LEARN INSURANCE

Your hospital has a great website with lots of clever graphics, health calculators, videos, and flash presentations ! Your marketing department is very pleased that you now have a Youtube and Twitter channel and a Facebook page. However, if you are using your hospital website as just a branding tool or a digital hospital brochure , you are not getting most bang for your buck !
You need to integrate Information Therapy as part of your medical workflow, so your doctors can provide better medical care to their patients; and your patients can have a hospital experience they can rave about !




By using clever new applications based on the Healthwise Knowledgebase , you can marry Information Therapy with EMRs, patient portals and web 2.0 social media, to improve the care you provide to your patients , to convert them into raving fans !

Let’s consider a patient with arthritis who needs knee replacement surgery. If your website has lots of valuable content on arthritis and its treatment options, it will rank high on google, which means the patient is very likely to come across your website during his search. If the information you provide is reliable; easy to understand; objective and updated, your hospital’s image in the patient’s eyes improves dramatically ! You can then “convert” this online visitor into a real-life patient by encouraging him to get in touch with you !

Similarly, let’s look at the same patient who is being admitted for elective knee replacement surgery. Prior to admission you can send a welcome email , along with a link to your hospital website which has a lot of accurate information on knee replacement surgery, so they know what to expect during their hospital stay. Not only does this help to relieve the anxiety of the patient and his family, they will also be very impressed by your thoughtfulness and patient-centred focus !

This can be automatic and inexpensive - you just need to embed this into your admission process ! It helps your doctors as well and saves them a lot of time , as they do not need to explain the basics once again, since the email has already done this ! You can do this after discharge as well – and this combination of high tech with high touch can be a winning formula ! It also helps to improve your doctor’s efficiency, as these emails reduce phone calls to your doctors , since most routine queries have been proactively answered !

Please email me at malpani@vsnl.com and I'll be happy to provide more information !

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 !

" 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."

Medical errors are a leading cause of preventable deaths. When a patient dies because of perceived medical negligence, hospitals get burnt down and doctors get beaten up. However, not all deaths are because of negligence - and not all errors can be prevented. In order to learn about what we can do to make sure that medical errors are minimised , India's first Patient Safety Workshop is being organised in Mumbai. This is the first conference in India which focuses on this key issue, which is usually misunderstood; and often ignored.

I am especially excited about the fact that this workshop will be involving patients as well, as I deeply believe that well-informed patients can play a very important role in preventing medical errors !

We've got some great speakers - please do come and join us ! You can get more details by emailing qcimumbai@yahoo.com !

NB Nrip, thanks for pointing out that there is an error in the conference announcement - it is on 24 April . Just shows how easy it is to make errors :)

The website for the conference is at http://thepatient.in/safety/

It's well known that most patients will google their symptoms and signs when they fall ill. Patients use the internet extensively to research their disease; to check on the treatment options available to them; to connect with other patients; and to select the right doctor.

However, if there so many patients are online, why don't more Indian doctors have their own websites ? Indian doctors are considered to be well-read; well-informed; and their clinical skills are usually excellent. Moreover, India is an IT powerhouse , which means one would logically expect that most Indian doctors would have their own website, which they could use to attract more patients; and to educate their existing patients.

While many Indian doctors now do have their own email address ( though many senior doctors still do not use email; or get their secretary to read and write their emails for them), most still do not have their own website because they do not see the need for this.

Senior doctors who have a flourishing practise without a website are quite happy to continue coasting along on their reputation. They do not think a website will add any value to their practise , and are not interested in exploring this new platform. Some are suspicious of these new-fangled fads; while others will actively criticise doctors who have websites, because they feel they are a form of advertising - something which is below their dignity !

Other doctors understand the value of having their own website, but because they are not computer-savvy, they are not sure how to go about getting one. They are worried that having a website is a very expensive option - and are not willing to invest the time and energy in creating one. They'd rather continue muddling along in the fashion to which they are accustomed - and they are quite contented getting patients through kickbacks and referrals because they cannot think out of the box.

Many doctors are employed by corporate hospitals; and they feel that the corporate hospital website provides enough of an online presence for them. Some doctors have had an unhappy experience with website companies in the past. They have burned their fingers badly, and are no longer willing to trust computer professionals any more. Others have done a half-hearted job ( using free websites offered to them by pharma companies) ;and because these did not result in any tangible benefits, they have jumped to the wrong conclusion that it's not worth creating a website because not enough Indian patients are online.

This is a major error on their part. Internet penetration is increasing by leaps and bounds in India - especially with the introduction of 3GH services and inexpensive smartphones. Doctors who do not have their own website will start losing patients to doctors who are online - and this gap will increase progressively over time !

If you are in practise, you cannot afford to be left behind - and this is especially true of the younger generation of doctors, who need to establish their practise and attract patients.

Rule Number 1 for any successful doctor is - go to where the patients are ! In the past, the patients were in hospitals, which is why hospital attachments were so actively sought after. Today, it's a completely different world - and the best place to reach out to patients is the online world !

Clever companies such as Plus91 ( in which I am an angel investor) have realised that there is a huge opportunity for a startup in India which specialises in providing websites for doctors only. They have married technological expertise with medical knowledge, to create a great portfolio of websites for Indian doctors. Since this is their only niche, they have a lot of expertise and experience in this space, in which they have become market leaders ! They can set up a customised website for a doctor ( with your own domain name) within 3 days ! You can check out their work at www.websitefordoctors.in !

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 !

One thing I like about the web is that it forces doctors and hospitals to be transparent. This empowers patients with information.

Patients often find it hard to find out how much medical procedures and surgery cost - and they have to doctor shop to find a hospital which they can afford. Also, many doctors are very reluctant to discuss costs - and some are very creative about their billing practises !

It's very helpful for patients to have a benchmark so they know what the "market rates" are. This way they do not suffer from "sticker shock" - or get taken for a ride by an unscrupulous doctor.

It's good to see that hospitals are now publishing their charges for the various medical procedures they offer online !

I am an angel investor in Plus91; and it's a matter of great pride that KEM Hospital ( Mumbai's most famous public teaching hospital and my alma mater) is now using their software to register their inpatients.

Using technology intelligently can help public hospitals to get their act together and improve their efficiency and productivity . Clever software makes for happy staff members - and happy
patients !

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.

Progressive hospitals are willing to learn lessons from the hospitality industry , and are willing to implement CRM to help their patients have a better experience when they come to the hospital. However, when I am talking about PRM, I am referring not to Patient Relationship Management ( something which all hospitals need to learn to do, but most still do badly !), but rather to Patient Relative Management.

The need for this is much more acute in Indian hospitals ! When most patients come to a hospital in India, they are accompanied by a bevy of friends, neighbours and relatives ! These people are extremely important in India, but sadly, they are often ignored and neglected by the hospital staff and management. Most hospital staff members consider them to be a nuisance and tolerate relatives as a necessary evil - and there are very few amenities available for family members , even for those who are on a 24-hour vigil outside the ICUs !

This is a very short-sighted approach ! Relatives are understandably concerned and worried about their patient's health. They are key decision makers, and need to be educated and informed about what to expect. They need to be addressed politely and kept updated about the clinical status of their patient.

Unfortunately, this is rarely done. Doctors ( and sometimes, the more senior they are, the worse their habits !) seem to take a perverse pride in making relatives wait for ever and ever ( often for completely flimsy reasons). They are not willing to share information about what goes on behind the intimidating doors of the Operation Theater and ICU. This is why family members often get angry with doctors, and when their patient dies, are eager to vent their frustration by burning down the hospital or beating up the doctors.

Doctors are very busy - and many may not have enough time to talk to even their patients, leave alone their relatives ! This lack of communication can cause frustration; and after bottling it up, relatives will often vent their resentment when a mishap occurs - even if the doctor was not to blame.

This is a systemic problem, which can be addresses proactively by the hospital management. In order to protect doctors, who are now feeling very vulnerable, the government is passing laws and hospitals are beefing up their security. However, this is a very short-sighted fix.

It's far more important that hospitals start investing time, money and energy in educating patient's relatives, so they have realistic expectations of the outcome of the medical treatment.
Dissatisfaction arises when there is a mismatch between expectations and reality - and helping relatives to have realistic expectations will help in reducing dissatisfaction with doctors and hospitals !

The most effective way of doing so is by setting up Patient Education Resource Centers in the hospital. The PERC will be run by nurses and librarians; and will help to educate patients and their relatives, so they know what to expect during their hospital stay.

As Indian hospitals strive to attract medical tourists and match global standards ( for example, by getting JCAHO accreditaion), documenting that patient education has been provided is going to be an integral part of patient care. The PERC will become an important department of the hospital . In the Mayo Clinic, the Dept of Patient Education occupies an entire building !

Not only are PERCs important for risk management, they are also very cost effective. All these relatives are prospective future customers for the hospital ( after all, we are all going to fall ill some day !) If they are treated with respect, they are likely to come back to the same hospital for their own medical care when they need this !

We all know that the best kind of marketing is word of mouth marketing . Instead of wasting money on advertising in the press , it makes much more sense for hospitals to invest it in PRM ! Relatives ( and the patient's visitors ) are potentially a captive customer base - why not educate them about health and illness ? In a hospital, everyone has a much more heightened sense of their own mortality. When you visit a friend who is sick, you are much more acutely aware of your own frailty - and much more health conscious ! ( What can I do to make sure my husband does not get a heart attack like his elder brother did ?) Reaching out to these relatives through a Patient Education Resource Center to help them learn more about their health can pay big dividends for the hospital , because they are much more likely to seek medical assistance in a hospital which has taken the time and trouble to educate them !

In an ideal world, doctors would be able spend as much time with the patient as he needed. They would understand the patient's personal beliefs and preferences; empathise with his worries and concerns; educate and inform the patient about his treatment option; and draw up a treatment plan which the patient was happy with.

Sadly, in real life, the only kind of people who are going to get this type of care today are billionaires who own their own hospitals. Today, most doctors are just too busy to be able to even talk to their patients for an uninterrupted ten minutes ! When they are young, they are rushing from clinic to clinic , trying to grow their practise . When they are senior, they have so many patients who have lined up to see them, that they just cannot devote the time needed.

As a result of this busyness, the first casualty is often patient education. Because doctors are not able to spend enough time with the patient, they are often not able to explain how they plan to fix the medical problem. As a result of this breakdown in doctor-patient communication, patients often have unrealistic expectations from their medical care - and if something goes wrong, the doctor is the one who bears the brunt of the patient's anger and resentment.

This is why patients now often spend hours on the internet, trying to educate themselves and learn as much as they can about their medical problems. While this is very good, the reality is that the quality of information on the net leaves a lot to be desired - and patients often get confused or misled by unreliable websites, making a bad situation even worse !

This is why librarians can be such a useful source of Information Therapy ! Librarians are information specialists, who have been trained to search for and retrieve high quality information.

In fact there are many reasons why librarians can do a better job at dispensing information therapy than doctors can !

They are trained professionals, who are expert at taking an interview with the patient, to determine what his information needs are. Because they are not medical professionals, they are able to provide objective, reliable information with no vested interest ! In fact, the information provided by an expert medical librarian is often better than that provided by a doctor. Unlike a surgeon who is quite likely to push for surgery, a librarian has no conflict of interest or hidden agenda and is quite happy to present all possible options, without any bias !

Equally importantly, patients are often more comfortable talking to librarians, who are seen to be non-threatening peers who encourage questions and take delight in providing high quality answers ! Doctors, on the other hand, can be quite intimidating - and most patients are very reluctant to ask their doctors questions, even when they are completely confused and do not understand what is going on !

Even better, librarians can help patients to make sense of the information they retrieve, because they are taught how to rate the quality of information. While patients will often get lost on the net, librarians can help them to judge how good the quality of the information is, based on a number of objective criteria. Of course, whether this information then can be applied to the individual patient is something which only the patient ( and his doctor) can decide ! Thus, while a surgeon may pooh-pooh a medical treatment option ( because he would rather do surgery than prescribe medicines !), a librarian can help the patient to explore all the available alternatives, with an open mind. Also, librarians do not use medical jargon to obfuscate the information they provide. They ensure that the patient understands the information - and because librarians are also lay-people, they are often much better at speaking the same language the patient does ( unlike doctors, many of whom do not seem to be able to communicate with their patients in simple English !)

There are many advantages of using this combination approach !

It fosters and encourages team work in medicine, and allows patients to get the benefit of multiple perspectives !
It keeps doctors honest, as they know that patients will be counter-checking the information they give them
The information is provided by information specialists, which means it is reliable, and current
Interestingly, doctors can also learn from the information which librarians provide. It's not going to teach them about medicine, but will teach them how to explain complicated medical concepts to their patients , and help them improve their communication skills
It can also help doctors to keep updated, if they have an open mind. Thus, these information searches are likely to teach them about alternative medicine options , which they would not otherwise be aware of
This kind of partnership can save the doctor time. He can focus on providing the medical care, because he is confident that the information needs of his patients are being met by trained professionals
It also helps the patient to be more confident that they are getting the best care , and will help them develop more trust in their doctor, because they have verified the information he has provided using independent sources provided by the librarian.
This approach will also help to reduce the difficulty patients often encounter when they search for medical information on the internet, because the librarian will make sure the information is authentic and current !

This excellent book, MANAGEMENT OF THE SICK HEALTH-CARE SYSTEM - What Is Wrong - What Can be Done is authored by Dr S.V.Nadkarni, Former Dean, L.T.Med.College, Sion.
It's 139 pages long, and is packed with the wisdom of a life time of working as a surgeon and medical administrator. Dr Nadkarni has some very clever and thought provoking ideas as to what makes our present healthcare system sick - and what we can do to heal it !

Dr Nadkarni's mobile is : 9320044525; and his email id is: sadanadkarni@gmail.com. The book is available with Vora Medical Publication, Near J.J.Hospital , Signal Traffic Byculla, Tel- 91-22- 23754161, E-mail : voramedpub@yahoo.co.in

Today's Times of India is full of reports about how doctors in private practise in Mumbai are no longer going to honour cashless policies from patients who have been insured by public sector insurance companies.

This is a battle ( doctors and hospitals versus insurance companies) which was simmering for a long time, and has now come to a head. Let's look at this dispassionately.

It's the doctor's duty to provide medical care to his patients. However, paying for this medical care is the patient's responsibility. Typically, this was a "fee for service" model . The doctor provided the services, and the patient paid for them. If the patient could not afford to do so , the doctor would reduce his fees - and even offer free services for poor patients who were deserving of financial assistance.

However, as medical costs increased, and patients found it difficult to afford these, health insurance companies stepped into this picture. The job of the insurance companies was simple - it was designed to protect the patient from the financial pain of paying for his medical care when he fell ill. This worked because the company would pool risks from the entire community. They would collect premiums from lots of people; and use this to pay the medical bills of the unfortunate few who fell ill.

The traditional model was one of indemnity. The doctor provided the services and the patient paid for them . The patient would then submit the medical bills to the insurance company, who would then reimburse these bills. The doctor did not have to deal with the insurance company because his only task was professional - to provide medical care to his patient. This was simple and beneficial for all parties concerned - so far, so good.

However, as time went by, two changes crept in which corrupted this system.

1. Doctors and hospitals started getting greedy. They would inflate the bills they would provide to patients who had insurance coverage and then share the spoils with their patients. Many doctors and patients were happy to indulge in this practise. They felt that they were milking a large faceless, heartless insurance company, so no one was getting hurt ( the moral hazard fallacy) , while they were profiting handsomely ! In fact, some patients felt entitled to getting reimbursement from the insurance company every year ; and would plot with doctors to submit fake medical bills even when they were not ill, just so that they could get this money from the insurance company. Their justification was - " We are paying a premium every year , so why shouldn't we get some money ? And anyway, the insurance company can afford this ! How will a few thousand hurt them ? "

In all fairness, the insurance companies also took a stand which encouraged this padding on the part of hospitals and doctors. They would take an inordinately long time to reimburse legitimate hospital bills; and would find many flimsy reasons to delay the payments due - and even to refuse payment altogether. They did this because they wanted to make money on the "float" - and the longer they delayed the payments they owed to hospitals, the more the money they could make. When hospitals found out that it was taking insurance companies 3 - 6 months to pay them their rightful dues, they started padding the submitted bills even more, to try to recover some of their rightful dues. Sadly, as more and more doctors and hospitals started indulging in this malpractise, insurance companies found they could no longer afford to overlook these losses, which were proving to be a drain on their profits ! They start scrutinising these claims and did their best to plug these loopholes. However, this was a difficult task; and was made even more difficult by the fact that health insurance was provided only by Public Sector companies owned by the Govt of India. They were allowed to collect artificially low premiums from their clients, because health was seen to be a social good, and the government was reluctant to charge realistic market-prices for these policies. All the players did their best to reduce their losses , but since they were forced to do so within the artificial constraints set by the government, everyone was unhappy.

2. As the health policies continued to lose money , insurance company executives started to think of new ways of reducing their losses. They realised that doctors were padding their claims and submitting inflated bills for insured patients. They decided to negotiate fees directly with hospitals and doctors; and since they had a lot of clout, they turned the screws on doctors by forcing them to accept capped fees for each procedure - fees which the insurance company set; and which the doctor was forced to accept. Since doctors did not have any unity and they did not want to lose their patients, many quietly agreed to toe the insurance company line. While the initial fees which were set were reasonable ( the company would ask for a 10% discount on the typical market fee for a procedure), the insurance companies started to act as bullies and continued to progressively lower the fee, year after year, until doctors could not afford to treat their patients at the abysmally low rates which the insurance companies were offering.

This was the flash point, which has triggered off the crisis which exists today !
The tragedy is that everyone is hurting today.

Originally, medical insurance was supposed to be a win-win situation. Doctors were happy, as their workload increased. Patients who would not have been able to afford to pay them their fees originally could now afford to have surgery done in private hospitals, because they had insurance coverage, and the insurance companies had deep pockets.

Patients were happy, because they could afford to get good quality care in private hospitals, without paying a bomb.

Insurance companies were happy, because they could collect the premiums and make money on the float.

However, because of some rotten apples, the entire health insurance business has now become confrontational !

Doctors are unhappy because insurance companies refuse to pay them their full professional fees. They are willing to pay only a pittance, and doctors find that they cannot survive on such low fees.

Insurance companies are unhappy because they continue to make losses on their health policies. If they go on bleeding , how will they be able to continue to provide health insurance policies ? Where will the money to pay the doctor come from ?

Patients are unhappy because they find themselves trapped between doctors and insurance companies. Insurance companies are happy to collect the premiums on the policies - but when it's time to pay the medical bills, they create an endless series of barriers and hurdles ! And when the doctor refuses to honour the cashless policy the insurance company has provided, patients feel angry and cheated.

So what's the solution ? Right now there's a lot of blustering and posturing going on. Doctors are trying to get organised, which is good. However , the AAMC ( Association of Medical Consultants in Mumbai) is threatening to penalise those of its members who continue to accept cashless policies. This is a completely toothless threat ! The AAMC is a private organisation for doctors, which some doctors choose to join. All the AAMC can do it cancel the doctor's membership - not an action which is likely to worry most doctors !

Consumer activists are also predictably threatening to go to court in order to protect patients. This is also an equally pointless threat. Doctors are free citizens and no one can compel a doctor in private practise to treat a patient if he does not want to ! Just like no lawyer can be forced to take on anyone as a client, no doctor can be forced t treat a patient if he does not want to ( except in an emergency, as a humanitarian gesture, so save the patient's life)

So what's next ? I think things are going to get a lot worse before they get better. The present antiquated model is broken, and we will have to come up with innovative new solutions. The good news is that these models do exist ! The US healthcare industry is also a mess right now, but there are many clever initiatives which have been piloted by some smart people there , and we can learn from these.

These models include:

• primary care doctors offering cost effective concierge care on a purely fee for service model ;
• allowing insurance companies to charge differential premiums for different policies, based on what the market will bear;
• using Information Technology to promote transparency and efficiency;
• limiting health insurance only to catastrophic illness insurance; and
• introducing consumer driven health care plans, such as Health Savings Accounts.

This crisis is actually an major opportunity - and entrepreneurs who craft win-win solutions will do very well !

This is a guest post from Mr Parag Vora, CEO of Infoseek in which I am an angel investor.

In the past, most doctors used to feel that marketing was below their dignity. Medicine was considered to be a noble profession, while marketing was seen to be a sleazy way of soliciting for patients. In today’s competitive market however, , a doctor can no longer continue to retain these outdated beliefs. Every doctor needs to wake up and realise that marketing has become a necessity for survival. Look around you - the corporate hospitals have already started eating into your market share and now take away a large chunk of patients who used to come to you in the past ! Is it because they are better than you? More experienced ? Or that they provide better patient care ? I don't think so ! In fact, the care in many of these hospitals is impersonal – and very expensive ! Why do patients go there ? The answer lies in the simple fact that they are able to 'MARKET'; 'BRAND' and 'POSITION' themselves much better than you can !

Marketing is not the same as advertising ! It basically means you use techniques which influence your patient's choice in selecting his doctor, by demonstrating the true value of your expertise and services. Marketing is something doctors has always done. It’s just that in the past, it was basically simple “word of mouth marketing. In today’s age, you need to adopt the marketing methods being followed by other industries.

To understand how marketing can help your medical practice, you first need to understand how a patient chooses a doctor. The quality of medical care and the expertise of the doctor is a major factor , but the truth is that it is extremely difficult for a patient to assess this , because he simply does not have the technical sophistication to be able to differentiate between a good doctor and a bad doctor ! Hence , patients look at proxy measures , such asreferences from family and friends; the doctor’s “reputation”; whom the local chemist recommends; and often by doing a google search !

In my opinion, a kick-start to your marketing efforts should be focused on your current patient population. Provide them with excellent care and service and they will be the best marketeers for your practice. If you treat them well and provide them cost effective medical care, they are certainly going to recommend you to their family and friends.

Your image is another very important marketing tool for you – and your clinic’s ambience plays a key role ! This could be a plus– or could be a black mark against you ! For instance - acramped waiting room with paint peeling off the walls ; a dirty consulting and examining room; ill-behaved support staff; and no information about the services that you offer. Do you think this will inspire confidence in your patient while he is waiting to see you ? Whenever I check-in to a hotel room, the first thing I see is how well maintained the washroom is. It tells me a lot about the hotel and its service , and builds up their image. Isn’t the first impression often the last?

You must have some marketing “collaterals” ( marketing also uses jargon, just like doctors do !) The list of such collaterals should include :
1. Brochure(about your practice and services)
2. A professional website
3. A patient resource center within your clinic with patient education books and DVD’s.
4. A short AV film about your clinic; your expertise; infrastructure; with patient testimonials.

Marketing yourself does not have to cost a lot of time and money . Marketing is simply letting your patients know that you are genuinely willing and able to take care of them !

There is a reason doctors and nurses are called "caregivers" and it's been proven time and time again that when putting patients in a caring, positive environment, healing time is decreased significantly as opposed to a sterile, strict atmosphere where doctors and nurses exude arrogance and are insulted when questioned.


Family Matters

Last year, as I sat in the hospital with my mom who was very sick with cancer and couldn't take care of herself, for the sixteenth time waiting to see which type of nurse and doctor we were going to get: Jekyll or Hyde, I realized how nervous I had become when it came to who was going to really take care of the most beloved person in my life. I wanted the best for this wonderful person and knew she deserved the best, but I had become extremely defensive each time we went to the hospital due to the spectrum of health care personalities we had experienced. Not wanting to over step my boundaries with a dozen questions about why and what the staff would do to help my sick mother, but I struggled with the fact that she needed treatment physically, but also emotionally and when we were blessed with a friendly nurse and doctor that went a little out of their way to show that they cared, we held onto them with both hands as they led our terrified family in what we trusted was the right direction.


Life and Death

I've heard several horror stories about arrogant doctors who got a little too cocky and make mistakes that could have killed their patient due to their overconfidence. These types of mistakes happen more frequently than most people realize but are overlooked or covered up. So question your doctor or nurse, don't be afraid to stand up for your rights as patients, after all, it's your body and if you are uncomfortable, find someone else. It's hard enough to go through a painful time or watch someone who is sick and needs help, but trusting your care giver and feeling confident that they are also looking out for the one you care about or your best interest is imperative in the healing process both physically and mentally.


This is a guest post from Alexis Bonari , who is a freelance writer and blog junkie. She is currently a resident blogger at onlinedegrees.org, researching areas of online universities. In her spare time, she enjoys square-foot gardening, swimming, and avoiding her laptop.

This is a guest post from my friend, Dr. Shalini Ratan, MD, Founder , Nirvan Life Sciences Pvt. Ltd. at http://nirvanlifesciences.blogspot.com/.

Health care today is unlike health care yesterday.

The healthcare market is growing by leaps and bounds. According to reliable sources, the market size for the private sector in healthcare has shot up from Rs 85,500 crore in 2006 to Rs 1, 48,050 crore now. This accounts for 80 per cent of the total market—the highest share in the world. About 15 hospital projects are slated to open this year. The number of doctors and nurses enrolled in medical colleges and nursing schools will have to triple over the next 10 years. An additional 520,000 students physicians will be required by 2012.

In this scenario there is enormous scope for clever medical professionals. However, with this demand come new challenges! Doctors need to learn new skills in order to keep their patients satisfied, because the modern breed of patients are evolving as consumers and demand much more attention from their doctor. At the same time one has to overcome the hurdles to achieve higher goals in practice. Doctors in private practice will need to develop themselves to compete with the corporate hospitals which have a marketing team for their service promotion, huge marketing budgets and well groomed medical practitioners. So at the end of the day, to provide complete healthcare experience to the patients the doctor has to play the role of a medical expert as well as a medical entrepreneur.

The role of a medical practitioner today is not only of a clinician and an academician, but also a manager and implementer for providing excellent medical services. And this requires a “Mindset Shift” of the medical professionals.

A doctor invests almost a decade in becoming a trained professional through technical education and internship. However the formal medical education fails to train the doctors in some key skill areas. A doctor to be highly effective need to learn art of communication with their patients, build a compassionate doctor – patient relationship and be highly efficient in operational skills. As doctors are not groomed in a corporate environment they need to polish their skills to become Medical Entrepreneurs.

Enhancing Doctor - Patient Relationship is an area of importance today. There is a need to empower and engage patients in today’s technology driven era. Knowledge and understanding of the needs of patients and their families now is more crucial than ever in providing exceptional patient service. Today a doctor’s reputation is driven by the combination of patient experience and perception of services provided to them.

The medical professionals would need to re-think about enhancing doctor-patient relationship, should be able to understand the basic principles of medical practice management, develop familiarity with the language of healthcare marketing and acquire various soft skills like communication, handling team and understanding the online digital world. This would help them handle medical practice effectively.

A doctor would need to combine multiple talents - technical expertise in their specialty; understanding the importance of hospitality in the hospital ; and above all, developing a compassionate and empathetic approach in order to create loyal patients.

So the need for a doctor today is to have a patient centric approach, practice medicine effectively as a professional, not a trade and earn profit smartly.

This is based on an interview I did for a cover story for Heal India magazine.

1. Why did you choose to become a doctor ?

Medicine is a service profession and I decided to opt for medical practice because this provides an opportunity for direct patient interaction. The emotional income in medical practice is unmatchable – and it’s a great feeling when patients thank you changing their lives by giving them a baby !

2. How easy or difficult was the transition from residency to practise ?

I have always enjoyed academics and won over 20 gold medals during my medical training. I continue to read medical journals and present papers at medical conferences, which means we are at the cutting edge of medical technology. In fact, our IVF clinic is more advanced academically than most departments of OB/GYN in teaching hospitals in India, because none of these offer IVF treatment. The Professors here only know and teach the theory while we actually do IVF in real life ! Yes, I do miss teaching medical students and residents, because interacting with juniors and young students is a lot of fun. This is why, instead of teaching medical students, we focus our attention on teaching our patients – which can be a lot of fun academically, as patients ask a lot of very intelligent and stimulating questions which keeps me on my toes ! I feel we have been able to get the best of both worlds in our clinic!

3. What drives you ?

I like getting up in the morning because I know that I can help to improve the life of my patients by giving them a deeply desired baby ! I love exploring new technology – both in the IVF lab; and Information Technology. This is why I am an angel investor in startups which deliver technology to doctors to help them improve the care they provide to patients !

4. Are you satisfied with the academic framework that we have in India ?

No – I think it can be improved a lot ! I feel academic departments in teaching hospitals have become outdated and stale. They do not have access to the latest technology, because of funding constraints. I feel it’s a crying shame that so–called teaching hospitals in India which provide postgraduate training in MD for gynecologists do not teach their residents how to do IVF because they do not offer IVF treatment for patients ! This is very sad – doesn’t Family Planning and Welfare also mean helping infertile couples to have a baby ? IVF is not expensive – and I feel that a Dept of OB/GYN which does not offer IVF in this day and age should not be recognised by the Medical Council of India. How can a gynecologist who has never seen a single egg collection during his residency consider himself to be well equipped or qualified to practice OB/GYN today ?

5. There is mass migration of medical students ? Why so and how can
this be curtailed if not contained.

The Brain Drain has always been a fact of life . After all, in a capitalistic society, bright students will look for the best opportunities for themselves , and there is no reason why they should restrict themselves to India. I do not think that trying to curtail this by making residents sign bonds is a good idea. It makes far more sense to provide young doctors with stimulating opportunities to practise high quality medical care in India, so they no longer feel the need to go abroad. In reality, most students who migrate to the US are just blindly following the herd mentality and being quite short sighted. For the bright medical students, India offers the best opportunities in the world today. We have a young and growing population – and for ambitious doctors who are willing to work hard, the sky is the limit. I often feel sorry for my classmates who have settled in the US – my quality of life is far better than theirs !

6. What inspired you to set up a clinic ? How do you find it different from others already existing ones ?

Most IVF clinics in the world are free-standing ambulatory care facilities. After all, infertile couples are not “sick” and do not need hospitalization. By operating an independent clinic, we offer a much higher quality of customized and personalized care to our patients, without all the hospital red tape. Not only is this much better for our patients, it’s much better for us as well. We provide a very cost effective service because we do not have any hospital overheads – and we do not need to give the income we earn away to the hospital management.

7. How do you envision..... (heart / cancer/ fertility,,,,) hospitals/ centres in India in days to come ?

I feel we will see a boom. Specialty hospitals ( between about 50 - 100 beds) , which are focused on a particular specialty are the best way of providing high quality medical care. They are focused factories – and can prove to be centers of excellence !

8. How do you divide the time between medical practice and academic
preparations ?

I feel this is a very artificial distinction. All practise is based on theory – and a good doctor needs to be proficient in both ! I learn by reading about my patient’s problems, so I can provide them with the best possible solution for their problem. By converting the theory ( in medical journals and text books) into practice, we remain at the cutting edge of both !

9. Combining medical practice and academics or on the job learning - which of the two do you think is preferable.

I think all good doctors will agree that the only way to learn medicine is by actually treating patients ! The only real learning which occurs in medicine is at the bedside – so all medical learning has to be on the job ! As Sir William Osler put it so eloquently, “He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.”

I agree that doctors need to improve their ethical standards, but what really upsets me is the double standards which have now been institutionalised, with the entry of corporate hospitals into the medical field.

While everyone is happy to loudly criticise the specialist who gives kickbacks to the family physician for referring patents to him, why is everyone so mute when it comes to the kickbacks which the hospitals give to doctors for filling their hospital beds ? All corporate hospitals give these cuts and commissions openly and shamelessly. They employ a large number of very presentable executives ( mostly female) in their Dept of Public Relations, and cleverly call it a "patient management fee", when the only management involved is writing the referral note !

It's the same story with the medical tourism companies. All hospitals are happy to give large commissions to these tourism companies for the "facilitation services" they provide, but these are costs which then get passed onto the poor unsuspecting patient !

Why should we allow double standards in medicine ? After all, both doctors in private practise and hospitals are competing for the same patient - let's have a level playing field; and not be hypocritical ! If it's OK for hospitals to give kickbacks ( which they treat as " the cost of doing business") , then let's allow doctors to do this as well ! In fact , doing it openly will help to improve transparency !

Want to learn

• how to choose the right doctor ?
• how to talk to your doctor
• how to get a second opinion ?
• how to prevent unnecessary surgery ?
• how to take care of yourself in a hospital ?

Check out our free e-learning course, How to Get the Best Medical care ! This is brought to you by HELP, in partnership with G-cubed solutions !

Image via Wikipedia

Parkinson's Law is now a classic, which states - "Work expands so as to fill the time available for its completion." I think it applies very well to medical care as well. Here it would be - " Patient supply expands to fill the hospital beds which are available".

A lot of government officials in India naively believe that the reason the medical care provided to Indians is so poor is because there are not enough hospital beds to provide them with medical care. Their solution is - build more hospitals and train more doctors, and the problem will be solved.

Actually, it will not ! More doctors and more hospital beds will just end up creating more demand for medical care and more patients - not better health !

Remember that doctors provide illness care - not health care; and that more more care is not always better for many illnesses ! Sometimes, less is more - and it would be far smarter for India to focus on teaching people to take better care of themselves, rather than spend money on 5-star hospitals.

Sadly, this will never happen. There is too much money to be made in opening new medical colleges ; training new doctors; building large new hospitals ; and "treating" patients. Healthcare business is huge - and consumes about 12% of the GDP in the USA. There's a lot of scope for it to grow in India - and it seems we are doomed to end up replicating all the mistakes the Americans have made !