Thursday, December 29, 2011

Review of the book, Using Information Therapy to Put Patients First

My teacher, Dr Bhandarkar, kindly reviewed my book, and had some very nice things to say about it !


It was a privilege to be asked to review Dr. Aniruddha Malpani’s book ‘ Using Information Therapy to Put Patients First ’. Dr. Malpani was my student at KEM Hospital and is now a practicing gynecologist and an ‘ IVF doctor’. But, his mastery over modern Information Technology is amazing. He has ably married his knowledge of both his specialties and produced this book. It is written in simple language and uses jargon only when absolutely necessary. This has made it a highly readable book. I enjoyed reading the book and learned a lot from it. While reading it, I was continually reminded of one the finest books of the same size as the present book that I have read 25 years ago viz. ‘ Statistics In Small Doses ’ by Winifred Castle. The similarity between the two books is uncanny: both have many small chapters, each dealing with one facet of the subject of the book, and are structured superbly with progressive increase in details of information. The chapters are independent of each other, and yet linked by the common theme, Information Therapy, for the empowerment of patients .

Dr. Malpani defines Information Therapy as the “ prescription of the right information, to the right person, at the right time to help him to make the right decisions ”. In this book he has discussed how not only patients but also doctors, hospitals, pharmaceutical companies insurance companies benefit from Information Therapy, medically and financially, the latter without the vulgarity of greed. It is a ‘ win-win situation ’ for every one in the health care world. For the doctors, whenever a patient asks questions about his ailment and its treatment, it should not be looked upon as a burden but as an opportunity to learn. In fact, in life ‘ No questions, No learning ’. Proactive Information Therapy does even better; for, teaching is the best method of learning.

The first eleven chapters describe in detail what the individual doctor can do for his patients and how he can do it. This part of the book resembles ‘ Good Medical Practice ’, a publication of the General Medical Council of Great Britain, in its philosophy. He rightly advocates ‘ ONLINE ’ technology for this purpose, and defends it with the skill of an advocate. He strongly favours each doctor having his own website to make it possible for the patient to learn about his ailment and its treatment at his home and at his own time. The book is full of URLs for a patient to use for learning more about what is prescribed, especially the drugs and their side effects, and to get answers to their questions on 24/7 basis. With the spread of computer literacy in India, and the availability of affordable computers this should be possible, at least for upper middle class and affluent patients. However, this method is time- and funds- intensive and is only possible for doctors who are willing to learn online technology, and are willing to spend the time and money needed, particularly in the initially stages. The online method of patient education also makes it possible for the patient to interact with the doctor via email, without having to visit him at his clinic, and even without using the telephone. Finally, the doctor can learn about the patient’s perception of the treatment which helps the doctor to fine-tune the treatment to suit the patient’s preferences It also facilitates the formation of online patient support groups.

This is followed by chapters on how it makes sense for hospitals, pharma companies and the health insurance companies to participate in generating and transmitting material for Information Therapy. Such an effort on their part gives them more visibility, more credibility, more goodwill and happiness on the part of the users of these services. It lowers their cost of doing business , making them more profitable.

The ready to use and easily accessible Information Therapy material on the internet; and that generated by the doctors for their own patients are the back bone of this effort by various health service providers. If the data generated by this effort is used to build centralized data banks, they will facilitate trans-physician, instant access to patients’ medical records, and therefore continuity and improvement in patient care. Such service has been made possible by the availability of smart-phones and tablets with increasingly powerful processing and transmitting facilities in them.

The author then stresses the importance of medical librarians, who are professionals specially trained in searching information from books, CDs as well as on the internet, and make it availability to practicing doctors, their patients and to the research workers. To do this successfully, they must be respected and given their proper status in the complex hierarchy of the healthcare world.

The author then takes to task the half-baked, circulation-oriented and. therefore, hurried, inaccurate and misguiding medical reporting on the ‘ latest medical advances ’ in the newspapers. He makes a plea that medical reporting in newspapers must be entrusted to a team of full-time devoted news reporter doing exclusively medical reporting.

Information Therapy makes for a more transparent and therefore more trustworthy doctor-patient relationship. It must be recognized that the patients also have ‘ The Right to Information ( RT I ) ’ and this right must be respected by all concerned. It now has received the judicial seal, and it is in the doctors’ interest to embed this in their day to day medical practice.

While doing all this, we will do well to learn from the experience of other countries such as the U S which have such services in place in an advanced form; and then modulate them to suit the ethos in this country.

All in all, this is a comprehensive, easily readable and informative book, and it is worthwhile for every doctor to possess his own copy. Now that the new medical syllabus in India includes an exclusive, 2 ½ month term for a Foundation Course immediately on admission to a medical college, this book should be recommended reading for every new entrant to the medical college. That is the best time to read this book. For the citizens, it can be a Right to Health Information adviser.

It will be helpful if the future editions include a summary appendix , listing all the URLs mentioned in the book and the type of information offered in each of them.

Great going, Aniruddha !

Dr S. D. Bhandarkar, M.D., F.R.C.P. (Edin.), F.R.C.P. (Glasgow)
Retd Hon. Professor & Head, Dept. of Endocrinology & Associate in Clinical Pharmacology
Seth G S Medical College & K E M Hospital, Mumbai

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