Saturday, November 30, 2013

Patient Advocacy Conference videos are now online !

16 NOVEMBER, 2013

Health Education Library for People (HELP) organized its 4th Annual Conference on Putting Patients First. The theme this year was Patient Advocacy - Giving Voice to Patients. On this occasion Dr.Aniruddha Malpani launched his latest book on the same subject. A "patient advocate" is a critical component in the healthcare delivery chain and a caregiver is in the best position to know and understand the needs of a loved one. For more information and to read the book online log on

Health Education Library for People (HELP) organized its 4th Annual Conference on Putting Patients First. The theme this year was Patient Advocacy - Giving Voice to Patients. On this occasion Dr.Aniruddha Malpani launched his latest book on the same subject. A "patient advocate" is a critical component in the healthcare delivery chain and a caregiver is in the best position to know and understand the needs of a loved one. For more information and to read the book online log on

Thursday, November 28, 2013

How patient advocacy can help to reduce avoidable care

Our conference on Patient Advocacy - Giving Voice to the Patient, was a big hit !

We are seeing an epidemic of overdiagnosis and overtreatment  today, leading to excessive medical care which is wasteful and expensive . This is called avoidable care.

There are many reasons for this.
o    Doctors have started practicing defensive medicine , in order to protect themselves from lawsuits for medical negligence
o    Demanding patients want the doctor to use the latest medical technology for their treatment
o    Doctors are seduced into using the latest technology, thanks to marketing pressures from pharma  who aggressively market the latest and most expensive drugs; and medical device manufacturers who push the latest and most expensive technology
o    Because of the issue of moral hazard , patients don’t care about the cost of this new and expensive technology, because it is health insurance companies who are footing the bills, and they don’t have to pay out of their pocket

Sadly, there are no checks and balances today. This hurts everyone.

o    Care gets depersonalized and fragmented amongst too many specialists
o    The latest technology is not always the best. Sometimes, time-tested and proven technology is much safer. There is always a learning curve with new gizmos, and patients end up being used as guinea pigs . Thus, it’s common to read about how drug companies are forced to withdraw the newest blockbuster drugs from the market,  because of side effects which were not recognised  during the research and development process
o    As care becomes more expensive, health insurance premiums will keep on going up

Patient advocacy can help to resolve many of these problems

•    One of one personal patient advocates . They act as well-informed intermediaries , who serve as a bridge between doctors and patients, helping to keep both happy
•    On a system wide basis, health insurance companies and the government can promote patient advocacy . Health insurance companies need to start investing in health guardians and health coaches who help patients to get the right care – not too much and not too little !

Tuesday, November 26, 2013

What patient advocacy can learn from Indian mythology

The 4th Annual HELP conference on Putting Patients First was a great success !

Dr Devdutt Pattnaik gave a great talk on What doctors and patient can learn from mythology. He is India’s leading mythologist – and it’s easy to see why he is in such great demand  as a business speaker. He held the audience spellbound ; and used the story of how the Gods created Amrit ( nectar) as a brilliant metaphor to explain how patient advocates can help bridge the gap between doctors and patients.

You can read the story at

Devdutt pointed out that the gods and the demons did not indulge in a tug of war to extract the nectar – they had to cooperate with each other in order to reach their goal. When one side pulled, the other had to push, and this constructive tension allowed the churn to occur. In order to stabilize the extraction, Vishnu assumed the avatar of the tortoise, who acted as the base .

Similarly, patient advocates have to serve as the patient tortoise, who helps the doctor and patient to work together, so they can reach their common goal.

From the field of mythology, Nrip Nihalani  of Plus91, then took us to the modern world, and suggested that modern information technology and social media could act as the pump to power the churning action ! Patient advocates can use social media to amplify their voice ; and make sure patients can converse with each other efficiently and effectively. The base of every religion is – Help Thy Neighbour – and social media allows us to cut across all geographic boundaries, so patients and patient advocates can transcend traditional barriers and reach out to help each other. Technology can help online communities to help each other more effectively.

Dr Bhavin Jankharia raised a very thought provoking question.  He pointed out that busy surgeons are sometimes not able to spend time advocating for the patient.  However, given their time constraints, does it make sense for specialists to also serve as advocates for their patients ? He asked – If you had to have surgery for a cancer, and had to choose between a technically superb surgeon whose published mortality rate was 10%, but who was rude and uncaring; and a technically average surgeon, whose mortality rate was 50%, but who was superb at caring and advocating for his patients, whom would you select ?

Saturday, November 23, 2013

Digital media for Indian pharma

I was invited to speak at a very interesting conference, Digisights 2013, organized by MediaMedic Communication P Ltd on 15 Nov 2013.  This was designed to allow pharma to explore marketing opportunities offered by Digital and Social media.  As one of the speakers put it cleverly, “ Digital media is like teenage sex – everyone wants to do it, but does not know how to ! “

Why has pharma been such a laggard in using digital media ? In the past, pharma used to be knowledge partners for doctors. They developed new molecules using R&D and  then educated doctors how to use these in their clinical practice, so they could help their patients to get better. Pharma was respected for its scientific prowess; and doctors trusted that the pharma sales force would help to keep them updated with the latest medical advances. This is why pharma depended upon on MRs to market their products; and they never needed to contact patients directly.

However, this model no longer works, primarily because most drugs today are “me-too” products, which are very similar to each other. This is why pharma needs to reinvent itself – and one way of doing so is to reach out to patients directly. The most effective way of doing so is by using social media.

Consumers have power today and its best to recognize this and give them even more by empowering them with information. After all, the drugs which pharma companies market are their molecules – they are the experts on them . They need to be generous and to share their expertise , so patients will appreciate this and be grateful !

However, it’s essential that the information the company provides is neutral and trustworthy. You cannot afford to put any spin on it – and you cannot use this for marketing purposes. If you try to do this, you will burn yoursel. 

Pharma needs to have guts if they want to use social media to reach out to patients. Using social media means giving up control, because you cannot predict what your customers will say about you and you cannot manipulate your audience.  The digital world is not a one way street ! You will get both bouquets and brickbats – but most executives would rather live in a fool’s paradise, rather than find out the truth about what the world thinks about them – and these will become extinct very soon.

Friday, November 22, 2013

Why pharma marketing needs to put patients first !

I was invited to be part of the panel at the CII Pharma Summit 2013.

The key person missing at this conference was the patient ! One of the big opportunities for pharma to reinvent themselves is by promoting patient advocacy by educating patients using digital media. Patients have lots of questions about the drugs the doctors prescribes them. Most of these doubts about side-effects are never answered by either the doctor or the chemist. This lacuna is a huge opportunity for pharma to step in, and educate patients about the medicines their doctor has prescribed for them – after all, pharma is the scientific expert on the molecules and has a responsibility to ensure they are used properly.

Pharma needs to educate the user about this medicines, when he wants this information ( usually, before he actually swallows the pill). Pharma has to be honest, open and transparent, and provide information which the patient wants to know ( warts and all !); in terms he can understand; and also check that he has understood .

It’s becoming increasingly easy and inexpensive to do this using digital technology today.  Pharma can create “ virtue-l solutions “ – after all, Pharma is in the  business of doing good by helping people to remain
healthy .  Doing good can do pharma good !

Is this cost effective ? The ROI can be measured , but not by tracking the number of likes ! The entire pharma industry is based on science, and they need to learn to apply this to marketing as well ! Pharma needs to run controlled experiments in marketing – and marketing team needs to learn how to do this split A/B testing or controlled marketing trial from the medical R& D team.

They need to formulate a hypothesis – that educating patients about their medicines will create good will for them in society; create a positive buzz; improve patient compliance ; and enhance patient loyalty to their brand. They then need to run a trial , using split A/B testing, thus allowing numbers to drive informed marketing, rather than going by preconceived notions, many of which maybe flawed .

The right way to approach this is – We don’t know how cost effective this new channel is, so rather than go by our gut feel or by what “ experts “tells us, let’s run a controlled trial and let our patients teach us !

Thursday, November 21, 2013

Finally, we have been blessed with a Baby !

It all started in 2008, when I had an ectopic pregnancy and got operated immediately. Since then, I had many visits with many gynecologists in Mumbai and many doctors had advised that we go in for IVF. It was a shocking news to me because I never expected that one ectopic pregnancy could lead to my needing IVF. Anyways, there might be other factors as well and the luck was against me at that time.

Before meeting Dr. Malpani, I had gone through two IVF cycles at different Mumbai clinics, but had no success and this added more frustration to me.

Prior to my meeting with Dr. Malpani, my morale was very down because of earlier failures. This changed after my first meeting with Dr. Malpani. The good thing about Dr. Malpani was that he kept on boosting me throughout the treatment and his approach to educating patients during the treatment was something very special. I never experienced this before and this helped me in keeping me relaxed and confident. In Feb’13, I became pregnant again, but with more hope this time. Finally, all the efforts put in by Dr. Malpani paid off and we have been blessed with a baby boy in Oct’13 and the little one has become the meaning of my life.

I sincerely thank Dr. Aniruddha Malpani and his wife Dr. Anjali Malpani for changing my life and I will never forget the efforts they put in during the treatment. Dr. Malpani’s clinic is not just a clinic but also a life changing health centre.

I will definitely recommend Dr. Malpani to all needy people like me and am sure they will not go home with empty hands.

Need a second opinion ?

Please send me your medical details by filling in the form at and I'll be happy to guide you !

Wednesday, November 20, 2013

Baby after 4 miscarriages - a success story with a difference !

It was the 6th year of my wedding anniversary and we were badly missing being parents. I had gone through the emotional and physical trauma of 4 first trimester miscarriages followed by D&C operations.

I was tired of visiting doctors and briefing them about all the miscarriages, blood tests and sonography. All the reports seem to be normal and none of the doctors from Leelavati, Jaslok and several such hospitals could firmly state the cause of our problems. Every doctor wanted to do tests such as hysteroscopy to check if there is any issue. Every doctor dad a different theory and plan. Some of them convinced me that my eggs were bad and could not give rise to a successful pregnancy.

We did not want to get into any experimental mode which would require surgery or cause risks. I started surfing the internet and found details of Dr. Malpani. We met him and in our first visit itself he diagnosed that I had occult polycystic ovarian disease, which could cause missed abortions ; and he advised me just one pill which would regulate my hormones , which were abnormal in the blood reports .

I met him just thrice in the clinic and that's it. Doctor explained to us very nicely that  we could have our own kids by trying in our bedroom; and that the medicine he prescribed, metformin , had helped lot of couples with similar problem. It was a visit of hope. I did not have to go back to the clinic again ! No more visits to the clinic for tests and checks.

I conceived within 2-3 months of treatment. All the further treatment was conveyed thru email and reports of blood tests and sonography were sent to him thru mail. Ask them any doubt and within hours he would reply.

We have a 4 yrs old baby girl now and and am 3 months pregnant with our 2nd baby. And nobody could believe  that I had just spent Rs. 2000 only - on just the consultation . No surgeries, no unnecessary tests.
Just plain talent, in depth knowledge of his subject and a genuine wish to help couples have their babies.
Infertility specialists generally are interested in advanced treatments like IVF and surrogacy , as there is is lot of money involved , but I am happy that there are still doctors who don't work only for money.

We are very thankful to Dr. Aniruddha Malpani. May God bless him always.

Swati Dangat

[email protected]

Need a second opinion ?

Please send me your medical details by filling in the form at and I'll be happy to guide you !

Tuesday, November 19, 2013

Patient Advocacy - What doctors can learn from lawyers

Mr Darius Khambata, the Advocate General of Maharashtra, released our new book, Patient Advocacy – Giving Voice to the Patient.  He eloquently discussed ( without using powerpoint !) the role patient advocates can play in reducing cases filed against doctors for perceived negligence. Medicine is a complex biological science and healing is unpredictable. Not every adverse outcome is a result of medical negligence but it’s become a knee-jerk reflex  now to blame the doctor for negligence every time a complication occurs. Mr Khambata explained that not only do advocates protect  patients from harm, when an unforeseen and unavoidable  medical accident does occur ( as it inevitably will , in a small percentage of cases), they can reassure the patient that this was not because of a careless or incompetent doctor.

He spoke at length about how court verdicts which award huge damages to patients can lead to the epidemic of defensive medicine which we are now seeing in the US – and hoped that we have the wisdom to steer clear of this hazard which leads to overtesting, overtreatment and expensive avoidable care.

He also pointed out that while technology is moving towards convergence, so that a single device can serve as computer, music player, diary , voice recorder, monitor and so on, the medical profession seems to be on the path of divergence, as a result of which specialists know a lot about technical minutiae, but precious little about the patient who has the disease. Family physicians can serve as effective patient advocates to help the patient make the most of modern medicine’s dazzling array of resources, which are spread all over the place, each in its own silo.

He pointed out that lawyers and doctors have a lot in common, and can learn a lot from each other. Lawyers can learn how to heal conflicts from doctors; while doctors can learn how to stand up and advocate for their patients from lawyers !

Patient advocates serve a role similar to what an amicus curae does  in the court.  Just like an amicus helps the judge to find the truth, a patient advocate can help the doctor to get better sooner !

You can read the book, Patient Advocacy – Giving Voice to Patients free online at

Please share this with your friends as well !

Monday, November 18, 2013

Times of India article on the Patient Advocacy Conference

The 6 missing Es in Medical Education

Medical training can be arduous. It comprises years of concentrated training, to ensure that the professional knowledge base of graduating doctors is sound , allowing them to efficiently and effectively take care of their patients . While medical school does a good job in inculcating sound professional theoretical and practical skills so that doctors can do a good job as medical professionals , there are still some glaring lacunae in medical education today. These gaps are one of the reasons the medical profession finds itself in the sad state it is in today.

Some of these gaps were well articulated by Dr. Reddy of the PHFI in an article published in the Hindu in 2009. This is my updated list !


This is a topic which is rarely discussed in medical college . I guess one of the reasons is that it’s very hard to really teach ethics . It’s something you imbibe from your parents, and if your ethical base is not sound by the time you enter medical college, then no amount of lecturing or preaching will help to fix the problem.  Unless we have medical college professors and teachers who are ethical role models, we can talk about ethics until we are blue in the face , but nothing will really change .


The two things which a patient comes to a doctor for are his professional skills and his compassion . If the compassion is missing , then no amount of professional and technical competence can make up for this. Unfortunately, polishing a doctor’s bedside manners and honing his humanistic skills is something which is given short shrift,  simply because there is so much academic content to cover within the four years of medical school , this is an area which is neglected and ignored. Some medical students are fortunate to be exposed to outstanding , who are empathetic , and serve as great role models which they learn to emulate.


Medical schools are usually so focused on teaching students how to make sure their patients get the best medial care, that they often don't factor in how much the treatment they prescribe costs the patient. Money is still a taboo topic – and not one which most doctors bother about.  It’s only when they actually start practicing that doctors learn that many of their patients find it hard to make ends meet ; and that medical care can sometimes be a luxury which a lot of them simply cannot afford . There needs to be more emphasis on the importance of exploring inexpensive alternatives ( such as generics ) during their prescribing thought process.


Doctors take pride in providing great one-on-one medical care – after all, this is their core competence ! They are taught to focus all their energies and attention on the patient sitting in front of them , to the exclusion of all else. While this is extremely important doctors , can't lose sight of the fact that they simple  cannot look at the patient in isolation. Patients come with cultural  baggage and this needs to be factored in when formulating a treatment plan. Unfortunately, students are not taught to think about the patient’s literacy levels or his socio-economic status . While epidemiology that way it is taught today is an extremely dry and boring topic , it is something which pervades all of medicine , and needs to be carefully considered to ensure that the patient gets the care which is right for him .


Lots of doctors enter private practice; and while medicine is a profession, every medical practice is also a small business . While its primary goal is to take care of patients , unless the business is profitable and the doctor is earning money , he will never be able to focus his energies on his patients. Unfortunately, practice management is a completely foreign topic for most doctors; and they often do a bad job at managing their finances, thus hurting themselves and their patients in the long run.


The purpose of medical schools is to educate doctors , and while they do a good job of cramming their students’ heads with tons of information ( which they are forced to regurgitate during the exam in order to graduate), the fact is that a lot of this knowledge will evolve and change as medicine advances. Ironically, most doctors will find themselves out of date within a few years, as medical knowledge today has a very short half life. The most important thing we need to teach future medical doctors is how to educate themselves , so they become efficient lifelong independent adult learners,  and remain up-to-date.

I shared this post with my friend, Dr. Sachin Ganorkar , works in the areas of primary care , family medicine and health administration. He is a proponent of patient centred care and is working on enabling Healthcare through social capital and Information technology platforms .

He had some interesting insights to add.

Doctor Malpani , you have left out some Es  !

This is one of the pillars of medical ethics, but one we aren't taught to factor in. Doctors focus on maximising personal benefits, but promoting equal and free access to heathcare should be at heart of medicine. Doctors are a pampered lot, who are educated in cities and surrounded by amenities they take for granted. The thought of spending even 3 months in a rural area makes all medicos take up arms. They need to be sensitized about the caste, class and economic realities of the country.  We are technically trained professionals, but have become cut off from the social milieu our countrymen live in. Empathy can only be kindled when a doctor spends time in these places - and understands first hand the economic , social and political forces which cause health inequity today.

Education for the Patient
This should not only be for themselves , but for the patient who has come to them to seek help. Doctors are very disrespectful of patients, and they need to learn to treat them with care and attention.  This would prevent over half the medical negligence cases we see today.

Young doctors need tools , and they should be able to be exposed to a skills lab and mentorship. Start up accelerators and incubators in the healthcare space can help to catalyse remarkable changes in this space, and these should partner and collaborate with medical colleges.
Entire Journey of the Patient
The physician should be taught to provide care and hand-hold the patient during his entire journey . Today's care is very episodic and patients often fall in between the cracks of our system. Specialization has lead to fragmentation ; and patients are desperately in need of a family doctor who can act as friend , philosopher and guide during his complete journey - from home to specialist to hospital and back !
E- Health
Everybody seems to be in the E-Health space today, except for doctors ! Physicians can leap frog traditional hurdles and improve their productivity in this technology driven era by participating in the e-Health boom . This can help them to reach out to many more patients much more cost-effectively.

Physicians need to be taught to tackle their egos. Most doctors today live in ivory castles of their own making.

Sunday, November 17, 2013

Patient Advocacy Book now available free online !

When you fall ill, you are likely to be scared and confused. While your doctor can provide you with medical care, patients need much more than just prescriptions and pills. You need:

Emotional support and hand holding
Information to understand your disease and to explore different treatment options
Protection against  medical errors and ensure care is being properly coordinated
Help with filling up forms and claiming reimbursement from the insurance company
Help in communicating efficiently with doctors, getting a second opinion and navigating a hospital’s labyrinthine maze

A patient advocate can do all this !

A patient advocate acts as your health guardian. This book, Patient Advocacy  - Giving Voice to the Patient, explains what patient advocacy is, what patient advocates do and how they can help patients. Anyone who is ill or wants to help a person who is ill will find this book a useful resource. We all need a helping hand especially when we are sick !

Friday, November 15, 2013

Conference on Patient Advocacy - make your voice heard !

One of the scariest place on this planet is a hospital ! This is true when you yourself become a patient – and is even more valid when your loved one is lying there , struggling to get well. Being ill robs you of your ability to judge rationally and take appropriate decisions. A hospital environment is a different world in itself - you enter into it believing , hoping and praying that your health problem will be solved and all will be well. You assume that doctors are angels working hard to protect you and save your lives and that they know everything which is needed to safe guard you. 
But once you find yourself lying in a hospital bed , you realize that being in a hospital is like being trapped in a world where you do not know the language, the inhabitants , and the culture ! You start to panic. Your doctor might speak in a language which you cannot understand ( because he uses medical jargon), and subject you to many tests and therapies (sometimes very painful ones) . When you are not sure what is being done and why, you start wondering whether the tests are really necessary or if it is just a way of taking away your hard earned money.  Most doctors start treating you like a broken object which needs to be repaired and forget that you are a human being with emotions. This happens because they are too busy to talk to you and clear your doubts and fears, while some are burnt out , and don't really care for your emotional well-being. As a result you might end up becoming emotionally exhausted and your mental well-being will be at stake every passing day. 
You do not know whom to ask for help to clear your doubts and concerns and how to get the best out of the many splendid resources that are available in the hospital. This is very true in case of couples who undergo IVF treatment too. You go to the clinic with the innocent expectation that you will come back with a baby . You soon end up frustrated because:
  • you don't understand what your doctor is telling you;
  • why you are being charged so much and for what procedures;
  • why you are being subjected to numerous tests ;
  • what your doctor is looking for; and
  • why your embryos refuse to implant even if they look super good .

Sometimes you start wondering if you are receiving the best treatment possible or if you are just being taken for a ride ! Difficult situation, isn't it ? 

The bitter truth is medicine has become a big business. Many doctors are more worried about their bank balance than their patients’ well-being. Many corporate hospitals operate with their profit in mind , rather than their patient's safety and comfort. In such a situation how will you feel when you find a saviour :
  • who is knowledgeable enough to communicate with your doctor and at the same time explain to you in simple terms what your doctor is thinking ;
  • who can protect your rights as a patient; 
  •  who can question your doctor about why he is ordering particular tests and therapies and their validity ; 
  •  who can understand what you are going through emotionally , and is empathetic enough to infuse you with realistic hopes; 
  •  who can help you make sense of hospital bills and question the hospital administration if there is any discrepancy ;
  • who can help you fill medical forms for claiming reimbursement from health insurance policy; 
  •  who can keep a constant vigil on your treatment so that you are safe - guarded from potential unintentional medical errors which may even endanger your life; 
  •  who can help you access all the available resources in the hospital in times of crisis;
in short, a person who is your teacher, friend, philosopher, guide and savior during your difficult times in the hospital !
Are you wondering whether such a person exists ? Yes they do, and in the field of medicine they are called patient advocates. A patient advocate is a person who is your confidant, who speaks for you, who works in your best interests, who helps you to navigate through the complex health care system and educates you about your medical problem when your health is in jeopardy. 
In the past, when the field of medicine wasn’t this complex , it was easier for a knowledgeable family member to take up the role of being a patient advocate. But today , when so many new discoveries are being made in the field of medicine, there are a mind-boggling number of different treatment options available to treat a particular condition. Even doctors are perplexed by medical complexity and not every doctor keeps himself updated about the advances in their particular field. This is why deciding which treatment option is best for you is not an easy task. Such a complex situation which is plagued with multiple variables, combined with a doctor who does his job mechanically (by mindlessly applying the same treatment approach to all his patients , irrespective of their individual needs) can prevent you from getting the best treatment possible. 
However, if you have a patient advocate by your side , who understands you as a person and cares for you; who is willing to thoroughly research your medical problem and treatment options; and who is happy to spend the time and energy to teach you, so you can jointly decide what kind of treatment will benefit you the most, you will start to feel confident and well-cared for during your difficult times in hospital !
A patient advocate can be your relative, a friend, a patient who has been through what you are going through now (and hence has gained immense knowledge through experience ) or someone who does it as a profession or even an organization which gives voice to the patients. A good patient advocate must be knowledgeable, must have good communication skills (because he acts as a bridge between you and your health care team), must be patient and empathetic enough;  and who is available for you around the clock. Above all a good patient advocate will be a good teacher as well as a student – someone who is skilled enough to help you understand your health problem , and one who is willing to educate himself and constantly update himself in the field he is working.
Patient advocacy is not a new field as far as western world is concerned. But in India the concept of patient advocacy is still new and growing . I am sure sooner or later patients and hospitals in India will encourage the importance of patient advocacy .
Through this blog , I work as a patient advocate ; and it gives me immense satisfaction that I am doing my best to help people who are in a similar situation as I am. So please do write to me if you need help in understanding your IVF treatment. I will be happy to help educate you (as far as my knowledge allows ) about your condition , so that you have realistic expectations; and can  select a treatment option which will work best for you; so you have peace of mind you did your best.
This is a guest post from our expert patient, Manju. You can email Manju at [email protected]
Her blog is at

Need a patient advocate ? Our 4th Annual Putting Patients First conference  will be held on 16 Nov, Nehru Center, Worli, from 10 am – 1 pm. Darius Khambatta, Advocate General, Maharashtra, will be Chief Guest and KeyNote Speaker; and we will be releasing our book – Patient Advocacy – Giving Voice to Patients, at this time. Star speakers include: Dr Devdutt Patnaik and Dr Hemant Morparia ! The website is

Please do come – we need to work together to heal a sick healthcare system !

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