PATIENTS FIRST

Producing content for delivering Information Therapy in India – opportunities and challenges

2011-09-21T09:40:00.003+05:30

2nd Annual Conference

Using Information Therapy to Put Patients First

Free Registrations: www.patientpower.in

Mr Parag Vora, CEO, PEAS. www.peasonline.com

Ram Khare, a security guard in a Mumbai suburban society, visits a doctor for his chronic cough, which is diagnosed as ‘bronchitis’. His doctor gives him medicines along with printed material on how bronchitis can be managed effectively. This handout is in three languages – English, Hindi, and Marathi. However, that doesn’t solve the issue. Ram Khare can’t read or write. How does Information Therapy come to the rescue here?

“Effective patient education ensures that patients have sufficient information and understanding to make informed decisions regarding their care.”
American Academy of Family Physicians’ Guidelines for Patient Education

In order for Information Therapy to be effective, the patient education materials used must be both accessible and understandable. Whenever I pose a simple question to doctors about their approach towards patient education and what tools they use for this purpose, their knee-jerk response is – ‘We use print material’. Printed material indeed is one of the most commonly used forms of patient education worldwide. They are either in the form of typical handouts given to patients by healthcare professionals or can be accessed via various health websites. These materials are and always will continue to be one of the most cost-effective methods of patient education for the masses. I am not contesting the efficacy of printed material but I am sure that this not always the best solution in poor countries where health illiteracy is so widespread, and where many health education materials are difficult to understand. This is especially true in India which is many countries within a country! As a result, we miss out on harnessing the power of patient education. Hence it is important to apply a patient-centered approach to developing patient educational material.

As a company involved in developing effective patient education material, we have come across various challenges and situations which have helped us create some simple yet effective ways of delivering patient education material using various media. High-quality patient education material respects the principles of adult learning and should be able to:

· Adapt teaching to the patient’s level of readiness, past experience, cultural beliefs and understanding
· Create an environment conducive to learning with trust, respect and acceptance
· Involve patients throughout the learning process by encouraging them to establish their own goals and evaluate their own progress
· Provide motivation by presenting material relevant to the patient’s needs
· Provide opportunities for patients to demonstrate their understanding of information and to practice skills Barriers in creating patient education material

To overcome the communication barriers created by poor health literacy, it is important to put the patient first when developing educational materials. In India, patient education is still a comparatively new field. While designing engaging patient education material, we come across various issues, practical problems and challenges. The most important of these problems are:
· Financial considerations
· Misconceptions about disease and treatment
· Low literacy and comprehension skills
· Fear of doctors
· Language barriers
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· Negative past experiences with doctors
· Denial of personal responsibility and a sense of fatalism

Over time, we have been able to build a team of doctors, artists and digital graphic specialists. We can tap into our experience and expertise in this niche area, to produce a wide variety of materials which are adapted to Indian conditions. We have made a conscious decision to use the animated format. This is universally understood; so that we do not have to reinvent the wheel every time we create new content.

We now have a library for over 150 hours of unique content; and given the fact that skilled computer professionals charge much lesser for their time in India, we can produce high-quality graphic digital patient educational materials for Information Therapy at a fraction of what it would cost in the western countries. Since we are addressing a neglected market, but are using high-tech tools to do so inexpensively, we feel the future is very bright.

Elements of successful patient education

- Interactivity
§ Educational materials should be engaging and leave an impact on the patient’s mind, thus increasing patient confidence and fostering fast recovery
§ Ease of access and navigation also forms a key feature of patient education programs, thus facilitating easy understanding of the health care plan
§ It should help the patient to develop a positive approach towards his/her health-related problems and not scare him
§ It should help to dispel common myths and misconceptions

- Language
Verbal communication between patient and doctor should ideally be in the same language. But in a country like India, it is impossible for a doctor to know all the regional languages and dialects. A knowledge-rich patient education material dubbed in multiple regional languages can solve this problem for doctors.

- Cultural beliefs
Culture affects how people communicate, understand, and respond to health information. To produce positive health outcomes, it is important for health organizations and doctors to recognize the local cultural beliefs, values, attitudes, traditions, language preferences, and health practices. This means that it’s often necessary to customise patient education materials for local needs. The use of modern digital media allows us to do this easily!

- Infrastructure requirement
Multimedia patient education materials can be used with a wide variety of devices. The good news is that many doctors own smartphones which can be easily used to facilitate one-on-one dialogue with the patient. Print materials should be placed where they can be accessed easily and the visuals are not distorted.

Types and tools to deliver patient education material

- Oral Communication
Communicating one-to-one with the patient is and always will be the cornerstone of effective patient education. In today’s scenario, it is very important the doctor spends enough time answering all of the patients’ queries. Quality is more important than quantity.

- Print
As I mentioned earlier, print material is the most economical and effective way of teaching patients. It is always good to give patients written explanations of their conditions and treatments. One should always look out for materials containing trusted content but at the same time make sure the materials are suitable for everyone. When choosing printed materials, one should remember that the layout and graphics play an important role. We have used a wide variety of printed materials, including:
§ Handouts
§ Leaflets
§ Posters
§ Flashcards
§ Pop-up books
§ Comic books
§ Illustrated books

- Multimedia material
Video and other multimedia presentations are more effective than traditional printed patient education methods in increasing short-term retention of information. However, they should be used as a supplemental part of the patient education process. Even the most well-produced multimedia patient education material will not be effective if there is no window to discuss the content with the doctor.

§ Since multimedia uses visuals and graphics, it helps overcome language barriers. The new clever touch screens are very user friendly, and allow even illiterate patients to assimilate information efficiently !
§ A doctor may sometimes forget to provide some information about a condition/procedure during a consultation, but multimedia content is always consistent
§ Multimedia material is a better choice than print when patients have low literacy levels.
§ One major advantage of video is that it’s possible for the doctor to document that the patient was adequately educated and the consent which the patient gave for the treatment was truly informed consent. This can help in risk management!

A major advantage of modern audiovisual media is that it is all produced in a digital format. This means that it can be delivered through a wide variety of channels and platforms, to a large number of devices, including TVs, PCs, and smartphones. This means that it’s possible to deliver the content inexpensively, no matter where the patient is – whether he is in a hospital bed or in a small village.

HOW INFORMATION THERAPY HELPS PATIENTS TO MAKE SENSE OF THEIR MEDICATIONS

2011-09-13T15:50:00.005+05:30

2nd Annual Conference
USING INFORMATION TO PUT PATIENTS FIRST
Free Registrations: www.patientpower.in

Mrs Kapoor visited her GP for a ‘nagging pain’ in the stomach. Her GP prescribed her a course of antacids. While Mrs Kapoor did get some temporary relief with the medicines, she decided to visit a specialist. The specialist gave her stronger tablets and she took them, while also continuing her GP’s medication. This interaction of drugs exacerbated her problem, and she found herself back to square one. As an educated patient, Mrs Kapoor should have informed the specialist of the medicines that she had been taking. It might well have resulted in a different prescription and a better outcome.

The right drug for the right patient in the right dose by the right route at the right time: this golden rule sums up the ideal prescription – and it seems like such a basic and simple rule. What’s disturbing is how often this rule is broken today in daily medical practice. The good news is that Information Therapy prescriptions can ensure that we follow this simple rule. Medicines are powerful – and every drug can have beneficial effects and undesirable effects. Information Therapy makes sure that the following questions have been clearly answered before taking any medicines.

What should you do if you are taking other prescribed or over-the-counter medicines? What are the short- and long-term risks associated with the medicine? Are there less risky alternatives? What should you do if you inadvertently miss a dose? The list is not exhaustive. As a patient, it is your right to ask as many questions as you wish to clear any doubts.

Your first step should be to read what your doctor has written (no matter how illegible the writing may be), and to clearly understand what the 'hieroglyphics' mean. Don't leave with questions unanswered: ask your doctor or chemist for an explanation of any confusing terms on your prescription. A very useful reference book you should consider purchasing is the Indian Drug Review. This book is easily available at any medical bookshop and is an excellent compilation of details on all the prescription drugs available in India: for instance, their cost; dosage; therapeutic action; drug interactions; and side-effects. Though this book has been written for doctors, it is easy enough for any layperson to use. Not only will this book help in understanding the medicines you are taking, but it may also help you to save money, since you can select a less expensive brand of medicine, after discussing the matter with your doctor.

Your doctor can also help you save money by prescribing generic drugs. ‘Generic’ means that the drug is not protected by trademark registration; and the generic name of a drug is usually a shortened form of its chemical name, so that any manufacturer can use it when marketing a drug. Usually, a manufacturer uses a trade name (or brand name) as well as a generic name for a drug, and you should be able to identify the generic name and the trade name of every drug you are taking. Generic drugs are generally priced lower than their trademarked equivalents, largely because the former are not as widely advertised as the latter. Also, do keep in mind that for certain drugs, it is not advisable to 'shop around' for an alternative, because differences can exist between brands of certain drugs.

The amount of medicine you buy at a particular time depends on several factors, the most obvious one being how much money you have, or how much the insurance company will pay for each purchase. Medicines to treat heart disease, high blood pressure, and diabetes may be purchased in bulk because you will need to take such medicines for prolonged periods. The chances are that you will pay less per tablet or capsule by purchasing large quantities of drugs, and save quite a bit of money: do ask the chemist for a bulk discount!

While medicines are useful in the treatment of certain illnesses, the overuse of drugs has taken its toll, not only in the form of unnecessary expenses but also in the form of sickness, and even death, as a result of an adverse reaction to the medicine. Patients still believe that there is a pill for every ill - and this desire for instant relief translates into billions of rupees for millions of pills, potions, ointments and powders. The pharmaceutical industry in the second-most profitable in the world –right after illegal drug trafficking! Most people take one medicine at least weekly, and more than 25% of the world’s population consumes drugs on a daily basis. Most patients are not happy unless the doctor prescribes a medicine for them - whether or not they really need it. Often, doctors too will contribute to this ‘overmedication syndrome’, and the huge advertising budgets as well as the largesse of pharmaceutical companies lure them to continue doing so on a regular basis.

You must, however, understand that no drug is without its side-effects - after all, anything that has the potential to benefit your body also has the potential to do harm. A 'therapeutic effect' is a desired effect, and a 'side-effect' is an undesired effect - but both are simply effects of the same drug on the body, and go hand in hand. Remember that 80 percent of all ailments are self-limiting and require no treatment. Therefore, think carefully about the costs and risks as well as the benefits before taking any medicine.

You should be especially wary when your doctor prescribes the ‘latest’ and newest drug. For one, such a drug is likely to be much more expensive than its 'older' counterparts. Drug companies nowadays spend large amounts of money in order to induce doctors to prescribe their newest products, because they are much more profitable for them. Also, remember that newer does not always mean better - in fact, new drugs may be more dangerous. Since they have not been used for long enough, some of their harmful effects may not become apparent until many patients consume them over a long period of time. Older medicines, which have been tried and tested over many years, are a safer bet, because doctors have considerable experience with them, and are aware of their risks and benefits. For example, Duract, a new non-steroidal anti-inflammatory drug (painkiller), was withdrawn from the market just a year after being approved for use in the USA (after having undergone rigorous testing), since it was linked with a dozen cases of liver failure, four of them fatal!

Surprisingly, no one knows how many deaths, injuries, and side-effects prescription drugs cause each year - there is no agency which monitors these effects. Who's responsible for this modern epidemic of drug-induced disease? All of us! Pharmaceutical companies, for a less-than-rigorous study of their approved drugs; physicians, who incorrectly prescribe drugs, or over prescribe the 'latest' drug; patients who don't follow instructions or don't tell their physicians about the other drugs they are taking; and even government agencies for not monitoring drug safety more effectively. As a patient, you can help to protect yourself from a therapeutic misadventure by not opting for a newly approved drug unless there aren't any other, well-established alternatives.

Older people are especially prone to the problem of unnecessary drugging. Often, once a doctor starts a patient on a medicine, the latter continues taking it, whether or not he needs it anymore. And each specialist adds to the drug overload, without having a clue about what else the patient is taking. Not uncommonly, it turns out that only one or two of the assortment of drugs is really needed and, once the unnecessary medicines are eliminated, the patient starts feeling much better. In contrast to today's enthusiasm for drugs, it is wiser for you to be a ‘therapeutic nihilist’, in order to let the body heal itself whenever possible.

What can you do to help prevent medication errors? The answer is simple. Learn to ask questions. Just because you haven't been trained as a doctor doesn't minimize the important role you play in preventing errors with regard to your medicines, or those for your family. By the very process of asking questions about your medicines, you understand why you are taking them, how to take them, and what to expect so that you can detect potential errors. The most common causes of medication errors are: similar drug names, similar packaging and labeling, and illegible prescriptions.
The following factors should always be borne in mind:
Avoid medicines to the extent possible. Pregnant women, for example, generally get along fine without drugs (or with very few drugs).
Periodically, bring all your medicines, including over-the-counter drugs, to your doctor for review. Ask your doctor for an information prescription, so you can check for drug side-effects and interactions. Be skeptical of patently extravagant claims made by pharmaceutical advertisers.

Remember that ‘big guns’ are not needed to treat self-limiting or non-dangerous diseases, and that side-effects of medicines may well create more problems than the original illness.
Take oral medicines as far as possible. Such medicines are usually equivalent to injections, and are both cheaper and safer. Many patients still naively believe that injections are more ‘powerful’, but this is purely a myth!
Beware of physicians who prescribe new medicines at each visit without modifying or discontinuing previously prescribed drugs. Many patients are not happy unless the doctor gives them a medicine for their problem, even if this is not required - and many doctors are happy to pander to their patient's fancy. In fact, many patients still judge the calibre of the doctor by the length of his prescription and by the cost of the medicines he prescribes!

Taking two or more drugs at a time can complicate matters considerably, since they can interact with each other, resulting in either adverse effects, or a reduction in their efficacy. The best way of minimizing this problem is to limit the number of drugs you consume, taking only what is strictly necessary.

OTC drugs

Drugs that can be purchased without a prescription are referred to as over-the-counter (OTC) drugs, and these have become a worldwide phenomenon in the present era of globalization. Common OTC medicines include pain relievers, laxatives, cold-relieving preparations and antacids. They are consumed rather indiscriminately by millions of people, but think carefully before purchasing an OTC drug. Do you really need a medicine in the first place? For example, rather than popping a sleeping pill into your mouth every night, a glass of warm milk may provide a better solution for your insomnia. Similarly, simple measures such as steam inhalation and salt-water gargling can provide as effective relief from a sore throat as can medicines. Unfortunately, most people would rather take a pill for every ill. More than 100 OTC drugs are available for treating the common cold - none of which have been shown to be effective.

Just because a medicine is available over the counter does not mean it is completely safe, and you should always check with your doctor before taking it. Sometimes, OTC drugs can actually be harmful. For example, taking painkillers over many years can cause kidney failure and swallowing tablets to self-treat a fever may mask certain illnesses such as tuberculosis or malaria. Don't just depend on a friend's advice or on your chemist's suggestions: always discuss OTC drugs with your doctor.
Discuss your medication with your chemist. Unfortunately, chemists still represent a very underutilized resource in India. Every chemist's shop must have a duly qualified and trained pharmacist. Pharmacists are professionals who have done a four-year course in a pharmacy college and are knowledgeable about medicines and their effects. If you have any doubts, seek out the pharmacist in the chemist's shop; the clerk or the shopkeeper may not know anything about medicines.

You should be able to identify your medicines properly. Many errors are made at home by taking a wrong tablet or capsule that appears similar to another family member's medication. The ability to recognize your medicines can help in preventing you from taking the wrong drug. If you believe an error has occurred, contact your doctor, pharmacist, or nurse as soon as possible. Do not take the medication until all your doubts have been dispelled.

As far as possible, patronize the same chemist for prescriptions drugs as well as over-the-counter drugs. A complete record of your medication history can be kept at the chemist's shop, and some modern chemists have now installed computers that allow them to store the details of the medicines you are taking. This precaution is especially important if more than one physician has been prescribing medicines. A competent pharmacist can also spot hazardous combinations of medicines, and help you avoid possible dangerous drug interactions.

Always keep medicines in their original containers. Many drugs look alike and this can cause an ‘identification crisis'.
Never use another person's medication; and never experiment with medicines just because a friend recommends them. Similarly don't ‘play doctor’ by lending your medicines to your friend or relatives.
Discard all medicines once they have reached their expiry date.
Always remember that you are the one taking your medicines. Therefore, ensure that you are well informed about them, so that you can take them safely. Every time a medicine is prescribed, please make sure that Information Therapy is prescribed with it as well. In most instances, it is as important as the medicine itself!

HOW INFORMATION THERAPY CAN PROMOTE SAFER CARE

2011-09-03T17:27:00.004+05:30

2nd Annual Conference on
Using Information Therapy to Put Patients First in India:
Register Now !

HOW INFORMATION THERAPY CAN PROMOTE SAFER CARE

Rajan Madhok,MB BS MSc FRCS FFPH ,
Medical Director, NHSManchester,ENGLAND
and GAPIO Lead on Patient Safety

Nikhil Datar
MD DNB FICOG FCPS LLB DGO DHA
Consultant Gynaecologist,HindujaHospital, Mumbai
and Commonwealth Fellow 2009, NHSManchester,ENGLAND
Correspondence to rajan.madhok@btinternet.com

HOW INFORMATION THERAPY CAN PROMOTE SAFER CARE

Most patients agree that Information Therapy makes sense. Owing to the anxiety when one visits a doctor, a majority of patients forget half of what the doctor tells them. In such instances, a summary sheet at the end of the consultation can be helpful. An electronic medical record can also ensure that all the information is easily available in one place. This results in a more holistic assessment, and ultimately, better care. But can Information Therapy also help with ensuring safer care? And how can it do so? These are the issues we explore in this chapter. First though, a few words about patient safety and why it is so important.

WHAT IS PATIENT SAFETY

Hippocrates, the father of medicine, exhorted doctors to ensure that their patients did not suffer unnecessarily and his dictum, ‘First, Do No Harm’ (Primum non nocere) has been the guiding principle for doctors worldwide. Medicine in those days was empiric and literally a ‘hit and trial’ affair, which is why such a caution was needed. With the recent dramatic advances in science and technology, most people naively assume that although modern medicine cannot cure everything, it must be much safer. Whilst they would be largely right, it is wrong to assume that modern medicine is completely safe. 21^st century medical care is much more complex, so organising and delivering it safely is a major challenge. Medical knowledge is evolving rapidly, making it difficult for doctors to keep up with newer trends. Since there are so many different players involved now (primary care physicians; organ specialists; nurses; physician assistants; hospitalists; technicians; medical informatics specialists; administrators), there is limited understanding of how healthcare systems can be made to function smoothly. Compared to other safety critical industries (especially aviation), medicine has not yet fully adopted the principles and practices necessary to ensure that complex health care can be delivered safely. The Institute of Medicine’s report ‘To err is human’ assessed that modern healthcare was the sixth leading cause of death; and that more deaths were caused by iatrogenic errors, as compared to breast cancer or road traffic accidents in the USA (Accessed 7 Aug 2011 http://iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx). It has been estimated that almost one in ten patients suffers an adverse event in the hospital; and there is a one in 300 chance of dying in a hospital due to a medical error. Modern medicine is clearly a two-edged sword: on the one hand it can alleviate suffering and on the other hand it can cause harm. Patient safety therefore has become an important public health issue.

HOW CAN INFORMATION THERAPY HELP TO ENSURE SAFER CARE?

Let us take one example to see how this may work.

Healthcare-associated infections (HCAI), acquired in a hospital or clinic, are the most frequent adverse events in healthcare delivery worldwide. Millions of patients are affected by HCAI worldwide each year, leading to significant mortality and financial losses for health systems. Of every 100 hospitalized patients at any given time, 7 in developed and 10 in developing countries will acquire at least one kind of HCAI. The burden of HCAI is also significantly higher in low-income countries than high-income ones, especially in intensive care units and in neonates. For example, newborns are at higher risk of acquiring HCAI in developing countries, with infection rates three to 20 times higher than in high-income countries. (From http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf accessed 7 August 2011)

Practicing good hand hygiene is a simple measure that can dramatically reduce the chances of getting an HCAI. This led the World Health Organisation (WHO) to launch a global campaign to improve hand hygiene among healthcare workers: ‘SAVE LIVES: Clean Your Hands’ is a major component of ‘Clean Care is Safer Care’ and can help reduce the spread of potentially life-threatening infections in healthcare facilities.

This is not a new revelation and the benefits of hand hygiene have been well documented in the past. Semmelweiss in 1847 demonstrated that obstetricians could cut down dramatically the number of women dying after labour by simply washing their hands between deliveries. However, he had great difficulty convincing his colleagues to do so and was hounded out of his hospital attachments for daring to speak out against doctors. Sadly, getting healthcare professionals to change their existing practices has not become any easier since then!

This means we now have a choice. We can continue relying on healthcare professionals to follow good practice to protect patients from HCAI (even though we know that they will often not do so in real life); or we can explore whether patients can do something about it.

This is where information therapy can play an active role! It can be used for the following:

- Advising all patients of the importance of HCAI since not many patients are aware of the magnitude of the problem.

- Convincing patients and their relatives about hand hygiene and getting them to use disinfectant hand sanitizers while in hospitals. This is especially important inIndia, where relatives play such an important role in providing nursing care to patients.

- Making hospitals publish their statistics of hospital-acquired infections. Ideally there should be open reporting of data, showing trends and improvements over time.

- Getting patients to request the healthcare professional ‘touching’ them to wash their hands.

So, here is a sample Information Therapy prescription for a patient going into a hospital:

Please be aware that hospitals are dangerous places and that your hospitalisation can cause you to acquire an infection.
You can reduce your chances of getting an infection by limiting the number of your visitors; and by asking them to wash their hands and to use disinfectant.
Do request your doctors and nurses to wash their hands before touching you or doing a procedure.

This kind of openness and transparency can empower patients; and reinforce the fact that the hospital is doing all it can to ensure that patients are safe and that the risk of errors is being actively minimised.

The Planetree model (www.planetree.org) is an excellent example of how hospitals can greatly improve patient outcomes and reduce patient errors by actively involving patient (and their family members) in medical care. It is the patient who has the most at stake; and by ensuring that patients are well informed, hospitals can help to reduce complications and errors considerably! This will help them to improve patient satisfaction scores and increase patient loyalty, which in turn will result in better hospital occupancy and boost their bottom line. It will also help to reduce the risk of lawsuits because of medical errors!

This prescription can be in the form of written notes, or in an audiovisual form since the use of multimedia can improve patients understanding and retention by over a third. In summary, Information Therapy increases the patient’s ‘ownership’ and helps the patient to explore alternatives by empowering them to choose appropriate care and set realistic goals. The doctor patient relationship becomes more open, based on partnership (rather than paternalistic) and shared decision-making can be achieved.

Information Therapy is equally useful in the doctor’s clinic as well. We all know that often a patient will need to visit different specialists. Unfortunately, as a result of this, care gets fragmented, and problems such as drug interactions are very common. By ensuring that the patient knows exactly what medications he is taking and why, these preventable problems can be avoided with the help of Information Therapy! Information Therapy acts like an immunisation against ignorance. It helps to make sure that things don’t fall through ‘in between the cracks’ and puts the patient back in charge!

CHALLENGES AND OPPORTUNITIES FOR INFORMATION THERAPY

To make information therapy work we have to address some challenges.

First, most people are still unaware of the problem of unsafe care: they believe that modern medicine is a force for good and that doctors and nurses are highly professional people and that they are in ‘safe hands’. So we do need to acknowledge that there is a problem and it is imperative to promote safer care. Second, we still do not know enough about the extent of the problem. How many incidents are occurring? Where? When? What kind? We need to ensure that appropriate data is collected. This will help us to understand the underlying causes of these errors and enable us to design solutions. Finally, do patients or their carers/relatives feel empowered enough to question, and indeed challenge, their doctors? Even doctors often shy away from questioning their own personal doctors when they are ill!

Information Therapy can be a major force in improving patient safety, and we need to create an ecosystem where patients can safely demand that they be given Information Therapy; and doctors feel comfortable doing this routinely and proactively.

The good news is that there are a number of organisations and initiatives to promote the involvement of patients in improving healthcare safety.

WHO Patients for Patient Safety

Patients for Patient Safety (PFPS) emphasises the central role of patients and consumers in improving the quality and safety of healthcare around the world. http://www.who.int/patientsafety/patients_for_patient/en/

Action against Medical Accidents

Action against Medical Accidents (AvMA) is an independent non-profit organisation that promotes better patient safety and justice for people affected by a medical accident. A ‘medical accident’ is where avoidable harm has been caused as a result of treatment or failure to treat appropriately. http://www.avma.org.uk/

Technology can help as well. We are learning how to design and deliver better healthcare, by looking at system designs, and hence are able to identify and eliminate steps where mistakes could occur. Information Technology has a very important role – and by having a unique identifier for every patient, and a single electronic health record, we can provide timely and accurate information to both patients and their doctors!

CONCLUSION

The delivery of the right information, at the right time, to the right patient, by the right doctors/nurses should no longer be left to chance; every patient should get this routinely as part of their care in the 21^st century. Sir Muir Gray, the Chief Knowledge Officer of the NHS inEngland, talks of good quality information provided directly to the patients being the way forward for the transformation of healthcare. In the recent reforms being proposed by the Government in the NHS in England, the Minister has made it clear that he wants a health service where patients are in the driving seat, not as passive recipients of care but as equal partners with healthcare professionals – ‘No decision about me, without me’ – and this cannot happen without huge doses of information therapy. Let us use the opportunities available to us to overcome the challenges and get the care that we all want for ourselves and for our dear ones.

Patients can contribute to Information Therapy

2011-08-31T19:32:00.001+05:30

2nd Annual Conference on Using Information Therapy to Put Patients First in India: Register Now !

What patients can contribute to Information Therapy?

Doctor Sourav Bose was finding it difficult to manage Mr Aditya Rao’s diabetes. Though he had changed the dose of the insulin thrice, his blood sugars remained high. He was at his wit’s end and did not know what to do. He put it down to “non-compliance” and wrote Aditya off as a “ difficult
patient “ ! He failed to recognize that by spending more time with his patient, delving into his lifestyle, and asking him why he was having a hard time with following the treatment plan, he could have come up with an effective solution. Aditya was as much to blame ! He should have discussed the practical difficulties he was facing with taking the insulin injections in his office, as advised by the doctor, instead of meekly accepting his doctor’s advise – and then failing to follow it !

Information Therapy traditionally means the prescription of the right information to the right person at the right time to help make a better health decision. However, if we accept the fact that patients are at the center of the medical universe and that it is patients who are the true experts on their illness, then an equally important part of information Therapy should be the provision of information from the patient to the doctor! After all, communication is a two-way street and the patient’s personal perspective is as important as the medical perspective through which the doctor views the world.

Why has this been neglected so far? Why don't more patients provide Information Therapy to their doctors? This kind of patient education has a long and respected history! While writers have written on what it is like to be a patient for hundreds of years, one of the most important books that taught doctors to re-look at things from the patient's perspective was Norman Cousin's classic, Anatomy of an Illness. In fact, there is now an entire a genre of books that does this very well. This is called pathography - a narrative that gives a voice and face to the illness experience, by bringing the person behind the disease to the forefront!

Pathography is a very useful teaching tool! It helps doctors to learn empathy, so they can learn to see things from the patient's perspective. For example, though I am an IVF specialist, I am not infertile myself. By reading first person accounts of the trials and tribulations faced by infertile couples, I learn a lot about the problems that my patients face – problems that they may not be willing to talk about when they meet me for the first time. All doctors learn medicine from their patients. As Sir William Osler said, ‘He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.’ Unsurprisingly, his best-known saying was ‘Listen to your patient, he is telling you the diagnosis,’ which aptly emphasizes how much a good doctor can learn from a patient!

Doctors usually remember their most challenging patients or their most complex and difficult cases all their life – these often form the defining moments in their professional career. It is true that these exceptional patients teach us a lot and good doctors treasure them, since they learn the most from them. These are a doctor's ‘memorable’ patients - many of whom teach us what not to do ! Intelligent doctors learn from their patients all the time, but this can only happen if patients are willing to teach them! These are the ‘expert patients’ - those who are articulate and treat their doctors as partners in their medical care.

Doctors can learn from every patient, but only if patients learn to speak up, and doctors learn to listen. It is not that doctors are going to learn medical facts from each patient – but each patient is unique and has valuable insights to offer. Patient feedback helps doctors to improve their services, and even complaints are gifts, when taken in the right spirit! Unfortunately, there are still many barriers to getting feedback from patients. Most patients are inhibited and scared and do not have the courage to displease their doctor by telling him the unpleasant truth. If patients want their doctors to do a better job, they need to learn to speak up. Most dissatisfied patients today just walk out of the doctor's clinic and never return. They find a better doctor - but by failing to give the doctor honest feedback, they lose the opportunity to help him improve and do a better job with his next patient. Similarly, most doctors are too busy to ask for feedback, and most continue deluding themselves that they do a perfect job with every patient!

Hopefully, the Internet will allow patients to offer critiques and criticism more easily. There are now many doctor-rating websites, where patients are encouraged to provide their opinion about their doctor. This kind of patient-generated content will help doctors to get their act together, if they are willing to keep an open mind and try to correct problems. Thanks to the Web, smart patients have adopted a number of clever initiatives towards improving medical care. These e-patients, of whom the most prominent is Dave, are speaking up and claiming their rightful place in the healthcare ecosystem, so that patients now have a voice which is heard, and more importantly, respected.

Online patient support groups have a lot of clout – and crowdsourcing the collective experiences of hundreds of patients can actually help advance medical research, as proven by innovative sites such as PatientsLikeMe (www.patientslikeme.com). Patients are also collaborating to fund clinical studies, so that doctors can do research on topics that are of interest to patients , and not just on areas which pharmaceutical companies find remunerative . Patients have also taken a lead role in simplifying medical research so that it becomes understandable to other patients. Cochrane Collaboration (www.cochrane.org) is a fine example of how it is important for researchers, providers, practitioners, and patients to collaborate. 28,000 people from over 100 countries work together to help healthcare providers, policy makers, and patients make informed decisions about healthcare. Such collaboration is imperative in today’s times. When individual knowledge turns into collective knowledge, medical care is substantially enhanced!

Second Pre-conference Seminar: Using Information Therapy To Put Patients First in India

2011-08-30T17:32:00.001+05:30

Invitation to

Second Pre-Conference Seminar@HELP on

Using Information Therapy to Put Patients First

on Saturday, 3rd September, 2011at 11.30a.m. at

HELP LIBRARY - Phone: 22061101, 22031133

Pls click here if you are unable to read this email:

Using Information Therapy to Put Patients First

Speaker	Topic
Dr.Taufiq Panjwani	A medical intern’s perspective on the application of Information Therapy.
Dr.Ninad Maniar	Information therapy and the medical student – a feasible symbiosis
Dr.Akanksha N.Thakkar	Using information therapy to effectively deal with neurodevelopmental disorder related childhood stress
Dr.Mihir Gangakhedkar	Information Therapy and Tackling Pandemics In Developing Nations

Health Education Library for People,
National Insurance Building, Gr Floor,
206, Dr.D.N.Road,
Mumbai - 400 001.
Tel Nos.65952393/ 65952394/22061101
www.helpforhealth.org
www.healthlibrary.com

Have a health query ? ASK US FOR FREE - Click here -

Patient as a Teacher for his Doctor

2011-08-26T10:46:00.000+05:30

There is no doubt that the one person who will look after his own interests the best is the patient himself. You need to do your homework thoroughly, find out more about your problem, and then discuss the results of your research with your doctor. This is your right and your responsibility as well! Every honest doctor will agree that his patients are his best teachers!

When you play the Role of a Communicator

2011-08-25T10:55:00.000+05:30

It is vitally important that you be open and honest with your doctor. When in doubt, ask questions, listen to the answers carefully and take notes. A prudent measure would be to write down your questions before your appointment, so that you do not forget important matters during the stress of consultation. Remember, the only stupid question is the one you don't ask! So, to re-emphasize, don't hesitate to ask questions! And if you don't understand the answers, the fault is not all yours; it could be that your doctor is not explaining the facts well!

2011-08-24T19:10:00.004+05:30

Patient Community Meeting : Pre - Conference Seminar

The first pre-conference was held at HELP on 20th August, 2011.

Young doctors and medical students shared their thoughts on how Information Therapy will help patients and doctors to get better medical care.

Some interesting ideas presented by Dr.Shaivi, Dr.Soumil, Dr.Manasi and Dr.Amar were:

1. The problem is not too little but too much information - how should the patient sieve through all the information
2. Patients are not aware of resources at hand;
3. Support groups are found to be helpful; online support groups equally helpful;
4. What makes the patient happy - is sitting down and talking to the patient - they don't care if the doctor is better known or better qualified;
5. Convert patients from being passive to active
6. Group therapy works better than individual therapy
7. How can IT be used: every hospital should have
- all health information available for patients
- EMR for each patient to help patients and also for research for specific populations
- information should be easily accessible
- translated information
- online access to pharmacies to purchase/refill medicines
- easy communication with your doctor (email/sms)
- obviate need of human communication
- online services should be interactive
8. End Goal of Information Therapy should be Happy Patient ...... Happy Doctor + Staff
9. A website to put up reviews of doctors/services by patients.
10. Arrange the hospital sections to provide a single window to patients for all services including information therapy.
11. Dr.Amar working at Tata welcomed the idea of patient education center at all hospitals.

When you play the Role of a Financial Manager

2011-08-24T11:00:00.001+05:30

Medical treatment can be very expensive these days, and you must make it a point to know the costs involved. Many patients are hesitant to talk to their doctor about money matters, but this reluctance can prove to be very costly! Also, if you are claiming reimbursement (either from an insurance company or from your employer) you must make sure that you have complete records of payments made along with their receipts.

When you play the Role of a Medical Record Keeper

2011-08-23T10:56:00.000+05:30

You must keep all your records safely, and this can be very helpful especially if you have a complex problem a chronic disease, or need to change doctors or get a second opinion. File all your records in reverse chronological order; and number all your documents in sequences. Also prepare a one-page summary sheet of your medical experiences. Software packages are available nowadays, which help you document all medical details very efficiently.

When you play the Role of a Treatment Decision Maker

2011-08-22T10:46:00.000+05:30

You will have to decide which treatment to choose among the alternatives. Sometimes the choices are straightforward, but sometimes they can be very confusing. A good doctor will offer you all the options and help you to decide, but ultimately, you have to exercise your right (and responsibility!) to select a course of treatment. You cannot afford to leave everything to god, or to the doctor either!

When you play the Role of a Medical Team Manager

2011-08-20T10:53:00.000+05:30

You will have to find, evaluate, select, hire - and sometimes fire - members of your medical team. As an enlightened patient, you need to remember that you are the one in charge of your body --- and that it's your medical team you are managing!

INFORMATION THERAPY AND THE RTI ACT

2011-08-19T11:12:00.003+05:30

2nd Annual Conference

Using Information to Put Patients First in India
Being afflicted with a serious disease is a difficult period for a patient. So when Mrs Shah was diagnosed with cancer, she wanted to know everything from her doctor. “Why do I need radiation?”, “Is there any alternative?”, “What are the possible side effects of such a treatment,” “What stage of cancer is this, and will I be completely cured?”, “What is the success ratio of radiation treatment?” were some of her queries. Years ago, such questions would not even occur in a patient’s mind, and he or she would trust her doctor blindly. Even worse, many doctors would not even bother to explain the treatment options to patients. However, today, just like the RTI Act has made government officials accountable and thus enhanced the relationship between the government and the public, information therapy helps to build a more transparent doctor-patient relationship.

The Right to Information (RTI) act has come as major breakthrough in good governance. It encourages transparency and inspires citizens to be more assertive about their rights, because bureaucrats are now more accountable to the public. Earlier, some government officials abused their power with impunity. They could easily manipulate the ‘rule book’ to suit themselves, as a result of which, ordinary citizens ( who were usually in the dark about their rights) were rendered helpless. However, with the advent of the RTI Act , citizens are now in a position to ask questions – and demand written answers ! The concerned official has no choice but to respond with the needed documentation. This has resulted in a healthy respect for the average citizen among officials and bureaucrats , who now think twice about hiding information from citizens.

If Information Therapy was similarly made compulsory, this would help to improve the doctor-patient relationship as well – after all, good doctors have always been happy to share information with their patients !

Unfortunately, some doctors still do not believe in leveling with their patients. This is why patients feel they are at their doctor’s mercy, and every word from their doctor’s mouth is treated as the gospel truth. When doctors had the upper hand and were used to making all the decisions, this resulted in a paternalistic style of practice. While this might have been advantageous in certain situations, it does not fit in with today’s times. Patients today want to play a more active role in making decisions that impact their lives. They do not like feeling handicapped as a result of incomplete and insufficient information. Good doctors understand the importance of having a well-informed patient and will do all they can in their capacity to provide information therapy. Some doctors may not be so proactive, and will require patients to ask for information before they dispense any. In the US, progressive health insurance companies are making it mandatory for doctors to keep patients in the loop about any risks or complications arising from their treatment, however small or insignificant. Even better, they are actually reimbursing doctors for dispensing information therapy, and this incentive is helping to create a win-win situation for everyone !

There is a great opportunity in India today for the IRDA ( Insurance Regulatory and Development Authority) to make the documentation of information therapy compulsory every time a patient claims for medical treatment expenses against his health insurance policy. This will ensure that patients are kept fully informed , and will also help the insurance company to reduce their expenses, as unnecessary surgery and overtreatment will be nipped in the bud.

Patients have the right to be thoroughly informed about their illnesses. Doctors who invest that extra effort in providing their patients with substantial doses of information therapy initiate a positive cycle , where there is transparency in the relationship. This helps foster confidence among patients , who feel that their doctors are interested in helping them get better, and that the relationship between them is not just a monetary one. Doctors also benefit from intelligent patients who ask questions ! Healthy discussions might reveal some issues that a doctor might have overlooked, which could have resulted in a poor outcome.

Empowering citizens with the RTI Act has helped to encourage them to take a proactive role in governance, thus helping to create a more vibrant democracy. Similarly, embedding Information Therapy within every medical encounter can also help to patients to take a more active and involved role in their healthcare – and this can make for happier patients – and happier doctors!

To register for the conference log on to: www.patientpower.in

When you play the Role of a Medical Information Researcher

2011-08-19T10:36:00.000+05:30

The more knowledgeable you are about your problem and its treatment, the better are your chances of getting the right treatment. Educate yourself: you need to become an informed participant in your medical care in order to ask the right questions and to participate in making decisions about your treatment. This step will also help you to critically assess media reports about 'new breakthroughs in medical treatment', and whether these 'breakthroughs' are relevant to your problem or not.

Your role as a Patient

2011-08-18T10:50:00.000+05:30

While you obviously have a vital interest in your medical treatment, unfortunately, you lack the specialized medical knowledge and skills to be able to take decisions in this context alone. This is why the concept of a team - which consists of you and your doctor, becomes very important. As a patient, your responsibilities are wide and varied. And you'll need to play several "roles" at various times.

Your Responsibility as a Patient

2011-08-17T10:50:00.000+05:30

As a patient, you have to shoulder a wide variety of responsibilities, some of which are as follows:

You should provide your doctor with accurate and complete information about your medical history, past illnesses, allergies, hospitalizations and medications.
You should report changes in your condition (however minor they may seem to you) to your doctor - don't keep him in the dark!
If you do not understand what your doctor says or wants you to do, you should let him know without any hesitation!
You should strictly follow your doctor's treatment plan.
You should keep your appointments on schedule, and if you cannot do so for any reason, let your doctor know well in advance.
You should pay your medical bills promptly!
You should follow hospital rules and regulations without fail.
You should have realistic expectations of what the doctor can do for you. Everyone would like to get well completely, but one should always bear in mind that the doctor is not a miracle worker.
You should help your doctor to help you! If you cannot stick to a particular treatment plan, let your doctor know, so that he can formulate an alternative plan.
You should maintain good health habits.
You should participate actively in your medical care. Patients who are highly motivated get better faster: in other words, help your body to heal it!
You should ask questions to clarify any doubts or dispel any misconceptions in your mind. A doctor or nurse may not know when you're confused, uncertain or just want more information. Therefore, do not refrain from asking questions.
You should respect the doctors and the nurses. The medical staff deserves your respect and courtesy: treat them the way you would like to be treated by them!
You should not ask for false medical certificates or padded medical bills (in order to get additional reimbursement).

Lost in the health information maze?

2011-08-16T21:05:00.003+05:30

Mrs Chopra. 45, was recently diagnosed with diabetes. Her doctor followed the standard protocol, prescribing her medicines, and advising her on diet and exercise. She was not content with the advice though. This was something that was affecting HER body, and she wanted to dig deeper for answers. She wanted to know how she could better take care of herself, and while she respected her doctor’s advice, she wanted more information that would set her confused mind to rest. She did what most patients in India and around the world would do – log on to the world wide web. A casual search for ‘Diabetes’ returned 268,000,000 results, with the first as always being Wikipedia, a helpful but often inaccurate portal. Mrs Chopra did not receive accurate, definitive information on her ailment, with different websites suggesting different measures to control diabetes. Frustrated, she simply stuck to her doctor’s advice. Whether she could have done do more for herself, she would never know.

Fifty years ago, the major problem was that patients had insufficient information. All the knowledge was locked up in medical books and journals, and this information asymmetry forced patients to put their doctors on a pedestal. Patients felt helpless, and they were unable to question their doctors due to their limited knowledge on medical matters. Today, there has been a sea change, but ironically, patients are still helpless! This is because they have access to too much information, a major chunk of which is wrong, inaccurate or outdated. Thanks to Google, patients can effortlessly unearth thousands of pages of information on any topic, but this information is poorly organised and is not put in context, which means that patients often find themselves at sea while surfing the web to find specific answers to their queries.

Why is too much information as dangerous as too little? This is because there is a marked difference between data, information, knowledge and wisdom! Moreover, there is no effective quality control when it comes to the internet which further aggravates the problem. It is common to find two different websites suggesting diametrically opposite things. This frustrates and confuses patients, and they wonder who to trust and why.

How can patients judge whether the information is reliable or not? There have been numerous initiatives to assist them in evaluating the sifting of information but, unfortunately, most patients are not equipped with sufficient knowledge to be able to differentiate between ‘good’ information and ‘bad’ information. The sad truth is that many commercial websites can be well-designed and attractive, but under that garb, the information they provide is completely false. Their primary agenda is to sell you something, and not to educate you, which means it is easy to be misled.

This is where Information Therapy comes in ! Information therapy is the prescription of the right information, to the right person, at the right time to help make a better health decision. Information therapy will both revolutionize the role of information in health care and enable patient-centered care.

What about the role of the government? While the UK and USA governments appear to be on track, the Indian government lags behind in providing the required confidence to patients. The NHS in the UK (www.nhs.uk) provides a comprehensive database for patients, assisting them in self-help. One can easily navigate through the myriad conditions and take the appropriate measures to treat their ailments. There are also links that inform you of the nearest hospitals, pharmacies, GPs, rehabilitation centres and the like. In the USA too, the FDA website (www.fda.gov) does a splendid job of informing and educating patients about the recent developments in healthcare. The section on ‘public health focus’ educates patients about the current trends in healthcare, often warning them of a potentially hazardous product or course of treatment. Moreover, patients in these countries are well aware of their rights, enabling them to make informed choices and adopt a no-nonsense approach to healthcare. In India, such an approach is seriously lacking, and patients are generally left to fend for themselves, relying on information on the web that could take them down the wrong path.

Patients need reliable information – a trusted guide who takes them through the healthcare information maze. Ideally, one’s personal doctor should assume this role, but sadly, most doctors cannot afford to spend so much time. So where do patients turn for help? High quality information can be provided by librarians, who are information specialists, and can help in separating the wheat from the chaff. Moreover, the positive aspect about relying on them is that they have no commercial interest in selling patients anything. The Medical Library Association of USA (www.mlanet.org) has taken phenomenal strides in this direction. It comprises 1,100 institutions and 3,600 individual members in the field of health sciences, all working to ensure that the best healthcare information is available to all.

There are also initiatives that provide quality seals to ensure that the information being provided to patients is reliable and of topnotch quality. An example of this is the Health on the Net Foundation (www.hon.ch). Health insurance companies in the USA such as United Healthcare and Aetna ( website url) invested a lot of time and energy in educating their patients, and it makes business sense for them to produce high quality information for their clients, as prevention is far better than cure. However, Indian companies are still lagging behind and have a long way to go before they can catch up!

To fill this gap in India, HELP has partnered with , Healthwiseto use the latest technology to empower patients. The sole mission of the Healthwise Knowledgebase is to empower patients with Information Therapy! Healthwise helps patients make better healthcare decisions by

1.Promoting self care and helping them to do as much for themselves as possible.
2.Providing them with evidence-based guidelines, so that they can ask for the right medical treatment that they need – no more and no less.
3.Equipping them with veto power, so they can say ‘No’ to medical care when they don’t need it, thus preventing overtesting and unnecessary surgery.
The Healthwise Knowledgebase (www.informationtherapy.in) is a free database that acts as a virtual guide, enlightening patients on their ailments, so they can take the right path to healthcare. One can also log on to the Health Education Library for People website (www.healthlibrary.com) where one can ask any question about a particular ailment

What of the future ? With advances in telemedicine and internet penetration and speed, it’s possible that the web will allow patients to access an online virtual doctor with impeccable bedside manners, who can guide and reassure patients , enabling them to take informed choices about their health!

The Ideal Doctor's Code of Practice

2011-08-16T17:15:00.000+05:30

The People's Medical Society in the USA encourages doctors to display the following code of practice in their clinics. This code comprises are excellent guidelines for all doctors to follow, and you might consider sharing it with your doctor!

The code runs as follows:

I will assist you in finding information resources, support groups and health care providers to help you maintain and improve your health. When you seek care for specific problems, I will abide by the following code of practice:

I will post or provide a printed schedule of my fees for office visits, procedures, testing and surgery, and provide itemized bills.
I will provide certain hours each week when I will be available for non-emergency telephone consultations.
I will schedule appointments to allow the necessary time to see you with minimal waiting. I will promptly return your phone calls and inform you if your test results.
I will allow and encourage you to bring a friend or relative into the examining room with you.
I will facilitate your getting your medical and hospital records, and will provide you with copies of your test results.
I will let you know your prognosis; including whether your condition is terminal or will cause disability or pain, and will explain why I believe further diagnostic activity or treatment is necessary.
I will discuss diagnostic, treatment and medication options for your particular problem with you (including the option of no treatment) and describe in understandable terms the risk of each alternative, the chances of success, the possibility of pain, the effect on your functioning, the number of visits each would entail and the cost of each alternative.
I will describe my qualifications to perform the proposed diagnostic measures or treatments.
I will let you know of organizations, support groups, and medical and lay publications that can assist you in understanding, monitoring and treating your problem.
I will not proceed until you are satisfied that you understand the benefits and risks of each alternative and I have your agreement on a particular course of action.

Promoting Information Therapy in India

2011-08-11T15:13:00.003+05:30

All does not seem to be well with the Indian healthcare system. To put it succinctly, it has become sick. Today, doctors assume the role of illness specialists, and not healthcare experts. India appears to be crumbling under the increasing demands that the burgeoning population is putting on the healthcare infrastructure. But is there a way out? Is there a plausible solution to this very real crisis? Yes, there is one, and it’s got a name – Information Therapy. The right information at the right time for the right person can be a powerful medicine!

However, this concept is still in its infancy in India. When people talk about the problems facing Indian healthcare, the primary focus is on the shortage of doctors, and how we need to invest more money in training new ones. While opening medical colleges is rather profitable for politicians (which is why they do this all the time), this does not address the underlying issue. More doctors just create more demand for medical services, and much of this medical care is unproven, unnecessary and expensive! Too many doctors often leads to overtesting and overtreatment – and not always to better medical care !

Our initiative, Health Education Library for People (HELP), has adopted an innovative approach. Conceived over ten years ago, it’s India’s first patient education library. Our website, www.healthlibrary.com, focuses on empowering patients with information. As time progressed though, we realized that this was not sufficient. The entire ecosystem needs an overhaul to fix the underlying issues that plague healthcare in India.

What is the point in educating patients if their doctors themselves do not have access to reliable information? In India, the tragedy is that doctors rarely bother to be abreast of the latest advancements in healthcare. A majority are content with depending on their friendly medical representative and attending conferences sporadically. With the phenomenally rapid advances that occur in medicine on a regular basis, their knowledge base is shockingly confined to outdated medical textbooks. Precious few invest in buying new editions of these textbooks or subscribing to medical journals. This is why our next step , in partnership with Elsevier, the world’s largest medical publisher , was to provide the MDConsult database – the world’s largest online medical library, with over 100 full-text medical books and journals, to Indian doctors, at half the price that US doctors pay.

Then, another aspect of the problem dawned upon us. While many Indian patients spend hours online scurrying for information, much of the content provided by Indian hospitals is devoid of any real, definite value to the patient. An example of this is evident in the contrast between the Apollo Hospital and Mayo Clinic websites! Our next initiative has been to tie up with Healthwise, USA, the market leader in providing online patient educational content, so that Indian hospitals now have access to affordable and reliable content for their websites.
We have also realized that there is a major shortage of graphic content designed for Indian patients. This is why we have invested in PEAS (www.peasonline.com), the market leader in making patient-friendly content for patients in India. We feel this market is now set to boom, as more and more patients demand reliable, easy to understand educational materials from their doctors and hospitals.
While there are millions of Indian patients online, where are all the doctors? To address this, we have invested in Plus91 (www.plus91.in) to help encourage doctors to publish their own websites. We have made this process easy and inexpensive, so that every Indian doctor can establish his or her own digital clinic. We hope this will help set up a positive cycle.
The road ahead is still a long one, but one that’s filled with promise. And our ultimate goal, a superlative Indian healthcare system, makes the journey all the more worthwhile. This book is one step in that direction. Our next action steps are to invest in companies which provide e-learning courses for patient education, mobile smartphone apps for educating patients, and companies which will create content in Indian regional languages – a completely untapped, but huge market!

These are exciting times, and we are happy to be playing such an active role in this transformation!

Be Careful

2011-08-11T10:46:00.001+05:30

Remember you have only one life, and you may not get a second chance to rectify a medical mishap. Many patients (or their relatives) who are victims of adverse medical outcomes, later regret not consulting another doctor, but by then the damage has already been done! The best method is to avoid a problem in the first place - by getting a second opinion!

Important point to be noted

2011-08-10T10:38:00.000+05:30

An important point to be noted is that a second opinion should be sought under certain circumstances:

* If surgery is recommended. About 80 per cent of all surgery is elective (i.e., performed on a non-emergency basis). Recent studies have shown that one out of five operations is not really required -- what is considered 'unnecessary surgery.' A second opinion can definitely prevent you from becoming an unsuspecting victim of an overenthusiastic surgeon's knife!
* If the diagnosis reveals a rare, potentially fatal, or disabling disease. The original diagnosis could be incorrect and may need to be revised. Or, even if it is correct, there may be new or experimental treatments available at an institution specializing in the treatment of such a disease.
* If your symptoms persist unrelieved and the doctor can provide no satisfactory explanation for them.
* If the risks and benefits of the proposed procedures are not satisfactorily explained. The patient has a right to know the details about risks and the cost involved and the potential benefits of any procedure, test or surgery. It is preferable to get the relevant details in writing, so that you can digest them at leisure.
* If the diagnostic procedures seem unnecessarily complex or expensive, or both. Some doctors are prone to making excessive use of technology in borderline situations, either due to insecurity or to protect themselves against malpractice litigation.
* If the patient lacks confidence in the doctor's ability to do all that can reasonably be done. Effective treatment demands trust, and a lack of trust is as valid a reason as any other for getting a second opinion.

Other Sources for a Second opinion

2011-08-09T10:45:00.000+05:30

You should also keep in mind that there are other ways of getting a 'second opinion' apart from going to another doctor. Presently, many sources of information can be tapped to verify and countercheck your doctor's opinion; for instance, health books and encyclopedias (all of which are available free at the Health Education Library for People, Bombay) as well as the Internet! For example, you can "Ask the Doctor" at www.flora.org/ask-doctor/, a free site which forwards your medical queries to specialists from all over the world, who then give their respective opinions on your problem.
You can also log in to our website – www.healthlibrary.com for any health related queries.

Second opinion from an Alternative Medicine specialist

2011-08-08T10:47:00.001+05:30

Remember that it is also possible to get a second opinion from a doctor who practices alternative medicine, for example, homoeopathy or ayurveda. Such an opinion will provide a completely different perspective of looking at a problem, and you may prefer this alternative.

Excellent source for a Second opinion

2011-08-06T10:41:00.000+05:30

An excellent source for getting an objective second opinion is the medical faculty of public hospitals - government or municipal. This source, unfortunately, has been grossly underused. The staff members here are basically academicians. Since they teach medical students and residents, they are usually well read and well informed. Moreover, since they do not have a financial stake in providing you with advice, their information is likely to be reliable and accurate. Of course, this procedure does involve the bother of waiting for a long time to get to see the doctor, but this wait is often well worth the effort!

What to tell and what not to tell your second doctor?

2011-08-05T10:30:00.001+05:30

A crucial question is: Should you let the expert know your first doctor's opinion? Many patients do not tell the specialist that they have already consulted another doctor, because they want an unbiased opinion. However, most doctors do not appreciate patients who play games with them. It's far better to be forthright and explain to the expert that you are looking for a second opinion, so that he can explain the pros and cons of all the available options.

Looking for a Second opinion, but where?

2011-08-04T14:20:00.000+05:30

Keeping all the foregoing factors in mind, the question then arises: From whom should you get a second opinion? You should seek a second opinion from an expert who has the courage to give you an unbiased independent conclusion. Such an expert would, obviously be difficult to find, but it's well worth searching for him!

Doctor’s insecurity over referring for second opinions

2011-08-03T10:51:00.001+05:30

They can even ask the doctor (whom they are consulting) himself to refer them to a second or even a third doctor for further consultation. No competent doctor will feel threatened if a patient wants a second opinion! However, many doctors in India do have reservations about referring a patient seeking a second opinion to someone else, as they are worried that the new consultant may 'snatch' their patient away. To solve this problem, some countries abroad have set up specialized second opinion clinics which consist of senior experts who have retired from active practice, but who use their experience wisely to provide unbiased second opinions! Many doctors are happy to refer their patients to such clinics, because they are confident that they will not lose their patients in the process!

Take a second opinion for Yourself!

2011-08-02T10:57:00.000+05:30

However, by getting a second opinion, patients should realize that they are not casting aspersions on a doctor's competence or judgment, but are rather adopting a responsible attitude towards their own health and well-being. All patients have a right to seek a second opinion, and certain circumstances may arise in which it would be appropriate, if not mandatory, for them to exercise this right.

Anxiety for a Second opinion

2011-08-01T11:03:00.000+05:30

Many patients also worry about getting a second opinion on their own accord. For one, they are apprehensive that if their first doctor were to find out that they have gone in for a second opinion, he may be offended. Another source of anxiety is the confusion that would result if they get differing opinions; they are worried they would not know what to do when confronted with such a situation. Most patients are quite passive and they tacitly feel that it much easier to trust their doctor and do whatever he suggests, rather than go through the trouble of getting a second opinion.

What if the Second Opinion differs from the First?

2011-07-30T11:54:00.001+05:30

What course of action should the patient adopt if the second opinion differs from the first? Such a situation can be very confusing. Consequently, the patient needs to do a good deal more homework before making a decision. It would be worthwhile to get a family physician (preferably one who has no vested interest in the matter) to advise you. It would also be prudent to discuss the differences in the two opinions with the concerned doctors, so that they can explain and justify the reasons for the discrepancies in their diagnoses or plan of treatment. Remember that it's your body which has to bear the consequences and you need to make your own decisions intelligently. It would be highly sensible to ascertain your options in advance, rather than to burn your fingers and then regret your actions later on!

Dr.Malpani says:

2011-07-29T10:57:00.000+05:30

I always encourage my patients to get a second opinion. As I explain to them: If two different doctors happen to reach the same conclusion, at least you know you are on the right track! However, don't always assume that just because the opinions of both doctors are identical, you are safe. For example, if you have angina and you consult a cardiac surgeon, there is a high likelihood that he will advise you to undergo bypass surgery. A second cardiac surgeon is also likely to recommend the same; after all, it's just simple financial common sense from the surgeons' viewpoint! Therefore, getting a second opinion from a non-surgical specialist (in this case, a cardiologist) can be helpful in preventing unnecessary surgery.

Consulting a second doctor individually

2011-07-28T15:35:00.000+05:30

It may be difficult to get an unbiased opinion from a second doctor who is a member of the staff in the same hospital as your doctor. If at all possible, you should consult an independent doctor in another hospital for a second opinion. Most medical insurance policies that cover consultation fees will pay for this. In case of disagreement between two specialists, a third opinion could prove helpful. In the present age of the telecommunication revolution, the 'magic' of telemedicine enables one to get a second opinion from a leading medical authority in any part of the world. The procedure usually consists of sending such an authority your clinical findings and medical reports through the Internet, so that you can get an unbiased opinion usually in as short a period as two days. Many clinics in India now offer this service in collaboration with leading hospitals from all over the world.

Second Opinion: Needed for Patient or Gain for Doctor?

2011-07-27T10:53:00.000+05:30

Second Opinion

2011-07-26T14:14:00.001+05:30

At present, getting a second opinion has become a common practice among doctors; in fact, the American Medical Association advises that 'physicians should seek consultation upon request; and in doubtful or difficult cases'. That is why family physicians often consult with specialists, and specialists, in turn, consult other specialists - and superspecialists. (Sometimes, though, the process could be misused, and the patient may feel that he is stuck on a non-stop merry-go-round of consulting a wide variety of specialists!)

Second Opinion

2011-07-20T19:24:00.003+05:30

Often, many patients tend to become sceptical or dissatisfied if their doctor suggests that they seek a second opinion, because they feel that such a suggestion indicates that their doctor is not competent. However, one should not forget that medicine is a highly complex science in which rapid advances are the order of the day and it is not humanly possible for one doctor to keep abreast of all developments in all fields. Consequently, a second opinion proves very useful for those patients afflicted with rare or complex problems. Unfortunately, some doctors tend to refer patients unnecessarily to other members of their fraternity. Also, doctors will often cross refer patients to each other for personal financial gain. In hospitals, especially, specialist consultation is often automatic and mandatory, and this process is inevitably overused. The upshot is that the patients bill shoots up! Thus, a hospitalized patient should ask the family physician (who should act as your medical manager) to intervene if the number of specialists involved in the treatment seems excessive.

It may be difficult to get an unbiased opinion from a second doctor who is a member of the staff in the same hospital as your doctor. If at all possible, you should consult an independent doctor in another hospital for a second opinion. Most medical insurance policies that cover consultation fees will pay for this. In case of disagreement between two specialists, a third opinion could prove helpful. In the present age of the telecommunication revolution, the 'magic' of telemedicine enables one to get a second opinion from a leading medical authority in any part of the world. The procedure usually consists of sending such an authority your clinical findings and medical reports through the Internet, so that you can get an unbiased opinion usually in as short a period as two days. Many clinics in India now offer this service in collaboration with leading hospitals from all over the world.

I always encourage my patients to get a second opinion. As I explain to them: If two different doctors happen to reach the same conclusion, at least you know you are on the right track! However, don't always assume that just because the opinions of both doctors are identical, you are safe . For example, if you have angina and you consult a cardiac surgeon, there is a high likelihood that he will advise you to undergo bypass surgery. A second cardiac surgeon is also likely to recommend the same; after all, it's just simple financial common sense from the surgeons' viewpoint! Therefore, getting a second opinion from a non-surgical specialist (in this case, a cardiologist) can be helpful in preventing unnecessary surgery.

When you visit the clinic

2011-06-13T10:41:00.000+05:30

Similarly, when you plan a visit to the clinic, the following points should be kept in mind.

1. Make sure you fix an appointment. Try to schedule it well in advance and call again to confirm it.
2. Try to reach the clinic on time, since the doctor's time (and yours!) is precious.
3. Make sure you have brought along all your records and documents.
4. Try to cooperate with the staff. For example, if the doctor is running late, rather than pepper them persistently with questions, read a book or magazine while waiting.
5. Try to learn the names of the staff members. If you treat them like VIPs, you'll be treated like one as well!

How to Make Your Doctor’s Receptionist Think You’re Terrific

2011-06-11T10:59:00.001+05:30

If you're well organized and well prepared when you phone or visit your doctor's clinic, you'll win the respect and appreciation of the receptionist, which will make him that much more helpful in helping you get the best medical care. For example, when you telephone with regard to a medical problem, the following guidelines can be very useful:

1. Introduce yourself. State briefly (in one sentence) why you're calling. ('I've had fever of 101° for three days and I was wondering if there's something else I should be doing about it apart from taking Crocin). If you don't think your problem is serious enough to merit a visit to the doctor, say so.
2. Be prepared to answer the following questions (use prepared notes!): · What are the specific symptoms? · When (what day/what time) did the symptoms start? · What have you done for relief, if anything? (Refer to notes for names of any prescribed medication or over-the-counter medication you may have taken). · What is the main cause of your anxiety? How would you like to be helped?
3. Keep a pencil or pen and paper handy to take notes.

Appreciate the helpers

2011-06-10T11:00:00.001+05:30

Thoughtful patients should therefore, make it a point to express appreciation to the doctor's gatekeeper, as well as to the doctor. Acknowledge that they have demanding jobs. Not only will this brighten their day (which is, in large part, filled with 'unrewarding' tasks), it will also increase the likelihood of their going the 'extra mile' for you when you need their services.

Tough Job for the Staff

2011-06-09T10:40:00.001+05:30

Remember that being a 'gatekeeper' for a busy practice isn't easy. Pressurized by patients on the one hand, and the doctor on the other a 'gatekeeper's job can be tough. For instance, whenever the doctor is 'running behind' it's usually the gatekeeper who (undeservedly) receives the nasty stares, and side remarks complaints.

Doctor-Staff

2011-06-08T13:32:00.001+05:30

Choosing the right doctor is a little like choosing the right life partner! Although it's true you're marrying only one person, all the in-laws come along as part of the package. Similarly, when you select a primary care physician, you automatically select his staff as well, so make sure you like them, as they will play an important role in your interactions with the doctor! The personality of the staff is often very similar to that of the doctor, and friendly, caring and competent physicians tend to hire friendly, caring and competent employees.

The Clinic Staff

2011-06-07T11:49:00.000+05:30

The clinic staff members are the first hurdle you need to cross in order to contact your doctor which is why they are often referred to as 'gatekeepers'. Your relationship with the staff will often determine how easily you have access to your doctor, which is why it's well worth spending a little time and energy making sure the staff members are on your side!

A Bad Example

2011-04-05T10:38:00.000+05:30

On the contrary, here is an example of a bad telephone call: 'I don't feel good. The doctor treats me for breathing problem. I take three breathing pills, one is green, one is white and one is real, and I ran out of the red one last week. While I have you on the phone, I think I have a fungus on my feet, can you suggest a prescription for something for that as well….'
Making effective use of the telephone can help to save both you and your doctor considerable time, effort and money! learn to use this instrument wisely and well.

A Good Example

2011-04-04T10:35:00.001+05:30

Let me give an example of a precise and useful telephone call: 'I am an asthma patient and have had increasing wheezing today. I am not coughing up any mucus. I am using my albuterol inhaler every three hours but it doesn't seem to work. Last year when I suffered a similar episode, the doctor gave me prednisone and it worked, but the prescription is a year old. What should I do now?

Talking to your doc

2011-04-02T10:42:00.001+05:30

Sometimes, you may have to call a doctor after the clinic has been closed. Remember when you call a doctor after hours, he is trying to help you solve your immediate problem, not provide advice about your entire medical situation. Try to be specific in your complaint; you should know what medications you are currently taking and which of them has proved successful in the past. If you are not happy with the physician's advice or if you feel you are getting worse, go to the nearest emergency room at once.

Be Prepared to

2011-04-01T10:53:00.000+05:30

When you reach your doctor or his assistant over the phone, be prepared to:

* Identify yourself.
* Get to the nitty-gritty quickly, especially if you've phoned after hours. (Have someone else call the doctor for you if you are unable to talk.)
* Define your problems and symptoms accurately but swiftly. Write them down and keep them near the telephone so you can report them quickly and completely.
* Report results of self-tests and other symptoms you have been keeping track of, such as a temperature of 101°F for two days, diarrhea that has lasted for 48 hours, and so on.
* Ask the doctor what you should do and write down his instructions carefully. Ask the doctor to spell out any word if you are unsure about it.
* Ask if and when you should call back, or if you should come to the clinic.
* Ascertain what complications could occur that may require you to hurry to the emergency room.
* Don't forget to thank the doctor for talking to you on the telephone!

Relevant Information

2011-03-31T10:50:00.001+05:30

Today, many physicians make themselves, an assistant or other staff member available to their patients over the phone. Pre-visit questions and routine follow-up on the phone can save you - and your doctor - both time and money. Before making a call, you need to certain relevant information in advance:

* When is the best time to call?
* What is the doctor's rule for returning calls?
* Whom should you speak with (e.g., assistant, nurse) if the doctor can't come to the phone?
* What is the phone number for making emergency calls or for calls when the office is closed?
* Whom can you call if your doctor is out of town?

Keep the following in mind

2011-03-30T10:53:00.000+05:30

* Keep a pen and paper ready so that you can write down the relevant instructions.
* Make sure all your medical records are at hand, so that you can answer questions about your medical problem intelligently and accurately.
* Identify yourself properly, giving your full name as well as your diagnosis (try not to tax your doctor's memory!).
* Ask if you can take a few minutes of the doctor's time now, or whether you should call back again - this is common courtesy!
* Report specific symptoms. For example, rather than just saying, 'I don't feel well, or I've got the flu,' which can be interpreted in different ways, be prepared to describe your symptoms precisely; for instance, fever, sore throat, cough, and/or body ache. Similarly, instead of just saying, 'my baby has a fever' specify the exact temperature and the duration of the fever as well as other signs or symptoms.
* When you don't know what you need (for example, you may not be sure how serious the illness is, i.e., if you require a visit to the clinic), tell the staff you're uncertain and request that you speak to a nurse or the doctor's assistant over the phone. Don't be hesitant; if you're feeling concerned or anxious, let the clinic staff know.
* Don't insist on talking only to the doctor every time you call. For example, if you just need to make an appointment, or merely clarify a doubt, the nursing staff or receptionist may be able to help you. To put it differently: respect your doctor's time!
* Don't misuse the phone by trying to wangle a free consultation. Not only is this act unfair to the doctor, but also such a consultation is likely to be very unreliable!

Get advice over the phone

2011-03-29T10:34:00.000+05:30

Often times, you can save yourself a long wait for the doctor at the clinic by getting timely advice on the telephone. Such a trend is becoming increasingly important today, when time is at a premium and commuting is so arduous, thanks to frequent traffic jams! You need to learn to make intelligent use of the phone to get appropriate help from the doctor. However, when you're sick or hurt, it becomes difficult to think clearly and the following routine may help you to help the doctor give you the care you need over the telephone.

Good Communication = Good Results

2011-03-25T10:43:00.000+05:30

Most capable doctors will agree that they learn from their patients all the time, just as a good teacher learns from his students! A skillful doctor treats the patient as the captain of the ship and himself as the navigator, and a balance of respect between the doctor and the patient can foster a partnership in which both learn all the time! However, remember that playing an active role in your own health care places the responsibility for reliable communication with your doctor squarely on you!

Help from your Family

2011-03-24T10:34:00.000+05:30

Even if a family member or a friend can't accompany you to the clinic, he or she can still help. For example, such a person can serve as your sounding board, helping you to practice what you want to say to the doctor before the visit. And, after the visit, talking with that person about what the doctor said can remind you about certain important points and help you come up with fresh questions to ask the next time.

Your care taker

2011-03-23T10:33:00.000+05:30

If a relative or a friend has been taking care of you at home, taking that person along when you visit the doctor could prove beneficial. In addition to the questions you have in mind, your caregiver may have certain concerns he or she could like to discuss with the doctor.

Taking a companion along

2011-03-22T10:59:00.000+05:30

It would definitely be advantageous to take a family member or a friend with you while visiting the doctor's clinic. You will feel more confident if someone accompanies you. Also, a friend or relative can help you remember what you planned to tell or ask the doctor. He or she can also help you remember the doctor's advice. But don't let your companion play too prominent a role; after all, the communication is between you and your doctor. Also, you may want to spend some time alone with the doctor to discuss personal matters. Therefore, let your companion know in advance the extent to which he or she can be helpful.

Communication is the Key

2011-03-21T11:07:00.001+05:30

Remember that communication between a doctor and a patient is a two-way process. Both the doctor and the patient must work together on activities such as listening as well as speaking to one another. Honesty and openness with each other are also important factors. The more honest you are, the better your doctor can help you. Much of the communication between the doctor and the patient is personal, as well as confidential. In order to obtain optimum results, you may need to be open about sensitive subjects such as sex, sexually transmitted diseases and death even if you feel embarrassed or uncomfortable. Doctors are accustomed to talking about personal matters and will try to ease your discomfort to the maximum extent possible.

You have communicated well with your Doc if

2011-03-19T10:36:00.000+05:30

A clear understanding of what precisely your doctor has told you is crucial if you're going to work together as a team.

At the end of your visit, you should be able to:

1. Describe your condition fairly accurately.
2. Know what additional tests are needed and why.
3. Explain your treatment, including the use of medications.
4. State if and when you need to return.

If you can't fulfill the preceding objectives, you're not communicating properly with your doctor!

Your Questions

2011-03-18T10:48:00.000+05:30

Even though most patients realize the need to ask their doctor certain important questions, many of them get tongue-tied when they actually come face to face with their doctor. Not only can they not think straight, but they also often forget what questions to ask! But remember that you will only get answers if you ask the right questions! Rudyard Kipling's five best friends - What? When? Why? Where? How? - should help guide you as to what to ask! A simple example would be asking: 'What is wrong with me? When did the disorder originate? Why? What can you do about it?'

Few Suggestions

2011-03-17T10:45:00.001+05:30

To sum up, the following suggestions will help you communicate effectively with your doctor:

1. Plan well ahead of time what you intend discussing with your doctor about your problem. Your own observations about your health problem can prove invaluable in helping the doctor make an accurate diagnosis. Carry written lists to make sure you don't forget any crucial aspects!
2. If you are confused by complex medical terms, ask for simple definitions. There is no need to be embarrassed; after all, your doctor does want you to understand what is happening to you! Remember that your doctor's objectives and yours are the same to help you to get better as soon as possible!
3. Repeat in your own words what you think the doctor meant and also ask: 'Is my version correct?' Such a clarification will ensure that you understand clearly what the doctor is saying and will also allow him to present the information to you again, if required, in a manner which you can comprehend.
4. Share your point of view with your doctor since he needs to know what's working and what's not. He or she obviously can't read your mind, so it is important for you to put across your thoughts and observations. If you feel rushed, worried, or uncomfortable, do convey your apprehensions to the doctor. Try to voice your feelings in a positive and courteous manner. For example: "I know you have many patients to see, but I'm really worried about my condition. I'd feel much better if we could talk about it a little more.' If necessary, you can offer to return for a second visit to discuss your concerns.
5. Take notes on what the doctor's analysis of your problem is and what you need to do to rectify the situation.
6. Discuss frankly with your doctor if any part of the visit has been annoying or dissatisfactory, such as a lengthy waiting time or discourteous staff. Your approach ought to be tactful, but honest.
7. Don't hesitate to voice your apprehensions about what you may have heard from well-meaning but ill-informed friends or relatives regarding your condition. The doctor may be able to dispel any misconceptions.
8. Discuss any self-medication practices you've used which have relieved symptoms.
9. Don't waste your doctor's time by asking irrelevant questions (for example, about your brother-in-law's medical problem). Such a digression is likely to upset the doctor! Also, try to do as much homework as possible, so that you can ask your doctor questions specific to your particular problem. After all, if you can find the answers to your questions from another source, say, a book or by asking the nurse or receptionist, you can save your doctor's precious time, something which he will deeply appreciate. You can, nevertheless, ask your doctor to confirm that the knowledge you have acquired is accurate!

Few relevant aspects

2011-03-16T10:41:00.001+05:30

The following aspects need to be highlighted:

* Your medical history (including instances of surgery and hospitalization).
* Your family's medical history.
* Allergies you are prone to.
* Medications you have taken (and are still taking).
* Your daily routine.
* Your work schedule.
* Pressures you have been subject to (and are still subject to).

Your thinking of your problem

2011-03-15T10:46:00.001+05:30

Remember to tell your doctor what you think the reason for your problem is! This 'revelation' can often provide the doctor with a useful clue. Ultimately, do not forget that you are the expert on yourself! You should also be able to provide relevant information about your health status, both past and present.

Common Gaffes

2011-03-14T10:53:00.001+05:30

The common gaffes patients make include:

* Getting bogged down in irrelevant details.
* Not providing all the facts.
* Not furnishing the information in a chronological sequence.
* Jumbling up the details, so that they jump from one problem to another completely unrelated one.

Giving a clear medical history

2011-03-12T10:37:00.001+05:30

It is a medical truism that if the doctor listens to the patient intelligently, he will be able to make the diagnosis correctly. However, just like learning to take in a good history is a skill the doctor needs to master, providing an intelligent history is a skill the patient needs to learn. Patients are often slipshod while recounting their medical history so that the doctor needs to methodically extract the facts from them: and this exercise can be a painful for both!

Categorize your problems systematically

2011-03-11T10:50:00.000+05:30

If you remember to categorize all your problems systematically, not only can you make better use of your time with your doctor but you can also help him arrive at a correct diagnosis more quickly! You could rehearse the details you are going to provide to your doctor with a friend or a relative. You could also summarize them on a single sheet of paper, just to make sure you don't forget any vital aspect.

Important Details

2011-03-10T12:32:00.000+05:30

In this context, a useful aide memoir includes the following details:

* Site: Location (e.g., pain is in the chest and then spreads to the left arm).
* Quantity: Bringing up a cupful of sputum when coughing.
* Quality: It feels like an elephant is sitting on my chest!
* Setting: I usually develop such aches after fighting with my wife.
* Aggravating factors: Stomachache becomes worse after eating.
* Alleviating factors: Breathlessness becomes better after resting.
* Associated Symptoms: Other related complaints.

Give a Clear Description

2011-03-09T11:11:00.000+05:30

You need to be able to describe your problem as accurately as possible. For example, if your problem is a headache, you should be able to provide all the details! For instance: Where does it hurt? Has the pain spread elsewhere? How severe is the pain? What does the pain feel like? Is it a sharp, dull, or throbbing pain? When does it occur? What makes it better? What makes it worse? Have you noticed any other symptoms or signs recently, such as fever, shortness of breath or blood in the urine? When did the problem start? Has it changed since then? Have you felt like this before? If so, when? What made the pain better then? Is it affecting your daily activities such as sleeping or eating?

Medical History

2011-03-08T10:49:00.001+05:30

The simple fact that in over 80 per cent of cases the diagnosis of the illness can be made purely on the basis of what the patient tells the doctor (what is called a medical history) should emphasize the importance of one's ability to talk intelligently to one's doctor! While the capability of absorbing the relevant details of an individual's medical history is one of the key skills of a competent physician, being able to provide a lucid history is a key skill on the part of a good patient.

The Final Analysis

2011-03-07T11:25:00.000+05:30

In the final analysis, remember that the most reliable test for a doctor's suitability for you is your own gut instinct - after all, if you don't feel comfortable with your doctor, you are not likely to be able to work well together in your health care partnership with him! On the other hand, if you have faith in his abilities and can trust him that he will do his best for you, you are likely to get excellent medical care!

No Doctor is Right for everyone

2011-03-05T10:42:00.000+05:30

There is no single who is Dr. Right for everyone, and you may need to hunt patiently and persistently for the doctor who is right for you, depending upon your temperament, personality, and perhaps age and sex. Different patients have different expectations- some need to be told what to do while others want all their questions answered. Obviously, they will need different types of doctors. Most people invest a lot of brain power and analytical skills deciding which shares or stocks to buy, but doing in - depth research for finding the right doctor is likely to pay much better dividends for you and your family!

Changing your Doctor

2011-03-02T10:18:00.000+05:30

Changing doctors is never easy, because, over a period of time you do build up a personal relationship with your doctor. However, you should consider changing doctors if you strongly feel that:

* the doctor is incompetent (i.e. he has ignored obvious symptoms, missed a diagnosis, prescribed the wrong drug, or can't get to the bottom of your problem);
* the doctor does not communicate with you effectively ( i.e., his explanations are not in lay person's language or no time is given to you to ask questions and bring up related problems);
* the doctor does not pay attention to your needs and concern
* you have lost confidence in the doctor's skill and ability.
* you find the doctor is too inconsiderate ( i.e., he makes you wait a long time for an appointment, he fails to return your phone calls, he does not provide clinic time during evening or weekend hours ); and
* your doctor is too expensive.

Evaluate your Physician

2011-03-01T10:41:00.000+05:30

In order to feel good about your medical care, you should feel good about your doctor, too. In this context, ask yourself the following questions in order to evaluate your physician:

* Does your doctor listen to you and answer all your questions about the causes and treatment of your medical problems, or is he vague, impatient or unwilling to answer them?
* Are you comfortable with your doctor? Can you openly discuss your inner most feelings and talk about intimate personal matters, including sexual and emotional problems?
* Does your doctor take a thorough history, asking for relevant factors about past physical and emotional problems, family medical history, medications you are taking and other matters affecting your health?
* Does your doctor address the root causes of your medical problems or does he merely prescribe medicine to treat the symptoms?
* Is your doctor well-groomed? A doctor who cannot be bothered to take care of how he looks may not look after you carefully either!
* Does your doctor smoke? (if yes, this should be a black mark against him!)
* Are you satisfied with the doctor's stand-in when he or she is unavailable?
* Do you feel at ease while asking your doctor questions that may sound "silly"?
* Does your doctor explain complex medical jargon in simple terms?
* Are the office staff members friendly? Do they listen to you patiently?
* Does your doctor answer your telephone calls promptly?
* Are you usually kept waiting for a long time even if you have fixed an appointment before hand?
* Does the doctor have hospital privileges at a respected medical institution?

If you are not satisfied with the answers to the proceeding questions, discuss your concerns with your doctor. Even after this discussion if you are still not satisfied, you should consider looking for another doctor.

Searching a Specialist

2011-02-28T10:19:00.000+05:30

The best way of beginning the search is by asking your doctor. To start with, your doctor knows you and your situation better than any other physician, also since most doctors are aware of the accomplishments of "super-specialists" who practice at large university hospitals or research based facilities, your doctor can help you identify there experts. If you can find a book relating to your problem, then the author (if he is a doctor) is likely to be a good choice. The other option is to find the name of a doctor or the head of a clinic or department which is actively publishing their medical research in this field (you can easily do this by doing a Medline search). This doctor (or the head of the clinic) is likely to be an authority in the subject, and will be well-informed of the latest advances in the field. Many patients naively assume that all they need to do to get good medical care is to make a beeline for the west. However, do not automatically assume that just because you go to the USA, the UK or Germany, you will find a competent doctor - you need to do your homework thoroughly before making the trip!

A Bad Doctor

2011-02-26T10:48:00.000+05:30

In contrast, a bad doctor is one who:

* Does not value your time, and makes you wait interminably on a routine basis
* Is more interested in treating your reports than in treating you
* Does not spend enough time with you
* Seems to be too busy and rushed all the time
* Orders tests whether or not they are needed
* Does not explain your options to you
* Discourages questions or refuses to answer them
* Promises too much.
* Makes remarks like "that's my secret."
* Doesn't explain clearly what he is doing during treatment. Sometimes, if you are a victim of a rare or complex problem, you may need to find a “Doctor’s Doctor" i.e. the best doctor in the city, country or the world for your particular problem. How do you go about locating such a doctor?

Attributes of a Perfect Doctor

2011-02-25T10:45:00.000+05:30

At this stage, one may well pose the question: what are the attributes of a perfect doctor? In my opinion, a perfect doctor is one who:

* is respectful and treats you with dignity;
* makes you feel welcome;
* treats more than the symptoms;
* recognizes the expertise of the patient;
* listens to you, explains the relevant facts, asks you questions and answers your questions;
* makes home visits if you require them, or arranges for another doctor to visit you after hours;
* uses pictures and diagrams to explain complex medical terms;
* explains everything, including diagnosis, procedures, treatment and what you can expect in the future;
* is easy to talk to and gives you clear - cut information;
* is open to discussion about alternative systems and is willing to refer you to say, a natural therapist;
* is interested in you, is down-to-earth and treats you as an equal;
* prescribes medication that you can afford;
* fits you in if you are really sick despite a tight schedule ;
* is up-to-date with the relevant information;
* refers to various sources (e.g., books, journals, internet )to clarify information;
* refers you to an appropriate specialist when required;
* refers you to other support services or self-help groups;
* phones back when additional information or tests results are obtained; and
* gives adequate consultation time.

Useful criteria to consider while selecting a doctor

2011-02-24T10:56:00.001+05:30

Useful criteria to consider while selecting a doctor are as follows:

* Is the location of the doctor's clinic important? (In other words, How far do I have to travel to see the doctor? Is it convenient for me? Is there parking space?)
* Is the hospital to which the doctor admits patients important to me?
* Are factors such as the age, sex, race, and religion of the doctor important?
* Do I prefer a solo consultation or a group practice?
* Do I have to choose a doctor who is covered by my insurance plan?
* Is the doctor duly qualified and in which field? For example, a patient with a heart problem may prefer to see a cardiologist, rather than a general physician.
* What days/hours does the doctor see patients? Are the timings convenient to me?
* Does the doctor ever make house calls?
* How much in advance do I have to make appointments?
* What is the length of an average visit?
* In case of an emergency, how fast can I see the doctor?
* Who takes care of patients after hours or when the doctor is away?

Influenced by a doctor’s degree?

2011-02-23T10:47:00.001+05:30

While looking for the ideal doctor, beware of quacks! While many of us tend to be overawed by a long list of alphabets behind the doctor's name, you need to remember that not all of them are legitimate degrees. For example, many doctors will use the 'embellishments' FICA (USA) and FRSH (London) to give the impression that they have been trained abroad. These acronyms are not qualifications- they merely indicate memberships in a society abroad, which are open to anyone- even a barber- on payment of a nominal fee, can acquire such memberships!

A concerned doctor

2011-02-22T10:46:00.001+05:30

A concerned doctor will organize the clinic and its functioning so as to minimize your visits- for example: blood samples can be collected in the clinic itself, to be forwarded to a reliable laboratory, so that you don't need to go there yourself. Similarly, many obstetricians provide the facility for ultrasound scans in the clinic itself, so that patients need not run around from one place to another.

Your First Consultation with a doctor

2011-02-21T10:36:00.000+05:30

During the first consultation, not only should the doctor get to know you and your medical problems by examining you, but you should also get to know a lot about him. Such a initial assessment is important in answering the following vital questions: Are you comfortable with him? Does he explain the details properly? Does he use relevant teaching aids? Does he ask for your views? Does he listen to you carefully?

The Doctor’s Clinic

2011-02-19T10:42:00.001+05:30

While it is true that many mediocre doctors flaunt posh clinics, the setting in which the doctor functions can reveal a lot about him. Is the clinic located in a decent building? Is public access easy? Has the doctor bothered to provide the basic amenities you need (e.g., drinking water, comfortable seating)? What kind of reading material is kept in the waiting area? (Old and torn magazines should qualify as a negative mark. Patient educational literature and current issues of health magazines indicate that the doctor respects your waiting time and wants to use it to educate you). Are the office staff members helpful? How do they answer the telephone? How do they treat other patients? You can learn a lot about a doctor and his practice from the personality of his employees: remember that efficient, caring physicians tend to hire competent, friendly personnel!

To find a doctor

2011-02-18T10:40:00.000+05:30

The best time to find a doctor is when you don't need one! This statement may seem paradoxical, but finding the right doctor when you are ill becomes much more difficult, because of the stress of the illness - as well as the pressure of time. Ask your friends for recommendations. A good source of referrals can be nurses and other paramedical staff. If you have a friend who is a doctor, seek his advice as well.

Primary care physician will oversee your overall medical care

2011-02-17T10:40:00.000+05:30

Primary care physician will oversee your overall medical care
Your primary-care physician should be someone who will coordinate and oversee your overall medical care, referring you to a specialist only if needed. It is not usually a good idea to consult the "top" specialist for every problem, though this seems to have become fashionable these days- for example, rushing to a neurologist for a headache such a step can actually lead to your getting poor care! Specialists often order unnecessary tests (which could be expensive and painful) to rule out rare diseases (after all, they are specialists, and they cannot afford to overlook any possibility, however, remote it may be, while making a diagnosis!).

More Benefits…

2011-02-16T10:25:00.000+05:30

An assurance of continued health may be the most valuable benefit of teaming up with a good primary care physician. Your lifestyle plays a major role in shaping your health and well being in the long run. You, in tandem with your doctor, can define your health goals, analyze your habits and get started on the basics to maintain or improve your health, now and in the future. Your working relationship with your doctor can help prevent serious illness from developing down the line apart from enhancing your well-being, the quality of your life, and your independence for years to come - the biggest benefit of all.

Benefits offered by a Primary Care Doctor

2011-02-15T10:54:00.001+05:30

Ideally, a primary care doctor can offer you the following benefits:

* A good starting point in the healthcare system. Whatever your concern or problem may be, your primary care doctor will either be able to either treat it or determine precisely when and where to send you for specialized help. In either case, you have the distinct advantage of a physician's expertise, and any trips through the medical 'maze' will be less confusing for you...and less of a hassle.
* Preventive healthcare. Your primary care doctor can help you with disease prevention, as well as prompt intervention during any illness.
* Continuity of care. You and your doctor can develop and sustain an on going health partnership. He will get to know your concerns, and you won't have to repeat your history each time you fall ill or need treatment. Your primary care doctor will know you as well as any chronic problems or potential troubles you may be facing. He will also be familiar with your family history.
* One stops shopping. You can consult the same doctor for a variety of conditions, and often, he can treat both you and your family. Your family doctor can take you and your family through pregnancy, childbirth and childcare; instilling the concept of good health at an early age.
* Lower cost and convenience. Primary care doctors generally serve large populations of patients, so they encounter and become familiar with managing the most common medical maladies. They have been trained to diagnose and treat a wide range of conditions cost- effectively. And, in most cases, it's easier to gain asses to a primary care doctor than a specialist, since general practices are usually geared up for maximum efficiency.

Why choose a Primary care Doctor?

2011-02-14T11:13:00.000+05:30

Choosing a good primary care doctor is perhaps the most important step you can take to insure that you get good medical care. A primary care doctor is much more than a quick fix 'craftsman' for an acute illness; he can become your healthcare partner in the long haul...helping you to establish your health goals and periodically evaluating how you're doing while treating any illnesses that come up along the way.

Your Primary care Doctor

2011-02-12T10:54:00.000+05:30

First of all, you need to find a primary-care doctor; i.e., someone who will provide medical care for your whole family; carry out regular checkups; and treat common illnesses. Such a doctor is a usually a general practitioner (also known as a family physician in today's trendy world) or a general physician. Women may prefer a gynecologist, and for your children you may choose to go to a pediatrician. A primary care doctor is trained to recognize common health problems in the patient as a whole; in other words, his "specialty" is comprehensive care of a patient, either on a short or long-term basis.

The Perfect Doctor

2011-02-11T11:20:00.000+05:30

The perfect doctor would treat you as an intelligent person, have plenty of time, as well as infinite wisdom, charge low fees, be totally honest yet compassionate, have a conveniently located clinic and understand your emotional as well as medical problems. While you may never find such a doctor, you need to keep your picture of your ideal doctor in your mind when you are looking for the physician of your choice.

We are the enemies of our health

2011-02-10T12:07:00.000+05:30

All of us hope never to fall ill, but this would be wishful thinking. When we do fall ill, we expect our doctor to be able to help us to tide over the crisis. However, it is a sad fact of life that most of us spend more time selecting a hairstylist than we do in choosing a doctor! Such an anomalous situation often results in our being unhappy with the medical care we receive. Invariably, patients stick to one doctor, even when they are not very happy with him, simply because their family has been going to him for years; or because "he knows my case". Others select a doctor on the basis of capricious reasons; for instance, because "he treated my cousin's friend's case successfully" or because "he is supposed to be the best." However, such reasons do not lead to efficient ways of finding a good doctor.

Certain categories of patients can be particularly irksome or tiresome

2011-02-09T10:59:00.000+05:30

For instance, doctors dislike patients who:

* Expect to be treated on a priority basis.
* Are always late.
* Waste time needlessly.
* Ask the same questions endlessly.
* Think they know all the answers.
* Do not value the doctor's privacy or personal time.
* Do not follow instructions.
* Go 'doctor shopping' i.e., change doctors all the time.
* Don't pay their fees on time. It's always helpful to put yourself in the other person's shoes; i.e., to see things from your doctor's point of view! The ideal patient would be one who:
* Comes to appointments on time, or is thoughtful enough to phone to cancel them.
* Tries to explain exactly what's bothering him; i.e., he can express his anxieties and apprehensions clearly.
* Answers questions honestly.
* Volunteers any important information that the doctor may not specifically ask about, including family history.
* Lets the doctor know if cannot follow his directions and specifies the reasons why.
* Takes medications as directed, strictly adhering to the dose schedule.
* Expresses his dissatisfaction in a courteous manner

Try to do your best to become an ideal patient, and learn to take an active interest in your medical care. After all, this is the only body you have! It's a simple fact of life that patients who know how to make the most of their doctor get better medical care. Therefore, it's very important that you learn how to do so!

Your Medical Records

2011-02-08T11:15:00.001+05:30

Make sure you carry photocopies of all your medical records and tests. You can give them to the doctor for his files, if needed - but keep your originals with you - they are your property! Also, make sure that you have clearly understood the contents of your medical records so that you can explain the details to another doctor if needed.

Speak out when you are made to wait too long!

2011-02-07T11:46:00.000+05:30

While an occasional delay is unavoidable (since a medical emergency could require your doctor's immediate attention), if you are made to wait for an eternity each time, something is seriously wrong with the doctor's attitude towards patients. For any inordinate delay, the clinic staff should be courteous enough to provide an explanation, and, if needed, an alternative appointment. As an example of efficient patient management, if a doctor at the famous Mayo Clinic in the USA makes you wait for more than 30 minutes without an explanation, you can complain to the hospital manager who will rectify matters.

Waiting for your doctor to see you

2011-02-05T11:35:00.000+05:30

The most common complaint of patients is that they are made to wait for ages before the doctor can see them! It is only because patients put up with such a situation that doctors get away with this unpardonable behavior. After all, no doctor would remain very busy if all his patients decide to refuse to wait for him! Some patients seem to believe that the longer they have to wait outside the doctor's clinic, the better he must be, since he has so many patients clamoring for his attention. This is simply not true! No matter how hard-pressed a doctor may be, he can always space out his appointments, so that you never have to wait for more than an hour to see him.

Talk to your physician

2011-02-03T11:43:00.000+05:30

What happens if you and your doctor differ about a treatment option? Let me point out that there's a right way of approaching your doctor and a wrong way. It's simply a matter of mutual respect; you wouldn't want your doctor to assume the worst about you, so, on a reciprocal basis, don't assume the worst about him! Often, if you can put across your feelings and apprehensions in the right way, you can get your doctor to help you. Explain your needs to the physician in a polite way, without any belligerence or hostility. Remember that you are both on the same side - yours!

Talk to your physician

2011-01-28T14:40:00.001+05:30

It is your Right to know your answers!

2011-01-27T12:32:00.001+05:30

Try to find a friend or relative to accompany you for the consultation, as his or her presence can be very useful. He or she can help reduce your anxiety, give you courage to ask the relevant questions, and also help you to interpret the doctor's statements. As mentioned earlier, do not hesitate to ask questions (and more questions); never mind how many other patients are waiting outside the doctor's clinic, or how stupid the questions may seem to you. When you are with the doctor, his only focus of interest should be you, and it's his job to provide answers. Remember, the only stupid question is the one you didn't ask. Be courteous but assertive while asking questions and obtaining information, but don't turn aggressive or antagonistic. Listen carefully to what your doctor says, and in case of doubt and ambiguity, do not leave till these have been dispelled. Remember, the word doctor is derived from the Latin root docere, which means 'to teach'. Therefore, look for a doctor who is willing to share his knowledge with you!

It is your Right to know your answers!

2011-01-27T12:32:00.000+05:30

Prepare your Questionnaire

2011-01-25T11:23:00.001+05:30

Another important point to be borne in mind is to carry written checklists with you during every visit. Normally, you can think up a wide range of questions to ask the doctor, but as a result of the stress generated by the consultation you invariably forget most of them. Such a situation is very frustrating, and you kick yourself when you get home. To prevent this from happening, write down all the questions you need to ask in order of priority. It is also helpful to write down the doctor's answers. Studies have shown that patients forget about 50 per cent of what the doctor tells them during a visit! Writing down the doctor's answers will prevent such a 'disaster'! Moreover, your doctor also stands to benefit because you need not pester him with your queries all over again!

Prepare your Questionnaire

2011-01-25T11:23:00.000+05:30

Next appointment

2011-01-24T11:34:00.000+05:30

Try to schedule your next visit at the end of the consultation. If the succeeding question-answer session is something which can be managed on the telephone, then try to do so. You could save both time and money by avoiding an unnecessary follow-up visit to the doctor's clinic.

Useful terms to talk to your doctor

2011-01-22T11:18:00.001+05:30

The following terms can be very helpful when you talk to your doctor:

* Please tell me more about that.
* What does that mean in simple English?
* Could you explain that to me again?
* Could you write that down for me?
* Where can I find more information about this subject?
* You seem rushed.
* When can I call you to talk about this in more detail?

Ask more

2011-01-21T11:59:00.000+05:30

Since it is your 'head on the block,' so to say, you are entitled to raise all relevant questions and seek satisfactory answers to them. If you cannot understand your doctor's explanations, ask him to repeat everything in simpler language. Ask him to show you illustrations; also, ask for written material that explains the medical issues in greater detail, so that you can study this later at leisure.

Patience with your Doctor

2011-01-20T12:16:00.000+05:30

Do keep in mind that doctors are also human, and they are badgered by their own share of problems. On certain days they may seem rude or curt; on such days, give them a little leeway and a lot of understanding!

The more you ask, the more you will be told

2011-01-18T11:38:00.000+05:30

Do not hesitate to share your thoughts with your doctor. If you think what he is recommending does not make sense, say so, and specify your reasons. If you're worried, do express your anxieties and find out how you can get more information and support to dispel them. If you just sit on your chair and listen meekly, your doctor will either assume that you are uninterested in a full explanation of your illness and its treatment - or that you are too stupid to understand! Remember - the more you ask, the more you will be told!

Speak out to your Doctor

2011-01-17T12:16:00.001+05:30

Your doctor is definitely not a mind-reader and you must tell him everything you know, think, and feel about your problem if you want an accurate diagnosis and the best treatment plan. There is no need to be shy or embarrassed about sensitive subjects such as sexual problems or sexually transmitted diseases as far as your doctor is concerned. Rest assured that doctors have 'seen it all' and 'heard it all' - they're not there to pass moral or ethical judgment on your conduct.