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Most Indian hospitals have their own websites which clearly means that they understand the importance of having an online digital presence. However, most of them use their website purely as a branding tool which means their sites are just digital brochureware. Inspite of being an IT global powerhouse, Indian medical websites have lagged behind. The biggest tragedy is that with just a little bit of effort, they could become world-class, given the fact that India has an unbeatable combination of medical and IT expertise !

Just compare www.mayoclinic.com with any Indian hospital’s website ! Or look at the Alexa ratings or Google page ranks for Indian hospital websites . They get only about one tenth the traffic which much smaller US hospitals do. While it’s true that the number of internet users in the US is more than in India, this is irrelevant. The internet has become a global playing field, where hospitals are doing their best to attract patients from all over the world ! And it’s not about the cost of the website or the use of clever flash graphics or Web 2.0 tools either. The reason for the poor traffic is much more basic – it’s poor quality content !

Most hospital websites are chockful of information about the hospital , but they have precious little content which is designed for the patient ! Remember that when someone is sick and is looking for medical care, they will not do a search for Fortis Hospital or Care Hospital ! They will google for more information about their disease – and because Indian hospital websites provide precious little information on just a few diseases, they rank very low on a google search !

The solution is simple – hospital websites need to offer a comprehensive library of online information for prospective patients. However, this is a surprisingly challenging and complex task. Most webmasters have no medical expertise and they naively expect the hospital doctors to provide them with the content for the website. However, most doctors are very poor at communicating and are of little help . Generating high quality content for patients can be a very expensive and time consuming exercise – especially when you need to keep it uptodate and error free . Also, hospital management is worried that they may get sued if they provide incorrect information, which is why they often prefer not providing any information at all !
So what do they do ? Some will get their doctors to provide a few pages of content – material which is badly written, full of medical jargon and hard to understand. Others will source free health information - for example, from Wikipedia. However, this is often of patchy quality – and these hospitals get what they pay for ! The other option is to license this information from US and UK publishers– but this can be very expensive !

The good news is that HELP, in partnership with Healthwise , the leading provider of patient educational content in the USA, now offers Healthwise content to Indian hospitals who want to improve their websites. This means that Indian hospitals can now get the exact same content which Healthwise provides in the USA - at a fraction of the cost ! Both HELP and Healthwise are non-profit organizations, whose mission it is to promote Information Therapy to help patients to make better decisions !

This means that hospital webmasters can get an instant painless Transfusion of Information Therapy ! This authoritative patient education library called the Healthwise Knowledgebase can be whitelabelled and plugged into your existing website within one week , thanks to our Technology Partners, Plus91.

As a result of including this Healthwise content, we are sure you will see a dramatic jump in your online traffic ! If this translates into even one more additional patient per week , you will recover your investment very quickly ! In fact, we are so sure about this, that we are happy to provide a free trial for one month. You need to pay for an annual license in advance. If your traffic does not improve by at least 50%, we will refund your money back.

What do you have to lose ? Please email me at malpani@vsnl.com and I'll be happy to provide more information !

" PwC and India Health Progress (IHP) have released a whitepaper "Healthcare Unwired - Health Insurance and Healthcare Access" which recommends health insurance as one of the prime drivers behind increasing healthcare access in India. The whitepaper is the outcome of a roundtable meeting held on 24 January 2011 on Health Insurance at India Islamic Cultural Centre, Delhi. The conference was attended by various healthcare and health insurance industry leaders as well as policymakers who emphasized the need to bring in new health insurance schemes at different price points."

I was disappointed that the Report did not talk about how health insurance companies can promote health by prescribing Information Therapy ! It makes business sense for health insurance to empower patients with information - and this is a great opportunity to create a win-win for everyone !

The Institute for Health Technology Transformation is a US based organisation that brings together private and public sector leaders to foster the effective use of technology across the healthcare industry.

Their report, "Top Ten Things You Need To Know About Engaging Patients' is a compilation of what key health IT experts from across the U.S. think are the most important things to know about engaging patients in the digital age along with four key recommendations for practical action.

Mostly common sense. Doctors just need to ask a simple question - How would you like your lawyer to communicate with you ? Use the same principles to open as many communication channels with your patients, so it's easy for them to connect with you !

• About 42% physicians use an electronic health record solution to document their patient care and about 1 in 3 uses an EHR during a patient encounter.
• Overall, 62% of physicians and 81% of patients have a positive perception of documenting patient care electronically.
• Forty-five percent of patients had a "very positive" perception of their physician or clinician documenting patient care with a computer or other electronic device.
• More than 60% of physicians feel the best benefit to using EHR is the access they have to patient records in real time.
• Physicians also believe that the ability to seamlessly share information with other doctors, pharmacies and payers are one among the most important benefits.

" In Denmark, we’ve developed communication thus far for almost all IT systems in the health sector. We have implemented all prescription and medication information, and all discharge letters and summaries from hospitals. This also includes outpatient notes, injury reports, x-ray reports, lab reports and lab orders. Reimbursements from health insurance have been made electronic, along with referrals to hospitals and private specialists, and referrals to psychologists. All private physicians have electronic health records today so they can communicate and transfer documents electronically, as well.

From the beginning it was a grassroots effort; we thought it was a good idea to exchange information electronically. And now it has become mandatory that you must communicate electronically. There was a state-wide agreement that this was a good idea."

" Here’s my question: How did it become normal, or for that matter even acceptable, to refer to medical patients as “consumers”? The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car — and their only complaint is that it isn’t commercial enough.

What has gone wrong with us?"

What people do not realise is that when patients start behaving as consumers, the doctors you deal with will stop behaving as trusted professionals and will start behaving as businessmen who will focus on their bottomline. When you are ill, you need a trusted advisor - and if you do not treat your doctor as a healer, he will not behave as one. What a shame that it's come to this !

" Guiding patients to better online sources of medical information should be a new physician responsibility for the digital age. Not only should doctors expect and be receptive to questions patients raise from Web research, they need to proactively engage patients online in order to dispel falsehoods and guide them to legitimate sites."

This is why I feel every doctor should have their own website ! It forces them to search for reliable health websites ( to which they can link) so they can guide their patients intelligently, rather than getting upset when patients come with many sheets of internet printouts ! Even better, it will encourage thoughtful doctors who are not happy with the quality of the information they find on other sites , to publish better customised content on their own website, thus helping lots of
other patients !

" Interactive health is about making health knowledge, supportive care, and motivation available to us, anytime and anywhere, so that we can integrate this wisdom into our daily actions to live longer, healthier, happier lives. Welcome to the new era of Interactive Health."

We are very nearly there now ! Everyone will have their PHR in the cloud; doctors and other medical professionals will use their EMRs to upload your medical data to this PHR, so that the medical information is automatically updated and complete. You can share portions of your PHR with others - and your doctor can prescribe Information Therapy to you, tailored to your needs !

“What can you possibly learn from your doctor that is not available on the Internet?” We suspect we'll hear such radical sentiments increasingly in the future. Knowledge is said to be power, and some of the past imbalance of power between patient and doctor may be equalized. But information and knowledge do not equal wisdom, and it is too easy for nonexperts to take at face value statements made confidently by voices of authority. Physicians are in the best position to weigh information and advise patients, drawing on their understanding of available evidence as well as their training and experience. If anything, the wealth of information on the Internet will make such expertise and experience more essential. The doctor, in our view, will never be optional."

Actually, there are some things which the internet can teach patients far better than the doctor
can ! Youtube videos ( on how to take your IVF injections for example) can be played and replayed - and websites don't lose their patience with patients ! Also, many doctors are often not very good at teaching because they cannot stop using medical jargon.

Websites and doctors are all tools which a smart patient should have in their medical tool box. The real mark of a wise patient is that she knows which tool to use at which time !

Doctors are having a hard time surviving. Even though small 20-bed doctor-run nursing homes are the most cost effective way of delivering medical care for common problems ( such as elective surgery and childbirth) , it's getting harder and harder for doctors to start a nursing home in India because of the license raj and government bureaucracy. Most doctors are being forced to join corporate hospitals, where they are extremely unhappy because they are exploited and ill-treated by the management.

Why are doctors so unhappy in many corporate hospitals ? Doctors have a bottom up approach. They have been trained to be patient advocates and do everything they can to help their patient to get better. This is their primary professional focus - and this is what makes them special. This is what patients expect from them and doctors take pride in their ability to provide the best possible medical care for their patient – and they will move heaven and earth to do so. They are so focused on each individual patient’s well-being , that they will often not consider extraneous factors such as the patient’s ability to pay.

The management’s world view is very different. From their point of view, the hospital is another business – and the bottomline comes first. They understand that until they continue to remain profitable, they will not be able to survive – and if they do not survive, how will doctors be able to provide care to their patients ?

Both these approaches are perfectly valid and sound – and usually there’s no conflict. Most of the time, it is possible to provide cost effective care profitably to patients, and everyone is
happy ! However , there are times when financial considerations and medical priorities do clash. This is when the divide starts.

Bad hospitals focus only on financials . They reward doctors based on their turnover and throughput – and do not care about the quality of their care. They pressurize doctors into doing unnecessary procedures; micromanage doctors; and their primary focus is on paperwork and forms. The management often treats doctors disrespectfully; hires and fires at will; and skimps on the amount of money they pay to their doctors. Good doctors will often walk out of such hospitals when they are treated badly – and this demoralizes the rest of the staff.

Good hospitals , on the other hand, understand that their interests are aligned with those of their medical staff. They involve doctors in important managerial decisions; provide doctors with staff, tools and technology to help them to improve their productivity; treat them as important team players; and provide interested doctors with training in business management . They invest in their doctors and try to create a life long bond with them !

Doctors also come in different flavours ! Bad doctors are good at playing games of one-upmanship. They may be medically incompetent, but they are very politically savvy – and will suck up to the management to try to keep one step ahead of the other doctors, whom they treat as competitors, rather than as colleagues !

Good doctors focus on the well-being of their patients. They will not sell themselves short; and take pride in their professionalism. They expect to be treated with respect and dignity; and try to understand the basics of how the hospital runs, so they can provide constructive inputs

We need to allow doctors to get on with their job of providing good care to their patients. The only reason a hospital exists is to take care of patients – and they can only do this is they have motivated doctors, who feel they have the support of the management.

The sufferers as a result of this divide is the poor patient, who feels neglected and uncared for, even though he is paying an arm and a leg through his nose for the 5-star ambience of a brand name hospital !

Everyone is worried about the escalating costs of providing medical care. Many solutions to this problem have been based on the premise that the reason medical care is a mess today is because health care delivery is not being properly "managed". The siren song is that if we can "manage" healthcare delivery properly, we will be able to provide better medical care to more patients at a lower cost !

Management seems to have become the panacea to all ills - and it's a very tempting idea ! After all, isn't it obvious that managing something can just help to make it more efficient and effective ?

Sadly, in real life, this is not true. In order to manage healthcare, we need managers who have special training and expertise in management; and then inject them into hospitals to manage doctors . All this ends up creating is an additional layer of people between doctors and patients - a layer which has no medical expertise - and which just adds to costs and paperwork !

Interestingly, this is as true in education as it is in medicine. A great book by Philip Howard called Life Without Lawyers has a thought-provoking chapter titled - Bureaucracy Cannot Teach ( from which I've lifted the title of my post).

He writes - " All these reforms have been based on an unspoken assumption: that better organisation is the key to fixing whatever ails schools. The theory is that by imposing more organisational requirements - better teacher credentials, more legal rights, detailed curricula, the pressure of tests - schools will get better. That's the theory. The effect, however, is to remove the freedom needed to succeed at any aspect of teachers' responsibilities - how they teach, how they relate to students, and how they coordinate their goals with administrators."

Applied to healthcare, this would read, He writes - " All these reforms have been based on an unspoken assumption: that better organisation is the key to fixing whatever ails hospitals. The theory is that by imposing more organisational requirements - better doctor credentials, more guidelines, more legal rights for patients, detailed medical curricula, testing for performance - hospitals will get better. That's the theory. The effect, however, is to remove the freedom needed to succeed at any aspect of doctors' responsibilities - how they treat , how they relate to patients , and how they coordinate their goals with administrators."

Bureaucracy often ends up smothering teachers - and doctors as well ! When we try to manage something, we often end up mismanaging it !

Most management principles are simple applied common sense - and rather than try to have more managers, it would make much more sense to teach doctors basic managerial skills, so they can do a better job managing their patients - and themselves !

" Four years after a pilot project to computerise services at state-run medical colleges and hospitals was launched, the state Medical Education Department has done a rethink and no longer considers the idea “feasible”.

This is typically what happens when these big buck projects are implemented with a Top-Down approach. A bureaucrat with a lot of money to burn decides this is a clever idea and tries to put it into practise. ( Because there's lots of money involved, it's easy to grease palms) . The results are very predictable - the project flops because there's no buy in from doctors . The project is then scrapped - and the technology gets a bad name ! It's not the technology or the idea which is flawed - it's just the way it was implemented. However, this will set EMR projects back by at least a decade, as everyone will now believe that the failure of this project " proves that EMRs do not work in India "

Happy patients are happy with their doctors - while unhappy ones are happy to blame and criticise their doctor. Doctors seem to have become everyone's favourite whipping boys - they are greedy and just want to make lots of money; they do not have time for their patients ; and cannot communicate well.

It's very easy to blame the doctor, but this is hardly helpful ! Patients need to understand that getting good medical care requires they they establish a healthy doctor-patient partnership - and in order to do this, they need to become expert patients !

This has become surprisingly easy to do, thanks to the net. All you need to do is invest some time and energy - and if you do get lost, there are lots of people who can help, including online bulleing boards and forums; and librarians.

The rewards are well worth it - after all, if you are not part of the solution, you are part of the problem ! You cannot change your doctor's behaviour - but you can change yours ! Do not underestimate your intelligence and common sense - you have a lot at stake ! A big plus to doing so is that armed with the information, you'll be able to find a better doctor !

Taking treatment at a world-class clinic will maximise your chances of success and give you peace of mind you did your best !

Social Media and Medicine – a Match Made in Heaven? | MedCrunch: "What about working with the new media in novel and valuable construct? The idea would be to engage all the players; clinicians, patients and industry. Users would complete a registration process and access a secure cloud. Individual disease, devices and medications would have a distinct information page with customized categories and questions relevant to a patient experience. Content would be assessed through an open on-line peer-review process and use material beyond the written word to minimize the potential for exclusion because of literacy or numeracy unmet needs."

A clever startup will use technology to marry PHRs with Information Therapy with social media, so patients can have intelligent conversations online with doctors , loved ones and other patients !

What makes a good doctor good is the fact that he has good clinical judgment. This is a term which is hard to define, but basically a good doctor is one has seen and treated and learned from lots of patients, each of whom adds to his knowledgebase and clinical wisdom. As the saying goes, "Good judgment comes from experience. Experience comes from bad judgment."

However, the mere passage of time does not provide good judgment . After all, 20 years of being a doctor could simply mean 20 years of doing the wrong thing ! It's important that doctors learn from their experience - and the only way they can do so is by tracking the outcomes of the patients they treat.

Unfortunately, this rarely happens in real life ! Let's take 2 patients whom a family physician treats for abdominal pain. One gets better and moves on with his life. He does not tell the doctor he is better, because who goes to a doctor when they are fine ? The other may get worse and may end up needing an appendectomy. However, he's not likely to go back to the doctor either ( unless he is angry and wants to sue !). This means that both patients who get better and those who don't rarely provide feedback to their doctor in real life.

However, without this feedback, how is the poor doctor going to learn ? He naively assumes all his patients have got better - and he loses track of those who do not improve , because unhappy patients will do their best to find another doctor.

How can doctors practise evidence based medicine ( EBM) without any evidence ? They need feedback from patients, so that can learn whether what they are doing doing is useful or not ?

EMRs can be a great tool in facilitating this kind of patient feedback ! One week after every clinical encounter, the system can automatically send an email to the patient, asking for feedback. This will provide very useful data - for which each doctor can learn about what he did right - and what he messed up.

Many doctors will agree that it can be very frustrating to treat an "interesting patient" - and then never find out how the story ends, because the patient never comes back and is "lost to followup" !

Not only will this data help doctors to learn and improve , it can also be very useful as a clinical practice builder , because patients are touched when their doctor reaches out to them proactively. Patients are happy when they learn that the doctor is interested in finding out how they are doing - and happy patients make for happy doctors !

The vast majority of patients are usually completely satisfied with their medical care and are grateful to their doctor. However, in some cases, problems can occur, and you need to know what steps you can take if you are unhappy or dissatisfied with the outcome of your treatment.

In the first instance, you should try to resolve the problem as quickly as possible. Talk to the doctor or the hospital administration to try and settle matters at the earliest, especially with regard to minor complaints ( such as rude staff, telephone calls not being returned or unpalatable hospital food). Most complaints originate due to seemingly trivial problems.

If however, if you have a serious complaint about your medical care, and if you are convinced that your doctor has been negligent, you can take appropriate action. However, do remember that just because the outcome has not been satisfactory ( for example, a patient dies during surgery) , it does not necessarily mean that the doctor has been negligent or irresponsible! There are many reasons why patients do not do as well as expected; after all, medicine is an inexact science which deals with many biological variables that are beyond anyone's control. Consequently, in spite of the best care, a patient may die or his condition may become worse.

There are many avenues open to you to get redressal, and you may choose any or all of them. For instance, you can make a complaint to the local professional medical body, usually the state medical council. The appropriate medical council can punish the doctor: for example, by removing his name from the medical register, if he has been found guilty of serious professional misconduct, either permanently, or for a specified period, so that he can no longer practice medicine.

Before taking legal action, you should carefully consider all the implications and repercussions. The process can be a very long and expensive one. You must also ascertain precisely what you want to achieve by initiating litigation. Do you merely want an apology from the doctor? Are you angry with the doctor because you feel he was careless and you want to seek revenge? Do you want to expose the doctor's incompetence to the public to protect other patients? Do you want monetary compensation? While all or any of these objectives may provide sufficient reason to go to court, do remember that medical malpractice lawsuits are powerful double-edged weapons which should be used only as a last resort. Not only can such lawsuits damage a good doctor's reputation, they can also create a lot of tension between patients and doctors in general. Let me point out, in this context, that unnecessary and excessive medical litigation has led to the regrettable situation in which American medicine finds itself today, in which both doctors and patients have become losers.

Most doctors get put off by patients who complain and most doctors will either ignore these patients – or fire them ! While I’d rather have smiling and happy patients as well , I also believe that every complaint is a gift – it’s a chance to learn and improve. In fact, we actively encourage our patients to provide us with feedback – and both compliments and complaints are welcome . Compliments give us a high and tell us we are doing a good job. Complaints remind us that we can do better !

As a doctor, I am focused on providing high quality medical care to my patients. However, I also run a clinic, and I may not see some basic problems ( which are easy to fix) unless someone takes the trouble to point them out to me !

Most patients are quite reluctant to complain to their doctor. For one, most are respectful and are quite grateful for the medical attention and care they are getting. They feel they should not be wasting their doctor’s time on minor trifles. Also, many are worried that if they complain, the doctor may get upset and may not provide them with good medical care. This is why most patients are docile and compliant in the clinic. However, when they leave the clinic, they will then openly criticize the doctor – an unhelpful approach , which does not help either the doctor or the patient !

I encourage patients to provide feedback to doctors – after all, if there are problems and you do not tell us about them, how will we improve ? However, not all complaints are helpful, so if you do want to provide constructive complaints, you must learn the right way of doing so. There’s no point in complaining when you are angry and upset. This might seem counter-intuitive, but this is the time when you are likely to say things you may regret later ! It’s best to complain when you are cool and collected – and when your doctor also has time to sit and listen to your feedback. Providing written feedback is also useful, if you are willing to take the time and
trouble . However, complaining behind the doctor’s back is very unhelpful !

Just like patients need to learn how to complain, doctors also need to learn how to listen to their patient’s complaints in a mature fashion. This is a useful skill for all doctors to acquire. Remember that for every one patient who complaints, ten will get upset – but rather than take the time to complain, will just walk out of your practice to your next door competitor !

Complaints should not be ignored – they need to be managed. Your patient is your customer, and you owe him a duty of service ! When dealing with angry unhappy patients, it’s very easy for problems to escalate , and when tempers are lost, everyone stands to lose. Often doctors do not have the maturity to listen calmly to a patient’s complaints. Many will take a complaint as a personal affront – and will feel the patient is disparaging them . Others may even get incensed – “ How dare a patient criticize me ! After all, I am a senior , respected and experienced doctor who knows much more than he does ! “ If you do not manage angry patients well, this will end up hurting you in the long run. Angry patients may end up suing a doctor – especially when they feel the doctor has been uncaring or rude.

Listen patiently and respectfully. It’s true that not all complaints are valid and not all problems can be fixed, but giving the upset patient a patient hearing can make a world of a difference !
When a patient complains, rather than getting angry or defensive, a useful acronym to remember is LEAD - L = Listen ; E= Empathise ; A= Act ; D= Document. When do patients complain ? When there is a mismatch between expectations and reality. This is why it’s so important to be honest and transparent with your patients.

I always tell my patients – If you are happy with us, please tell the world ! If you are not happy with us, please tell us, so we can fix the problem !

I am an IVF specialist, and know lots about IVF. I read all the medical journals and keep myself updated, so I can provide high quality medical care to my patients - after all, my professional knowledgebase is my major asset and I spend a lot of time on polishing my skills and keeping current with recent advances. Since IVF is such a specialised field, it's much easier for me to do so, as compared to a general physician, for example, who has a much broader area to cover.

However, no matter how good my intentions, the fact still remains that there will be areas in IVF in which I have blind spots. The good news is that my patients are getting smarter and are happy to help me fill in these blind spots. I have always respected my patients and I learn a lot from them all the time.

Medicine is a rapidly advancing field and doctors need to learn all the time. Our best source of information and knowledge is our patients - and rather than getting angry and upset when patients bring huge sheaves of internet printouts, we need to treat our patients are intelligent expert research assistants, who can help up to provide them with the best possible medical care by helping to keep us on our toes ! These expert patients can act as our eyes and ears - and explore areas we may not be aware of.

Not all these expeditions will be worthwhile or productive - but you never know what the next expert patient can help you to unearth !

By passing the Clinical Establishment Act, the Indian government is planning to make accreditation compulsory for clinics, to ensure that patients get good quality medical care from doctors, because they will be forced to meet basic standards.

I am thrilled to observe that one of the requirements for accreditation is that doctors provide patient educational materials in their clinics.

The good news is that innovative companies like PEAS ( in which I am an angel investor) are producing patient educational DVDs in Indian languages, customised for Indian patients !

Information Therapy will hopefully become an integral part of Indian medical practise !

Patient Centered Health Internet: "Eventually, the IHE-based Health Internet will support patients as equals on the Health Internet. Eventually, the routing between different IHE nodes will be more direct, and then the benefits of IHE might begin to outweigh the benefits of the simple Direct Exchange.But for now, the Direct model empowers the patient in ways the IHE model could never hope to."

New models will allow patients to share their medical records with other doctors - and with other expert patients as well - many of whom can give excellent advice, since they've "been there , done that " !