MedWorm: Obstetricians and Gynecologists

Why americans are going abroad for health care

The Patient's Doctor — Fri, 16 May 2008 08:49:00 +0100

Why Americans Are Going Abroad for Health Care: "For someone such as Toral, the hypertrophied medical-industrial complex is just begging for a dose of disruptive innovation. He calls his vision the 'Toyota-ization of health care,' a metaphor so vast that it contains multiple readings, some fit for industry conferences and others he'll cop to only in confidence. In Toral's view, medical tourism as we know it is already giving way to 'globalized health care.' Hospital chains at home will buy, partner with, or even sell out to foreign rivals like Bumrungrad, creating worldwide networks of patients who will hopscotch across continents chasing the best care and costs. Insurers will leap at the chance to lower their own bills and offer members more options. And employers, dying to do the same, will induce employees to play ball by kicking back a share of the savings." (Source: The Patient's Doctor)

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Medinnovationblog: 25 things i've leaned about the physician culture

The Patient's Doctor — Fri, 16 May 2008 08:48:00 +0100

medinnovationblog: 25 Things I've Leaned about the Physician Culture: "25 Things I've Leaned about the Physician Culture .1. People become doctors to serve patients, not hospitals or business corporations.2. Patients are not “customers,” they’re individuals who need your help, even when that help may be expensive and experimental.3. Physicians are “the patient’s advocate,” a protector and guide through a world fraught with obstacles to care.4. Filling outforms frustrates doctors because paperwork takes time away from seeing patients: some doctors take hospital jobs because they can practice medicine rather than processing paper." (Source: The Patient's Doctor)

Could that symptom be from your meds?

The Patient's Doctor — Fri, 16 May 2008 08:47:00 +0100

Could that symptom be from your meds? : "4,000 Americans Die From Adverse Drug Effects Every Week . Protect Yourself and Your Loved Ones. Ask the First Question First: Could that symptom be from your meds? PharmaSURVEYOR is the fast online way to find out!Simply enter your current medications and review the risks. Search for your symptoms to see how your medications may be contributing to them. PharmaSURVEYOR identifies the compound risks associated with additive toxicities in addition to drug interactions, providing more complete risk assessment across your entire drug regimen." (Source: The Patient's Doctor)

The trillion dollar challenge

The Patient's Doctor — Thu, 15 May 2008 18:19:00 +0100

The Trillion Dollar Challenge: "My MD and Me spokesman said, 'If the patient does not pay the doctor a barrier is placed between them and costs are inflated. Think about it like a grocery store. You get coupons, great service. You know who offers the best value by shopping around, word of mouth from friends and reputations in the community. This changes if the customer stops paying the bill. What is the incentive to know the cost if you do not pay the bill? What is the stores' incentive to give good service? How does the consumer know who offers the best value?' he continued, 'Service naturally declines because the ?customer' is not the person getting the milk, but the person paying for it. The costs naturally increase through artificial inflation. The only way this stops is to putting the customer in charge of the dollars being spent.'" (Source: The Patient's Doctor)

Successful medical practise management

The Patient's Doctor — Thu, 15 May 2008 08:52:00 +0100

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How information therapy can heal a sick healthcare system

The Patient's Doctor — Thu, 15 May 2008 08:50:00 +0100

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Information therapy and the empowered patient

The Patient's Doctor — Thu, 15 May 2008 08:49:00 +0100

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Indian healthcare success story - emergency management and research institute

The Patient's Doctor — Thu, 15 May 2008 08:18:00 +0100

Indian healthcare success story - Emergency Management and Research Institute: "EMRI (Emergency Management and Research Institute) is a pioneer in Emergency Management Services in India. It is a not - for - profit professional organization founded, funded and nurtured by Mr.B.Ramalinga Raju, founder and Chairman, Satyam Computers and his brothers. Operating in the Private Public Patrnership (PPP) mode, EMRI is the only professional Emergency Service Provider in India today.EMRI handles medical, police and fire emergencies through the ' 108 Emergency service'. This is a free service delivered through state- of -art emergency call response centres and over 610 ambulances accross Andhra Pradesh and Gujarat. With the expansion of fleet and services set to spread accross more states in 2008, EMRI will have more than 2000 ambulances covering a population in excess of 200 million by July 2008."This is one of India's great healthcare success stories ! They provide emergency medical care which is as good as the US 911 care - at one tenth of the cost ! This is a great example of using a clever mix of managerial skills; advanced technology; entrepreneurship and public-private partnership to provide high quality medical care. It's a very inspiring story - and is full of lessons we can all learn from. (Source: The Patient's Doctor)

Nagging via text messages to help teens remember meds

The Patient's Doctor — Thu, 15 May 2008 08:15:00 +0100

Nagging via text messages to help teens remember meds: "4gt yr meds? Getting kids to remember their medicine may be a text message away. Cincinnati doctors are experimenting with texting to tackle a big problem: Tweens and teens too often do a lousy job of controlling chronic illnesses like asthma, diabetes or kidney disease.It's a problem long recognized in adults, particularly for illnesses that can simmer without obvious symptoms until it's too late. But only now are doctors realizing how tricky a time adolescence is for skipping meds, too.Of necessity, parents start turning over more health responsibilities to their children at this age. It's also an age of angst, sometimes rebellion, and when youths may most hate feeling different from their friends because of medication, special diets or other therapy." (Source: The Patient's Doctor)

Could i be any less productive?

Midwife with a Knife — Wed, 14 May 2008 20:02:00 +0100

Yesterday was a gorgeous day in America's 3rd world country. The sun was shining, it was not cold outside, the birds were singing, so after 2 attendings told me that I should take some time to enjoy it, I left. I wasn't getting much done anyway.Then, today, I've been trying to do some data analysis. One is from some genetic stuff, and it involves more than 2 million data points, and I did some of it by hand before and now the analysis is automated, and I'm trying to make sure I got different results because I made a mistake with the manual analysis (not a big stretch there).But mostly, I've spent the day reading blogs and pondering my coming night on call tonight. I've been chatting with the other people in the lab. I walked over to the hospital cookout. I've been thinking about how I only have 50 call nights left as a fellow (assuming I do the analysis and finish my thesis!). And trying to decide what I really want to do when I grow up. But mostly... wasting time.There are some days that I just can't do data analysis on 2 million data points.....Somehow I can always get my act together to see and take care of patients.What do people do on days like this in the real world where their productivity matters more than mine does?(image credit) (Source: Midwife with a Knife)

Suture for a living: words to live by

The Patient's Doctor — Wed, 14 May 2008 10:31:00 +0100

Suture for a Living: Words to Live By: "'Although we may remember David Cheever as a surgical innovator, his character is more aptly revealed in the following passage from a lecture, delivered before the Harvard Medical School class of 1871, entitled “How to Study Medicine”: If you seek for wealth you have mistaken your avocation. There must be something more, and something higher. That something is a love of your profession; a passion for science for its own sake; a broad humanity, which covers all the sick with a mantle of charity. Never lose sight of that motive, for if it once takes flight, your profession is reduced to a trade, and there is absolutely nothing left. As long as you can keep alive the sacred flame of this early passion which first called you to embrace the medical profession, so long shall you be warmed, sustained, upheld amid disappointment, unjust treatment or reverses.'" (Source: The Patient's Doctor)

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Baltimore health examiner - medical information: tainted or pure? - examiner.com

The Patient's Doctor — Wed, 14 May 2008 10:02:00 +0100

Baltimore Health Examiner - Medical Information: tainted or pure? - Examiner.com: "Here’s a secret: the medical information that you hear, whether on the radio, on TV or straight from your doctor’s mouth, may not be as pure as you think. You might imagine that those medical experts on the morning news or big-shot specialists at Johns Hopkins are simply sharing straight-up facts. Think again.As much as we, physicians, like to imagine that we are unbiased, there are many forces influencing us. Drug companies dangling generous consulting fees, the desire to please media sponsors, and the need to recruit patients for our research studies just to name a few." (Source: The Patient's Doctor)

Being an ivf specialist helps me to be a patient advocate !

The Patient's Doctor — Wed, 14 May 2008 09:05:00 +0100

(Source: The Patient's Doctor)

Free ebook - how to have a baby - free download

The Patient's Doctor — Wed, 14 May 2008 05:05:00 +0100

You can now download the book ( both as a pdf file and as an ebook) free at http://drop.io/howtohaveababy. (Source: The Patient's Doctor)

Allafrica.com: africa: toll-free mobile service to give rural africa access to medics (page 1 of 1)

The Patient's Doctor — Tue, 13 May 2008 04:25:00 +0100

allAfrica.com: Africa: Toll-Free Mobile Service to Give Rural Africa Access to Medics (Page 1 of 1): "A toll-free mobile service being launched in selected remote areas in Africa promises to save lives by connecting people with emergency medical cases to health personnel.Under the initiative launched in Nairobi on Wednesday, health workers will also be trained through mobile phone sessions on day to day skills like collecting and sharing basic household health information.Telecommunication equipment provider Ericsson and mobile phone service provider Zain have adopted the new approach in a bid to stimulate the demand of mobile solutions in areas they consider commercially challenging." (Source: The Patient's Doctor)

Do i lie to you?

Midwife with a Knife — Mon, 12 May 2008 21:49:00 +0100

So... my job search is progressing well. As it turns out, most people need MFMs as badly as I need a job. I didn't anticipate this little side effect of subspecialty training.... but it's good to be me, that way. 7 years of torture...erm, I mean training (as much as many neurosurgeons) ought to pay off some how.So here's the thing.... A lot of places are having me fill out these "I'm not a serial killer nor am I a convicted pedophile" forms for their credentialing committees before they even see me. For the most part, it's not a problem. I am, after all, not a serial killer, nor am I a pedophile.However, some of the forms ask more.... personal questions. Such as, "Have you ever been treated for a psychiatric illness?".What a lousy question. And I wish I could honestly answer "No". But I can't. The issue is my having been involved in a terrible c-section many years ago, when I was a resident. The outcome of the baby was good. The mom eventually did ok. And while I did the best local anesthetic I could manage, it wasn't good enough. Not by a long shot. Fast forward a few months, I'm still not sleeping, still feeling nauseated and ill every time I have to operate. I kept thinking I'd get used to it, and I was not getting used to it. I was considering leaving medicine all together. Well, a friend of mine convinced me to try something else, anything else, before leaving medicine. I ended up at my internists' office, she sent me (practically immediately) to a psychiatrist (who I almost didn't go to see, but I am glad I did), who diagnosed me with PTSD and depression (we still agree to disagree on the exact diagnoses a bit. ;) But I still do what he says) and also sent me to a psychologist. A bit of Lexapro, a bit of psychotherapy, and I felt much, much better. Able to continue. Able to be a doctor. Now, pretty much ancient history, although I still take the Lexapro (just waiting for my life to get un-stressful to try to d/c it again.. the last attempt didn't work so well...), and I still check in with the psychologist once a month or so (he thinks my job is ridiculously stressful, and he knows I don't complain until I'm really miserable).Now, while this story may have some bearing on the kind of doctor I am today (I have a very limited tolerance for the pain of others. Oh, well.), I don't think it has any bearing on my ability to be a doctor. I would agree that I'm a much better doctor when I'm not depressed or anxious or traumatized or whatever. But, I never allowed myself to become ill to the extent that I posed a threat to my patients. And since worse doctors than I am are allowed to practice, I really think that that little episode of my life is nobody's business. I was a good patient. I never operated under the influence of alcohol. I chose to seek care before something bad happened. I did what my doctors told me to do. I never jeopardized anybody. I was a good doctor. I still am a good doctor. I really feel like it isn't right that this sort of thing should follow me the rest of my life. It makes me feel like this little foray into the world of mental health isn't any body's business but my own. Now, if all of the forms said something like, "Have you ever been asked to seek psychiatric care as a condition of maintaining hospital privileges or state licensure?" (which is the sort of question that it would be ok if they did ask), I wouldn't feel like I was lying if I said "no". But to ask, "Have you ever been treated for a psychiatric illness?" seems a bit intrusive. On the other hand, if people answered honestly, probably 10% of the population would say "yes". Which would make the question much less informative, anyway, and they'd probably stop asking. At the same time, I don't know that I want to have the discussion about that events and the events that it lead to at a job interview. And if I answered "no", it would be hard (but not impossible) for them to find out that I was lying.... (Source: Midwife with a Knife)

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Using information therapy to heal a sick healthcare system

The Patient's Doctor — Mon, 12 May 2008 17:58:00 +0100

Patients and doctors both feel the healthcare system today is sick . One reason for this is because it is so doctor-centric. Healthcare is fragmented and disorganized and there are too many specialists , most of whom have tunnel vision. Often your cardiologist has no idea what your gastroenterologist is doing – and they are so focused on treating the heart or the liver, that they sometimes forget that these belong to a human being ! To reform the healthcare ecosystem we need to put patients at the center ! Patients ( or their relatives and friends) are intelligent and capable; and because they have a lot at stake , they are motivated to get good health care and are willing to invest time and energy if given the right tools to ensure a good outcome. We believe that patients are the largest untapped healthcare resource – we just need to provide the tools direct to patients ! One of the major influences which is rapidly changing the equation between doctor and patient is the easy availability of medical information on the internet. The democratization of medical knowledge has helped to improve the balance of power, so patients no longer feel so exposed and vulnerable. The doctor no longer has a monopoly on medical knowledge, and patients are now hunting for this on their own. After all, knowledge is power ! The trouble is that it’s not easy to find reliable information , and patients often get lost and frustrated. They go to the doctor with reams of internet printouts, and often end up upsetting their doctors in the bargain, because they have to wade through tons of rubbish. This is why doctors need to take the initiative and prescribe information. Information Therapy means providing the right information; to the right patient; at the right time. If we agree that information therapy needs to be prescribed, how do we ensure that it is efficiently dispensed ? One solution would be to have a patient education resource center at every point of clinical care. This would include the doctor's clinic ; the pathology laboratory ; the diagnostic center; the pharmacy ; and the hospital. When someone falls sick, these are their contact points with the healthcare system. Each of these represents an opportunity to educate the patient. We know that for an information prescription to be effective , this information should be provided at the point at which the patient wants it. All of these are ”moment-of-truth” encounters when a patient wants to know more about his problem and his treatment options. Unfortunately most of these opportunities for educating patients are routinely lost. Patients are being forced to search out information for themselves. While it is true that thanks to google this has become a lot easier to do, the internet is not the most effective form of providing information therapy. Let’s look at what happens to you when you fall ill today. You meet your doctor, who examines you , makes a tentative diagnosis , advises some tests and scans to confirm the diagnosis ; and possibly writes a prescription. Typically , you get to spend about 15 minutes with your doctor. During this time you have so many questions and are so stressed out that you usually do not retain most of the information your doctor tells you. You then go to the laboratory to get your blood tests done; and then to the diagnostic center to get an x-ray or a scan. You are dying to know what the results of the scan and blood tests mean , but they make no sense to you - and unfortunately , no one is willing to tell you. The standard answer from the technician is - You need to wait to see your doctor , who will explain these results to you. You then has to suffer through another 2 – 3 days of suspense, anxiety and tension, till the next appointment with the doctor. The interaction with the chemist is also not much better . All he does is fill the prescription , but you are still full of unanswered questions. Why this medicine ? What are the side effects ? Is there a cheaper alternative ? The answer is usually the same – Ask your doctor ! This is an unfriendly way of treating the patient, who is forced to wait ; or to use the internet to find information , which may often be wrong, outdated or unreliable. What a waste of the doctor’s precious time and energy . And what a wasteful use of the other healthcare personnel ! Let's look at an alternative scenario. While you are waiting to see your doctor, you can spend time at his clinic’s patient education resource center which has books and videos about the common clinical problems your doctor sees . At the end of the consultation, the doctor writes you an Information Prescription about the possible diagnosis ; and the tests , scans and medicines he has advised . These are “keywords” which you need more information on. This Information Prescription can be filled by any healthcare worker you encounter during your journey through the healthcare system. All you need to do would be to show the prescription and ask for information . The laboratory , the diagnostic center , and the pharmacy would also have a patient education resource center . This could just occupy a corner of about 50 - 100 sq ft and would have a core collection of basic books ; as well as pamphlets for the patient to take home ; and a PC or thin client with an Internet connection with links to reliable websites. If you need help , a staff member ( or another patient !) can help you find the relevant information. The beauty of patient education is that it is inexpensive and easy to incorporate in daily practice. It should be an integral part of every patient encounter; and also offers the doctor, the laboratory and the diagnostic center a great way of marketing their services. Anyone who takes the time and energy to educate the patient is likely to create a lot of good will and get repeat patients . It also creates increased brand awareness in the community, as reliable health information is valued by patients and family members. We know that medicines play an important role in helping patients get better , which is why doctors prescribe them . Information has an equally important role to play in medical treatment, and needs to be routinely prescribed and dispensed. This is an effective way of improving the medical care you receive . Every time you visit your doctor, please ask him to prescribe information ! (Source: The Patient's Doctor)

Happy mother's day

Ob/Gyn Kenobi — Sun, 11 May 2008 21:31:00 +0100

Happy Mother's Day to all of you Mothers, would-be-mothers, and glad-you-aren't-mothers, We had a great active weekend here. CindyLou had her 4th birthday party (dinosaur theme, of course, every girl's dream), and the Bean was baptized this weekend. I also was on call, but so far the call gods have been kind to us! May has been a crazy month, with lots of travel, and busy-ness in general. I am hopeful for the summer. I am looking to interview with other practices in the coming weeks. I am also going to meet "the other woman" this weekend at a mutual friend's wedding. Give me the strength to be civil and polite to this person with whom I regard with contempt. Apparently they are going to become engaged soon. It blows my mind how my friends can call her a "nice person" when I know and she knows that she is a home wrecker. Hopefully I won't get drunk enough to tell her what I really think of her! Today I am thankful for my perfect babies. They are truly the best Mother's Day presents of all! (Source: Ob/Gyn Kenobi)

What i'm going to do on my summer vacations

Midwife with a Knife — Sun, 11 May 2008 18:51:00 +0100

That's right. Summer vacations. Our "vacation year" (is that a real term?) runs from July through June (like the academic year). I haven't taken real vacation in over a year, and I don't believe in letting vacation time go unused. So, I'm taking 3 weeks off, starting in 8 days. During that time, I will clean my house and go to visit my family. I'm hoping it will be relaxing, although there's always that family stuff. The fact that my mom always resents my visiting other people other than her (although, really, that shouldn't be my problem. I've taken to telling her my plans and expecting her to deal with it, which isn't a perfect solution, but.... really.... she's a grown-up, she has to learn to act like it).Then, in July, I'm going to Ecuador to provide medical care for a week (as it turns out, there's not a lot of docs in Ecuador). The hilarious part of this is that I'm helping to staff a general medical clinic. I have done no general medicine in 6+ years, and I speak no Spanish. I'm told that this won't be a problem. If anybody has any good medical Spanish references, please feel free to let me know! I want to go see the Galapagos, but I'm not sure if that will work out with my time and money restrictions. Having said that, I'm about 14 months away from becoming an attending, and so, I may just do the Galapagos as a separate trip then.Then, later in July, I'm going to Bar Harbor, Maine for 2 weeks for a course on clinical genetics. I think of this as "summer camp for grown-up science geeks". Seriously, it should be fun. And since it involves the Hyatt Regency, I don't think we'll really be roughing it all that much.Then, in August, I have a couple of job interviews I'm working on lining up (more later, one of the opportunities sounds perfect, but I have to decide if I still like the geography). I'm also giving an oral presentation at the International Society for Ultrasound in Obstetrics and Gynecology.All in all, a busy summer. Too bad I can't plan on hibernating next winter!(image credit) (Source: Midwife with a Knife)

In other words...abbreviations, acronyms, and other healthcare shorthand - health literacy

The Patient's Doctor — Wed, 07 May 2008 10:25:00 +0100

In Other Words...Abbreviations, Acronyms, and Other Healthcare Shorthand - Health Literacy: "Frank Federico, RPh, is concerned about abbreviations and acronyms from a patient safety point of view. Federico is content director for the Institute for Healthcare Improvement in Cambridge, Massachusetts. One area that particularly concerns him is the use of abbreviations for medications.Federico says one of the more serious safety concerns is the fact that the meaning of an abbreviation may differ from one hospital to another. For example, depending on where you work, “MTX” could stand for either “methotrexate” or “mitoxantrone” (different drugs that are both used to treat certain kinds of cancer).Another concern is providers using a variety of abbreviations and shorthand terms when communicating orally with patients. For instance, one provider might refer to a patient’s drug as “HCTZ” while another might call it “hydrochlorothiazide.” A third may refer to it simply as a “fluid pill.” The confusion only mounts when the patient picks up his prescription from the pharmacy and the pill bottle has yet another way of describing ingredients and dose." (Source: The Patient's Doctor)

In other words...helping patients separate true health information from false - health literacy

The Patient's Doctor — Wed, 07 May 2008 08:43:00 +0100

In Other Words...Helping Patients Separate True Health Information From False - Health Literacy: "Use external aids to improve accurate recall. To aid recall, Skurnik recommends the use of memory aids such as note taking, supplemental reading material, or using another person as a “second set of ears.” Memory aids can help to offset the fact that people may remember just bits and pieces of claims, especially when the situation — or context — is rushed, harried, or otherwise distracting, as is often the case in a clinical setting." (Source: The Patient's Doctor)

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Medical travelers market - mapping the market for medical travel - health care - strategy & analysis - the mckinsey quarterly

The Patient's Doctor — Tue, 06 May 2008 18:35:00 +0100

medical travelers market - Mapping the market for medical travel - Health Care - Strategy & Analysis - The McKinsey Quarterly: "Mapping the market for medical travel * Medical travel has captured the world’s attention and imagination, but a new McKinsey study suggests that the market isn’t as large as reported and that most medical travelers seek high quality and faster service instead of lower costs. * McKinsey places the current market at 60,000 to 85,000 inpatients a year, but these numbers could grow substantially if certain barriers, such as noncoverage from payers, were removed. Payers and providers looking to benefit from this nascent market have a substantial opportunity." (Source: The Patient's Doctor)

Challenging patients make our work interesting !

The Patient's Doctor — Tue, 06 May 2008 13:24:00 +0100

(Source: The Patient's Doctor)

The enquirer - text messages help teens with asthma

The Patient's Doctor — Tue, 06 May 2008 09:42:00 +0100

The Enquirer - Text messages help teens with asthma: " Tylor Thomas, 16, has never counted how many text messages he gets in a day, but it’s a lot.Tucked in among all those shout-outs from friends, one potentially lifesaving message arrives every morning around 9 for the Winton Hills teen.“They just text me and tell me, ‘Hi. Don’t forget to take your asthma meds,’” Tylor said.He’s one of a handful of teens participating in a Cincinnati Children’s Hospital Medical Center pilot project to determine how well text-message reminders work to help teens manage their asthma.If text messages are an effective solution for asthma management, there’s no reason they won’t work for patients with diabetes or other chronic illnesses, said Maria Britto, an adolescent medicine specialist at Children’s." (Source: The Patient's Doctor)

Pleio health support systems

The Patient's Doctor — Tue, 06 May 2008 09:39:00 +0100

Pleio Health Support Systems: "For millions of patients, new medications are often misunderstood or misused. Everyone has a parent, friend, brother or sister who fails to get the advice, encouragement or support they need when they need it. Most patients quickly abandon drug therapy; many times for the wrong reasons—and with serious consequences. Pleio brings people together to improve patients' experiences with new medications, for the beneﬁt of patients, their families and the entire healthcare industry.Pleio GoodStart™ is a practical adherence support system for patients in the early adoption stage of a new medicine—the ﬁrst 100 days. It provides enrolled patients with answers, encouragement, reminders and peer support, when they need it, how they want it, in their language." (Source: The Patient's Doctor)

Personal health profiler: part 1 | trusted.md network

The Patient's Doctor — Tue, 06 May 2008 08:28:00 +0100

Personal Health Profiler: Part 1 | Trusted.MD Network: "I’m going to delve into the details of a truly next-generation personal health record (PHR). As I discussed in my last post, this paradigm-busting software technology is a radical departure from current day applications. It addresses this question: How can a computer help an individual and his/her healthcare professionals understand how the person’s health, wellbeing and quality of life are affected by his/her: * Thinking processes (one’s beliefs, attitudes, perceptions, etc.); * Emotional processes (how one feels in different situations and why); * Behavioral tendencies (including how and a person act in self-defeating ways); * Coping strategies (how one tends to deal with life problems and the benefits one receives) ; and * Mind-body interaction?What I'm describing is the Personal Health Profiler™ (PHP) application, which I invented after decades of R&D. It's useful to consumers, as well as their sick-care providers and wellness coaches. My intention here is to gain exposure for my invention in hopes it will stimulate dialogue about what personal health records could be, as well as spark creative collaboration projects. (Source: The Patient's Doctor)

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Hifi's and healthcare | trusted.md network

The Patient's Doctor — Tue, 06 May 2008 08:24:00 +0100

HiFi's and Healthcare | Trusted.MD Network: "Specialty facilities can offer more expert care more quickly, and (perhaps) more cost-efficiently than traditional hospitals. They lack, of course, extended stay options; when my mother was recently hospitalized, she was taken first to the same facility as I had been, but had to be transported later that day to a 'regular' hospital. Still, we couldn't have known that at the time, and it seemed a reasonable choice.It seems to me that 'distributed healthcare' may be on the horizon. By unbundling services, providers can specialize more efficiently, which may lead to a reduction in the cost of health care (and hence, of health insurance).Something to keep an eye on." (Source: The Patient's Doctor)

All you wanted to know about adoption in india !

The Patient's Doctor — Tue, 06 May 2008 06:32:00 +0100

NAAF, the National Association for Adoptive Families in India, has published an excellent guide for prospective parents who want to adopt a baby. Unfortunately, this is now out of print, so we've uploaded this to the web ! It's a free download - and is packed with useful information ! (Source: The Patient's Doctor)

How information therapy can help to improve healthcare

The Patient's Doctor — Mon, 05 May 2008 17:38:00 +0100

Traditionally, most of us think of Information Therapy as information which is prescribed by the doctor and administered to the patient. Actually, it can be much more than this !For one, Information Therapy can be dispensed by other healthcare professionals , such as pharmacists and X-ray technicians . At present, they are often underutilised. By getting them to teach patients, we can make more effective use of their skills. They much more likely to be experts in their area of interest ( for example, most pharmacists would know much more about drug interactions than the average doctor); and because they are much less intimidating than doctors, patients find it much easier to ask them questions and get answers in plain English. Talking to patients and explaining medicalese to them also helps to improve the bedside skills and empathy of these professionals, so they become much more than just technicians.Even more importantly, Information Therapy can be provided by other patients ! Expert patients often have a wealth of knowledge which they are happy to share - and since they have "been there, done that", they a gold-mine of practically useful information ( which most doctors are clueless about).Prescribing Information allows doctors to help patients to tap into these sources of wisdom and knowledge ! (Source: The Patient's Doctor)

Costs of overtreating patients - los angeles times

The Patient's Doctor — Mon, 05 May 2008 16:28:00 +0100

DOCTORS ARE frequently criticized for the things they fail to do. In general, they don't spend enough time on patient education, don't provide adequate preventive care and don't treat many chronic disorders aggressively enough.These shortcomings are well-documented. An equally important problem that attracts less attention, however, is doctors who do too much. Whether it's ordering an unnecessary test or advocating an aggressive form of treatment over one that's more measured, the result is the same. Patients wind up getting more than they need. (Source: The Patient's Doctor)

Self indulgance and exercise

Midwife with a Knife — Sun, 04 May 2008 14:37:00 +0100

I have many posts I've been meaning to do.... home births, non-compliance, the rising c-section rate, teaching residents, the fact that nobody ever listens to me (heh!), but instead of blogging about something important, today I'm blogging about me...So, I've been on prednisone for the colitis for most of the past year, with doses averaging at about 20mg, but on 10 mg for the past couple of months (ever since I saw New GI Doc). I'm not symptom-free on 10mg, but my symptoms are manageable and tolerable on that dose. It's not a very high dose, but there's still a difference (for me) in side effects in being on 10mg vs 0 mg of prednisone. Most of the side effects have to do with appetite; and since my weight's always been a bit of a struggle, well, being on prednisone at any dose isn't terribly helpful with that. Also diabetes, vascular disease, and osteoporosis (my mom had an osteoporotic hip fracture a couple of years ago and has some vertebral compression fractures... pretty severe osteoporosis) are concerns on prednisone. Exercise actually reduces the risk of all of those things, helps with weight control (although whether or not it helps with actual weight loss is debatable, I think it does), and it makes me feel good.So, I started jogging, which I liked more than I thought I would, and still do, especially since the sun is coming up earlier in the morning now, and soon it will be dawn when I'm out jogging at 6am. I like jogging at dawn. But the problem with jogging is that it's lonely.And I get lonely here sometimes. I mean, I work with plenty of nice people, and I have plenty of friendly acquaintances, but no real true friends here (although I do have friends from other places I talk to on the phone at times). It's part of the price of living a nomadic existence during medical training, sometimes.And I needed a hobby. I liked pottery, but didn't have much in common with the other people who took pottery. So, then I tried tae kwon do, and it's been a lot of fun. 2 hours every night I can make it of kicking, punching, throwing, and self defense. And the people who go tend to be people who I have something in common with, in general. Even though I haven't found my BFF there, we chat and laugh, and it's a good time. In fact, I got my yellow belt (which means I'm not a newbie any more) on Friday, and I will be sticking with the tae kwon do for a while. I think I want to get a black belt.But I also still like jogging, and that's a good 45 minutes of time in the morning. You add that to the tae kwon do in the evening, and maybe throw in some strength training (so I can keep improving my upper body and core strength, which could use some help), and that's like 3 hours of exercise a day.I know that my program directors (we have 2 for the fellowship) would think that spending 3 hours on exercise, plus the time I need for ADLs (15-30 min a day), plus the 8 hours (and when I'm exercising this much I really need 8 hours) of sleep would think that it's all self indulgent, because when you do the math, I can only spend 10 hours a day on work and do all of this exercise.24-8=16-3(exercise)=13-1(driving)=12-1 (eating)=11 -1 (ADLs, blogging, tv, etc)=10 (work).If they knew, their argument would be (and I've heard it before, but not directed at me) that I should spend all available time while I'm a fellow on my fellowship, and that this sacrifice will pay off later. Or that I should sacrifice sleep for my exercise (although like I said, all this exercise makes me need more sleep... and makes me sleep like a rock) or for work.I've come to the point where my tolerance for this level of sacrifice just isn't there any more. So, I continue my self-indulgent level of exercise, mostly in secret, so that the powers that be at work don't find out.Having said this, it used to be that doctors (both in training and after training) gave up everything: exercise, family, sleep, activities of daily living, absolutely everything, in order to be doctors. And all of my current attendings trained during that era, so to them, my 3 hours of exercise, 8 hours of sleep, and an hour of adl's really probably does seem self-indulgent, and it isn't their fault, entirely, that they view medicine and life like that.And maybe this is a temporary phase in my life. Perhaps, I'll return to working harder on work soon. Figuring out where a good work-life balance actually is is really quite difficult, and I expect that that balance will shift for me quite a bit as the years go on.(image credit) (Source: Midwife with a Knife)

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The democratization of health knowledge by steve denning, guest contributor « lisa neal

The Patient's Doctor — Sun, 04 May 2008 05:32:00 +0100

The Democratization of Health Knowledge by Steve Denning, Guest Contributor « Lisa Neal: "Steve Denning wrote previously about The democratization of knowledge: anyone can know anything.“This phenomenon is particularly notable in the spontaneous formation of global communities of interest in the field of medical problems. Patients who were once at the mercy of doctors who had unique access to esoteric medical knowledge now find themselves able to contact other doctors and patients and explore their particular subject, gather new data, discover new leads for treatment, and learn how to cope with side effects. The emerging communities are global in nature. A patient in the US may be able to learn from a doctor in China or a suffering patient in Argentina and vice versa. The sufferers of rare diseases, where perhaps only a few victims exist around the world, can now make contact with each other and share experiences…”" (Source: The Patient's Doctor)

Health 2.0 - modern healthcare online

The Patient's Doctor — Sun, 04 May 2008 05:31:00 +0100

Health 2.0 - Modern Healthcare Online: "The first principle, O’Reilly says, is the software of a Web 2.0 company has to be Web-based, has to provide a service and that service has to be structured so that the more people use it, the better it becomes. He described it as 'an architecture of participation.' An exemplar is eBay; as more and more buyers and sellers participate, the broader the eBay market becomes, which creates more value to the customer.O'Reilly calls the second key principle 'harnessing collective intelligence,' which also is referred to by others as 'the wisdom of crowds.' To avail themselves of this wisdom, Web 2.0 developers must create applications that are dynamic, with user participation designed into the systems, so that participation itself becomes an integral part of making the underlying database more valuable. Amazon.com adds value by enabling readers to write and post reviews of software and books and to be engaged in other ways, such as preparing wish lists.O'Reilly's third principle, 'Data is the next 'Intel inside,' ' notes that specialized data, enhanced through analysis performed by the service provider as well as by the contributions of service users, becomes the core asset of a Web 2.0 company. The Amazon wish lists, for example, are aggregated by Amazon and used as buyer's guides." (Source: The Patient's Doctor)

The open-access medical office - seeing patients when they want to be seen helps you respond to their needs and stay competi

The Patient's Doctor — Sat, 03 May 2008 13:48:00 +0100

The open-access medical office - Seeing patients when they want to be seen helps you respond to their needs and stay competitive. - Medical Economics: "How important is open access? It's one of the seven core components of the medical office of the future as envisioned by TransforMED, a practice redesign initiative of the American Academy of Family Physicians. If you want more proof, witness the burgeoning growth of retail clinics and urgent care centers that patients can visit at the drop of a hat. For medical practices to compete, they'll need to be just as convenient.Beyond delighting patients with quick service, open-access scheduling produces a cascade of other benefits. Chief among them are a steep reduction in no-shows and cancellations (the further out you schedule patients, the higher the risk that they'll skip or cancel) and improved continuity of care (rather than be shoehorned into the schedule of any clinician who's available, acutely ill patients are far more likely to see their own physician)." (Source: The Patient's Doctor)

Six word meme

Midwife with a Knife — Sat, 03 May 2008 02:24:00 +0100

A long time ago, I was tagged by TBTAM for the six word memior meme. The instructions? Write a 6 word memior and tag 6 others. Catch a baby, watch the floor.I'll tag all three shrinks at shrink rap, someonetc, RLBates, and Mark's Tails. (Source: Midwife with a Knife)

Literacy partners of manitoba - plain language service

The Patient's Doctor — Thu, 01 May 2008 16:11:00 +0100

Literacy Partners of Manitoba - Plain Language Service: "Literacy and Health Manual. This workshop manual introduces health providers to the links between literacy and health and offers strategies for reaching clients with low literacy skills. Another cool tool is the ClearDoc Index which is a handy plain language checklist." (Source: The Patient's Doctor)

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Dispensing patient information

The Patient's Doctor — Thu, 01 May 2008 02:35:00 +0100

If we all agree that information therapy needs to be prescribed, how do we ensure that it is efficiently dispensed ? One solution would be to have a patient education resource Center at every point of clinical care. This would include the doctor's clinic ; the pathology laboratory ; the diagnostic center; the pharmacy ; and the hospital. When someone falls sick, these are their contact points with the healthcare system. Each of these represents an opportunity to educate the patient. We all know that in order for an information prescription to be effective , this information should be provided at the point at which the patient wants it. All of these are ”moment-of-truth” encounters when a patient wants to know more about his problem and his treatment options. Unfortunately most of these opportunities for educating patients are routinely lost. Patients are being forced to search out information for themselves. While it is true that thanks to the Internet and clever search engines this has become a lot easier to do, the internet is not the most effective form of providing information therapy. Let’s look at what happens to a patient today. He takes an appointment with his doctor, who examines him, makes a tentative diagnosis , advises some tests and scans to confirm the diagnosis ; and possibly writes a prescription. Typically , the patient gets to spent about 15 minutes with the doctor. During this time he has so many questions and is so stressed out that he usually does not retain most of the information the doctor tells him. He then goes to the laboratory to get the blood tests done; and then to the diagnostic center to get an x-ray or a scan. He is dying to know what the results of the scan and blood tests mean , but they make no sense to him and unfortunately , no one is willing to tell him. The standard answer from the technician is - You need to wait to see your doctor , who will explain these results to you. And he then has to suffer through another 2 – 3 days of suspense, anxiety and tension, till the next appointment with the doctor. The interaction with the chemist is also not much better . All he does is fill the prescription , but the patient is still full of unanswered questions. Why this medicine ? What are the side effects ? Is there a cheaper alternative ? The answer is usually the same – Ask your doctor ! This is an extremely unfriendly way of treating the patient, who is forced to wait ; or to use the Internet to find information , which may often be incorrect, outdated or unreliable. What a waste of the doctor’s precious time and energy . And what a wasteful use of the other healthcare personnel ! Let's look at an alternative scenario. While the patient is waiting to see the doctor, he can spend time at the clinics’ patient education resource center which has books and videos about the common clinical problems the doctor sees . At the end of the consultation, the doctor writes a prescription for information about the possible diagnosis , and the tests , scans and medicines he has advised . These are the “keywords” which the patient needs more information on. This information prescription can be filled by any healthcare worker the patient encounters during his journey through the healthcare system. All he would need to do would be to show the prescription and ask for information . The laboratory , the diagnostic center , and the pharmacy would also have a patient education resource center . These could just occupy a corner of about 50 - 100 sq ft and would have a core collection of basic books ; as well as pamphlets for the patient to take home ; and a PC or thin client with an Internet connection with links to reliable websites. If the patient needs help , a staff member would help them find the relevant information. Patient education should not be seen to be an expense. It is actually an integral part of patient service; and also offers the clinic , the laboratory and the diagnostic center a great way of marketing their services. Anyone who takes the time and energy to educate the patient is likely to create a lot of good will and get repeat customers. It also creates increased brand awareness in the community, as reliable health information is highly valued by patients and family members. We all know that medicines play an important role in helping patients get better , which is why doctors prescribe them routinely . Information has an equally important role to play in medical treatment, and needs to be routinely prescribed and dispensed. This is an extremely cost-effective way of improving patient satisfaction and patient compliance. (Source: The Patient's Doctor)

The doctor is part of the patient's tool-box of dealing with illness

The Patient's Doctor — Wed, 30 Apr 2008 08:43:06 +0100

One of the problems with modern healthcare is the excessive importance given to doctors. When patients fall sick , they are very happy to dump their problems on the doctors's lap and they expect him to provide a quickfix. Unfortunately , this is an unrealistic expectation; and gives rise to a lot of unhappiness and stress both for patients and for doctors.An illness is just an episode in the patient's life; and that while the doctor usually sees only a disease which needs to be treated and is fixated on fixing the medical problem, the patient has a life which is much more than just his illness.One way of putting the patient at the center is by changing the way we look at doctors. Doctor should be treated as just one of the tools which are available to patients to help them manage their illness. There is no doubt that the doctor can be an extremely valuable tool, but this is no reason to treat them as gods.The doctor is so important because he plays so many roles. He needs to make the right diagnosis; confirm it ; formulate the treatment plan ; and provide counseling . The doctor acts as a gatekeeper to the entire healthcare system and the good doctor guides the patient down the right path. However , doctors are not indispensable , and thinking of the doctor as a tool helps the patient to realise how important the role he himself plays .Smart patients know which tools to use- and when. Clever patients have multiple tools in their toolbox - and these include: spirituality; friends and family for support; humour ; and information therapy. The more the tools you have in your armamentarium, the better equipped you are in your ability to manage your illness.As with all tools , doctors can be used and misused. The trick is to identify the right tool and use it for the right purpose. While doctors may be very good at making a diagnosis , mastering the tools to live with the illness are skills the patient needs to learn for himself. Insulin is a tool a diabetic uses to to manage his illness. However, he cannot depend upon insulin alone. He also needs to learn how to control his diet ; how to exercise; and how to improve his lifestyle.Similarly, a doctor is also a tool - and patients need to learn how to use this powerful tool intelligently and sparingly ! (Source: The Patient's Doctor)

Learning health from the scriptures:

The Patient's Doctor — Tue, 29 Apr 2008 14:08:00 +0100

Learning health from the scriptures: " It is often said that Indians are fatalists who leave everything to fate or to God. The excuse patients usually quote is: "Our religion tells us that bodily sufferings are a result of sins incurred in our past life". This excuse is used to avoid taking medicines or insulin, and to explain inertia on part of the patient. "My sugar levels are always 400: they will never come down." What do our scriptures actually teach us? Lord Krishna exhorted Arjuna to fight the Mahabharata, not to bow before his enemies. Lord Ram and Hanumanji fought Ravana and his army of demons. Hindu scriptures talk of Gods fighting 'asuras'( demons) whenever they are attacked. Sikh and Islamic tradition boast of fighting against injustice (and winning). Christianity speaks of Lord Jesus healing the sick, thus giving divine approval to our fight against illness. What, then, do we learn from the scriptures? We learn to fight disease, to fight diabetes, to fight its complications. We learn not to admit defeat, but to persevere. Because if we persevere, victory will be ours." (Source: The Patient's Doctor)

Patient education in ancient india

The Patient's Doctor — Tue, 29 Apr 2008 13:46:00 +0100

Patient Education in Ancient India " The treatise Sutrasthana mentions four essential parts of a successful treatment regime, known as The Quadruple of Atreya. The four components necessary to treat diabetes, or any other disease, are1.The Physician.2.Drugs.3.The Patient.4.Attendants. [ = Family = nurses]Just as successful cooking requires utensils, fuel /fire, food items and a cook, successful medicine requires all the above four. Similarly, the potter has to coordinate earth/clay, water and his wheel to create good pottery.And just as a strong table needs four equally stable legs to stand, all four components of the quadruple of Atreya have to be equally effective .A chain is just as strong as its weakest link, and diabetes practice cannot be stronger than the weakest link of the quadruple.Thus the concept of team work, patient education and diabetes awareness was propounded over 3000 years ago. The physician represents today’s diabetologist or endocrinologist, while the patient stands for an educated, empowered person with diabetes in equal partnership with his doctor."There's nothing new under the sun ! (Source: The Patient's Doctor)

Doctors , patients, problems and solutions

The Patient's Doctor — Tue, 29 Apr 2008 10:31:00 +0100

Patients come to a doctor because they have a problem and want a solution. Doctors are fascinated by problems - especially those which are rare or complex. Differential diagnosis can be one of the most intellectually challenging parts of a doctor's practise - and since most doctors are intelligent, they love "cracking diagnostic conundrums" and interpreting scans and images. However, once the problem has been diagnosed and the disease given a name, many doctors lose interest, because treatment is usually quite cut and dried and not very intellectually stimulating. After all, zebras are fun to talk about while horses are boring.On the other hand, while some patients are quite happy to be the center of medical attention because they have a complex problem, most just want a solution so they can move on with their life.A good doctor will spend as much time and energy on crafting a treatment plan for the patient, as he will on creating a plan for a diagnostic workup. This can actually be harder to do, because it requires the doctor to see things from the patient's point of view - and offer advise which the patient is willing to carry out ! (Source: The Patient's Doctor)

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Why i don't think doctors should educate their patients

The Patient's Doctor — Tue, 29 Apr 2008 07:02:00 +0100

I am a big believer in patient education . I feel this empowers patients and allows them to form a partnership with their doctors. All these years, I have advocated that doctors spend time on educating their patients, but I have now had to change my beliefs, and I no longer think doctors should educate their patients.Let me clarify.1. Most doctors are not good educators. They use complex medical jargon and are not able to simplify matters, so that that patients often cannot understand what they are saying.2. Doctors have not been taught how to teach patients , and this is not always an easy skill to acquire.3. Because doctors can be intimidating , patients are very reluctant to ask questions. This means that even though the doctor feels that he has provided an adequate explanation, the patient often understands very little, and is still full of doubts and queries. After all, good communication is always a two-way process.4. Often , the doctor may not provide the right information , because of a vested interest or a hidden agenda.5. Doctors find educating patients very boring and get fed up very quickly of answering the same questions6. The doctor's time is precious , and could be better utilised in providing clinical care.So what is the solution ? Just like we have independent trained counselors who can guide patients, we need to have patient educators to educate patients. This does not mean we need to create new jobs or positions. It just means that the clinic should identify one person who likes talking to patients and is good at this . This is often an innate skill( these are "people persons " !) which can be polished with training . This person could be a nurse or a secretary who then takes on the additional responsibility of educating patients. They are likely to do a much better job than the doctor can , for many reasons.1. They often have more time2. Patients are much more comfortable talking to them , rather than the doctor; and are much more likely to ask questions3. They are much more likely to use the local language , when providing explanations. This helps patients to understand complex concepts much more easily4. Because they spend a lot of time educating patients , constant repetition will ensure they get very good at it. They can use a number of teaching tools and models to help them get their point acrossThis is a much more cost effective way of educating patients , rather than using the doctor's expensive time !This model means that doctors will continue to prescribe information therapy. It is just that the information therapy would be dispensed by someone else in the clinic other than the doctor.In the past , doctors would do all the lab tests themselves. Today , these lab tests are outsourced to a specialised pathology laboratory. Using exactly the same analogy , patient education can be better provided by an individual who has a special interest in this field. This creates a win-win situation, where everyone benefits. More importantly , it also serves to emphasize how highly the doctor regards patient education ! If we have specialists for taking x-rays ( called X-ray technicians), why can't we have specialists for educating patients ? (Source: The Patient's Doctor)

Microsoft says web 2.0 can give consumers more control over health care

The Patient's Doctor — Tue, 29 Apr 2008 04:19:00 +0100

Microsoft says Web 2.0 Can Give Consumers More Control over Health Care: " Ben Flock, a Microsoft Healthcare & Life Sciences Industry advisor, told attendees during his closing keynote at Microsoft's Health & Life Sciences Developer and Solutions Conference, held April 22 through 24 in Atlantic City, N.J., that Web 2.0 technologies moved information out of isolated silos and into interlinked community computing platforms that function like software for users.Flock said applying those same concepts to the health care industry would provide tools that would allow for better and more relevant information sharing, collaboration, and ultimately better care as consumers gained more control over their information and, ultimately, their health.Web 2.0 features like product and service ratings, information search, social communities, and tools are a natural evolution of health care technology, Flock said, and represent a new business paradigm that companies and institutions will have to adopt in order to remain competitive and relevant." (Source: The Patient's Doctor)

Virtual office visits appeal to patients, physicians, insurers -- orlandosentinel.com

The Patient's Doctor — Tue, 29 Apr 2008 04:18:00 +0100

Virtual office visits appeal to patients, physicians, insurers -- OrlandoSentinel.com: "The cost to her for the online consultation: zero. Her insurance company, Cigna, paid Dienst $35 for the virtual office visit, and under her health plan Steinert had no co-pay (compared with a $20 co-pay for an office visit). 'I'm not into computers,' said Steinert, 57. 'But this was easy. It's a good idea.'It's a good idea for doctors, too, said Dienst, who is among the first physicians in Central Florida to conduct online, reimbursed consultations with patients. With three major health-insurance plans now reimbursing physicians for online consultations, Dienst expects he'll soon have plenty of company." (Source: The Patient's Doctor)

Payer pilots diabetes smart phone app

The Patient's Doctor — Tue, 29 Apr 2008 04:18:00 +0100

Payer Pilots Diabetes Smart Phone App: "Owings Mills, Md.-based CareFirst BlueCross BlueShield will conduct a pilot study in which it will offer 260 patients mobile phone-based diabetes management software from WellDoc Communications Inc., Baltimore. The 12-month study seeks to evaluate the effectiveness of such disease management software on reducing Ac1 hemoglobin levels of patients with Type 2 diabetes.The application enables diabetic patients to enter their blood sugar readings into their mobile phone and receive real-time feedback on what they should eat and other ways they can help stabilize it. The software also can alert patients when they need to test their levels.Further, the application sends the data to the vendor's servers, where it is analyzed and can be accessed by the patient's physicians and disease management case workers. It also can support glucose meters that can send data via Bluetooth wireless technology." (Source: The Patient's Doctor)

Still alive

Midwife with a Knife — Mon, 28 Apr 2008 21:40:00 +0100

Hey everybody, thanks for the inquiries. I'm still alive, just working a lot. I'm on clinical service right now, and working at least 12 hours/day, plus prepaying my call so I can take all of my vacation (I have 3 weeks left) in May/June.So, if you haven't given up on me, thanks for not giving up on me. If you have, well, then, that's your fault. More soon. I understand I get my life back at the end of the month. ;) (Source: Midwife with a Knife)

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Half of americans don't get a second opinion - health care- msnbc.com

The Patient's Doctor — Mon, 28 Apr 2008 17:29:00 +0100

Half of Americans don't get a second opinion - Health care- msnbc.com: " Even if you don't take the second doctor's opinion, simply knowing your options and thinking through the pros and cons can improve your care. You don't have to have a serious condition to benefit. 'There may also be more than one way to approach the same problem, or there may even be a financial incentive for a physician to recommend one treatment over another,' says Gail Gazelle, MD, an assistant clinical professor of medicine at Harvard Medical School and president of MD Can Help, an online patient advocacy practice. 'Also, doctors can diagnose any problem incorrectly.'Now you can get an elite doctor to weigh in as well: Top medical centers such as the Cleveland Clinic and Partners' Center for Connected Health (which is affiliated with Harvard Medical School) offer second-opinion services via the Internet. This practice of consulting from afar using patients' medical records and test results is having a profound effect on how problems are treated. According to Partners, although its experts changed only 5% of diagnoses during its first year of providing e-consults, 90% of the treatment recommendations differed from the referring physician's plan."I have now been offering a free second opinion for infertile couples for over 5 years . I enjoy doing this - and have helped many couples , which means good karma for me ! (Source: The Patient's Doctor)

Help to setup patient information centers in hospitals in india

The Patient's Doctor — Sun, 27 Apr 2008 08:17:15 +0100

Objective: · To set up a Multimedia Patient Education Resource Center in the hospital to attract more patients; improve patient care, and enhance patient satisfaction. Background of HELP: · The Patient Education Resource Center of HELP is located on DN Road in Mumbai. The centre hosts a large number of visitors daily. It is a great way to experience the power of ‘Information Therapy ’ first hand. The numerous success stories of patients who are empowered by the information provided here has prompted HELP to set up more centres all over India. · HELP is a one of the world’s largest patient education and information centres. It has been recognized by the Limca Book of Records. Established in 1997, HELP has over 10000 books and 500 videos. It set up India’s first health website www.healthlibrary.com. It is a self-sufficient, registered charitable trust and a non-profit organization. Current Market Status: · The market scenario with regards to patient education is not very organized at present. The increasing instances of violence in hospitals, litigation, etc. are an ample testimony to the fact. A well-informed patient is a happier patient because he has realistic expectations. Moreover with the increasing level of awareness, people nowadays prefer doctors/hospitals who keep them informed and updated about their medical condition, prognosis and the course of treatment. The days when the doctor’s words were unquestionable are over. · The commonest complaints patients have about medical care in hospitals are: Being made to waitNot being told about how the patient is progressing Poor doctor-patient communication · Slowly, but surely, hospitals are realizing the fact that educated and informed patients are happier patients. Further, partnering with a patient’s family to provide information is a vital ‘differentiating’ factor for a hospital. HELP value proposition: HELP sets up a branded information centre in the hospital. This centre is instrumental in increased patient satisfaction as it provides vital information to the patient and his family. For example, a son can learn about his hospitalized father’s hepatic failure in the information centre. The centre also draws in people from the neighborhood. People living in the close vicinity of the hospital enhance their knowledge about the chronic conditions being faced by themselves or their family members. For example, A type II diabetes patient can frequent the centre and subsequently can become a patient in case he needs hospitalization. The information centre also solicits questions from the users. These questions are then e-mailed to the main HELP hub in Mumbai. The answers to these questions are sent within 48 hours of receiving them. Moreover, the website the hospital also carries a link where people can post queries and the answers are given on the behalf of the hospital within 48 hours. Patient education has been shown to improve doctor-patient communication; save the doctor’s time; improve patient satisfaction; and improve patient compliance and treatment outcomes. Information Therapy can be a powerful medicine. Each inpatient gets at least about 5-15 visitors daily. In one sense, this is a captive audience who is very likely to be responsive to healthcare marketing, because they have come to visit someone who is ill, and therefore have a heightened sense of their own biological frailty. Visitors can spend time at the patient education library , which is likely to induce them to select your hospital whenever they need medical care. This free service will also help to create a lot of goodwill for the hospital; improve brand visibility; and provide a unique selling proposition. Execution Plan: A Patient Information Centre site is recognized at your hospital. This site is ‘branded’ and done up by you based on the recommendation of HELP. The required amenities like book shelves, computer, etc. are installed. Patient educational material is provided by HELP Your staff members are trained by HELP to run and manage the Patient Information Centre. All aspects of running the centre are taught to one or two of your staff people. An additional backup to answer patient’s queries free by email is also set up. Your web site ‘Ask Us’ icon is linked to our main information hub. Printed information prescription pads to encourage doctors to refer patients to the information centre are provided. The collection is upgraded every year. Responsibility Matrix: HELP provides the books (100 titles ) and DVDs (50 titles) to start the core collection. You provide space ( about 500 – 1000 square feet in a high traffic area) and infrastructure ( racks for the books; signage; DVD player with TV; Xerox machine; internet computers) ; and staff. Branding material is provided by HELP, which is installed by you to do up the information centre. HELP trains your staff members (free 3-day training at HELP) so they can manage the show effectively. HELP provides strategic guidance as to how you can maximize the utilization of the library – for example, by developing your own patient educational materials; having talks and seminars by your doctors. HELP answers questions free by email, through your website , if your patients have further queriesImplementation Time line: 1. Identifying and Purchasing books – 1 month 2. Supplying books – 1 month 3. Training your staff members – 3 days 4. Inauguration of fully furnished library – 3 months Action Points: 1. Visit HELP so you can see the valuable services a Patient Education Resource Center can provide 2. Sign MOU 3. Identify space and set up infrastructure 4. Depute staff member for training at HELP 5. Include the Ask HELP service in your website 6. Set up a Department of Patient Education in the hospital. (Source: The Patient's Doctor)

How to make a hospital hospitable

The Patient's Doctor — Sun, 27 Apr 2008 07:27:00 +0100

Hospitals can be very unfriendly. Even though hospitals are meant to serve patients, in real life they seem to be designed to serve doctors. Not only do hospitals strip you of all your dignity (having to wear a half-open hospital gown which barely covers your body properly does not do much good to your ego!), but they also subject you to painful routines and humiliating rituals performed by a retinue of strangers. You are woken up at any time of the day, (or night), deprived of your privacy, forced to eat unpalatable food, cut off from friends and family, and denied a lot of the independence which you take so much for granted in daily life. What are commonest complaints patients have about hospitals ? It’s a long list, but the primary concerns are: 1. Waiting interminably to see the doctor 2. Being kept in the dark about the treatment 3. Not knowing how much it’s all going to cost What can you do to take care of yourself ? The simple answer is – find a good doctor in a good hospital. While this is the best possible solution, it’s also a fact that you may not be able to do this. So, is there anything hospitals can do to resolve the problem ? Hospitals need to reinvent themselves to keep up with the changing times, and there is a simple solution which can help them to keep their patients happy . The answer is Information Therapy for patient education. This is a win-win situation, which will help hospitals, doctors and their patients. Hospitals need to understand that patient education is not an expense – it’s a basic service which can actually help them to improve the quality of their medical care – and their profitability as well ! A Patient Education Resource Center is a great way of marketing medical services and getting more patients. For example, if a patient is admitted with asthma and they sell books on asthma, the chances of the patient ( or his relatives) buying this book are huge ! Ideally, the hospital should have a circulating collection of books, which patients can borrow and read, so they understand more about their illness. This is an effective way of empowering patients. Another great opportunity which hospitals routinely ignore is educating the patient’s visitors and relatives. Every patient in hospital routinely gets about 10-15 visitors every day. However, most hospitals barely tolerate the presence of visitors, who are usually treated as pests who just get in the way of the staff and the medical treatment. However, these are all potential future customers for the hospital, and should be treated with respect ! Because they have come to visit someone who is ill in hospital , they are very motivated to do something to prevent themselves from falling ill. ( For example, if you go to visit a friend who has had a heart attack, your wife would be very happy to buy books on how to prevent a heart attack !). Not only is this a great “teachable moment”, it’s also a good way of promoting the hospital’s heart health care services to potential new customers ! Similarly, the TV screens in hospital OPDs can be used to show health educational films, so that patients can learn about their health and ways of improving it, instead of watching soap operas or the news. It’s a fact that patients are increasingly unhappy in India today – and while they are still not as likely to sue as in the US, angry patients do burn down hospitals and beat up doctors. Errors do happen even in the best run hospitals – and well-informed patients ( who ask questions and know what to expect) are extremely good at preventing problems because they can speak up and prevent errors. Patient education has also become an integral part of risk-management. While a bad outcome does not always mean to a lawsuit, if this mistake is compounded by poor doctor-patient communication, this is likely to lead directly to the court. By educating patients and communicating with them on an ongoing basis, the chances of the aggrieved patient going to a lawyer are dramatically reduced. Some doctors used to feel threatened by a well-informed patient. However, this is no longer true; and the younger generation of doctor respects a well-informed patient, because both doctor and patient are on the same side. It’s true that patient education can take time – but it’s much better to answer the patient’s questions now , rather than his lawyer’s questions in a court of law ! In a hospital setting, doctors are a scarce resource and they are usually the bottlenecks. By setting up a separate Dept of Patient Education, the doctor’s time can be saved; and your time can be utilized constructively, instead of wasting it. Patients often get impatient when made to wait without rhyme or reason ! Thus, if you go to see your doctor and if he is running 45 min late because he is held up in surgery, his secretary can request you to go to the library where you can read a book or watch a DVD about your problem. You will be called on your mobile when the doctor comes to the clinic. Not only will this prevent you from getting upset because of the delay; it will also help to save your doctor’s time, because you will be much better informed about your problem. Similarly, your doctor can hand out patient educational brochures ( published by the hospital, with their logo and address) to you patient after the consultation. Not only will this reinforce the information given to you; it will also help to improve the level of health information in your family - and thus the community . Patient education can be a great way of improving patient satisfaction, because a patient who has had all his questions answered , is likely to be much happier with the doctor; and have realistic expectations of the treatment. Patient education also helps to cultivate empathy in the medical staff, who learn to see things from the patient’s perspective; and can help to teach the staff to respect the patient. If it’s so simple and obvious, why doesn’t every hospital do this ? Actually, the world’s best hospitals do this routinely. For example, Mayo Clinic has a separate building devoted to Patient Education. Also, the JCAHO guidelines ( the US body which provides accreditation to hospitals) also makes patient education compulsory. Unfortunately, it’s not a very glamorous service to provide, which is why most Indian hospitals don’t bother to do so. Also, they are so busy competing with other hospitals on how many slices their newest CT scanner offers, that they end up ignoring such a basic need. This is a shame – and a great opportunity as well , because a simple inexpensive change in attitude can remarkably improve the patient’s hospital experience – thus improving the hospital’s bottom line !I write this article for my Empowered Patient column for Times Wellness. (Source: The Patient's Doctor)

72 hours (in bullet points, because i'm just that tired)

Ob/Gyn Kenobi — Thu, 24 Apr 2008 23:54:00 +0100

Listed below are 3 days (in a row) that I have had the pleasure of undergoing recently. You can't make this stuff up. The only thing that makes it better is wine. So for those of you wanting to "know what it is like to be an OB ," here you go. Day 12:00 am - Page #1 - Induction for preeclampsia, asking for pain meds for contractions. Nurse didn't bother to check the orders I had called in the evening prior, for pain meds, for contractions. Oops.3:00 am - Page #2 - Triage - 32 weeker, pain with urination, no contractions, cervix closed. UA, Rx antibiotics, see in office.5:00 am - Page #3 - Induction requesting epidural, IV bolus running. Please come in?5:01 - 5:15 am - Lie in bed and curse the universe.5:15 am - Shower, dress, warm Bean's am bottle, label bottles for daycare, prep CindyLou's breakfast, take upstairs to Mr. Whoo, drive in to hospital5:40 am - Arrive, find a place to pump while epidural gets placed.6:00 am - Check now comfortable patient, 6 cm, BBOW, no contractions picking up on the monitor, AROM, IUPC6:15 am - Start rounds7:15 am - Triage patient, term, in labor, 4 cm. Write admission orders.9:00 am - Induction patient now 9 cm/0 station, variable decels, FSE. Call office, cancel AM patients.9:30 am - Breakfast, pump, rest in empty labor room.10:30 - 11:30am - Dictate delinquent charts, field office pages for various "emergent questions."11:30 am - Labor patient gets epidural, induction patient complete, but too numb to push...laboring down.12:00 pm - Check labor patient, 5 cm, SROM after epidural (she had thought she had peed) comfy.12:30 pm - Pump, induction patient pushing.1:30 pm - Labor patient feeling pressure, complete, starts pushing.1:45 pm - Deliver labor patient's baby, placenta, get called away before laceration repair to catch induction patient's baby.1:49 pm - Deliver induction patient's baby, sew 3rd degree laceration (14.5 in head).2:10 pm - Return to labor patient's room, repair 2nd degree laceration. Write orders on both patients.2:30 pm - Sign off NSTs, head to office, stop for fast food lunch on the way.2:45 pm - 6pm - Office patients.6:30 pm - Arrive home. Make dinner.6:32 pm - Page # ???? - Triage patient, 38 weeks, oligohydramnios. Admit for induction.7:30 pm - Baths, stories, and bedtime.8:30 pm - 12 am - Dishes, bottles, tv, and sleep.Day 27:00 am - Page #1 - Triage patient, 39 weeks, labor, 4 cm. Admission orders.7:30 am - Rounds, oligo induction 3 cm/60% effaced, start pit, encourage ambulation.8:45 am - Arrive at office, pump while signing off labs.9:00 am - 5:30 pm - Office patients (32, not too shabby!), charts, 20 min for lunch and pumping.5:35 pm - Page #2- Labor patient 9 cm with BBOW, call Mr. Whoo to pick up kidlets, drive to hospital.5:50 pm - Check oligo patient (who's been walking the halls all day long on pit). No cervical change. Decide to rest overnight and restart in the AM.5:54 pm - AROM Labor patient, complete, fetal decels, resolution with O2 and reposition. FSE placed.6 pm - 8 pm - Intermittently push with patient. Get hemorrhoids. Pump with "fred" the hospital pump. Fun times.8:15 pm - Maternal exhaustion, deep variable decels, successful vacuum delivery, repair 2nd degree episiotomy.8:30 pm - Write orders. Check on induction for post dates for the AM. Finally leave fragging hospital. Curse universe once again. Get page from UTI triage patient...still with painful urination. Encourage to continue antibiotic.9:00 pm - Arrive home.9:15pm - 11 pm - Dinner, Ti.Vo, and bed.Day 36:30 am - Get up, pump, see kids for 2.5 seconds, drive to hospital. Eat breakfast bar. Yawn. A lot.7:00 am - Rounds. AROM oligo patient, place FSE/IUPC.7:30 am - 1st surgery of the day. L/S, endometriosis, ovarian cystectomy, lysis of adhesions. Dictate. Talk to family.9:30 am - Check on postdates patient, getting epidural. Pump. Round some more.10:45 am - 2nd surgery of the day. L/S, endometriosis, adhesions, H/S, endometrial ablation. Smooth. Dictate. Can't find family.12:00 pm - Check back with postdates patient. 4 cm, AROM, IUPC. Contractions not nearly as impressive on the IUPC.12:15 pm - Oligo patient's epidural not working. Re - do epidural. Pump. Consider eating, but get called for...12:30 pm - 3rd Surgery of day - LEEP, easy. Dictate. Reassure overanxious family.1 pm - Grab bag of vanilla creme cookies from Doctor's Lounge for "lunch." Get paged to speak with 2nd surgery's family. All is well.1:10 pm - Check Oligo patient. Cervical change! Yesss! 5-6 cm, comfy.1:30 pm - Finally finish rounding on 10 patients. Write orders and scripts and discharges.2:30pm - 4th Surgery of the day - D & C, endometrial hyperplasia. Lots and lots of curettings. Pray for no cancer. Dictate. Talk to family.2:55 pm - Check post-dates patient. 6 cm, sleeping. Check oligo patient, sleeping, no cervical exam.3:00 pm - Circumcision on 39 weeker's baby.3:30 pm - Leave hospital, get fast food snack (mmm, french fries), go to pick up kids a little early from daycare. Feel like a good mom.4:30 pm - In the midst of gathering kids from daycare, get urgent page. Oligo patient complete and ready to push (!!!) !@#@*#&(*!&4:31 pm - Drive like a crazy person to the hospital, with kids hanging out in the backseat. Leave frantic messages on Mr. Whoo's cell to pick up the kids at the hospital.4:45 pm - Arrive at hospital. Hand off kids to kindly nurses. Feel like a terrible mom. Go catch a baby.5:15 pm - Repairing laceration and working on post partum hemorrhage. Guess birth weight exactly. Get word that Mr. Whoo has arrived to pick up the kids. Also, post-dates patient is 8 cm.5:30 pm - Finish paperwork, check post-dates patient - 9 cm. Call Mr. Whoo, check on kids. Kids are sad and miss the mama. Feel like a criminal. Cry a little.5:30 pm - 8:00 pm - Hang at the nurses station. Pump. Feel sorry for myself. Whine a little bit. Check post-dates patient. Patient begins pushing once night shift nurse is ready.8:00 pm - 10:00 pm - Pushing. More hemorrhoids. Anguish. Bitching at the nurses station. Occasional fetal decels, and, finally, fetal tachycardia.10:10 pm - Have "come to Jesus" talk with post-dates patient. Decide to place vacuum. Successful vacuum with one push. Berate myself for not doing this 2 hours ago. Repair 2nd degree episiotomy. Get the birth weight right within one ounce. 10:30 pm - Finish paperwork. Hear about term fetal demise getting admitted (not my patient, but still devastating.) Leave the god forsaken hospital. Curse the universe, once again.11:00 pm - Arrive home. Shower, dinner, and bed.Glamorous, is it not? More wine, please? (Source: Ob/Gyn Kenobi)