Information Therapy in India
Lost in the health information maze?
Mrs Chopra. 45, was recently diagnosed with diabetes. Her doctor followed the standard protocol, prescribing her medicines, and advising her on diet and exercise. She was not content with the advice though. This was something that was affecting HER body, and she wanted to dig deeper for answers. She wanted to know how she could better take care of herself, and while she respected her doctor’s advice, she wanted more information that would set her confused mind to rest. She did what most patients in India and around the world would do – log on to the world wide web. A casual search for ‘Diabetes’ returned 268,000,000 results, with the first as always being Wikipedia, a helpful but often inaccurate portal. Mrs Chopra did not receive accurate, definitive information on her ailment, with different websites suggesting different measures to control diabetes. Frustrated, she simply stuck to her doctor’s advice. Whether she could have done do more for herself, she would never know.
Using Information Therapy to fill the Communication Gap
Mrs Bhatia’s physician informed her that she had arthritis. While prescribing her the usual course of medicines, her doctor did not provide her with a list of the possible side effects. Mrs Bhatia, on the other hand, also did not tell him that she had a very sensitive stomach. Inevitably, the medicines took a toll on her system, leading to undesirable side effects. Frustrated with her doctor for not warning her, Mrs Bhatia began to criticise him, posting comments on forums about his supposed ‘incompetence’. This greatly unsettled her doctor, a genuine, caring person with a good reputation in the industry.
INFORMATION THERAPY AND THE RTI ACT
Being afflicted with a serious disease is a difficult period for a patient. So when Mrs Shah was diagnosed with cancer, she wanted to know everything from her doctor. “Why do I need radiation?”, “Is there any alternative?”, “What are the possible side effects of such a treatment,” “What stage of cancer is this, and will I be completely cured?”, “What is the success ratio of radiation treatment?” were some of her queries. Years ago, such questions would not even occur in a patient’s mind, and he or she would trust her doctor blindly. Even worse, many doctors would not even bother to explain the treatment options to patients. However, today, just like the RTI Act has made government officials accountable and thus enhanced the relationship between the government and the public, information therapy helps to build a more transparent doctor-patient relationship.
RIGHT PRESCRIPTION FOR THE GOVERNMENT: START INFORMATION THERAPY
Rajendra P Gupta
When it comes to healthcare, the government’s role is threefold: financier, provider, and regulator. However, the government’s efforts in these directions are far from satisfactory. Citizens account for over 78% of total healthcare spending, and still get a bad deal in return! It is clear that the government is unable to finance the entire healthcare of the nation. Also, it cannot provide healthcare at all levels (primary, secondary and tertiary care). Even as a regulator, the Indian government has not progressed beyond basic accreditation of facilities to ensure quality healthcare.
Getting doctors to prescribe Information Therapy
Mr Rathod had been experiencing pain in his abdomen, so he went to his GP for a check-up. After examining the test reports, his doctor told him that he had ‘Choledocholithiasis’. Mr Rathod was taken aback, thinking it was a serious disease, only to breathe a sigh of relief when he was informed that the simpler definition for his ailment was ‘gallstone in the gallbladder’, a fairly common condition which is easily treatable. When it comes to interacting with patients, using simple, jargon-free language is of the essence. Imagine if a doctor told you that you had ‘Xerostomia’? You would think ‘oh, woe is me.’ Well, all it means is that you have a dry mouth! So how do doctors communicate in an unambiguous manner to their medically uninformed patients? Information Therapy to the rescue, again!
How Information Therapy can provide synergy between conventional and alternative medicine
Mrs Sharma’s house help, Anita, was afflicted with eczema, and needed money for treatment. Her employer willingly gave her the money, thinking Anita would opt for conventional treatment. However, she instead went to a ‘famous doctor’ in her locality. This ‘doctor’ did not have training in medicine, but he did have a clinic. The only information below his name was ‘Ayurvedic doctor’. Unfortunately for Anita, he was a quack, with no real training in Ayurveda. His spurious drugs exacerbated the eczema condition, making it worse than before. After learning about Anita’s bitter experience, Mrs Sharma, also a believer in alternative medicine, took her to a dermatologist while also consulting a trained, qualified naturopath.
INFORMATION THERAPY – A PATIENT’S PERSPECTIVE
Vandana Gupta, Founder V Care
“YOU HAVE HODGKINS LYMPHOMA. WE WILL TREAT YOU”.
There was a stunned silence. All I could comprehend was that I had something serious. I knew nothing more and the doctor did not have time to explain anything more. So my husband and I were forced to go to look for more information in a medical encyclopedia.(Remember that GOOGLE did not exist 18 years ago ! )
Why hospitals need to provide Information Therapy
CRM ( customer relation management ) is a tool which all service industries to keep their customers happy. While one would expect hospitals to use CRM routinely, unfortunately, most hospitals still do not bother. Given the large patient:hospital bed ratio in India, most hospitals continue to take the approach that patients do not have a choice as to where they can go for their treatment, which is why most hospital staff adopt a high-handed attitude towards patients . Stories of hospital staff rudeness and arrogance are innumerable – and this is reflected in the increasing number of incidents of violence against doctors and hospitals.
What patients can contribute to Information Therapy
Doctor Sourav Bose was finding it difficult to manage Mr Aditya Rao’s diabetes. Though he had changed the dose of the insulin thrice, his blood sugars remained high. He was at his wit’s end and did not know what to do. He put it down to “non-compliance” and wrote Aditya off as a “ difficult
patient “ ! He failed to recognize that by spending more time with his patient, delving into his lifestyle, and asking him why he was having a hard time with following the treatment plan, he could have come up with an effective solution. Aditya was as much to blame ! He should have discussed the practical difficulties he was facing with taking the insulin injections in his office, as advised by the doctor, instead of meekly accepting his doctor’s advise – and then failing to follow it !
Information Therapy for Doctors
Doctors need Information Therapy too ! The doctor’s major asset is his professional knowledgebase. As medical science progresses, doctors need to keep up with current trends. Medical textbooks get outdated very quickly – and new editions and medical journals can be very expensive ! Sadly, most doctors today are dependent on medical representatives to learn more about advances in therapeutics – and reps are not always the most reliable source of information.
HOW I PRESCRIBE INFORMATION THERAPY IN MY PRACTICE
My patients, Mr and Mrs Gupta, are sitting in the waiting lounge of my clinic, awaiting their turn. The usual gamut of magazines is in front of them. But do these serve any purpose? Instead, my receptionist gives them a comic book about IVF, so they can learn more about their treatment options. This puts them in a better frame of mind, and many of their doubts get resolved even before they come in. The beauty of Information Therapy is that it can be used in many innovative ways !
HOW INFORMATION THERAPY CAN PROMOTE SAFER CARE
Rajan Madhok,MB BS MSc FRCS FFPH
Medical Director, NHSManchester,ENGLAND
and GAPIO Lead on Patient Safety
Nikhil Datar
MD DNB FICOG FCPS LLB DGO DHA
Consultant Gynaecologist,HindujaHospital, Mumbai
and Commonwealth Fellow 2009, NHSManchester,ENGLAND
Correspondence to rajan.madhok@btinternet.com
Most patients agree that Information Therapy makes sense. Owing to the anxiety when one visits a doctor, a majority of patients forget half of what the doctor tells them. In such instances, a summary sheet at the end of the consultation can be helpful. An electronic medical record can also ensure that all the information is easily available in one place. This results in a more holistic assessment, and ultimately, better care. But can Information Therapy also help with ensuring safer care? And how can it do so? These are the issues we explore in this chapter. First though, a few words about patient safety and why it is so important.
How a doctor’s personal website helps deliver Information Therapy
Dr Aniruddha Malpani, MD
Not too long ago, most doctors in India were unaware of the concept of an email address! This maybe hard to believe , but it’s true ! However, times have changed dramatically, and today most doctors use email regularly. But even that is not enough. If you are a doctor, you need to have a personal website. This rapid pace of change is symbolic of how quickly things are changing in today’s world. In fact, it is my contention that doctors in private practice in India can no longer afford to not have their own website. Just like how you need a telephone line to practice medicine, a website has become an integral part of modern medical practice – and doctors who are not proactive are likely to get left behind!
HOW INFORMATION THERAPY HELPS PATIENTS TO MAKE SENSE OF THEIR MEDICATIONS
Mrs Kapoor visited her GP for a ‘nagging pain’ in the stomach. Her GP prescribed her a course of antacids. While Mrs Kapoor did get some temporary relief with the medicines, she decided to visit a specialist. The specialist gave her stronger tablets and she took them, while also continuing her GP’s medication. This interaction of drugs exacerbated her problem, and she found herself back to square one. As an educated patient, Mrs Kapoor should have informed the specialist of the medicines that she had been taking. It might well have resulted in a different prescription and a better outcome.
Producing content for delivering Information Therapy in India – opportunities and challenges - Mr Parag Vora, CEO, PEAS. www.peasonline.com
Ram Khare, a security guard in a Mumbai suburban society, visits a doctor for his chronic cough, which is diagnosed as ‘bronchitis’. His doctor gives him medicines along with printed material on how bronchitis can be managed effectively. This handout is in three languages – English, Hindi, and Marathi. However, that doesn’t solve the issue. Ram Khare can’t read or write. How does Information Therapy come to the rescue here?