, who uses Information Therapy to help make Hiranandani Hospital one of Mumbai's finest hospitals. He speaks passionately on how Hiranandani Hospital empower patients Information Therapy.

He presented this talk at the 2nd HELP Conference on Using Information Therapy to Put Patients First !

Thursday, October 27, 2011

How Information Therapy helps - an expert patient's viewpoint

Vandana Gupta is my role model of an expert patient ! She started a support group for cancer patients called V-Care, to help empower cancer patients with Information Therapy.

Here's her heart-felt touching account of her personal experiences in promoting Information Therapy in India !

She presented this talk at the 2nd HELP Conference on Using Information Therapy to Put Patients First !

Wednesday, October 26, 2011

Does it make any sense to use IVF to treat recurrent pregnancy losses

One of the most frustrating problems to treat in reproductive medicine today is that of recurrent pregnancy loss. This is frustrating for both patients as well as for doctors because we have many questions and very few answers . Because we often cannot determine the reason for the pregnancy loss in an individual patient , we often end up grappling in the dark. What makes matters even more confusing is the fact that this frustrating condition has a surprisingly high spontaneous cure rate ! This seems completely counterintuitive , but many studies have shown that even women with three or four repeated pregnancy losses for unexplained reasons have a better than 75 percent chance of having a healthy baby, even if they are treated only with tender loving care. This means that practically any treatment is likely to give gratifying results. This is why there are so many potential treatments for this problem, and why every doctor swears by their own particular preferred remedy.

Since we are not very good at pinpointing what the exact problem is in an individual patient, we are forced to rely on medical experience in order to treat these patients. This is called empirical therapy. There are many kinds of empirical therapy ranging from low-cost treatment with low-dose aspirin all the way to extremely expensive and complicated treatment using intravenous immunoglobulins and lymphocyte immunization therapy.

One of the treatment options for these patients is that of IVF. This may seem quite surprising, given the fact that most of these patients have no difficulty conceiving on their own. After all, if they can get pregnant on their own and if the problem is that they cannot carry the pregnancy beyond 12 weeks, then how on earth is IVF going to help them ? What sense does this make ?
Interestingly , we do know that the commonest reason for a miscarriage is a genetic problem in the embryo ; and that a miscarriage is usually nature's defense mechanism to prevent the birth of the normal baby. This is why recurrent miscarriages are common in older women. They have poor ovarian reserve, also known as oopause, because they have older eggs which contain more genetic abnormalities because they have aged in vivo. Theoretically it's possible to use IVF to help them to grow better quality eggs and better quality embryos. It's possible that super ovulation , as well as treatment with supplementation such as DHEA , helps to improve ovarian reserve and therefore helps them grow better quality eggs, which are more likely to be genetically normal and give rise to genetically normal embryos.

Also, since there is much more aggressive luteal phase support given during an IVF cycle, IVF treatment can help to prevent recurrent miscarriages which are a result of hormonal problems .
One of the biggest advantages of IVF is that it allows patients to telescope time. If they continue to try in the bedroom, they would produce just one embryo every month . Whether or not this embryo would be genetically normal is purely a random matter of chance . Doing IVF allows the doctor to superovulate the woman , and therefore create multiple embryos at one time. Since we allow these embryos to compete amongst themselves, we can then select the embryos which grow the best. There is evidence to show that rapidly developing blastocysts have a better chance of being chromosomally normal as compared to slowly growing embryos.

For the future, as the technology for embryo biopsy and comparative genomic hybridization improves, we will be able to treat these patients with a much more scientifically sound basis. Doing an embryo biopsy will allow us to identify the chromosomally normal embryos and then selectively transfer only these embryos , thus systematically reducing the chance of a miscarriage because of genetic abnormalities.

For now , however , the fact remains that there are still lots of unanswered questions. One advantage of doing IVF is that it helps patients to have peace of mind that they have taken advantage of whatever reproductive technology is available, even though it does have its limitations.

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Tuesday, October 25, 2011

Confused patients - and confused doctors !

All good doctors know that medicine is not an exact science and there are often multiple options to treat a particular problem. It's very easy for a doctor to tell the patient what to do ( and this is something doctors are trained to do all the time), but often this is not in the patient's best interests.

However, when the doctor tries to explain the fact that there are options to the patient , and then asks the patient to provide inputs as to what their preferred course of action is, this sometimes creates a lot of anxiety, stress and tension in the patient's mind. For one thing patients aren't used to making decisions like this, so they are often clueless and don't know how to proceed.

For another , they expect the doctor to make these kind of decisions for them. They are surprised when the doctor offers choices to them. Some of them feel ( in the back of their mind ) that the Doctor must be incompetent if he cannot makes these decisions himself ! After all, aren't they paying for his expertise to make the right decision ?)

It's important for doctors to level with patients , and to communicate with them that often there are no black-and-white answers in medicine. Lots of topics are fairly controversial , because medicine is an evolving science. There are often no easy answers to some complex situations.

Let's take the case of the patient whom I saw who had a small polyp and required an embryo transfer . Some doctors recommend that the polyp be removed before doing the transfer ; while others feel that a small polyp does not affect the chances of embryo implantation. I explained both these choices to her , and then asked her what she wanted me to do. She was completely paralyzed and kept on insisting that I make the decisions for her , because she felt that I had superior knowledge and more experience ; and would be able to provide her with the " right : answer. When I explained that often it's six of one, half dozen of another she didn't know how to proceed.

It is important that we realize that it's not only doctors who have a particular philosophy . While some doctors are quite aggressive, others are conservative. Patients have a certain philosophy as well, and while some will do everything possible to avoid surgery , others are much happier with a quick fix surgical solution.

The problem is that often the doctor has no way of knowing what the patient's personal preferences are , which is why good doctors will explicitly ask patients these questions , and factor in their personal preferences , when making such important decisions. It's very easy for doctors to be dogmatic and say - This is the right way to do it ; or to pretend that this is the only way to do it , but this is actually not in the patient's best interest.

The patient is then being deprived of the information that there were alternative options available to handle that particular problem. I prefer taking a straightforward approach and explaining the options upfront to all patients, but sometimes this also has the downside of leaving these patients very confused.

The important thing is to step back , look at the big picture, and understand why some of these quandaries occur in medicine . When I offer a choice, I also tell them that the very fact that I'm offering them an option means that both options are equally correct from my professional perspective . I explain the pros and cons, and tell them that as their doctor, it's my job as a professional to make sure that I will not let them make a wrong decision ; but when there are options , it's important that they apply their own mind and use their own personal preference system , so that I can factor this in , when helping them to make the right decisions for themselves.

When your doctor asks for your opinion, this does not mean that he does not know what to do ! In fact, it means that he is a real expert, who can look at the big picture; understand that there are choices available; and it willing to respect you so that he can factor in your personal preferences before making a final decision. It's only doctors who are insecure who get upset when discussing choices and who deceive the patient by pretending that there's only one right way of doing something in medicine !
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Monday, October 24, 2011

Create once, use many times

It’s true that doctors are bottlenecks. After all the doctor only has 24 hours in a day , and the number of patients whom he can actually see , examine , or talk to is going to be limited. This is especially true for highly skilled doctors because their services are often in great demand and they often have long lines of patients waiting to see them. While this can be very gratifying to their ego, this is not a very efficient use of the doctor’s time – or the patients’ ! One way these doctors can amplify their effectiveness is by employing assistants (physician assistants or junior doctors ) who can help them to process more patients (by taking a history or by doing the initial examination) .

Today, they can increase their efficiency and efficacy by using technological tools to achieve exactly the same end. An extremely good example of this is the intelligent use of patient education videos which can be used to counsel patients , and ensure that patients provide informed consent prior to going in for surgery.

Often explaining things to patients is not something which a lot of doctors are good at. They find this very boring, repetitive and monotonous , and would rather be doing more interesting things with their time. Cleverly crafted audiovisual tools can ensure that doctors can communicate the information which their patients need , without having to do it themselves. This can be done by using interactive services such as virtual coaches, or health games, which they can also share with other family members.

Not only will this free up a lot of the doctor’s time , so that he can then start doing the things which interest him, it'll also ensure that the information which is provided is of high quality . Equally importantly, it allows the doctor to document the fact that this information has been provided to the patient.

This way high-quality information, which is complete, comprehensive, and based on sound medical principles can be provided to all patients no matter how many there are. The doctor now no longer acts as a bottleneck , and can use the time freed up to be more efficient and productive.

The trick is to spend a lot of time and energy on creating a good video . This can be expensive and time consuming, but once it’s been created , it can be used multiple times . This comes back to the principle of “ create once , use many times “ - something which doctors need to learn to use if they want to reach out to more people efficiently.
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Saturday, October 22, 2011

Using medical technolology appropriately to amplify a doctor's efficiency

There is no question that technology can be a two-edged sword. Technology can cause healthcare to become depersonalized – for example, when doctors are more interested in looking at x-rays and reading lab reports rather than laying hands on the patient or talking to the patient . It’s true that today there is too much emphasis on poring over scan images and analysing lab printouts, especially when we have super specialists who deal with organs rather than with patients. This causes doctors to transmit an image of being uncaring and unfeeling. This is why a lot of patients feel that doctors are not very interested in them as people, but are much more interested in the particular pathological lesion or disease which they happen to have.

While it's true that technology can cause these undesirable side effects it’s also equally true that technology when used cleverly can help to amplify a doctor’s efficiency and effectiveness. One of the things the doctor needs to do a lot of is patient education and counseling. Sometimes , this is not something which doctors are good at – and many are not very interested in doing this either, as they feel it’s basic , boring and simple. It's in these situations that doctors can intelligently use patient educational videos, many of which are now available online , so that they can empower their patients with information , without actually having to go through the nuts and bolts of what's wrong with them personally .

Not only does this save a lot of time for the Doctor , it also ensures that the patient absorbs and retains the information much more effectively , because it's been crafted in an audiovisual format which is much more memorable. It also allows the doctor-patient conversation to then proceed at a much more highly evolved plane because the patient already knows the basics and can now focus only on the points which are of special concern to him. This kind of intelligent use of technology helps to increase patient satisfaction - and the doctor’s professional satisfaction as well.

Friday, October 21, 2011

mHealth and smart phones to deliver Information Therapy in India

Mr Ankit Khambatti is a very successful medical entrepreneur and CEO of CheenyKum. He talks about how his company is using SmartPhones and mHealth cleverly to promote Information Therapy to help keep diabetics healthy !

He presented this talk at the 2nd HELP Conference on Using Information Therapy to Put Patients First !

Thursday, October 20, 2011

How medical librarians can promote Information Therapy

Mrs Vasumathi Sriganesh is India's most articulate medical librarian. She talks about the key role medical librarians can play is ensuring that Information Therapy is used properly in order to keep patients healthy !

He presented this talk at the 2nd HELP Conference on Using Information Therapy to Put Patients First !

Technology for doctors

Some senior doctors are worried that the use of technology will cause medical care to become depersonalized. Sadly , it’s true that there are doctors who spend more time looking at the computer screen and entering data into the electronic medical record, rather than talking to the patient. I think this is tragic and it actually represents a misuse of the technology .

The whole point of the electronic medical record is to allow the doctor to capture, store record and retrieve the data when he needs it afterwards - not while he's talking to the patient . A well-designed electronic medical record system should allow the doctor to look at the patient , talk to the patient , examine the patient and then record his findings later on , rather than instead of talking to the patient.

The intelligent use of technology actually allows doctors to amplify their efficiency and their efficacy , so they can leverage the limited amount of time which they have with the patient.
Just because some doctors misuse technology is no reason to throw the baby out with the bathwater.

We need to develop tools which doctors can intelligently used to increase satisfaction both for themselves and for their patients. For example, the appropriate use of technology would be create patient educational videos which the patient could watch before the consultation, and even afterwards, so that a lot of the basic explanation does not need to be done by the doctor himself. This kind of basic information transfer can be done more efficiently by a well-designed video , which will cover all the important points so the doctor can document that the patient has understood the key basics, and then he can spend his ( limited) with the patient focusing exclusively on the important stuff which the patient wants clarified.

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Tuesday, October 18, 2011

How the HSG can lead to overdiagnosis and overtreatment in infertile couples

The HSG ( hysterosalpingogram, X-ray of the uterus and tubes) is one of the commonest tests done for evaluating the fertility of a woman . It is done to confirm that the uterine cavity is normal and the fallopian tubes are open.

What makes this test special is the fact that it is only done for one reason - to test the fertility of a woman. However, since it is only done for infertile women, this means this test if often misinterpreted. Let me explain.

Many women have minor anatomic variants of their uterine cavity . A common example is an arcuate uterus ( in which the upper border of the uterine cavity is curved rather than straight).
An arcuate uterus is something which many fertile women have as well. However, neither they nor their doctor knows they have an arcuate uterus, because they have enough sense not to get a HSG done.

This means that the only HSGs a doctor sees are HSGs done for women who are infertile. Because of this , every time the doctor sees this finding, he chooses to (mis) interpret this as an "abnormality" and happily jumps to the conclusion that this is the reason for the infertility.

The doctor is happy, because he has made the right "diagnosis" and found the problem ! The patient is happy too, because she feels she has finally found a very competent doctor , who has been able to diagnose the cause - something which all the other doctors had overlooked . This diagnostic acumen testifies to his superior skills and competence.

The trouble, of course, is that this minor anatomic variant is of no clinical importance and does not affect fertility at all ! However, the minute the doctor finds the '" problem" , he needs to treat it. Overdiagnosis leads inexorably to overtreatment, and many of these patients end up being subjected to useless procedures such as hysteroscopic metroplasty, which can actually end up reducing their fertility !

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Monday, October 17, 2011

Feedback from the audience at the Putting Patients First Conference !

The HELP conference on Using Information Therapy to Put Patients First was a big hit !

One of the clever innovations the compere, Mr Rajesh Jain introduced was a mobile application which allowed the audience members to provide comments and feedbacks during the lectures by sending messages ( SMses) using their phones. These messages were then displayed on a screen, and the speakers could reply to these in real time.

The great thing about this clever innovation is that it encourages audience interactivity and participation, using only their personal phones ! No investment in expensive hardware is needed. This is the kind of clever technology which will help to make conferences more meaningful for the audience !

Here is a sampling of some of the SMes we received during the conference.

This kind of feedback allows the audience to engage with the speakers; and will help us to do a better job for our next conference !

I liked the varied information provided. The sessions could be better connected.

The theme of the conference is really great and very relevant. It was nice to get so many people talk on different issues. The time clock and online sms and web cast is a great idea.

I liked the beeper keeping d speaker's time

Good conference. Limit number of speakers

If I have read all the blogs of Drmalpani then do I still need to buy the book:-)

The Mode Of Delivery Of Information Therapy Should Change From Passive To Aggressive and Active. Instead Of Waiting for The Patient To Ask, Institutions Like HELP Should Reach Out.

Right to Information has definitely empowered us largely by an Act of GOI but still it is not a Fundamental Right. Therefore it has limited deterrent effect. Unless this information therapy for patients is made a FUNDAMENTAL RIGHT every effort by like minded people striving hard in this direction would be futile.

How patients from rural areas will be benefited from this program

Comment= All pharmaceutical company provides info along with medicines are in a very small letters - people can not read easily without magnifying glass!!!

There is a very thin line between right to information & patients getting depressed by info given to them. Who will decide whether info passed on won’t harm the patients ?

Do we require a healthcare regulator in India?

Many doctors are Information Literacy challenged. How are they going to educate people?

Can't we have central hotline no like 100, 101 where experts will be available to clear the doubts. It cn be advertised to rural n urban parts

Given the extent of illiteracy, lack of resources and load sheds in India, how do u thing info will reach out to the patients.

Using Information therapy to put patients first will require this to be a part of the standard operating procedure ( SOP) to be implemented among doctors and support groups . How can this be done ?

What can be done about information therapy in public hospitals? The high patient load makes it impossible to have a good doctor-patient relationship.

How to address the problem of patients who claim that patient information will scare us.

Our government cannot get the names of terrorist correct on its website. How can we trust it on providing right healthcare information

How does one draw the line between adequate and too much information?

Every doc has his own opinion. For some doctors, a particular medicine works best for a particular disease according to his experience ; and for others, it would be a different one for the same disease..Which opinion should we trust??

When Government spend on health care is a minuscule % of GDP is it important to spend on ensuring basic health care in non urban areas or Information Therapy?

Do Doctors always educate patients with all the alternative methods of treatment clearly informing about the time for the treatment and costs?

Do patients really want to know EVERYTHING about the disease and treatment?

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Friday, October 14, 2011

Why I expect my patients to become experts

I work hard at maintaining my technical skills , so I can continue to offer my patients world-class IVF treatment. But just like my patients expect me to be an expert, I expect my patients to be experts as well. In fact , I suggest that they do their homework before coming and seeing me – and in between visits as well ! This is good for them - and it's good for me as well

It ensures that they have realistic expectations of the treatment. They understand that no matter how good an IVF doctor I may be, the success rate is never going to be hundred percent. Even if the IVF cycle fails , if they have a clear understanding of the process , at least they have peace of mind they got the best possible medical treatment.

When patients take the time and trouble to become experts, it helps me to maintain my expertise and my professional edge as well. Because they're well informed, they keep me on my tools by asking me challenging questions which I do my best to answer. Expert patients can be the best form of continuing medical education for a doctor ! All good doctors learn medicine all the time from their patients and well informed patients can do a much better job of teaching their doctors ! Expert patients and expert doctors can help set up a positive virtuous cycle , which allows both of them to keep on improving all the time.

As part of my professional responsibility as a doctor, I need to create and provide tools to my patients to enable them to learn for themselves. After all, the word doctor is derived from the word “docere” , which means “ to teach” . While it does take time, effort and money to create these tools, once they've been created they can be used multiple times , making them a very cost-effective investment of my time and energy.

Of course , I still have to draw the line sometimes. I am the doctor, and am in charge of providing the medical treatment and it’s my job to make sure that I do not allow patients to make a decision which I feel can harm them, no matter how expert they may be !

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Thursday, October 13, 2011

Creative Commons License for our free online book !

Creative Commons License
My book, Using Information Therapy to Put Patients First is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
Based on a work at

The Indian patient - lots of choice , but not enough choices !

I was talking to a doctor who was visiting from the US . Much to my surprise, he was quite impressed by how much choice Indian patients have !

In the US , most patients belong to a HMO , because they are covered by a health insurance plan which is usually provided to them by their employer. Health care is very expensive and they require health insurance coverage to be able to afford medical care. In order to keep costs down , the HMO allows them to see only a limited number of doctors , whom they have empanelled. Typically , they first have to see a primary care physician who acts as a gate keeper . It’s only if the primary care physician decides a referral to a specialist is appropriate will the patient be then able to see a specialist. This means that even if the patient has a lot of money , his ability to be able to see a specialist doctor of his personal choice becomes fairly limited in real life.

In India, things are completely different. For patients who can afford private medical care - the booming middle class , which is now more than 300 million strong- because most medical care is provided on a fee for service basis, they are free to choose whichever doctor they want to go. This means they have a lot of choice , and they can choose any specialist they want, if they can afford his services.

While it seems quite exciting that Indian patients have so much choice , the flip side of this is that they really aren’t that many choices in real life. Let me explain this paradox. While it’s true that they can choose any one they want to, it’s also equally true that the number of leading specialists who have a good reputation is very limited. This means that anyone who requires cardiac surgery for example, will often be compelled to wait for hours on end to see the cardiac surgeon he selects, because the busy ones are so busy that they just do not have enough time to spend on providing personalized care for individual patients.

This is actually an opportunity for clever technological solutions ! The fact is that there are lots of cardiac surgeons ( and other specialists ) who are very competent. The tragedy is that most patients are not aware of the existence of these specialists simply because these doctors do not get a chance to advertise their specialized services. This results in the grey-beard syndrome , in which only senior doctors ( like me !) who have been established for many years and have built up a lifelong reputation of being experts , end up attracting all the patients.

The clever use of technology can change this equation very quickly. Young doctors who are starting practice and who have a lot of expertise , skill and spare time can use a website in order to display their skills to potential patients . This will make it possible for patients to be aware of the fact that they do have choices ! Once they know equally skillful alternative options exist, they will no longer be forced to wait for hours on end in the waiting rooms of the 2 or 3 top names in an individual city.

Not only does technology empower Indian patients with choice , it also offers them more choices as well ! This kind of competition is actually good for senior doctors as well , who will then become a little more respectful and polite to their patients , because they will understand that they can no longer afford to be arrogant or get away with rude behavior , just because they have long lines of patients waiting for them !

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Monday, October 10, 2011

A HELPing Hand!

This is a guest post by Dr. Amar Udare

When my colleague informed me about the Patient first Conference organized by the HELP library, I was not sure whether I would find enough information about the topic. However once I started my research for the presentation I found a plethora of information. So much has been written about it in articles and research papers all over the world but very little of it is being implemented in India. Once I started collecting the background data, I realized that it is something which we doctors can and should or rather ought to inculcate every time we communicate with the patients.

Working as an intern and now as a junior resident/houseman in a Tertiary Care Centre and a Government hospital I come across a number of patients every day, from all sections of the society. These patients are already crippled by their illness. To make things worse the lack of information paralyses them. Just imagine if you are thrown into a complex maze with people speaking any random foreign language with no shelter and a meager sum of money. To add to it you have been left helpless with some kind of deformity and people around don't really care who you are and why are you here. That is what a Bengali/Assamese or any other vernacular patient goes through every day when he visits a Government hospital in Mumbai, or probably worse than this.

The state of Patient Information is analogous to that of the medical services. The rich get more of it than they actually need and the weaker sections of the society who need them the most are totally neglected. The higher class will manage to get the information by hook or by crook. Many of the time it is these Over Informed patients that create a lot of problems for everyone. The internet gives you too much information. We should be able to extract what is relevant in our case. On the other hand the weaker patients have no information at all. Many of them still have blind faith and follow the philosophy of "Dactar toh bhagwan hota hai.Jo karenge ache ke liye karenge".There needs to be a balance between the two extremes. Organizations like the HELP library can help us bridge this gap by concentrating on the underprivileged section. This can be achieved by setting up health inquiry centers at various Government Hospitals

So through my presentation I have tried to highlight the same point that Patient Information should be delivered to the right people at the right time and in the right way.
I would like to thank Dr Malpani and the entire team at HELP library for giving us an opportunity to voice our opinion and setting up such an amazing event.
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Using Information Therapy to Put Patients First

All of us will be patients some day. What can we do to ensure that we get the best medical care when we fall ill?
Information Therapy – the right information at the right time for the right person – can be powerful medicine! Ideally, with every prescription, your doctor should prescribe information; and in a perfect world, every clinic, hospital, pharmacy and diagnostic centre would have a patient education resource centre, where people can find information on their health problems.
This book explores how Information Therapy impacts all players in the healthcare ecosystem – patients, doctors, hospitals, health insurance companies, pharmaceutical companies, and the government – and how it can help all of us.
Information Therapy can help to heal a sick healthcare system – and everyone has an active role to play in making this a reality!

Twins are twice as nice - a success story in Oman !

I am 32 years old and my husband 36 years old. We got married in December 2005. For one year after getting married we didn’t really get a chance to stay together because my husband was working in Oman and I was in Mumbai. I joined him in Oman in 2007 and it’s from then that I had been trying to conceive. We met a few doctors in Oman and also in Mumbai but no one could give a solution to our problem; they just kept prescribing some medicines which did not help us. We were losing patience and could feel a vacuum in our lives, but we kept faith in God and continued to pray. One day my husband came across an article in a health magazine and that’s how we came to know about Dr. Malpani. We emailed our test reports to doctor and were advised to go for ICSI treatment.

My husband and I came to Mumbai in June 2010 and the treatment started, unfortunately it didn’t work for us,it was very depressing but, Dr. Malpani didn’t let us lose hope and we decided to go for a second attempt. The treatment started again in September 2010, by end of the month we were back in Oman and the most awaited day i.e. the day of BHCG test arrived. The test was done and the result was positive, we immediately called doctor to give him this good news and he said that it might be a multiple pregnancy;since the HCG level was on a higher side. The same test had to be repeated twice on alternate days and it was confirmed that it’s a healthy pregnancy and the scan report showed two little hearts beating.

God answered our prayers through Dr. Anirudh and Dr. Anjali and blessed us with the happiness of parenthood. Our twin baby boys are now 5 months old. My husband and I thank Dr. Anirudh and Dr. Anjali from the bottom of our hearts and also the cheerful and friendly staff of their clinic for their prompt and excellent service.


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Saturday, October 08, 2011

Conference on Using Information Therapy to Put Patients First !

Our conference is tomorrow on Sunday, 9 Oct at 10.30 am at Hall of Harmony, Nehru Center, Worli.

So why should you attend ? What makes this conference different ?

1. We have lots of clever speakers , covering many unique points of views. Of the 10 speakers, only 2 are practising doctors , and this highlights the fact that we are approaching this topic with a completely different and new viewpoint !

2. We want this to be a platform where different participants can get together to work for the good of patients ! This can be used to cover many burning issues, including patient rights ; medical ethics; and health literacy. While work has been done in these fields in India, it's been very scattered and disorganised.

3. We want this conference to act as a catalyst , to spark off unexpected and novel interactions. These have to be unplanned, as we cannot predict what will work and what will not, which is why we have a lot of time for audience interaction and participation. Please come and grill our speakers !

4. A lot of what will happen in the conference will be captured live on our website at, so that the conversation keeps on growing, even after the conference is over !
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E-patients – Engaged, Empowered, and Enabled experts

It’s fitting that in a book which talks about how we can use Information Therapy to put patients first , the last word goes to the most important person in the healthcare space – the patient!
Jay ’s blog, Stork Stalking, can be accessed at She is my role model of an e-patient – the expert patient who is active and articulate and is changing the face of medical care. There is great power in Participatory Medicine – and when used along with Information Therapy, Health 2.0 can transform healthcare.

To explain how Information Therapy has helped me, I need to provide some background. I am, by profession, a scientist, whose extensive training has included an education in all the life science disciplines (which include immunology, cell biology, genetics, biochemistry, neurobiology, and developmental biology). This training has given me an advantage that few patients outside the medical field possess. My condition is an infertility of sorts. I am a single woman, who is trying to conceive using donor sperm. At first, it seemed like everything was right with me. All my tests looked absolutely perfect on paper. I conceived on my first attempt. Everything went smoothly until the end of the first trimester, where I discovered my baby had died, around 7 weeks. Most people, at this point, would have just had a D&C, but would not test the products of conception for an abnormality because their doctors would never order this test voluntarily at that point. It was my training as a scientist (which instills a need to have answers for everything) that primarily compelled me to ask the doctor to run the karyotyping test for my baby. Many women who have suffered multiple miscarriages start having this test done only after the third loss – as a result, they are left with no idea of what went wrong the first few times and hence do not have the information to know which treatment option would be best suited.

As a patient, you have to be your own advocate. No doctor is going to go that extra mile for you, unless the doctor taking care of you is a physician you personally know. Without this, the factors that dictate the medical care you receive are statistics and economics – many tests are not run and only a standard protocol is followed. It is very easy to be aggressive and go the extra mile when you have been trained like me? But what do you do if you have not had that training? Google everything – try every single permutation and combination of query phrases. While writing this article, I googled ‘tests to run after a miscarriage’, just as a training exercise. I did not need to do this after my own loss, but had I done so, the first page that pops up tells you to do a karyotyping.

So Google – Then, spend a few hours reading the results and then use Wikipedia to try to make sense of it. I also read the original scientific studies, either using the Google Scholar or the ‘Pubmed’ databases. It is very easy for me to say, ‘Go through this massive amount of information and make sense of it.’ But what if you are somebody who hated biology in school and are struggling with an incredibly vast information overload? Even the most uneducated, biology-hating patient can become an expert, if the determination is there. You don’t need to become a doctor, but you can easily become an expert patient. There are lots of patients online, who will be happy to hold your hand and help you, even if your doctor is not willing to do so! Far worse than having to deal with an information overload in a subject you detest is the sense of not understanding what you are up against. If you are lucky and have a good physician, that can go a long way, but not all of us are guaranteed to have good physicians. There is nothing as painful as the combination of a bad doctor and an ignorant patient.

And sometimes, you can find the answer to your own problem. Continuing my story, we found that my baby was a boy, with a normal XY karyotype. Most pregnancy losses exhibit abnormal genetics. My doctor at that time looked at this result, and flatly turned down my request to run more tests. I saw another doctor, who did order some tests and discovered a mild thyroid autoimmunity that I was subsequently treated for. I went on to try to conceive again, and succeeded immediately. Unfortunately, that story had the same ending, another pregnancy loss at a similar time point. Shortly after my second loss, I met Dr Malpani, who ordered a test for a hormone called AMH. While giving blood, as a stroke of blind luck and happenstance, I decided to get my Vitamin D3 levels tested. I wish I could claim that this all-important test had been ordered by me as a result of extensive and logical internet searching, but no, it was about as fortuitous and accidental as the discovery of penicillin. When my AMH results came back, they were low. It was a grim, scary result that did not make sense. The only other abnormal finding in my blood work panel was that I was also Vitamin D3 deficient. This is the point where the internet was of profound use to me – I googled ‘AMH and vitamin D3 deficiency’ and found a study which showed that Vitamin D3 can bind to the AMH gene and ‘switch’ it on. It is then a logical argument that if you are Vitamin D3 deficient, you might have issues with AMH synthesis. I decided to increase my Vitamin D3 levels and retest my AMH, and like magic, it went up, and stayed up. If I had not found all this by myself, it probably would never have come to light. It was a combination of incredible serendipity and using the internet well. This has been my one giant payoff from my incessant googling, but there have been many, many small ones as well. Being well informed can save you many missteps.

When you are lost and looking for answers, message boards are also good places to log on to. And then there are blogs. Blogs, in my experience, are not that good for gaining information, but they can be very useful from an emotional standpoint. Be it cancer or infertility, both are horribly isolating. If you suffer from any disease or condition, you are probably one person surrounded by about 50 other healthy people who will never have such an issue. Moreover, while they are genuinely sympathetic, they are uncomfortable when you talk about this problem and have short attention spans when you are going on and on about it. Basically, it is not their problem. Blogging gives you a way to connect to people who WANT to listen to you, who can provide the kindness that can only be generated by empathy, since they too have had the same experience as you. Plus, the act of writing down what you feel can be incredibly cathartic. Being in ill health, for any reason, is incredibly stressful. Blogging helps take away some of that stress. If you can start a blog, then do. It has helped me tremendously in my darkest days.

In summation, yes, the internet is an incredibly valuable resource. Not using it, and continuing to allow a doctor to make all these tremendously important decisions for you, while not having a clue as to what is happening, is not prudent and can be potentially dangerous. What’s the point of being literate if you refuse to read? Is there a downside to having access to tons of information available? Yes. You need to look at the 1000 little details, and then step away, and get a true sense of the big picture. This is not at all easy, and many people can look at one tiny study and panic, many times, unnecessarily. You can get hopelessly confused by all the contradictory information out there; and trying to decide on which path to follow can be very challenging. This often leads to paralysis by analysis! How do you deal with this? As an example, I’ve seen many, many studies that show that if you test positive for anti-thyroid antibodies, you might be at a higher risk for miscarriage. Then there are the studies that show it has no effect. There are doctors in both camps and honestly, nobody has a real clue. That is most often the crux of the issue – nobody knows the right answer. What do you do? You look at the suggested fix to the problem – is it safe, inexpensive and easy? If it is, go for it, whether you believe it to be a problem or not. If it is not an easy fix, then that is where the real issues lie. Sometimes, we have to put our faith in something expensive, difficult or even potentially dangerous while not knowing whether it will work.

When nobody knows what is the right call to make, and everybody is straddling the fence, if you know enough and have the strength to do so, then you should be the one that makes the decision as to which path to take. Sometimes, that is the best we can hope to do. I have learned that you rarely regret the things you do – you usually regret the ones you don’t. When you are at a crossroads, please remember the Serenity Prayer – God grant me the serenity to accept the things I cannot change; the courage to change the things I can; and the wisdom to know the difference. At the end of the day, you should have the peace of mind that you did your best, and Information Therapy can help you achieve this goal.

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Thursday, October 06, 2011

Why it makes business sense for health insurance companies to invest in Information Therapy

Ketan Shah, a sales representative for a major heath insurance company, has his work well cut out. The senior management has asked him to maximize sales of insurance policies to keep the company ahead of its rivals. Yet, this is a very shortsighted approach. Instead, if the company looked beyond the obvious profit motive and directed its efforts towards ensuring the health and well-being of its clients, this would not just attract more customers and increase revenue, but also build lasting relationships. Providing Information Therapy to their customers makes a lot of business sense !

No one wants to fall ill, but when you do, the last thing you want to worry about is the doctor’s bills. This is why purchasing a health insurance policy to protect yourself against the financial losses caused by a medical problem has become so important. Medical care has become increasingly expensive and unaffordable and a health insurance policy can provide financial protection and ensure you can afford the best medical care.

The traditional form of health insurance is called indemnity insurance (also known as fee-for-service), in which the insurer pays for the cost of covered healthcare services after they have been provided. In most indemnity insurance plans, the patient is free to choose his own doctor or hospital. In the past, the health insurance business in India was a monopoly, so the only medical insurance policy available for most of us was MediClaim, through the subsidiaries of the General Insurance Corporation (GIC). Today, with increasing liberalization, the insurance business in India has been opened to the private sector, and there are now many more options to choose from. While this extra choice is great, because companies are competing with one another to offer customers the best deal, having so many options can be confusing!

Given the huge Indian middle class; the fact that medical care costs are escalating every year; and that the government infrastructure is not able to provide basic healthcare, experts believe that the health insurance market is going to boom over the next few years. However, for historical reasons, most health insurance companies in India are still losing money and scrabbling for market share. This is actually a great opportunity for a health insurance company which is willing to think out of the box to stand out from the crowd. With IRDA mandating health insurance portability , this is going to become even more important now !

What do customers want from a health insurance policy? Their basic needs are: protection from financial loss because of hospital bills; free access to doctors and hospitals they want to go to; no fine print for exclusions; reasonable costs; convenience at the time of hospitalization so they don’t have to pay first and then claim the money from the company (what is called a ‘cashless’ transaction); prompt payment of medical claims; quick processing of claims; minimal paperwork; and friendly customer service.

Today, because there are so many companies competing for business, they all have great marketing campaigns and are happy to sign up customers left, right, and center because they want to increase their market share and they know that once signed up, most customers usually stay for life. However, most Indian health insurance companies are still stuck in the past when their only role was limited to paying the hospital bills. All they seem to do is collect the premium every year and pay the medical bills (claims) when customers fall sick and need hospitalization. What’s worse is that while they are very efficient at collecting the premium, when it’s time to pay out the claims and settle the hospital bill, they create a lot of unnecessary hurdles in order to delay making the payment, causing a lot of grief and anguish to the customer . This is why health insurance companies have received so much bad press recently.

This is shortsighted. Remember that a health insurance policy should not just provide illness care, but should also help us to remain well. In the USA, which has the most evolved health insurance market, things are very different. Insurance companies have realized that spending on medical care after a person falls ill is expensive for them. It’s much more cost-effective to invest money in educating, counseling and motivating people to remain well, so they do not fall ill in the first place - after all, prevention is better than cure. In fact, in ancient India, this was a well-accepted principle and the doctor (whose job was to keep the family in good health) was paid only as long as everyone was healthy. If anyone fell ill, the payments stopped, until they recovered. Innovative health insurance companies in India need to come up with a modern version of this model - and providing Information Therapy is a great way of doing this.

There are many options now available to insurance companies which they can use to help their customers remain healthy. These include tools for counseling; lifestyle improvement; weight loss; and smoking cessation programs. Many of these can be provided online on the web, which makes them inexpensive to deliver. Just look at the wellness tools which the United Healthcare website at offers to its US customers; or the Aetna website at! And compare this with any Indian health insurance company website. The difference is clear.

Indian health insurance companies need to leapfrog and use the web to deliver Information Therapy to their customers. Most affluent Indians are now online and because it’s so inexpensive to develop web services and applications in India, it’s very cost effective for insurance companies to deploy these. Once they have the email addresses of their customers, they can encourage them to submit their claims and pay their premiums online – again saving both the insurance company and the customer time and money. They can also offer discounted memberships to gyms, spas, yoga classes, meditation retreats and counseling sessions, to help their customers take a proactive approach in managing stress and fighting off disease.

Similar tools can be used to help patients with chronic illnesses manage their disease better so they don’t need hospitalization. Hospital care has become very expensive and teaching patients to take care of themselves is a powerful therapeutic intervention. This is called ‘disease management’ and is an integral part of providing Information Therapy. It has been applied abroad for a wide range of diseases, ranging from asthma to hypertension to diabetes.
These programs are cost-effective for the insurance company to offer – and they don’t need to spend too much on them either. An excellent example is the recent study from Partners Health Initiative (PHI) in Anderson, South Carolina which showed they saved an estimated $34.5 million in 30 months—thanks to simply gifting a copy of the world’s largest selling patient education book, the Healthwise Handbook, to all their customers!

The lesson is clear - not only is there a business case for health insurance companies to be investing in Information Therapy, but it’s also a great way of helping them win more customers and keeping their customers happy. Knowledgeable customers should demand that health insurance companies provide them with Information Therapy tools to promote their health.

HELP will be organizing its 2nd Annual Conference on Putting Patients First. The theme this time is : Using Information Therapy to Put Patients First in India.
The website is at

This will be held at Nehru Centre on Sunday, 9th October’11 from 10.30 am - 1.30 pm. Mr.Ken Long , Vice President, International Operations at Healthwise, U.S.A, will be the keynote speaker and he will be talking on “What Healthwise is doing in the US to Promote Information Therapy – what we’ve learned so far”.

On this occasion, we will be releasing a book titled, Using Information Therapy to Put Patients First.

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Wednesday, October 05, 2011

IVF success story for an infertile couple from Africa

I'm 37 weeks pregnant and this is our success story!!! We are a couple from Africa and after 3 years of trying to get pregnant naturally then with a couple rounds of clomid we started to get very sad my husband and I because it was not working. We started some check up and discovered that my husband had a low sperm count it devastated us. We got married in May 2009 and after the wedding i discovered that I was in fact 5 weeks pregnant and i was so happy I did not even notice the pregnancy during the heavy wedding preparation!!!
But I miscarried at 6 weeks . I was devastated again.

In October 2009 we decided to go to New York to have my first IVF done. We went to a very upscale IVF clinic and it cost us a lot of money between treatment, hotels, plane tickets..... My Doctor decided for an ICSI because of the low sperm count of my husband. I had a cyst in my left ovary and we had to wait for it to dissolve it did but my cycle had started already. We finally started treatment and grew only 4 eggs. They transferred 2 (8 cells) 1 (6 cells) and a bad one, but after 10 days of the eggs transfer I had a chemical pregnancy. My level was only 14 then 7 then you know.... I was again devastated and after a couple months I started to think about using a sperm donor for a new IVF . But my husband was not OK with it.

Finally at the end of year 2010 I started to look over the Internet into IVF treatment again but this time in India because I had heard that it was cheaper and a lot of success stories. For me it was ideal too because from Africa it is not too far and I could do some tourist visits. I finally found Dr Malpani's clinic web site and learnt about it for weeks , looking for success stories and comments from other people.

My husband and i finally decided to give it a try before going to a sperm donor and I'm glad we did it. I arrived in Mumbai in January 2011 very late at night and by 2 o'clock in the afternoon I was with Dr Malpani in his office. I booked an hotel nearby is office in a very nice neighbourhood called Colaba just by the sea (a very nice, clean and cheap hotel that I will recommend to you all!!!).

Dr Malpani was very nice and sweet he was so positive about me that he gave me some happiness and I started to believe that it will finally work this time. I had a cyst again and his wife aspired it and from then we started treatment. After 6 days of treatment (you have the choice of coming to the clinic every day for injections or to do it yourself . I did them myself - it was scary at first but I have to say that when you get used to it , it is actually not painful at all) I started to feel so bloated that i looked 5 months pregnant!!! And Dr Anjali told me during a scan your body is responding well to the treatment that is why!! I was so happy!!!! My husband finally arrived for the end of treatment. His sperm count was still low but the embryologist told us it was enough (only need one for one egg, he said).

I grew 25 eggs!!! They retrieved 21 and 12 fertilized!!!! WOW I had even some left for freezing amazing!!!!!

Dr Malpani decided for a 3 days transfer and I wanted to have 4 or 5 embryos transferred lol.... Dr Malpani told me NO No NO and he transferred 3 (8 cells with very good grades ) . They showed me all my little babies on the computer it was amazing and I even got a picture of the ones they transferred into me . I looked at this picture all the time and will put it in my baby album when my baby is born. We froze 9 embryos with very good grade. I saw both the doctors one more time , got all my prescriptions and was off to Africa for the famous 2ww (2 weeks wait).

I had embryos transfer in the afternoon and at 2 am took my 5 hours flight back to Africa. I stayed in India for a total of 3 weeks and my husband 2.

And as you already know it!!! Like most of us I did not wait the 2ww to start POAS (pee on a stick) I started to poas 7days later and I got a very very faint line that only I could see , of course. I started to drive my husband crazy because he could not see anything. I poas everyday and it kept getting darker until the 12 days after embryo transfer , it was definitely a +++ wow......

I got my blood test result and HCG level at 12 days after transfer was 371 wowwwwww and at day 14 was 731 rewowwwwwww!!!!! This time it worked i was thinking of multiple because of the level but no I'm having a healthy big baby and waiting to finally see my baby in a couple days or weeks.....

During the 2ww you have to know that I sent a lot of emails to Dr Malpani with crazy questions (like will the embryos fall out because i had bad coughing and stuff.... about my follow up treatment....and really a lot of question) Dr Malpani always responded to ALL my emails in 24 hours!!!! and still does today.

About the cost!!! I paid exactly what it is advertised for an ICSI on the web site plus the aspiration of the cyst and embryos freezing. There was no hidden cost.

My husband and I can never thank you enough Dr Malpani and Dr Anjali for this miracle. I can't wait to come again in Mumbai next year for a FET (frozen embryo transfer) . It worked the first time with you and I am sure it will again. You gave me faith again.

If some of you want more information please contact Dr Malpani for my email address i will be glad to help you.


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Tuesday, October 04, 2011

Why we no longer respect doctors

" What's happening now to American physicians is the result of a long-term cultural shift in the way society views you and your role in public life. Physicians, America has demoted you. Previous generations saw you as vital experts offering crucial advice and service to individuals and families, mostly via the private sector. Today, doctors are viewed as anonymous "providers" in a healthcare system that is better understood as a quasi-public utility than as a private industry."

This is equally true in India as well. While patients may still look upto their personal physician, the medical profession is no longer held in the high regard it used to be. Physicians are partly to blame, because we have failed to take a leadership role and have allowed ourselves to be bashed up and bad mouthed.

The tragedy is that all of us will pay the price for this - not just the doctors . When you become a patient you will find it hard to trust your doctor !

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Great opportunity for health insurance companies in India

The IRDA guidelines have allowed on Health Insurance Portability in India from 1-10-2011

What this means is that customers can now switch their Mediclaim health insurance policies. This is good news for customers, because it will force health insurance companies to become more customer friendly and more patient-centric !

Hopefully, more of them will now invest in providing their customers with Information Therapy !
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Information Therapy: The Role of Medical Librarians

This is a guest post by Vasumathi Sriganesh, CEO, QMed Knowledge Foundation, Mumbai

When Mr and Mrs Shukla’s child was diagnosed with ‘Down’s syndrome’, they wanted all possible information on the illness. Endless hours of searching on Google provided little useful information, driving them to frustration. On a friend’s advice, they visited a consumer health library. There, a helpful and informed librarian scanned through the catalog and gave them a list of popular books on the subject, many of which were written by parents of children of Down’s syndrome. In today’s high-tech age, visiting a library was the Shuklas’ last resort. However, it clearly ended up being the best one.

‘Information Therapy is the prescription of the right information, to the right person, at the right time to help make a better health decision.’ This simple definition of Information Therapy raises many questions. How can information have therapeutic effects? What do we mean by ‘the right information’? Isn’t every person who needs health information a ‘right person’? And is there a ‘right time’ to provide health information? Isn’t now as good as any time? This chapter will explain how a medical (or health sciences) librarian can help in the provision of the right information to the right person at the right time.

The problem with information and information delivery

Health-related information is useful if it is available to us in the right doses at the right time, but only if it is authentic and beneficial. The problem is that very often – and alarmingly so – the information we get is inaccurate. In such cases, the information can be actually harmful, rather than being helpful. It may be the result of wrong research. It maybe outdated. It may be too complicated for us to understand. It may not be available unless we are ready to pay a substantial fee. And sometimes we simply do not get information because our healthcare providers forget to tell us some facts or instructions. This could happen due to human factors like their overly busy schedule, or they may assume that we already know these facts.

A simple example illustrates this:

A lady went to have a blood sugar test. A lab technician drew her blood when she was on an empty stomach. She was then told to eat and come after two hours. She went home, ate after an hour and came back within two hours of her first visit to the lab. A clearer instruction would have been, ‘Come back to give a sample two hours after you have eaten.’ For the technician, this was routine knowledge. Without realizing this , he had assumed that anyone who came for this test would know these facts. A simple handout for such patients would have made a big difference. In this case, luckily the patient herself had a doubt and gave the second blood sample after another hour.

Information Therapy and the role of a medical librarian

A medical librarian can add major value in providing Information Therapy. First, she will usually have a Master’s degree in ‘Library and Information Sciences’. During her training, a librarian learns a lot about the various types of information resources; the way information is structured and organized ; and how to search correctly , using structured techniques , to get the right information quickly . Librarians are information specialists – they know how to classify and retrieve information. During their training, they also learn how to evaluate the quality of the resource : is it comprehensive ? is it biased ? is it suitable for the reader ? They are trained to pick the best resources , based on the user’s query and needs. Because a librarian works with information resources daily , she specialises in ensuring that they are utilized optimally.

It is important to note that a medical librarian will not make a diagnosis or provide advice about a treatment – that’s the doctor’s job! Librarians will collaborate with doctors, to ensure that patients get the information they need. Patients should treat the librarian as a researcher on their medical team – and discuss the information they unearth with their doctors.

Librarians classify Information resources in several ways and it is a good idea to understand this.

By its contents:

• Basic resources – textbooks, dictionaries, telephone directories
• Research resources – journals – where research is published on an ongoing basis
• Analytical resources – where experts study all available research, analyze it (through a systematic process) and then synthesize it, presenting unbiased facts, evidence, and guidelines to help others to provide the right healthcare

By the format in which the information is published:

1. Primary resources – journal articles, original research papers
2. Secondary resources – Lists (or databases) that lead us to primary resources
3. Tertiary resources – Lists of lists or databases that lead us to all available secondary resources

By target audience:

Based on its utility to doctors, nurses, dieticians, consumers and patients

By medium of publication:

Print, offline electronic resources like CDs, and the Internet

Medical librarians ensure that the information that a patient or consumer seeks will be sourced from authentic and reliable resources. They will search every available resource as required and will contact other information professionals for additional help if required.

Examples of Information Therapy, and some specific experiences:

As a former librarian at HELP, I can share some examples of how we used Information Therapy to help patients.

• A young mother of an autistic child came to the library to know more about the condition. Our team of librarians was able to provide her with books, pamphlets and magazine articles in the library collection, because we had catalogued them in detail, through our library software. The mother was very grateful because the library had such an extensive collection and that we were able to get out everything in minutes for her. She mentioned that she got a lot of ‘day to day’ and ‘common sense’ information that would hold her in good stead when helping her child cope with autism.

• A lady brought her daughter-in-law who was pregnant. In Indian culture, it was uncommon for girls to proactively learn a lot about pregnancy and labour – especially about 15 years ago. The two sat in the private area reserved for viewing videos and watched one on pregnancy and labour. They were happy to have watched it and to us librarians, it appeared that their bond strengthened through this.

• A doctor called us, and told us that his wife had recently delivered a baby who had a rather rare condition, where a part of the brain was absent. In medical terms, this was known as ‘Agenesis of corpus callosum’. This happened when Internet access was in its early days in India. The doctor did not require medical information on the condition, but was keen on finding out how he could get in touch with other parents who had babies with a similar condition. We did a search and presented him with websites and also gave him the address of a ‘Support Group’ which offered more information and help to parents like him. He called us again in a few days and said that the Support Group had asked him if he would be a local resource in India and that he had happily agreed.

In each of these cases, the librarians helped patients with information that they would not have easily got from their doctors for several reasons. Providing this kind of information creates a positive virtuous cycle – and the doctor whom we helped has been able to help many more parents as well.

Specialized information provision

Librarians sometimes have to provide information on very specific queries that a patient may have. Examples are:
• Does the long term use of a particular drug cause cancer?
• A relatively new drug has caused adverse effects – is it really safe?
• Is it important to rest in bed or to continue to be active if you have back pain?

There are evidence-based sources of information that answer these queries. These sources are created by experts who continually research every available publication on the topic and publish the ‘evidence’, which are updated on a regular basis. There was a time when librarians answered such questions only if a doctor prescribed Information Therapy. Today, the trend has changed as there is now an increasing awareness of the ‘right to health information’. Librarians possess certain strong personal traits like maturity, empathy and a love of interacting with people. The skill to use these while providing the necessary privacy and confidentiality while delivering their services is something that every librarian must cultivate!

Why are librarians considered as ideal providers of Information Therapy?

• Librarians are helpful professionals and patients find it easier to ask them questions that they may forget to (or be reluctant to) ask their doctor, given the stress of the consultation and the paucity of time.
• They are trained to interview patrons for their information needs, so they can help them formulate their requirements correctly.
• They are objective and neutral because they do not have any vested interests in influencing the patient’s medical decisions.

The role of librarians is not restricted to helping only patients. Medical librarians are trained and experienced in conducting medical literature searches. They are often asked to locate a specific medical journal article by a doctor when he encounters a patient with a rare problem. Their expertise in drilling down and finding the most relevant references or information can often make a significant difference in the quality of medical care which a patient with a complex or rare problem will receive.

For instance, abstracts from most medical journals are published free online in PubMed - []. Doctors and patients can search the medical literature themselves, using this excellent resource. However, they often get lost and may not be able to find critically important information because they have not searched using the right keywords (MeSH terms – which are very special in PubMed). PubMed is a complex database, and the experience and expertise which a medical librarian can bring can make all the difference between a useful search and an exercise in futility.

With Google at our disposal, one might wonder whether we still need librarians and libraries. Contrary to popular belief, Google does not cover all the resources on the Internet. And not all information is available online – free or for a fee because a lot of high quality information is locked up in books ! Google searches the entire Internet, and since it’s not intelligent, often its search results contain unreliable and outdated information , which can harm rather than help. And of course a librarian can help you use Google itself to get better answers. If patients need in-depth answers and have got upset, frustrated and lost on the net (which is often the case), they are far more likely to appreciate the immense value which a librarian can add in holding their hand and helping them to find prescription quality information.

Sadly, medical librarians are an unappreciated and underutilised lot in India today, and we have failed to take advantage of their unique skill sets. In fact, in countries like the US, medical librarians accompany doctors on their rounds, so that the medical staff can make optimal use of medical journals and databases. Ideally, every hospital should have a consumer health library (which could be a part of the medical library) so that just as doctors send their patients to chemists, they can also refer them (or their relatives) to the library for Information Therapy.

Information Therapy is an integral part of the healthcare process. Doctors may not be able to explain every single detail to their patients. Instead of wasting time wading through information on the Internet (where a lot of it may be misleading), using a library’s resources (print and electronic access) and a librarian’s help can make a world of a difference to patients.

HELP will be organizing its 2nd Annual Conference on Putting Patients First. The theme this time is : Using Information Therapy to Put Patients First in India.
The website is at

This will be held at Nehru Centre on Sunday, 9th October’11 from 10.30 am - 1.30 pm. Mr.Ken Long , Vice President, International Operations at Healthwise, U.S.A, will be the keynote speaker and he will be talking on “What Healthwise is doing in the US to Promote Information Therapy – what we’ve learned so far”.

On this occasion, we will be releasing a book titled, Using Information Therapy to Put Patients First.

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Monday, October 03, 2011

The story of a couple's dream to have a baby.

Here's a success story from one of our patients. There are still lots of myths and misconceptions surrounding IVF in India, and these first hand accounts help to dispel many of these.

I and my wife come from a middle class family from Pune. We have been married for 5 years and have been trying to conceive baby for 3 years. Around two years back I was diagnosed with Asoospermia. This news was heart breaking especially when we came to know that this situation cannot be reversed. We visited lots of doctors and there was positive outcome of any visit.
Things were very painful specially when see friends of the same age having babies and people asking us.

We thought now there is no chance to have baby at least in the life and thought of going on with the life. But suddenly realized that things are not going to be good given the fact in India it is very important for a couple to have baby. Parents/relatives/friends kept on asking and we kind of tried to kept it away.

One day I was researching on the internet on this situation and came across Dr. Malpani website. Went though the website and thought of giving it last try we scheduled the appointment with Dr. Malpani.

So, we first visited Dr. Malpani in March and we were pretty much impressed the way doctor explained the various options we had to conceive a baby. Since we had already decided to have a baby, we decided to go with the option of IVF/TESE.

We started the treatment and had to visit the clinic only 2-3 times before the IVF. So, in the second visit to the clinic we met Dr. Anjali Malpani. Dr. Anjali Malpani was so good that in few minutes after talking to her you will feel like you talking to a friend/relative. We liked the way she talked to us that day. Definitely cannot be easily forgotten :)

We had our first IVF which didn’t go very smooth the way doctor would have liked. Doctor found out some complexity while doing the embryo transfer but still Dr. Malpani did successfully transfer the embryo.
So, now started the waiting for next couple of weeks to wait and see the results. Unfortunately, the results came negative and it was heart breaking. So, we thought of giving it a one more try and visited doctor one more time. Earlier during first IVF Dr. Maplani suggested to freeze the embryos which was an excellent idea since in the next IVF the cost and medical process is much simpler in the next IVF cycle.

Also, since there was some complexity during the first IVF cycle, Dr. Maplani suggested the approach of ZIFT technology to transfer the embryo. This is a pretty modern technology that only very few doctors can do it today and Dr. Maplani already had the expertise towards this. Also the chance to achieving pregnancy goes high with ZIFT. So, my wife went through ZIFT embryo transfer in the second cycle. This time things went the way doctor was expecting and the minor operation went very well.

So, again the waiting time started for the next couple of weeks. The first pregnancy blood test came out positive and we couldn’t believe it finally happened to us also. After that the second blood report also came positive. My wife is now four month pregnant and we are looking forward to a healthy baby.

I forgot to mention about the clinic staff in the above paragraph. Let me tell you something, I have never-ever seen a good medical staff as Dr. Maplani clinic. They were so good and made us comfortable and helped us in every aspect.

We would like to take this opportunity and thank all of the staff members and also Dr. Aniruddha and Anjali Malpani for all of the happiness that they have given in our lives.

Anybody who is reading this story, I would like to recommend at least to meet Dr. Maplani once before they meet anybody other doctor.

Finally the dream came true of having a baby came true.

Thank you!!!

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Can you trust an IVF clinic's website ?

Most IVF clinics have their own websites these days. This can be very useful for patients , because it allows them to find the information they require about the IVF clinic before actually visiting the clinic itself. However, having so many websites generates a lot of confusion as well. Most websites look very similar - and a lot of them provide exactly the same information. How can the patient trust what information is provided on the website ?

Let’s not forget that websites are created by the clinics to market themselves. They're all full of success stories - but what about the failures? It's hard to trust everything you read on a website , and that's why it's so important to verify everything independently.

Actually , you need to use exactly the same common sense principles which you would in real life as well. Just like you would not blindly trust an ad in the newspaper or buy a television set from the first electronic store you go into , you need to do exactly the same kind of home work when you're selecting an IVF clinic online. While websites can provide a lot of useful information , you need to take them with a pinch of salt and use your own judgment.

You can do a simple test to see how responsive the clinic . Contact them by e-mail through their website. A good clinic is patient centric and will respond promptly to your queries , because they value you as a patient. However, if the clinic cannot be bothered to respond to your queries, this most probably suggests that their service leaves a lot to be desired !

Just like a real world reputation is not always reliable or a good guide, the clinic's website is just a part of the story. It's up to you to fill in the details before making such an important decision. The good news is that the clinic website makes your life a lot easier !

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Sunday, October 02, 2011

Exploring principles from the ER to envision a new patient care model

Please see this video - it gives us a sense of what the future holds for healthcare when clever people starting applying their minds !

“We are at a moment in time in healthcare where we have an opportunity to rethink how we serve patients.” —Kai Worrell. This video documents their exploration of one potential care model for a patient centric future.
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The Baby Boom - Malpani Clinic in Outlook Business magazine

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