Your SlideShare is downloading. ×
Using Information Therapy   to put Patients First
Using Information Therapy   to put Patients First Dr Aniruddha Malpani, MD   Edited by: Rohan Pasricha
All rights reserved. This book or any part thereof may not be reproduced inany form or by any means without written permis...
This book is dedicated to all patients in India with the hope that Information Therapy willallow all of us to become e-pat...
ContentsPromoting Information Therapy in India           9What is Information Therapy?                    12Chapter 1Lost ...
Medicines – The good, the bad and the ugly        56Chapter 11Listening to the patient                          63Chapter ...
Chapter 21Do patients have a Right to Information?             118Chapter 22FutureGov – Transforminghealthcare by prescrib...
Promoting Information              Therapy in IndiaI nformation Therapy is an idea that seems so simple and  obvious that ...
patients with information. As time has progressed, we haverealised that the entire ecosystem needs an overhaul to fix theu...
We have also realised that there is a major shortage of graphiccontent designed for Indian patients. This is why we havein...
What is Information Therapy?I  nformation Therapy is the prescription of the right   information, to the right person, at ...
complexity involved in doing so. This is one of the reasonswhy there is such little quality information available in India...
compensated). There is a new focus on quality that promotessafer medical care and a move towards pay for performance;a new...
1      Lost in the Information Maze?M     rs Chopra, 45, was recently diagnosed with diabetes.      Her doctor followed th...
has been a sea change, but ironically, patients are still helpless!This is because they have access to too much informatio...
lags behind in providing this key service to its citizens. TheNHS in the UK (www.nhs.uk) provides a comprehensivedatabase ...
Indian companies are still lagging behind and have a longway to go before they can catch up!To fill this gap in India, HEL...
2        Bridging the doctor-patient           communication gapW     hen Mrs Bhatia had swollen, painful knees, her      ...
unpredictable. Most patients understand that the outcome ofmedical treatment is uncertain and that just because a problemo...
outcome, this is the equivalent of adding insult to injury.Patients then get angry and find outlets to express their anger...
3   Synergising alternative medicine     with conventional therapyM     rs Sharma’s house help, Anita, was afflicted with ...
consulted an alternative medicine practitioner, mainly becausethey were unhappy with modern medical care.There are many re...
not have a universally accepted scientific basis; hence, it isdifficult to rigorously analyze its claims. Since there is n...
There is one common underlying principle of medicine thatdoctors should always keep in mind – patient health is toppriorit...
not require formal training or licensing. They pick up a ND orMD degree from some online university, label themselves as‘d...
alternative counterpart, can also be misleading. It is importantfor practitioners of both systems to see the larger pictur...
4 How can we get doctors to prescribe      Information Therapy?M      r Rathod had been experiencing pain in his abdomen, ...
good teachers. All patients want detailed informationregarding their ailments and many feel that their doctors donot bothe...
use tools that make it easy to for them to prescribe InformationTherapy without disrupting their workflow, they will behap...
4. Let us not forget that doctors are rational human beings,   and will respond appropriately to the right financial   inc...
5                How I prescribe              Information TherapyM     y patients, Mr and Mrs Gupta, are sitting in the   ...
I proactively use Information Therapy to clear doubts andanswer questions. This helps ensure that everyone is on thesame p...
Even better, you can get your patients to contribute to youronline resources. For example, we have a section calledSuccess...
that our success rates are excellent, it is also a fact that theoutcome of any IVF cycle is always uncertain, and patients...
6         Doctors need Information               Therapy too!Y   ou’re a doctor from one of the best medical schools in   ...
position to provide state-of-the-art medical care to theirpatients.The only form of CME credits that the MCI recognizes is...
ensure that doctors remain up-to-date. If a doctor’s knowledgebecomes outdated, he or she ends up losing patients to well-...
This is a highly discounted price for Indian doctors only. Youcan take a free tour at www.thebestmedicalcare.com/mdconsult...
7     How patients can contribute to        Information TherapyD     octor Sourav Bose was finding it difficult to manage ...
Why has this been neglected so far? Why dont more patientsprovide Information Therapy to their doctors? This kind ofpatien...
Doctors can learn from every patient, but only if patients learnto speak up, and doctors learn to listen. It is not that d...
role in simplifying medical research so that it becomesunderstandable to other patients. Cochrane Collaboration(www.cochra...
8                 Please ask for             Information TherapyV   andana Gupta was diagnosed with Hodgkin’s    lymphoma,...
understanding the meaning of these terms. My husbandmade the ‘mistake’ of asking the doctor for some information.We were p...
understand. Having suffered the results of an informationfamine during my treatment, I wanted to do my best to makesure th...
requirements, long stay facilities, available treatment optionssuch as chemotherapy, radiation, and surgery, and the rolet...
clinical assistants to provide this information. This reassurespatients because they now know that they are in the hands o...
power to find the right treatment and assist them on the roadto recovery.Doctors, apart from being entrusted with the obvi...
9               Minimizing risk,               Maximizing safety      Dr Rajan Madhok, Medical Director, NHS Manchester,  ...
largely right, it is wrong to assume that modern medicine iscompletely safe. 21st century medical care is much morecomplex...
risk of acquiring HCAI in developing countries, with infectionrates three to 20 times higher than in high-income countries...
•   Making hospitals publish their statistics of hospital-    acquired infections. Ideally there should be open reporting ...
empowering them to choose appropriate care and set realisticgoals. The doctor-patient relationship becomes more open,being...
initiatives to promote the involvement of patients in improvinghealthcare safety.WHO Patients for Patient Safety: Patients...
10             Medicines –     The good, the bad, and the uglyM     rs Kapoor visited her GP for a ‘nagging pain’ in the  ...
alternatives? What should you do if you inadvertently miss adose? The list is not exhaustive. As a patient, it is your rig...
blood pressure, and diabetes may be purchased in bulkbecause you will need to take such medicines for prolongedperiods. Th...
newer does not always mean better – in fact, new drugs maybe more dangerous. Since they have not been used for longenough,...
What can you do to help prevent medication errors? Theanswer is simple. Learn to ask questions. Just because youhavent bee...
•   Taking two or more drugs at a time can complicate matters    considerably, since they can interact with each other,   ...
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Using information therapy to put patients first
Upcoming SlideShare
Loading in...5
×

Using information therapy to put patients first

10,094

Published on

All of us will be patients some day. What can we do to ensure that we get the best medical care when we fall ill?

Information Therapy – the right information at the right time for the right person – can be powerful medicine! Ideally, with every prescription, your doctor should prescribe information; and in a perfect world, every clinic, hospital, pharmacy and diagnostic centre would have a patient education resource centre, where people can find information on their health problems.

This book explores how Information Therapy impacts all players in the healthcare ecosystem – patients, doctors, hospitals, health insurance companies, pharmaceutical companies, and the government – and how it can help all of us.
Information Therapy can help to heal a sick healthcare system – and everyone has an active role to play in making this a reality!

Published in: Health & Medicine, Business
5 Comments
7 Likes
Statistics
Notes
No Downloads
Views
Total Views
10,094
On Slideshare
0
From Embeds
0
Number of Embeds
6
Actions
Shares
0
Downloads
218
Comments
5
Likes
7
Embeds 0
No embeds

No notes for slide

Transcript of "Using information therapy to put patients first"

  1. 1. Using Information Therapy to put Patients First
  2. 2. Using Information Therapy to put Patients First Dr Aniruddha Malpani, MD Edited by: Rohan Pasricha
  3. 3. All rights reserved. This book or any part thereof may not be reproduced inany form or by any means without written permission from the author. Theviews and opinions expressed in this book are the author’s own and the factsare as reported by him which have been verified to the extent possible andthe publishers are not in any way liable for the same.Using Information Therapy to put Patients First© Dr Aniruddha MalpaniPrice : Rs. 300HELP - Health Education Library for People,Excelsior Business Centre,National Insurance Building, Ground Floor,(Near Excelsior Cinema)206, Dr. D.N. Road,Mumbai 400 001.www.helplibrary.comaniruddha.malpani@gmail.com
  4. 4. This book is dedicated to all patients in India with the hope that Information Therapy willallow all of us to become e-patients – engaged, empowered and enlightened!
  5. 5. ContentsPromoting Information Therapy in India 9What is Information Therapy? 12Chapter 1Lost in the information maze? 15Chapter 2Bridging the doctor-patient communication gap 19Chapter 3Synergising alternative medicinewith conventional therapy 22Chapter 4How can we get doctorsto prescribe Information Therapy? 28Chapter 5How I prescribe Information Therapy 32Chapter 6Doctors need Information Therapy too! 36Chapter 7How patients can contributeto Information Therapy 40Chapter 8Please ask for Information Therapy! 44Chapter 9Minimizing risk, Maximizing safety 50Chapter 108 ● Using Information Therapy
  6. 6. Medicines – The good, the bad and the ugly 56Chapter 11Listening to the patient 63Chapter 12How hospitals can earn patient loyalty 72Chapter 13Promoting Information Therapyis good for pharmaceutical companies 76Chapter 14Why Information Therapy makesbusiness sense for health insurance companies 82Chapter 15Healthcare entrepreneurs,disruptive innovation, and Information Therapy 86Chapter 16IT for IT 90Chapter 17Doctor.com 96Chapter 18Switched on – Using mobile phonesto deliver Information Therapy 102Chapter 19Medical librarians – An underrated resource! 105Chapter 20Healthier reporting using Information Therapy 113
  7. 7. Chapter 21Do patients have a Right to Information? 118Chapter 22FutureGov – Transforminghealthcare by prescribing information 122Chapter 23Creating content in India on a shoestring budget 126Chapter 24Learning from the USA – What does the future hold? 132Chapter 25E-patients – Engaged,Empowered, and Enabled experts 14010 ● Using Information Therapy
  8. 8. Promoting Information Therapy in IndiaI nformation Therapy is an idea that seems so simple and obvious that you might wonder – why do we need a bookon this? Doesn’t every doctor educate and inform his patients?Do we really need a new buzzword for something that is sobasic? The tragedy is that Information Therapy, despite beingan unbelievably simple concept, is not implemented routinelytoday – hence the need for this book.It is commonly argued that the primary problem concerningthe Indian healthcare system is the shortage of doctors, andthe need to invest more money in training new ones. Whileopening medical colleges is rather profitable for politicians,this does not address the underlying issue. More doctorscreate more demand for medical services, and much of thismedical care is unproven, unnecessary, and expensive. Toomany doctors can lead to overtesting and overtreatment – andnot always to better medical care!Our initiative, Health Education Library for People (HELP),has adopted an innovative approach. Conceived over tenyears ago, it is India’s first patient education library. Ourwebsite, www.healthlibrary.com, focuses on empowering Promoting Information Therapy in India ● 11
  9. 9. patients with information. As time has progressed, we haverealised that the entire ecosystem needs an overhaul to fix theunderlying issues that plague healthcare in India. We haveadopted the following holistic approach to tackle this complexchallenge.If doctors themselves do not have access to reliable information,then how much good can educating patients do? In India, thetragedy is that doctors rarely bother to be abreast of the latestadvancements in healthcare. A majority are content withdepending on their friendly medical representative andattending conferences sporadically. With the phenomenallyrapid advances that occur in medicine on a regular basis, theirknowledge base is shockingly confined to outdated medicaltextbooks. Few invest in buying new editions of thesetextbooks or subscribing to medical journals. This is why ournext step, in partnership with Elsevier, the world’s largestmedical publisher, was to provide the MDConsult database(www.thebestmedicalcare.com/mdconsult) – the world’slargest online medical library, with over 100 full-text medicalbooks and journals, to Indian doctors, at half the price that USdoctors pay.We also realised that while many Indian patients spend hoursonline sorting through masses of information, much of thecontent provided by Indian hospitals is devoid of any realvalue to the patient. An example of this is evident in the sharpcontrast between the Apollo Hospital and Mayo Clinicwebsites! Our next initiative has been to collaborate withHealthwise, USA (www.informationtherapy.in), the marketleader in providing online patient educational content, so thatIndian hospitals now have access to affordable and reliablecontent for their websites.12 ● Using Information Therapy
  10. 10. We have also realised that there is a major shortage of graphiccontent designed for Indian patients. This is why we haveinvested in PEAS (www.peasonline.com), the frontrunners indeveloping patient-friendly content for patients in India. Wefeel this market is now set to boom, as more and more patientsdemand reliable, easy-to-understand educational materialsfrom their doctors and hospitals.While there are millions of Indian patients online, where areall the doctors? To address this, we have invested in Plus91(www.plus91.in) to help encourage doctors to publish theirown websites. We have made this process easy andinexpensive, so that every Indian doctor can establish his orher own digital clinic. We hope that this will help set up apositive cycle.The road ahead is still a long one, but one that’s filled withpromise. And our ultimate goal, a patient-friendly, high-quality Indian healthcare system makes the journey all themore worthwhile. This book is one step in that direction.These are exciting times, and we are happy to be playing suchan active role in this transformation! Promoting Information Therapy in India ● 13
  11. 11. What is Information Therapy?I nformation Therapy is the prescription of the right information, to the right person, at the right time to helpmake a better health decision. This information cannot bejust generic information, so much of which is easily availableonline. In fact, easy access to so much information at theclick of a button has made both doctors and patients highlysceptical about the usefulness of this information in real life.Excessive information has resulted in information smog,causing greater confusion and uncertainty, since a lot of it isunreliable and misleading.Information Therapy refers to prescription-strengthinformation, tailored to the patient’s needs. Such informationcannot just be of theoretic value – it must result in a tangiblegood. It should help the patient make better decisions. Sowhat do we mean by the ‘right’ information? Who decideswhat is right and what is wrong?The right information needs to be evidence-based; approvedby experts; up-to-date; easy to read and understand; availablein different formats (local languages and audiovisual formats);and referenced. Producing such high-quality informationis not a walk in the park. We underestimate the cost and14 ● Using Information Therapy
  12. 12. complexity involved in doing so. This is one of the reasonswhy there is such little quality information available in Indianregional languages – no one has invested the time and thetrouble to create this as yet, since they still do not see thevalue in doing so.The right person means that this information needs to bedelivered to the patient (and his caregivers), who will make(or help in making) the decision (or behaviour change).The right time means it should be provided when the patientneeds it – just in time to help make a better medical decision(or to improve a health behaviour).There are many ways of delivering this powerful tool.Information Therapy can be clinician-prescribed, system-prescribed, or consumer-prescribed. At present, most patientsget information through their own research. However, theyare often not knowledgeable enough to conduct searches thatprovide valuable results. Ideally, the information should beprescribed by doctors – but this is likely to happen regularlyonly when they get paid for this! The good news is thathospitals and health insurance companies that systematicallyimplement Information Therapy applications will be in a betterposition to gain market share, profitability, and prestige overthose that do not. They will hopefully start doing so routinelybecause it makes business sense for them.Healthcare is changing and we now have to deal with a rapidlyevolving ecosystem. It may take us some time to get there, butwe can learn a lot from what is happening in the US today.The healthcare system there is under a lot of stress, since theyhave empowered consumers (who demand time, information,control, and service) and embattled doctors (who are burntout and resentful because they are starved of time and poorly What is Information Therapy? ● 15
  13. 13. compensated). There is a new focus on quality that promotessafer medical care and a move towards pay for performance;a new way of validating what works and what does not inmedicine (the science of evidence-based medicine); andtechnology to reach out to consumers – thanks to the Internet,which connects anyone, anywhere to top-quality information24x7. These drivers create a compelling case for InformationTherapy – a new approach to healthcare that revolves aroundan expanded patient role.The future of healthcare will emerge in the following ways: • Every clinic visit will be preceded or followed by Information Therapy prescriptions. • Every medical test and surgery will be preceded and followed by Information Therapy prescriptions. • Every hospitalization will engage patient and family support through Information Therapy prescriptions. • Information prescriptions sent between in-person visits will extend the continuity of care.Information Therapy is a very cost-effective solution thatallows the healthcare industry to adopt the long-promisedshift to patient-centered care. As Kahlil Gibran said, ‘Progresslies not in enhancing what is, but in advancing toward whatwill be.’ Information Therapy is the future – and in India,using our medical and IT expertise, we can outdo the restof the world and become leaders in this space. This bookexplores how Information Therapy impacts all players in thehealthcare ecosystem – patients, doctors, hospitals, healthinsurance companies, pharmaceutical companies and thegovernment – and how it can help all of us.16 ● Using Information Therapy
  14. 14. 1 Lost in the Information Maze?M rs Chopra, 45, was recently diagnosed with diabetes. Her doctor followed the standard protocol, prescribingher medicines, and advising her on diet and exercise. Shewas not content with the advice though. This was somethingthat was affecting HER body, and she wanted to dig deeperfor answers. She wanted to know how she could better takecare of herself, and while she respected her doctor’s advice,she wanted more information that would set her confusedmind to rest. She did what most patients in India and aroundthe world would do – log on to the World Wide Web. Acasual search for ‘Diabetes’ returned 268,000,000 results,with the first as always being Wikipedia, a helpful but ofteninaccurate portal. Mrs Chopra did not receive accurate,definitive information on her ailment, with differentwebsites suggesting different measures to control diabetes.Frustrated, she simply stuck to her doctor’s advice. Whethershe could have done more for herself, she would neverknow.Fifty years ago, the major problem was that patients hadinsufficient information. All the knowledge was locked up inmedical books and journals, and this information asymmetryforced patients to put their doctors on a pedestal. Patients felthelpless, and they were unable to question their doctors dueto their limited knowledge on medical matters. Today, there Lost in the Information Maze? ● 17
  15. 15. has been a sea change, but ironically, patients are still helpless!This is because they have access to too much information, amajor chunk of which is wrong, inaccurate or outdated.Thanks to Google, patients can effortlessly unearth thousandsof pages of information on any topic, but this information ispoorly organised and is not put in context, which means thatpatients often find themselves at sea while surfing the web tofind specific answers to their queries.Why is too much information as dangerous as too little? Thisis because there is a marked difference between data,information, knowledge and wisdom! Moreover, there is noeffective quality control when it comes to the internet, whichfurther aggravates the problem. It is common to find twodifferent websites suggesting diametrically opposite things.This frustrates and confuses patients, and they wonder whoto trust and why.How can patients judge whether the information is reliable ornot? There have been numerous initiatives to assist them inevaluating the quality of information but, unfortunately, mostpatients are not equipped with sufficient knowledge to beable to differentiate between ‘good’ information and ‘bad’information. The sad truth is that many commercial websitescan be well-designed and attractive, but under that garb, theinformation they provide is completely false. Their primaryagenda 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! InformationTherapy is the prescription of the right information, to theright person, at the right time to help make a better healthdecision. Information Therapy will both revolutionize therole of information in healthcare and enable patient-centeredcare.Who better to provide Information Therapy than thegovernment? After all, a major role of the government is tolook after the health of its citizens! While the UK and USAgovernments appear to be on track, the Indian government18 ● Using Information Therapy
  16. 16. lags behind in providing this key service to its citizens. TheNHS in the UK (www.nhs.uk) provides a comprehensivedatabase for patients, assisting them in helping themselves.There are also links that inform you of the nearest hospitals,pharmacies, GPs, rehabilitation centres, and the like. In theUSA too, the FDA website (www.fda.gov) does a splendid jobof informing and educating patients about recent developmentsin healthcare. Moreover, patients in these countries are wellaware of their rights, enabling them to make informed choicesand adopt a no-nonsense approach to healthcare. In India,such an approach is seriously lacking, and patients aregenerally left to fend for themselves, relying on informationon the web that could take them down the wrong path.Patients need reliable information – a trusted guide who takesthem through the healthcare information maze. Ideally, one’spersonal doctor should assume this role, but sadly, mostdoctors cannot afford to spend so much time. So who canpatients turn to for help? Librarians are information specialists,and can help in separating the wheat from the chaff. After all,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 comprises1,100 institutions and 3,600 individual members in the field ofhealth sciences, all working to ensure that the best healthcareinformation is available to all.There are also initiatives that provide quality seals to ensurethat the information being provided to patients is reliable andof top-notch quality. An example of this is the Health on theNet Foundation (www.hon.ch). Health insurance companiesin the USA such as United Healthcare (http://www.uhc.com/health_and_wellness.htm) and Aetna (http://www.besmartaboutyourhealth.com) have invested a lot of time andenergy in educating their patients, and it makes businesssense for them to produce high-quality information for theirclients, since prevention is far better than cure. However, Lost in the Information Maze? ● 19
  17. 17. Indian companies are still lagging behind and have a longway to go before they can catch up!To fill this gap in India, HELP, a non-profit organizationwhich runs the world’s largest free patient education resourcecentre has partnered with Healthwise to use the latesttechnology to empower patients. The sole mission of theHealthwise Knowledgebase is to empower patients withInformation Therapy! Healthwise helps patients make betterhealthcare 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, enlighteningpatients on their ailments, so they can take the right path tohealthcare. Patients can also log on to the Health EducationLibrary for People website (www.healthlibrary.com), wherethey can ask any question about a particular ailment.What of the future? With advances in telemedicine andinternet penetration and speed, it is possible that the web willallow patients to access an online virtual doctor withimpeccable bedside manners, who can guide and reassurepatients, enabling them to make informed choices about theirhealth!20 ● Using Information Therapy
  18. 18. 2 Bridging the doctor-patient communication gapW hen Mrs Bhatia had swollen, painful knees, her physician made the right diagnosis of osteoarthritis.While prescribing the standard course of anti-inflammatorymedicines for her, he did not provide her with a list of thepossible side effects. Mrs Bhatia, on the other hand, also didnot tell him that she had a peptic ulcer. The medicinescaused her ulcer to start bleeding, leading to an emergencygastroscopy to control this. Frustrated with her doctor fornot warning her, Mrs Bhatia complained to her friends andneighbours about her doctor’s incompetence. This greatlyunsettled her doctor, a caring physician, who felt betrayedthat his reputation was being tarnished for no fault of his.Every doctor wishes to see his patients get better. The strongurge to help and heal others is the primary driving force forchoosing medicine as a profession. It is the ultimate serviceprofession, and since it entails a one-on-one relationship,good doctors devote a lot of their time and energy in keepingtheir patients happy. Apart from making doctors feel goodabout themselves, patient satisfaction also makes immensebusiness sense. Contented patients are the best source of newpatients. Word-of-mouth marketing goes a long way inexpanding a doctor’s practice. This is why happy patientsmake for happy doctors!Unfortunately, not all patients respond well to treatment.Medicines do not always work, and the human body is Bridging the doctor - patient communication gap ● 21
  19. 19. unpredictable. Most patients understand that the outcome ofmedical treatment is uncertain and that just because a problemoccurs, this does not mean that the doctor was incompetent ornegligent. Sadly, not all patients adopt such a matureapproach. They are angry and need to vent their frustrations,and a doctor is an easy target! Some get abusive (both in reallife and online), and others may even get violent. Rather thansit dispassionately with their doctors, they often end up bad-mouthing them and damaging their hard-earnedreputations.Whats worse, this sets up a negative vicious cycle. Doctorswho have been abused by angry patients often start becomingresentful. They start practising defensive medicine anddistancing themselves from patients to protect themselves.Also, doctors talk amongst one another, gathering from otherdoctors’ experiences that patients can be vengeful (for no faultof the doctors), and that doctors need to protect themselvesfrom their patients! It is tragic that affairs have come to such asorry state. A lot has been written about how the doctor-patient relationship has deteriorated in recent times. Whilemany people are happy to blame doctors for this, unfortunately,no one has highlighted the role that patients play in damagingthis relationship. Any relationship is a two-way street, and adoctor who has been sued or abused is no longer going to bethe same person he was before the ugly episode.It is a vicious cycle – unhappy patients create unhappydoctors, which in turn again create unhappy patients, sincesuch doctors do not take good care of their patients and oftenend up disrespecting them and providing poor quality care.The doctor-patient relationship starts deteriorating andbecoming adversarial!Many studies have shown that patients do not sue a doctorsimply because of an undesirable outcome. Most patients dounderstand that doctors are not Gods, and that medicine isnot an exact science. However, if the doctor does not bother tocommunicate effectively with the patient after such an22 ● Using Information Therapy
  20. 20. outcome, this is the equivalent of adding insult to injury.Patients then get angry and find outlets to express their anger.The best way to prevent this problem is to ensure that patientshave realistic expectations. However, doctors are often toobusy to be able to sit down and talk patients through allpossible outcomes, and most doctors do not want to scare offtheir patients by talking about risks and complications!This is why providing Information Therapy through websitesand videos is such a great way of obtaining informed consent.It allows patients to understand what the likely outcomes are,at their own pace, in an unhurried, relaxed manner, so theyhave the time to think it through and make decisionsaccordingly. It saves the doctor time too, since he does nothave to repeat the entire process himself for each patient. Itensures that all possible outcomes have been properlydiscussed; after all, sometimes doctors may forget some pointstoo, when they are pressed for time. Finally, from a riskmanagement perspective, clever websites that take informedconsent online allow documentation of the fact that all risksand complications were properly explained to the patient,thus protecting the doctor in case of a lawsuit. Effectivecommunication helps build relationships, and goes a longway in building a healthy doctor-patient bond that is mutuallybeneficial. Bridging the doctor - patient communication gap ● 23
  21. 21. 3 Synergising alternative medicine with conventional therapyM rs Sharma’s house help, Anita, was afflicted with eczema and needed money for treatment. Heremployer willingly gave her the money, thinking Anitawould opt for conventional treatment. However, she insteadwent to a ‘famous doctor’ in her locality. This ‘doctor’ didnot have training in medicine, but he did have a clinic. Theonly information below his name was ‘Ayurvedic doctor’.Unfortunately for Anita, he was a quack, with no realtraining in Ayurveda. His spurious drugs exacerbated theeczema condition, making it worse than before. Afterlearning about Anita’s bitter experience, Mrs Sharma, also abeliever in alternative medicine, took her to a dermatologistwhile also consulting a trained, qualified naturopath.Modern medicine often evokes awe. Massive gleaminghospitals, expensive computerized equipment, andsophisticated scanning machines appear very impressive andreassuring when you are afflicted with a disease. However,paradoxically, even though the effectiveness of medicaltechnology has improved considerably, more patients thanever before are dissatisfied with their medical care today. Thissituation has resulted in a move towards alternative medicine,which has become increasingly popular all over the world.Even in the United States of America (the bastion of high-techscientific medicine), more than 50 percent of the patients have24 ● Using Information Therapy
  22. 22. consulted an alternative medicine practitioner, mainly becausethey were unhappy with modern medical care.There are many reasons for this growing unhappiness withmodern medicine. Patients increasingly feel that medicine hasbecome excessively commercial. They are unhappy with theimpersonal nature of modern medicine, especially when thedoctor spends more time looking at their reports rather thanwith them. While it is true that patients need technology, theyalso need tender, loving care; after all, doctors need to lookafter not only their medical problems, but also their emotionalneeds! Moreover, while modern medicine excels in certainareas (such as complex surgery for the repair of birth defectsand the use of antibiotics for serious infections), it has failedmiserably in the areas of disease prevention and themanagement of the myriad chronic illnesses (such as diabetes,hypertension and heart disease) to which modern humanbeings are prone to, owing to their lifestyle.Alternative medicine, on the other hand, offers a markedlydifferent perspective. Rather than focussing on a personsmedical problems in isolation, alternative medicine treats thepatient as a whole; hence the popular term, holistic medicine.Doctors practicing alternative medicine sit down and talk tothe patient; they add the element of personal touch, and askmany questions. Such attention feels good, and is in refreshingcontrast to the modern doctor who rarely has even 15 minutesto spend with the patient. Often, tender loving care andpersonal attention are all that alternative medicine practitionershave to offer, but they offer it very well indeed! There is nodoubt of the efficacy of the placebo effect, and many ailmentswill get better when the patient has someone he can talk to.Moreover, the simple act of a comforting touch can have atherapeutic effect. Alternative medicine doctors are very goodat reassuring patients, which is in sharp contrast to the coldscientific approach of western medicine.Unfortunately, the practice of alternative medicine in Indiatoday leaves a lot to be desired. For one, such medicine does Synergising alternative medicine with conventional therapy ● 25
  23. 23. not have a universally accepted scientific basis; hence, it isdifficult to rigorously analyze its claims. Since there is no needfor formal publication or peer review in alternative systems ofmedicine, there is little scientific documentation availableabout their efficacy or side-effects, making it difficult toconfirm or dispute claims. Consequently, one has to blindlytrust the doctor. Authoritative journals or texts are difficult tofind. Most publications use little scientific rigour and arebased mostly on anecdotal case reports, with littledocumentation or proof. Since there is no official monitoringof alternative medicine practitioners, anyone can make tallclaims and get away with them. Also, there are few formaltraining requirements, and anyone can practice alternativemedicine, with minimal skills or qualifications. This had ledto the mushrooming of unscrupulous practitioners or ‘quacks’,who are out to make a quick buck.Alternative medicine practitioners need to be madeaccountable for their actions to ensure that they are up-to-date with their education. Also, some type of peer reviewmechanism needs to be put in place to ensure the safety of thepublic. Otherwise, there is a grave danger that medicine canbecome a bastardised system (for example, there arehomeopathic practitioners in India who prescribe allopathicantibiotics for coughs and colds). This can have a considerablydetrimental effect on patients. Even worse, it actually amountsto cheating patients both financially and emotionally, sincethey decided to shun allopathy for a more ‘natural’approach!Alternative medicine has its place in society, but the aboveissues must be addressed. One of the reasons for this sorrystate of affairs is that alternative medical systems receive littleofficial support and minimal funding. The situation oftendeteriorates into a conventional versus alternative medicineconfrontation, with each system belittling the other, and thisis a real tragedy. By ignoring alternative systems, doctors maybe depriving patients of better medical treatment options.26 ● Using Information Therapy
  24. 24. There is one common underlying principle of medicine thatdoctors should always keep in mind – patient health is toppriority. Essentially, all doctors are on the same side. We allwant our patients to get better, no matter what system ofmedicine we practice! Then why discredit each other?The combined knowledge of both old and new healingmodalities is ultimately superior than a single-model approachto health and well-being. After all, no system of medicine canclaim to have a monopoly on knowledge! What is neededtoday is a clinically responsible balance between the scienceof modern medicine and the comfort of alternative medicine.We need to combine the best of both worlds, much like fusionmusic does, and physicians from both ends of the spectrumcan learn from each other. Indian doctors must be willing toblend an open, receptive mind with the scientific disciplineneeded for rigorous research. If they adopt such an approach,they can become world leaders in providing the best medicalcare to their patients, given our immense patient populationand rich traditional medical knowledge base.This is where Information Therapy can play a key role andhelp to bridge the gap. There is still immense confusion aboutalternative medicine systems with regard to what works andwhat does not. For one, many of these systems do not have asound scientific basis, which is why modern doctors are sosceptical about their claims. After all, if you progressivelydilute something, common sense will tell you it will becomeless effective. How can homeopathy make the astoundingclaim that a higher dilution increases potency? Isn’t thiscounterintuitive and illogical? However, just because wecannot understand the scientific rationale behind alternativemedicine doesn’t mean that it does not work. There are lots ofdrugs in western medicine for which we do not understandthe precise mechanism of action, but we still use them all thetime.Sadly, a lot of alternative medicine practitioners are quacks.They take advantage of the fact that many of these systems do Synergising alternative medicine with conventional therapy ● 27
  25. 25. not require formal training or licensing. They pick up a ND orMD degree from some online university, label themselves as‘doctors’, and start practicing. To make matters worse, theytake great pride in making tall, ridiculous claims. Thus, theypromise to cure everything and anything – something whichno self-respecting doctor (or patient) can possibly accept.They end up losing all credibility and a result of which theentire system of alternative medicine gets a bad reputation.There must be stricter laws in place that prevent such quacksfrom flourishing. Public awareness is of paramountimportance.Alternative medicine, when practiced with integrity andsufficient medical knowledge, can be helpful. There is lots ofempirical evidence that alternative medicines do work wellfor some conditions – but no system is a panacea for all ills.Sadly, rather than working out a common solution, there aremainstream versus alternative medicine battles. These areprimarily being waged for financial reasons, since systemsthat acquire legitimacy can earn their practitioners lots ofmoney!Why does western ‘modern’ medicine pejoratively label othersystems as being complementary or alternative? This smacksof cultural arrogance – after all, Ayurvedic medicine andChinese medicine boast of a far longer track record thanwestern medicine! And western medicine does not have amonopoly on knowledge. Patients simply want to get better.Most do not really care how. Then why have this sillydemarcation and unnecessary mud slinging? Instead, we canuse all this energy to learn from each other!Personally, I hold the opinion that there are only two types ofmedicine – effective and ineffective. The dirty little secret isthat lots of accepted ‘treatments’ in western/ mainstream/scientific medicine are ineffective and have never been provento cure. These include billion dollar interventions, such ascholesterol reducing drugs, disc surgery for back pain, andbypass surgery. So conventional medicine, just like its28 ● Using Information Therapy
  26. 26. alternative counterpart, can also be misleading. It is importantfor practitioners of both systems to see the larger picture.How do we separate the good from the bad and the ugly?Information Therapy can come to the rescue! The goal ofeffective Information Therapy is not to label treatments,disparage them or make prejudiced judgments. It has anuncomplicated mission – provide authentic, reliableinformation, and allow patients to make well-informeddecisions. Then whether they head to an MBBS-qualifiedphysician or one with a degree in alternative medicine orconsult both is entirely up to them. A healthy dose ofInformation Therapy will ensure that they make decisionsbased on knowledge and facts, and not whim or fancy! Synergising alternative medicine with conventional therapy ● 29
  27. 27. 4 How can we get doctors to prescribe Information Therapy?M r Rathod had been experiencing pain in his abdomen, so he went to his GP for a check-up. After examiningthe test reports, his doctor told him that he had‘Choledocholithiasis’. Mr Rathod was taken aback, thinkingit was a serious disease, only to breathe a sigh of relief whenhe was informed that the simpler definition for his ailmentwas ‘gallstones in the gallbladder’, a fairly commoncondition that is easily treatable. When it comes to interactingwith patients, using simple, jargon-free language is of theessence. Imagine if a doctor told you that you had‘Xerostomia’? You would think ‘oh, woe is me.’ Well, all itmeans is that you have a dry mouth! So how do doctorscommunicate in an unambiguous manner to their medicallyuninformed patients? Information Therapy to the rescue,again!The word doctor is derived from the Latin word, docere,which means ‘to teach’, and teaching patients is something alldoctors think they are good at! Most feel their bedside mannersand communication skills are impeccable because illusorysuperiority is a cognitive bias which afflicts doctors as wellsince they are not immune to the Lake Wobegon effect (namedafter Garrison Keillors fictional town where ‘all the childrenare above average’). Communication, however, is a two-waystreet, and sadly, most patients do not think that doctors are30 ● Using Information Therapy
  28. 28. good teachers. All patients want detailed informationregarding their ailments and many feel that their doctors donot bother devoting enough time explaining their problemsto them. Additionally, many patients observe that whendoctors do explain, they use complicated medical jargon thatis beyond their understanding. Patients also feel thatsometimes their doctors seem too busy and unapproachable,so they hesitate in asking too many questions.If doctors are indeed smart and know that patients want moreinformation about their illnesses, then why don’t doctorsroutinely prescribe Information Therapy? There is noconspiracy of silence here! The sad truth is that most doctorssimply do not understand the importance of InformationTherapy. It is not that doctors enjoy keeping their patients inthe dark, so they can extract money from them. Most doctorsare happy to share information with their patients, andeducating them will not turn them into medical professionals.Patients will still need to come to their doctor to get thetreatment they need. The core problem is that educatingpatients is still not a top priority for doctors. They have acompletely different worldview. Since they are doctors andknow a lot about medicine, they sometimes assume that theirpatients are equally well-informed, which of course is not thecase. Many will use jargon without even realizing that it isgoing above the patient’s head. ‘Medicalese’ has become theirprimary language!Doctors suffer from the ‘curse of knowledge’, just like all ofus. We know what we know, and we know it so well that weassume that everyone else knows it just as well as we do. Thisis why doctors sometimes overestimate the ability of theirpatients to understand what they are talking about – theynaively believe that if they know all these medical terms, theirpatients will too. Moreover, the primary focus for most doctorsis providing quality clinical care. Sometimes, they are so busydoing this that they just don’t have time to educate theirpatients. There is no question that doctors are busy people,and they will always remain busy. However, if doctors can How can we get doctors to prescribe Information Therapy? ● 31
  29. 29. use tools that make it easy to for them to prescribe InformationTherapy without disrupting their workflow, they will behappy to do so.The trick is to make the patient do the work, using the self-service model supermarkets do, versus the old fashionedkirana shop! In the kirana store, all products are fetched by anassistant from shelves while customers wait in front of thecounter and indicate the items they want. This is a very labour-intensive and therefore also quite expensive. The shoppingprocess is slow, since the number of customers who can beattended to at one time is limited by the number of staffemployed in the store. Supermarkets, on the other hand, makecustomers select their own goods and cart them to the front ofthe store to pay for them, so that they can service a muchlarger number of customers by making them do most of thework! Similarly, Information Therapy tools allow patients toserve themselves, so their doctor’s precious time can be usedfor more productive and empathetic patient interaction.What can we do to persuade doctors to prescribe InformationTherapy routinely?1. Some will start doing so when they realize the value that Information Therapy adds to their practice – and to their patients. These are the ‘early adopters’ – who pick up on new trends, and use them cleverly. They take pride in delighting their patients; and will use new technology and tools to do so.2. Many will prescribe Information Therapy when they see leading doctors doing so regularly. We are all social animals, and the herd mentality is strong amongst doctors as well!3. Some will start when they are pushed into doing so by their patients. Patients do have clout, even though they often do not realize it! Doctors cannot survive without patients, and if enough patients start clamouring for information, doctors will toe the line and start offering it.32 ● Using Information Therapy
  30. 30. 4. Let us not forget that doctors are rational human beings, and will respond appropriately to the right financial incentives. Once they get paid for providing Information Therapy (either by the government or by health insurance companies), many will start routinely providing this to their patients.Doctors must be provided with access to a wide variety ofinexpensive, easy-to-use tools, so that they can easily prescribeInformation Therapy. Different doctors have different workingstyles and their patients have different learning needs. It ispossible to use technology cleverly and efficiently, so that wecan cater to these diverse requirements by using a combinationof text, audio and video, which can be tailored to the individualpatient’s and doctor’s needs. Sadly, many doctors are stillunaware of the wide variety of tools that are already availablefor educating patients; this is why they still don’t makeeffective use of them. Perhaps, some technology therapyneeds to be prescribed to doctors first so that they are well-equipped to dispense Information Therapy to their patients! How can we get doctors to prescribe Information Therapy? ● 33
  31. 31. 5 How I prescribe Information TherapyM y patients, Mr and Mrs Gupta, are sitting in the waiting lounge of my clinic, awaiting their turn. Theusual gamut of magazines is in front of them. But do theseserve any purpose? Instead, my receptionist gives them acomic book about IVF, so they can learn more about theirtreatment options. This puts them in a better frame of mind,and many of their doubts get resolved even before theycome in. The beauty of Information Therapy is that it can beused in many innovative ways!I am an IVF doctor, and I put my heart and soul into treatingmy patients. IVF is often the last resort for infertile couples,and, understandably, these couples will have countlessquestions about IVF. This is an expensive treatment, and theyare investing immense time, hope, and energy in buildingtheir family. Since the outcome of IVF is always uncertain,they have a lot of doubts and misgivings. There are still manymyths and misconceptions surrounding IVF, and manywomen are worried that IVF babies are ‘weak’; or that all IVFpregnancies are multiples; or that the hormonal injectionstaken for IVF will make them fat or cause them to developovarian cancer in the future. Moreover, infertility oftenimpacts the entire family (and not just the couple), anddecisions about medical treatment are made in consultationwith many family members.34 ● Using Information Therapy
  32. 32. I proactively use Information Therapy to clear doubts andanswer questions. This helps ensure that everyone is on thesame page. Since I provide this information, patients arereassured that I am open and transparent. They know theyare in safe hands, since they can see that I am well informedand knowledgeable. The fact that I am an expert in my fieldmakes them put their faith in me.Information Therapy needs to be embedded in clinicalworkflow, and we start providing Information Therapy wellbefore the patients come to us for a consultation. We do thisonline, using many channels, including our website (www.drmalpani.com); videos on You Tube (http://www.youtube.com/user/aniruddhamalpani); and social media, includingTwitter (http://twitter.com/#!/drmalpani) and Facebook(www.facebook.com/Dr.Malpani).Web-based information prescriptions have majoradvantages:1. I can update the information quickly and easily.2. The information is accessible to all my patients around the world. Using Google translate, patients can read it many different languages!3. The information can be presented in an interactive and engaging manner through the use of animation and videos (www.ivfindia.com).4. Delivering the information does not cost me anything.5. Patients can absorb and review the information at their own pace – and for free!Isn’t all this expensive? Who has the time to do all this? Yes, itis expensive and time-consuming, but the beauty is that onceyou have done it, you can use it many times, for many patients,and over many years! ‘Create once, use multiple times’ is avery cost-effective proposition. Updating and maintainingcontent is much easier once you are familiar with theprocess. How I prescribe Information Therapy ● 35
  33. 33. Even better, you can get your patients to contribute to youronline resources. For example, we have a section calledSuccess Stories (http://www.drmalpani.com/ivfsuccessstories.htm). We request our patients to write about their infertilitystory and their experiences at Malpani Infertility Clinic andthen upload this to our website. This first person accounthelps other infertile couples when they are making decisionsregarding their treatment, as they are getting informationfrom someone who has been there, done that! We alsoencourage our patients to act as email buddies, to help otherinfertile couples in distress. I always remind my patients thathelping others is a great way of helping yourself.The internet has become an important source of health andmedical information. However, a significant amount of health-related information on the Web is inaccurate, unreliable, oruntrustworthy. By creating our own content, we can directpatients to information that is of high quality, appropriate totheir condition, and consistent with our approach to treatment.This helps them to save time and stops them from gettingconfused or misled. Patients still depend on doctors to providethe most credible answers to their health questions.In addition to providing Information Therapy online, we alsoprovide it in the real world. When patients come to the clinicfor a consultation, we give them with an IVF comic book whilethey are waiting for an appointment. Thanks to suchInformation Therapy, my consultations have become mucheasier. I do not have to waste time going over the basics andcan focus quickly on the patient’s key concerns. The fact thatI am an author reinforces their confidence in my professionalcompetence and helps to reassure them that they are in safehands. Doctor shopping is a fact of life in today’s world, andsince we provide this information proactively, our patientsprefer coming to us, because they can see that we are openand transparent.All our educational materials help to ensure that patientshave realistic expectations of their treatment. While it is true36 ● Using Information Therapy
  34. 34. that our success rates are excellent, it is also a fact that theoutcome of any IVF cycle is always uncertain, and patientsneed to be prepared for failure. Reading about this in blackand white helps them to understand the limitations of ourtechnology.Patients often forget a great deal of what is told to them. Thisis why we give them a DVD to take home, which they canreview at leisure – often with other family members. Thishelps to reinforce my message, and it also ensures that westand out amongst the other IVF doctors that they have visited.During and after the IVF treatment, we encourage patients toremain in touch by email. I find this a very efficient way ofanswering questions. This way we don’t have to play telephonetag – and since everything is in writing, patients don’t getconfused or forget things. We also have a FAQs page on ourwebsite, while helps us to proactively reassure patients andput their doubts to rest.We know that different patients have different learning styles,which is why we use diverse tools to deliver InformationTherapy. On our site at www.ivfindia.com, we have developeda wide variety of educational tools, including e-learningcourses, animated cartoon films, games, and you tube movies.Providing this kind of Information Therapy has helped me tobecome a better doctor. It ensures that I look at the worldthrough my patient’s eyes, so it is easier for me to beempathetic. Also, since we help patients to have realisticexpectations, they don’t get emotionally shattered if the cyclefails, and they are able to cope better with the emotional rollercoaster ride that often accompanies IVF treatment! How I prescribe Information Therapy ● 37
  35. 35. 6 Doctors need Information Therapy too!Y ou’re a doctor from one of the best medical schools in the country. You aced your class, and know medicalterms like the back of your hand. One day, a patient comesin with an ailment, and while you think you know everythingabout the problem, his detailed, extraordinary questionsstump you! He is not the regular, accept-whatever-the-doctor-says sort of patient. He’s well-informed and has doneextensive research on his illness. You could refer him to aspecialist, but how will that enhance your own medicalknowledge?Doctors need Information Therapy too! A doctor’s major assetis his professional knowledgebase. As medical scienceprogresses, doctors need to keep up with current trends.Medical textbooks get outdated quickly – and new editionsand medical journals can be very expensive. Unfortunately,most doctors today are dependent on their ‘friendly’ medicalrepresentatives for information on all the latest advances intherapeutics, and these reps are not always the most reliablesource of information. This is why the Medical Council ofIndia (MCI) has made Continuing Medical Education (CME)compulsory for doctors. The motive behind this move is toenable doctors to invest in educating themselves, so that theyremain abreast with the latest medical advances. Whenequipped with this knowledge, doctors will be in a better38 ● Using Information Therapy
  36. 36. position to provide state-of-the-art medical care to theirpatients.The only form of CME credits that the MCI recognizes isattendance at a medical conference. This medical conferencehas to be approved by the council (presumably based on thequality of the content provided); and doctors who attendapproved conferences get a certain number of credits for theirattendance. Doctors need to prove that they have accumulatedthe required number of credits every year if they want torenew their registrations. The biggest problem is that in reallife, medical conferences are terrible tools for teaching doctors!Lectures are the most inefficient form of transferringinformation.Have you ever attended a medical conference? If you ever do,you are likely to find half the audience outside in the hallway– chatting, collecting freebies at the stall, and eating. Most arefast asleep once the lights are dimmed, while other doctors goout shopping or sightseeing once lunch is over. Few speakershave the eloquence and presentation skills to grip theiraudience since most are selected based on a quid pro quobasis – ‘If you invite me as a speaker for your conference, Illinvite you for mine.’ This is why most conferences have thesame speakers talking on the same topics. Most presentationsare boring and poorly prepared. They often contain outdatedinformation, prepared at the last minute by a junior residentdoctor, who has lifted information straight from the internet.The speaker then reads out the text on the slides, and tries toshow off his erudition. The only reason doctors can get awaywith this is because few doctors in the audience are listening,and most doctors know even less than what the speaker does!This is why the ‘learning’ that doctors derive from conferencesevaporates so quickly!The reality is that these conferences are an utter waste of timeand money. Can we really afford to waste the doctors precioustime on such insipid conferences that offer no real value orenhance the doctor’s knowledge? We need better tools to Doctors need Information Therapy too! ● 39
  37. 37. ensure that doctors remain up-to-date. If a doctor’s knowledgebecomes outdated, he or she ends up losing patients to well-equipped specialists in corporate hospitals. Being poorlyinformed can also be embarrassing for doctors, when theirpatients with internet printouts know more about their diseasethan they do! The biggest problem arising from such ignoranceis lawsuits for medical negligence – a doctor’s worst nightmare.This is why when doctors are stumped by difficult patients,they refer them to a specialist or expert, who then helps themto learn more about the management of that particularproblem. However, this kind of learning is very episodic andopportunistic, and not all consultants are good at educatingfamily physicians!Doctors do not choose to remain wilfully ignorant aboutmedical advances. The reality is that, in a busy practice, whendoctors spend all their time taking care of their patients, it isvery hard to keep up. The trick is to deliver InformationTherapy to the doctor ‘just in time’ – exactly at the time heneeds it. This means the best way of providing it is when he isactually seeing a patient with a perplexing clinic problem.Today, the vast majority of doctors have easy access to theinternet – either through a PC, laptop, or their smartphone.This is why many will turn to the internet to keep themselvesupdated. While there are many online free resources, such asMedscape (www.medscape.com), Medicine Net (www.medicinenet.com), Doc Guide (www.docguide.com), andWebMD (www.webmd.com). The sad truth is there is verylittle high-quality, free medical information available on thenet. Much of it is patchy and unreliable.The good news is that now, for less than Rs 30 per day, Indiandoctors can subscribe to the world’s largest online medicallibrary, at www.mdconsult.com. MDConsult provides doctorswith instant online access to the full text of over 40 respectedmedical books and 50 prestigious medical journals that areconstantly updated, eliminating the need to ever buy amedical book! MDConsult provides convenience and peaceof mind – at the doctor’s desktop – for only Rs 9,995 per year.40 ● Using Information Therapy
  38. 38. This is a highly discounted price for Indian doctors only. Youcan take a free tour at www.thebestmedicalcare.com/mdconsult.It must be emphasized that Information Therapy for doctorsdoes not just comprise learning from medical books andjournals. The scope of Information Therapy goes much beyondthat. It is equally important for physicians to learn to seethings from a patient’s perspective. Doctors sometimes takepatients for granted, not realizing that conversing with apatient can open new doors of knowledge, and lead to moreeffective diagnosis. Doctors need Information Therapy too! ● 41
  39. 39. 7 How patients can contribute to Information TherapyD octor Sourav Bose was finding it difficult to manage Mr Aditya Rao’s diabetes. Though he had changed thedose of the insulin thrice, his blood sugar levels remainedhigh. 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 asa ‘difficult patient’! He failed to recognize that by spendingmore time with his patient, delving into his lifestyle, andasking him why he was having a hard time with followingthe treatment plan, he could have come up with an effectivesolution. Aditya was as much to blame! He should havediscussed the practical difficulties he was facing with takingthe insulin injections in his office, as advised by the doctor,instead of meekly accepting his doctor’s advise – and thenfailing to follow it!Information Therapy traditionally means the prescription ofthe right information to the right person at the right time tohelp make a better health decision. However, if we accept thefact that patients are at the centre of the medical universe andthat it is patients who are the true experts on their illness, thenan equally important part of Information Therapy should bethe provision of information from the patient to the doctor!The patient’s personal perspective is as important as themedical perspective through which the doctor views theworld.42 ● Using Information Therapy
  40. 40. Why has this been neglected so far? Why dont more patientsprovide Information Therapy to their doctors? This kind ofpatient education has a long and respected history. Whilewriters have written on what it is like to be a patient sincetime immemorial, one of the most important books that taughtdoctors to re-look at things from the patients perspective wasNorman Cousins classic, Anatomy of an Illness. In fact, thereis now an entire genre of books that does this very well. Thisis called pathography – a narrative that gives a voice and faceto the illness experience, by bringing the person behind thedisease to the forefront!Pathography is a very useful teaching tool. It helps doctors tolearn empathy, so they can learn to see things from thepatients perspective. For example, though I am an IVFspecialist, I am not infertile myself. By reading first personaccounts of the trials and tribulations faced by infertilecouples, I learn a lot about the problems that my patients face– problems that they may not be willing to talk about whenthey meet me for the first time. All doctors learn medicinefrom their patients. As Sir William Osler said, ‘He who studiesmedicine without books sails an uncharted sea, but he whostudies medicine without patients does not go to sea at all.’Unsurprisingly, his best-known saying was ‘Listen to yourpatient, he is telling you the diagnosis’, which aptly emphasizeshow much a good doctor can learn from a patient!Doctors usually remember their most challenging patients ortheir most complex and difficult cases all their life – theseoften form the defining moments in their professional careers.It is true that these exceptional patients teach us a lot andgood doctors treasure them, since they learn the most fromthem. These are a doctors ‘memorable’ patients – many ofwhom teach us what not to do! Intelligent doctors learn fromtheir patients all the time, but this can only happen if patientsare willing to teach them. These are the ‘expert patients’ -those who are articulate and treat their doctors as partners intheir medical care. How patients can contribute to Information Therapy ● 43
  41. 41. Doctors can learn from every patient, but only if patients learnto speak up, and doctors learn to listen. It is not that doctorsare going to learn medical facts from each patient – but eachpatient is unique and has valuable insights to offer. Patientfeedback helps doctors to improve their services, and evencomplaints are gifts, when taken in the right spirit!Unfortunately, there are still many barriers to getting feedbackfrom patients. Most patients are inhibited and do not have thecourage to displease their doctor by telling him the unpleasanttruth. If patients want their doctors to do a better job, theyneed to learn to speak up. Most dissatisfied patients todayjust walk out of the doctors clinic and never return. They finda better doctor – but by failing to give the doctor honestfeedback, they lose the opportunity to help him improve anddo a better job with his next patient. Similarly, most doctorsare too busy to ask for feedback, and most continue deludingthemselves that they do a perfect job with every patient.Hopefully, the internet will allow patients to offer critiquesand criticism more easily. There are now many doctor-ratingwebsites, where patients are encouraged to provide theiropinions about their doctors. This kind of patient-generatedcontent will help doctors to get their act together, if they arewilling to keep an open mind and try to resolve problems.Thanks to the Web, smart patients have adopted a number ofclever initiatives towards improving medical care. Thesee-patients, of whom the most prominent is Dave (www.epatientdave.com), are speaking up and claiming their rightfulplace in the healthcare ecosystem, so that patients now have avoice which is heard, and more importantly, respected.Online patient support groups have a lot of clout – andcrowdsourcing the collective experiences of hundreds ofpatients can actually help advance medical research, as provenby innovative sites such as PatientsLikeMe (www.patientslikeme.com). Patients are also collaborating to fundclinical studies, so that doctors can research on topics that areof interest to patients, and not just on areas that pharmaceuticalcompanies find remunerative. Patients have also taken a lead44 ● Using Information Therapy
  42. 42. role in simplifying medical research so that it becomesunderstandable to other patients. Cochrane Collaboration(www.cochrane.org) is a fine example of how it is importantfor researchers, providers, practitioners, and patients tocollaborate. 28,000 people from over 100 countries worktogether to help healthcare providers, policy makers, andpatients make informed decisions about healthcare. Suchcollaboration is imperative in today’s times. When individualknowledge turns into collective knowledge, medical care issubstantially enhanced. How patients can contribute to Information Therapy ● 45
  43. 43. 8 Please ask for Information TherapyV andana Gupta was diagnosed with Hodgkin’s lymphoma, but her doctor’s busy schedule and lack ofcommunication skills resulted in her knowing practicallynothing about her ailment, apart from its name. However,she wasn’t going to be one of those patients who took thingslying down. Insufficient information about her illness ledVandana to start a patient-support group for patients withcancer called V Care, which prescribes patient-friendlyInformation Therapy. She recounts her experiences.‘You have Hodgkin’s Lymphoma, but we will treat you.’A chilling silence engulfed the room, as the doctor deliveredthose words. All I could comprehend was that I was afflictedwith a serious ailment. That was all I knew, and the doctordid not have the time for further explanations, so my husbandand I were left with no choice but to scan through informationin a medical encyclopedia (Google did not exist 18 years ago!).Reading about Hodgkin’s provided us with greater insight,and we were shocked to realize that it was a type of cancer. Thenext day, we met the doctor in a crowded room at a leadinghospital in Mumbai. In barely five minutes, I was shooed outof the room with a prescription in my hand and instructionsto go to the day care center to start chemotherapy.In one day, I had to learn so many new words – Hodgkin’slymphoma, day care, and chemotherapy – without46 ● Using Information Therapy
  44. 44. understanding the meaning of these terms. My husbandmade the ‘mistake’ of asking the doctor for some information.We were promptly handed a medical journal article whichwas published to teach doctors how to handle the side-effects and complications of the medicines used for treatingHodgkin’s disease. This was the worst possible thing thatcould have happened. The doctor was trying to be helpful,but after reading the article (laden with statistics and complextechnical terms), both of us started wondering why treatmentwas being prescribed at all, and whether it was even beneficialtaking the treatment, since the chemotherapy would cause allthe organs to fail anyway!I sincerely wished that the professional, the doctor whom Itrusted, had prescribed some information along with thediagnosis and medicines. I would have been empowered andthe starting point of this empowerment would have comefrom my doctor who was going to help me fight this life-threatening disease for the next six months. However, despitemy bitter experience, I have forgiven the doctor. I guess hewas complying with our request and trying to ‘arm’ us withinformation, but he forgot that the information must to betailored to the patient’s needs. Otherwise, the informationcan actually be detrimental. Sadly, the doctor did not haveaccess to patient educational materials – and may not evenhave known that they existed!Two days later, in the dead of the night, I got a phone callfrom my uncle (he lives in Leeds, hence the midnight call)congratulating me. Puzzled, I asked him the reason, and hesaid ‘If you had to have cancer, you have the best one.’ Ofcourse, this was hardly a consolation for me. All I could thinkwas that I had cancer and it was a serious issue. I simplycould not fathom anything ‘good’ about my illness. The onegood thing however that emerged as a result of this lack ofinformation was the birth of the V Care foundation. I startedthis after completing my treatment, and my goal was simple– to provide information to patients in terms they could Please ask for Information Therapy ● 47
  45. 45. understand. Having suffered the results of an informationfamine during my treatment, I wanted to do my best to makesure that other cancer patients did not go through the sameexperience purely because of the absence of doctor-prescribedInformation Therapy!Doctors and patients seem to come from completely differentworlds, especially in India. Doctors usually are highlyprivileged, affluent, upper-class professionals, who think,read, and write in English. Patients, on the other hand, comefrom all strata of society. Many are illiterate; they can onlyunderstand their regional language; they are poor; and havelimited ability to read, write, and understand. Given theseconstraints, it is not sensible for us to blindly adopt the U.S.model for providing Information Therapy – this would neverwork in India. This is both a challenge and an opportunity.Indian doctors and patients are smart and by workingtogether, they can devise clever inexpensive solutions that aretailored for India. The Information Therapy movement mustensure that information is universally available and tested onreal patients, so we know that it does effectively serve theirneeds. Different patients have different learning styles – somepeople process written material easily, while others needvisual information or interactive communication. Multipleapproaches will help in ensuring that Information Therapyreaches out to everyone.The diagnosis of cancer – a life threatening disease – sendspatients (and their family members) into a state of shock.Such patients must be made familiar with hospital procedures– for example, the implications of being registered in aparticular type of category (free, general, private, etc). Thepatient should be informed of the various tests that would berequired, and a general time frame in which they need to bedone. Every centre should have patient-support groups, andinformation about these groups should be routinely sharedwith patients. Medical treatment can be very expensive, andideas about the cost (and sources of financial assistance), blood48 ● Using Information Therapy
  46. 46. requirements, long stay facilities, available treatment optionssuch as chemotherapy, radiation, and surgery, and the rolethey play in treatment, must be provided in a non-threateningenvironment. It may not be the doctor’s job to do all this –and in fact, it is not sensible use of the doctor’s time to evenask him to do so. But it is the doctor’s job to ensure that thepatient has easy access to all this key information. With thiskind of guidance, the patient and his caregivers are preparedfor what to expect, and their involvement with the treatmentstarts from the first day. It also builds a good reputation forthe hospital, since it shows that the hospital really cares aboutits patients. Even today, there are patients who come fromvillages, expecting to return home in a few days, not beingaware that treatment for cancer could go on for a couple ofmonths or more.Patients equipped with information are in a more confidentframe of mind to meet their doctors. Doctors too are happierinteracting with knowledgeable patients – it makes theirlife much easier if they do not have to spend precious timeexplaining the basics to each patient. Once the diagnosis isknown, then the patient would like more information beforethe treatment commences. The biology of the patient’scancer can be explained, along with the available treatmentoptions. Patients must be told what to expect, possible side-effects, success rate of every treatment, survival statistics andprognosis, and the future course of action if things do not goas planned. The practice of providing information proactivelyto patients will help them to contribute to their personalhealing.Engaging the patient is powerful medicine! Doctors sometimesforget that a consultation is very stressful for a patient, andfifty to eighty percent of everything that a patient hears ina doctor’s clinic is forgotten (or distorted) by the time he orshe gets home. This is why ongoing Information Therapysessions will help patients immensely. It is not necessary fordoctors to do this personally. They can train volunteers and Please ask for Information Therapy ● 49
  47. 47. clinical assistants to provide this information. This reassurespatients because they now know that they are in the hands ofa genuine, caring person. Well-off patients have easy accessto the internet, but often they complain that the informationthey receive from their doctor is markedly different from theinformation on the net, and they do not know whom to trustor how to make sense of this conflicting information.The end of the treatment often marks the end of the frequentdoctor-patient meetings, and while doctors get busy takingcare of new patients, their former ones are often left high anddry! The treatment is now over, but what next? Can theycelebrate? Is this really the light at the end of the tunnel theywere looking forward to, or is it the start of another uncertainjourney? More sessions of Information Therapy at this timewould be of great benefit to patients. How they can take careof themselves at home, and what follow up is required mustbe explained to patients to avoid making them feel neglectedand uncared for. They must be assured that their doctorsare just a phone call away, should there be any doubts orconcerns. Such queries are common among cancer survivors,especially in the first year. Is that fever just a viral infection?Or is it a more ominous sign? A patient’s mind plays lots ofgames, and Information Therapy can help to settle problemswhich may be minor to a doctor, but are a source of majorstress to the patient!There is a huge gap in what a doctor knows and what the patientunderstands. The ideal situation would be to actively engagepatients so that they are completely aware of all the intricaciesof treatment. Information Therapy is a great tool whichenables the doctor to achieve greater patient participation.This is true, even for illiterate patients, provided the tools aredesigned thoughtfully. As a patient advocate, I would likeevery patient to be provided a recording of the conversationand an after-visit summary routinely. For patients, visiting adoctor or hospital is not just a clinical encounter – it is a visitto a trustworthy and knowledgeable professional who has the50 ● Using Information Therapy
  48. 48. power to find the right treatment and assist them on the roadto recovery.Doctors, apart from being entrusted with the obviousresponsibility of ensuring that their patients get better, alsoneed to be able to comfort their patients and put their doubtsto rest. All patients are deserving of respect – and the bestway to empower patients is with Information Therapy. Whois better positioned to provide this to them than their team ofhealth professionals, in whose hands they place their lives? Please ask for Information Therapy ● 51
  49. 49. 9 Minimizing risk, Maximizing safety Dr Rajan Madhok, Medical Director, NHS Manchester, ENGLAND and GAPIO Lead on Patient Safety (rajan.madhok@btinternet.com) Dr Nikhil Datar, Consultant Gynaecologist, Hinduja Hospital, MumbaiR amesh Sawant was in a deluxe suite in a corporate private hospital, recuperating from the multiple injurieshe had sustained in a car crash. Just when he seemed to begetting better, he acquired an HCAI (healthcare-associatedinfection). Who was responsible for this? The doctors, thehospital staff, or his relatives? Can Information Therapyprevent such incidents from occurring?What is patient safety?Hippocrates, the father of medicine, exhorted doctors toensure that their patients did not suffer unnecessarily and hisdictum, ‘First, Do No Harm’ (Primum non nocere), has beenthe guiding principle for doctors worldwide. Medicine inthose days was empiric and literally a ‘hit and trial’ affair,which is why such a caution was needed. With the recentdramatic advances in science and technology, most peoplenaively assume that although modern medicine cannot cureeverything, it must be much safer. Whilst they would be52 ● Using Information Therapy
  50. 50. largely right, it is wrong to assume that modern medicine iscompletely safe. 21st century medical care is much morecomplex, so organising and delivering it safely is a majorchallenge. Medical knowledge is evolving rapidly, making itdifficult for doctors to keep up with newer trends. Since thereare so many different players involved now (primary carephysicians; organ specialists; nurses; physician assistants;hospitalists; technicians; medical informatics specialists; andadministrators), there is limited understanding of howhealthcare systems can be made to function smoothly.Compared to other safety critical industries (especiallyaviation), medicine has not yet fully adopted the principlesand practices necessary to ensure that complex healthcare canbe delivered safely. The Institute of Medicine’s report ‘To erris human’ assessed that modern healthcare was the sixthleading cause of death; and that more deaths were caused byiatrogenic errors, as compared to breast cancer or road trafficaccidents in the USA (Accessed 7 August 2011 http://iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx). It has been estimated that almost one in tenpatients suffers an adverse event in the hospital; and there isa one in 300 chance of dying in a hospital due to a medicalerror. Modern medicine is clearly a two-edged sword: on theone hand it can alleviate suffering and on the other hand itcan cause harm. Patient safety therefore has become animportant 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 ahospital or clinic, are the most frequent adverse events inhealthcare delivery worldwide. Millions of patients areaffected by HCAI worldwide each year, leading to significantmortality and financial losses for health systems. Of every 100hospitalized patients at any given time, 7 in developed and 10in developing countries will acquire at least one kind of HCAI.The burden of HCAI is also significantly higher in low-incomecountries than high-income ones, especially in intensive careunits and in neonates. For example, newborns are at higher Minimizing risk, Maximizing safety ● 53
  51. 51. risk of acquiring HCAI in developing countries, with infectionrates 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 candrastically reduce the chances of getting an HCAI. This ledthe World Health Organisation (WHO) to launch a globalcampaign to improve hand hygiene among healthcareworkers: ‘SAVE LIVES: Clean Your Hands’ is a majorcomponent of ‘Clean Care is Safer Care’ and can help reducethe spread of potentially life-threatening infections inhealthcare facilities.This is not a new revelation, and the benefits of hand hygienehave been well documented in the past. Semmelweiss in 1847demonstrated that obstetricians could considerably reducethe number of women dying after labour by simply washingtheir hands between deliveries. However, he had greatdifficulty convincing his colleagues to do so and was houndedout of his hospital attachments for daring to speak out againstdoctors. Sadly, getting healthcare professionals to changetheir existing practices has not become any easier since then!This means we now have a choice. We can continue relying onhealthcare professionals to follow good practice to protectpatients from HCAI (even though we know that they willoften not do so in real life); or we can explore whether patientscan do something about it.This is where Information Therapy can play an active role. Itcan 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;• Educating patients and their relatives about the importance of hand hygiene and getting them to use disinfectant hand sanitizers while in hospitals. This is especially important in India, where relatives play such an important role in providing nursing care to patients;54 ● Using Information Therapy
  52. 52. • Making hospitals publish their statistics of hospital- acquired infections. Ideally there should be open reporting of data, showing trends and improvements over time; and Getting patients to request the healthcare professional ‘touching’ them to wash their hands before doing so.So, here is a sample Information Therapy prescription for apatient 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 using 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 empowerpatients; and reinforce the fact that the hospital is doing all itcan to ensure that patients are safe and that the risk of errorsis being actively minimised.The Planetree model (www.planetree.org) is an excellentexample of how hospitals can significantly improve patientoutcomes and reduce patient errors by actively involvingpatients (and their family members) in medical care. It is thepatient who has the most at stake; and by ensuring thatpatients are well informed, hospitals can help to reducecomplications and errors considerably. This will improvepatient satisfaction scores and increase patient loyalty, whichin turn will result in better hospital occupancy and boost theirbottom line. It will also help to reduce the risk of lawsuitsbecause of medical errors.This prescription can be in the form of written notes, or in anaudiovisual form since the use of multimedia can improvepatients’ understanding and retention by over a third. Insummary, Information Therapy increases the patient’s‘ownership’ and helps the patient to explore alternatives by Minimizing risk, Maximizing safety ● 55
  53. 53. empowering them to choose appropriate care and set realisticgoals. The doctor-patient relationship becomes more open,being partnership-based rather than paternalistic; and shareddecision-making can be achieved.Information Therapy is equally useful in the doctor’s clinic aswell. We all know that often a patient will need to visitdifferent specialists. Unfortunately, as a result of this, caregets fragmented, and problems such as drug interactions arevery common. By ensuring that the patient knows exactlywhat medications he is taking and why, these preventableproblems can be avoided with the help of InformationTherapy. Information Therapy acts like an immunisationagainst ignorance. It helps to make sure that things don’t fallthrough ‘in between the cracks’ and puts the patient back incharge!Challenges and opportunities for Information TherapyTo make Information Therapy work, we have to address somechallenges. First, most people are still unaware of the problemof unsafe care: they believe that modern medicine is a forcefor good and that doctors and nurses are highly professionalpeople and that they are in ‘safe hands’. So we do need toacknowledge that there is a problem and that it is imperativeto promote safer care. Second, we still do not know enoughabout the extent of the problem. How many incidents areoccurring? Where? When? What kind? We need to ensure thatappropriate data is collected. This will help us to understandthe underlying causes of these errors and enable us to designsolutions. Finally, do patients or their carers/relatives feelempowered enough to question, and indeed challenge, theirdoctors? Even doctors often shy away from questioning theirown personal doctors when they are ill!Information Therapy can be a major force in improving patientsafety, and we need to create an ecosystem where patients cansafely demand that they be given Information Therapy; anddoctors can feel comfortable doing this routinely andproactively. Today, there are a number of organisations and56 ● Using Information Therapy
  54. 54. initiatives to promote the involvement of patients in improvinghealthcare safety.WHO Patients for Patient Safety: Patients for Patient Safety(PFPS) emphasises the central role of patients and consumersin improving the quality and safety of healthcare around theworld. (http://www.who.int/patientsafety/patients_for_patient/en/).Action against Medical Accidents: Action against MedicalAccidents (AvMA) is an independent non-profit organisationthat promotes better patient safety and justice for peopleaffected by a medical accident. A medical accident is whereavoidable harm has been caused as a result of treatment orfailure to treat appropriately. (http://www.avma.org.uk/).Technology can help as well. We are learning how to designand deliver better healthcare, by looking at system designs,and hence are able to identify and eliminate steps wheremistakes could occur. Information Technology has a veryimportant role – by having a unique identifier for everypatient, and a single electronic health record, we can providetimely and accurate information to both patients and theirdoctors.The delivery of the right information, at the right time, to theright patient, by the right doctors and nurses should no longerbe left to chance; every patient should get this routinely aspart of their care in the 21st century. Sir Muir Gray, the ChiefKnowledge Officer of the NHS in England, talks of high-quality information provided directly to the patients beingthe way forward for the transformation of healthcare. In therecent reforms being proposed by the Government in theNHS in England, the Minister has made it clear that he wantsa health service where patients are in the driving seat, not aspassive recipients of care but as equal partners with healthcareprofessionals – ‘No decision about me, without me’ – and thiscannot happen without huge doses of Information Therapy.Let us use the opportunities available to us to overcome thechallenges and get the care that we all want and deserve forourselves and for our dear ones. Minimizing risk, Maximizing safety ● 57
  55. 55. 10 Medicines – The good, the bad, and the uglyM rs 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 themedicines, she decided to visit a specialist. The specialistgave her stronger tablets and she took them, while alsocontinuing her GP’s medication. This interaction of drugsexacerbated her problem, and she found herself back tosquare one. As an educated patient, Mrs Kapoor shouldhave informed the specialist of the medicines that she hadbeen taking. It might have resulted in a different prescriptionand a better outcome.The right drug for the right patient in the right dose by theright route at the right time: this golden rule sums up the idealprescription – and it seems like such a basic and simple rule.What’s disturbing is how often this rule is broken today indaily medical practice. However, the good news is thatInformation Therapy prescriptions can ensure that we followthis simple rule. Medicines are powerful – and every drug canhave beneficial effects and undesirable effects. InformationTherapy ensures that the following questions have beenclearly answered before taking any medicines.What should you do if you are taking other prescribed orover-the-counter medicines? What are the short- and long-term risks associated with the medicine? Are there less risky58 ● Using Information Therapy
  56. 56. alternatives? What should you do if you inadvertently miss adose? The list is not exhaustive. As a patient, it is your right toask 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 clearlyunderstand what the hieroglyphics mean. Dont leave withquestions unanswered: ask your doctor or chemist for anexplanation of any confusing terms on your prescription. Avery useful reference book you should consider purchasing isthe Indian Drug Review. This book is easily available at anymedical bookshop and is an excellent compilation of detailson all the prescription drugs available in India: for instance,their cost; dosage; therapeutic action; drug interactions; andside-effects. Though this book has been written for doctors, itis easy enough for any layperson to use. Not only will thisbook help in understanding the medicines you are taking, butit may also help you to save money, since you can select a lessexpensive brand of medicine, after discussing the matter withyour doctor.Your doctor can also help you save money by prescribinggeneric drugs. ‘Generic’ means that the drug is not protectedby trademark registration; and the generic name of a drug isusually a shortened form of its chemical name, so that anymanufacturer can use it when marketing a drug. Usually, amanufacturer uses a trade name (or brand name) as well as ageneric name for a drug, and you should be able to identifythe generic name and the trade name of every drug you aretaking. Generic drugs are generally priced lower than theirtrademarked equivalents, largely because the former are notas widely advertised as the latter. Also, do keep in mind thatfor certain drugs, it is not advisable to shop around for analternative since differences can exist between the brands ofcertain drugs.The amount of medicine you buy at a particular time dependson several factors, the most obvious one being how muchmoney you have, or how much the insurance company willpay for each purchase. Medicines to treat heart disease, high Medicines – The good, the bad, and the ugly ● 59
  57. 57. blood pressure, and diabetes may be purchased in bulkbecause you will need to take such medicines for prolongedperiods. The chances are that you will pay less per tablet orcapsule by purchasing large quantities of drugs, and savequite 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 ofunnecessary expenses but also in the form of sickness, andeven death, as a result of an adverse reaction to the medicine.Patients still believe that there is a pill for every ill – and thisdesire for instant relief translates into billions of rupees formillions of pills, potions, ointments, and powders. Thepharmaceutical industry in the second-most profitable in theworld – right after illegal drug trafficking! Most people takeone medicine at least weekly, and more than 25 percent of theworld’s population consumes drugs on a daily basis. Mostpatients are not happy unless doctors prescribe medicines –whether or not they really need them. Often, doctors too willcontribute to this ‘overmedication syndrome’, and the hugeadvertising budgets as well as the largesse of pharmaceuticalcompanies lure them to continue doing so on a regular basis.You must, however, understand that no drug is without itsside-effects – after all, anything that has the potential to benefityour body also has the potential to do harm. A therapeuticeffect is a desired effect, and a side-effect is an undesiredeffect – but both are simply effects of the same drug on thebody, and go hand in hand. Remember that 80 percent of allailments are self-limiting and require no treatment. Therefore,think carefully about the costs and risks as well as the benefitsbefore taking any medicine.You should be especially wary when your doctor prescribesthe ‘latest’ and newest drug. For one, such a drug is likely tobe much more expensive than its older counterparts. Drugcompanies nowadays spend large amounts of money in orderto induce doctors to prescribe their newest products becausethey are much more profitable for them. Also, remember that60 ● Using Information Therapy
  58. 58. newer does not always mean better – in fact, new drugs maybe more dangerous. Since they have not been used for longenough, some of their harmful effects may not becomeapparent until many patients consume them over a longperiod of time. Older medicines, which have been tried andtested over many years, are a safer bet, since doctors haveconsiderable experience with them and are aware of theirrisks and benefits. For example, Duract, a new non-steroidalanti-inflammatory drug (painkiller), was withdrawn from themarket just a year after being approved for use in the USA(after having undergone rigorous testing), since it was linkedwith a dozen cases of liver failure, four of them fatal!Surprisingly, no one knows how many deaths, injuries, andside-effects prescription drugs cause each year – there is noagency which monitors these effects. Whos responsible forthis modern epidemic of drug-induced disease? All of us!Pharmaceutical companies, for a less-than-rigorous study oftheir approved drugs; physicians, who incorrectly prescribedrugs, or over prescribe the latest drug; patients who dontfollow instructions or dont tell their physicians about theother drugs they are taking; and even government agenciesfor not monitoring drug safety more effectively. As a patient,you can help to protect yourself from a therapeuticmisadventure by not opting for a newly-approved drug unlessthere arent any other, well-established alternatives.Older people are especially prone to the problem ofunnecessary drugging. Often, once a doctor starts a patient ona medicine, the latter continues taking it, whether or not heneeds it anymore. And each specialist adds to the drugoverload, without having a clue about what else the patient istaking. Not uncommonly, it turns out that only one or two ofthe assortment of drugs is really needed and, once theunnecessary medicines are eliminated, the patient startsfeeling much better. In contrast to todays enthusiasm fordrugs, it is wiser for you to be a ‘therapeutic nihilist’, in orderto let the body heal itself whenever possible. Medicines – The good, the bad, and the ugly ● 61
  59. 59. What can you do to help prevent medication errors? Theanswer is simple. Learn to ask questions. Just because youhavent been trained as a doctor doesnt minimize theimportant role you play in preventing errors with regard toyour medicines, or those for your family. By the very processof asking questions about your medicines, you understandwhy you are taking them, how to take them, and what toexpect so that you can detect potential errors. The mostcommon causes of medication errors are similar drug names,similar packaging and labelling, 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 sceptical 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 most doctors are happy to pander to their patients fancy. In fact, many patients still judge the calibre of doctors by the length of their prescriptions and by the cost of the medicines they prescribe!62 ● Using Information Therapy
  60. 60. • 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 drugsDrugs that can be purchased without a prescription arereferred to as over-the-counter (OTC) drugs, and these havebecome a worldwide phenomenon in the present era ofglobalization. Common OTC medicines include pain relievers,laxatives, cold-relieving preparations, and antacids. They areconsumed rather indiscriminately by millions of people, butthink carefully before purchasing an OTC drug. Do you reallyneed a medicine in the first place? For example, rather thanpopping a sleeping pill into your mouth every night, a glassof 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 sorethroat as can medicines. Unfortunately, most people wouldrather take a pill for every ill. More than 100 OTC drugs areavailable for treating the common cold – none of which havebeen shown to be effective.Just because a medicine is available over the counter does notmean it is completely safe, and you should always check withyour doctor before taking it. Sometimes, OTC drugs canactually be harmful. For example, taking painkillers overmany years can cause kidney failure and swallowing tabletsto self-treat a fever may mask certain illnesses such astuberculosis or malaria. Dont just depend on a friends adviceor on your chemists suggestions: always discuss OTC drugswith your doctor.You should also discuss your medication with your chemist.Unfortunately, chemists still represent an underutilizedresource in India. Every chemists shop must have a dulyqualified and trained pharmacist. Pharmacists are professionals Medicines – The good, the bad, and the ugly ● 63

×