LEARN INSURANCE

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 !

This is a guest post from a very thoughtful patient of mine. I know many IVF patients will be able to identify with her experience . I just wish more doctors would read this as well, so they can provide more support to IVF patients !

When you do ivf as a medical tourist soon you'll find out you have become a traveller between the worlds. Between continents and between medical worlds: "normal" obstetrics and ivf. Unexpectingly it turns out to be much easier finding an ivf doctor in India than finding an obstetric gynecologist in your home town. And once you are lucky enough to get an appointment, you are faced with different treatment concepts: pregnancy in obstetrics and pregnancy in ivf are a world apart it seems.

Unless you are already established with an ob gyn - not so likely; you would not be an ivf patient if you had made it into the normal gyn world - getting an appointment with a gynecologist becomes a real challenge.

After returning from India I called a gyn I had seen once to schedule appointments for the row of betas after the two week wait. She reluctantly ordered one blood test and told me right away that she was not willing to deal with ivf patients in general, much less with ivfers from abroad and that she was not an obstetrician anyway for that matter.

I then contacted other obgyns in my area but they were so fast in telling me that there were no appointments available any time soon that I did not even had the chance to explain the vital importance of the row of betas in ivf and that this was why I needed an appointment much sooner. Since this was my fourth ivf cycle, as a recurrent ivfer I had by now acquired a daunty respect for those fearful beta numbers and their always heart-wrenching doubling time. During the two weeks of wait for the first beta, the tension grows denser and denser and the only thing that can ease your strain, slightly, is a good doubling time. I had to find a beta-willing gyn at any cost.

A certain familiarity with the medical establishment led me to the conclusion that local doctors in private practice might have arbitrary freedom as to wether accept new patients and therefore insisting on small private practice doctors would lead nowhere. I had to find a public structure with more inclusive patience acceptance. I called the medical faculty associates office at a the local university. Among the options at the answering machine : "if you are pregnant ..."That sounded promising.

I pressed the required key and a friendly voice said, he would now check for available appointment dates. I explained right away that I was doing ifv abroad and that I needed two blood tests and a scan done on specific dates. He was listening for a while and after what seemed to me a long stretch of silence he was trying to find out where in his scheduling scheme I could possibly fit in with my outlandish request for a row of betas. "A row of betas ? I don't think the doctor will do that for you". He appeared to want to be helpful, but just could not comprehend my urgency for blood tests. He suggested to do a home test in the meantime.

I did not want to lecture on the difference between qualitative and quantitative bhcg testing for fear this might ruin his sympathetic attitude towards me. I just began to understand myself that timing in ivf was far away from timing in normal obstetrics. The beta frenzy was a thing exquisitely ivf. He was willing to give me an appointment to see a doctor on a day that luckily turned out to be the day my ivf doctor wanted me to have my first scan, in 10 days to come. I gratefully accepted. I had to find another way to find relief from beta hell. There was no way I could wait 10 days without knowing my beta numbers' fate.

When dismissed from Dr. Malpani's clinic, he will ask you to inform him on your beta results. I emailed him that I was not able to obtain blood tests and therefore could not inform him. Within a few minutes he replied sending me a link to a online lab. What a relief. I would have had to pay for the tests privately though. Relief from awful beta-anxiety has no price.

The beta numbers came in, anxiety stayed. Doubts about adequate doubling time and no doctor to talk to. Again I emailed with Dr. Malpani and was reassured.

While my appointment with the obgyn was approaching, I imagined that I would have to go through at least two assistants before I could talk to the doctor. They would both ask me the same questions again ,checking the same checklist. Why was I so hypercritical ? I should be thankful that someone was paying attention to me no matter how formal.
This doctor turned out to have one assistant only and she was indeed simply friendly and asked me where I had my ivf done. "India ? That's pretty far away".
"Only on the map" I replied thinking of how easy it was to get advise from my ivf doctor by email while I hadn't yet seen the local doctor. I was so tense about seeing the doctor and whether he would have me have a scan done, that I made no attempt to explain this apparent contradiction. Whatever her assumption regarding my state of mind that moment , she was surely right.

And then she asked me about the due date. The due date ? WTH ? Heavens, I am doing ivf ! I am not in the usual pregnancy business. In ivf the due date is an almost non-existing concept. In ivf you go from hurdle to hurdle, from beta to beta, from scan to scan, day by day, week by week. The relief of one doubling beta lasts the blink of an eye and you start worrying about your next beta two days from now. And once you made it to the ultra sound level and you are lucky enough to see what could be a a gestational sac, a black little hole, you start getting very nervous when your next appointment approaches: will there be a heartbeat ? You will never forget that flimsy flickering filament and life appears to be so fragile and delicate, a friable thread of silk.

"The due date", I said, "I never got that far". A look at her told me that she considered my situation to be too complex. She did not inquire and I was glad I did not have to go over my ivf history. I handed her my discharge papers. Without having a look at them she said the doctor would be here soon and left.

The doctor stepped in, I explained I was doing ivf abroad. I told him my beta numbers and he decided they were too low. The feeling of desperation took over. I had the impression that maybe he was not used to see beta numbers at such an early stage of pregnancy and that was why he considered them too low. But I had not enough energy to find that out. I would ask Dr. Malpani.

By now I have become an established patient with both the pregnancy worlds. Pregnancy symptoms might be the common interface. I learned to navigate myself through the "normal" obgyn world being aware that I am confronted with a somewhat different obstetric culture. There is no "clash of civilization" in obstetrics, no self-fulfilling prophecy of conflict. After all, a pregnancy is a pregnancy, no matter where.

While patients in the US are deluged with information, patients in India are usually starved for this. They have to depend upon US websites for information ( much of which is not applicable to Indian conditions and diseases); or upon their doctor ( who is often too busy to educate them !)

One of the major issues is that the importance of educating patients has still not become a pressing issue for doctors. Traditionally, Indian doctors have always been quite paternalistic; and most Indian patients are quite happy to follow the doctor's orders.

While it's true that times are changing, and that the younger generation of doctors is more willing to be open ad to invest time in discussing treatment options with their patients, another limitation has been the acute shortage of patient educational materials designed for India.

Another major issue has been the fact that there are so many regional languages in India - and many Indians are illiterate.

The good news is that this challenge is actually a great opportunity - and clever startups like PEAS India ( in which I am an angel investor) are now developing a library of patient educational DVDs , customised for India !

As i have written earlier, the primary job of a doctor it to teach patients. After all, medical care does not just consist of making a diagnosis or prescribing a medicine. Teaching patients about their illness; what they can do to manage it; and what they can do to remain healthy is an integral part of a doctor's job.

However, as important as teaching is learning. Doctors need to learn all the time. Medical science makes dramatic advances all the time, and doctors have to invest time, money and energy in ensuring they knowledge base is updated and current . This is why doctors read medical journals and medical conferences !

However, a very important teaching tool ( which many doctors sometimes overlook) are patients. Patients can be your best teachers - if you give them an opportunity to teach you ! Patients will not teach you just about the medical details of the disease ( though reading medicine about patients you have actually seen is the best way of making sure that the knowledge "sticks" !) .

Patients can teach doctors how to live; and how to cope with adversity ! Expert patients know a lot about their disease, and can teach a doctor a lot about how his patients can learn to live with their disease.

( And if you are lucky, and your patient is an investment consultant, he can also teach you how to invest in shares and stocks ! )

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 !

“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 !

Hi, We are from Canada and this is our short story that we would like to share as noted below:

First of all, would like to extend our warm gratitude to Dr.Aniruddha & Dr.Anjali Malpani, and your staff making our IVF treatment a SUCCESS !!!
I am on the eleventh week of pregnancy now and hoping and always pray it will be a SUCCESS until the baby is born.

Planning/deciding to undergo IVF is not a joke/easy. There are a lot of things to consider.

1. Financial - IVF involves a huge amount of money like travelling expenses, hotel,food,medicine and might affect the job as well
2. Stress - Need to manage your stress - IVF involves a lot of stress.
3. Taking the risk

a. Job - Ready to quit the job to have full rest if required according to case to case basis before and after the treatment until the baby is born
b. Effort - Regardless how much effort you exerted expect that sometimes it doesn't succeed at one time treatment only.
c. Time - Ready to accept that in first/second try did not go thru.
d. Budget - It might be very tight at times especially if income is limited.

4. Health - It is very important to remain healthy like balance diet, avoiding caffeine,/alcohol/smoking and have a daily exercise with the doctor's guidance according to health conditions.

I am now in my first pregnancy which is my third IVF treatment with Dr.Malpani coming from Canada to India 3 times. It was really hard to travel and adjustments to another country and lot of stress and finance involved. We cannot fight with God's creations or the nature but the doctors can help to make it happen.

We are really lucky to find the right clinic with experienced doctors who are always there to help, and taking extra steps to make the IVF treatment a success and its so fantastic to have a doctor who responding to all our inquiries promptly all the time additionally his staffs are all helpful and very co-operative treating us like a family and clinic has an excellent facilities everything is done in the clinic itself no need to go somewhere else which is very convenient for us, being a patient for 3 times there we know everything. and enjoyed as well. There are lots of good things to tell but there is no words to express...

However, just to let you know that there are still lot of trauma during my pregnancy on 6th to seventh week had 3 times heavy bleeding but this did not lost our hope I have to deal with and relax thank god did not happen again and very soon I am going to finish my first trimester by April 16,2011.

Thank God !!! There is really nothing impossible. First of all trust in God, trust your doctors, trust yourselves, take a risk and go for it!!!

crpp1@hotmail.com

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 !

Have you got fed up of waiting for ever and ever at your doctor's clinic ?
Are you upset when your doctor talks down to you or uses jargon ?
Do you resent the fact that it's impossible to make sense of your hospital bill ?
Why can't hospitals be more patient friendly ?
Why can't doctors be more transparent ?

Instead of just complaining, here's an opportunity for you to provide some answers !
Remember , if you are not part of the solution, you are part of the problem !


You are invited to attend the launch of
The Patient Community@HELP
on Thursday,7th April, 2011 at 11.30a.m.

Introduction and launch of The Patient Community@HELP

Dr.Aniruddha Malpani, M.D., IVF Specialist, Founder, HELP and Patient Advocate- "How Patients can Heal a Sick Healthcare System".

Mr.Kanu (Harshad) Kamdar, Member, Parkinson's Disease and Movement Disorder Soc. of India - will speak on "Partnering with the Health Care Team for Graceful Aging".

Dr.Shantanu Nagarkatti, M.D., Surgeon, Professor, Expert in mind body medicine will speak on "Improving Patient Communication - Learn how to talk to your doctor !"

Mr.P.K. Rao, - Founder, JASCAP will speak on "Converting A Personal Tragedy Into A Socially Useful Project".


The first meeting of The Patient Community@HELP will be held on Saturday, 14th May, 2011 and every second Saturday of the month thereafter.

Goal: To provide a platform for patients and doctors to connect, to help improve the doctor-patient relationship

Get Involved ! Whether you are a medical student, a physician, a patient or a caregiver, we need you.

If you are doctor, you can take a workshop ! If you are an expert patient, you can help other patients ! We are inviting registrations to The Patient Community @ HELP. Call us on 022-65952393/94 or send us an email.

Be there and contribute!
For more Information Click here.

" 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 "

I just received this thoughtful questionnaire from a patient.

We are looking for “gestational surrogacy” in India. There are many clinics offering these services and before moving forward in this decision, we want to have more information about your clinic and some steps of the process. Here are our questions and concerns.


1. How many years of experiences in fertility and surrogacy does your clinic have?

20 years

2. What are the main steps and what is the time table of the whole process
a. Steps

The process is described in details at www.indiansurrogates.in

b. Timeframe

20 days

3. What is the delay from first contact to start of surrogacy?

3-4 months

4. What are the legal concerns with surrogacy?

Our legal consultant will take you through these

5. What are the legal procedures we have to go through?

Our legal consultant will draft the contract which you and the surrogate will have to sign before we start your treatment

6. What is the selection process for the surrogates?

We select the surrogate for you. We screen them for their health; and to rule out infectious diseases; and counsel them as well


7. What facilities do you provide and what control do you then have with surrogates?

The surrogate’s pregnancy is monitored by our obstetric consultant

8. What is the cost and what does it include?

US $ 25000

9. What other expenses / costs (not included) that are at my charge?

Travel

10. How much goes to the surrogate and how much goes to the clinic?

Described at www.indiansurrogates.in

11. What is the probability of success/failure?

Our pregnancy rate is 56% when we transfer 3 Grade A embryos

12. Has there ever been health related issues when the new born is taken back to the parents’ country?

No

13. Do you have a blog webpage where parents can share their experience with your clinic?

You can talk to some of our patients by email at www.drmalpani.com/ivfsuccessstories.htm

14. Why should we select your clinic more than another?

You can read about how we pamper our patients at http://www.drmalpani.com/ivf-treatment-at-malpani-ivf-clinic.htm

Infertile patients can be desperate for a diagnosis. They naively feel that once they know what the problem is, we'll be able to find the solution !

This leads to testing - which has now become an epidemic of overtesting.

Let's see why. Patients still have unrealistic expectations from IVF treatment. Doctors often do not bother to counsel them. They are so focused on "grabbing patients" to do one IVF cycle, that they overpromise success. They make tall claims during the IVF cycle to keep the patient's hopes high - everything is going very well- you will definitely get pregnant ! Then, when the cycle fails, the doctor becomes inaccessible ! Patients get disillusioned and hunt for a new doctor. The new doctor needs to do something more - something different - as compared to the old one - after all, he needs to show the patient he is better !

The new doctor will then order a whole panel of expensive new tests. Many of these are completely irrelevant and do not affect fertility or the IVF treatment, but patients are quite clueless and do not know any better. They are happy to do whatever the new ( and improved !) doctor suggests - after all, aren't more tests a sign that this new doctor is very thorough and competent ?

An excellent example of this is : PCR for TB testing in India; immune testing for killer cells in the US; and sperm DNA fragmentation tests.

All doctors know that if you do a lot of tests , it's a matter of statistical certainty that you will find an abnormality. Once this is found, this is considered to be the problem causing the infertility which then needs to be fixed ! The new doctor is triumphant ! See, the earlier doctor was incompetent and did not bother to test you properly which is why the cycle failed. Aren't you glad you came to me ? Now that I am treating you , this problem will be solved and you will get pregnant !

Patients are happy too ! They are impressed by how well-informed and thorough the new doctor is. In fact , is sometimes seems that the more the tests - and the more expensive they are, the happier the patient - and the happier the doctor !

This leads to a negative vicious cycle of overtesting and overtreatment. Doctors often end up "treating" red herrings. All this just wastes time and money - and then the new doctor fails, then
patients lose confidence in doctors - and in themselves !

Caveat emptor - do your homework before agreeing to do tests ! And always ask this simple question - How will this change my treatment ?

I want all my IVF patients to become an expert on IVF , which is why we spend a lot of time and energy in educating them; and in creating unique online educational tools to help them to learn more about IVF.

Now, I am not trying to teach my patients how to do IVF in their bedroom ! The reason we want them to know as much about their treatment as possible is because this is the best way of explaining to them why we are so good at what we do - and what makes us better than other IVF clinics . The outcome of any IVF treatment is always uncertain, and no matter how good I am , there is no certainty that the IVF cycle will be successful. Also, it's a very competitive field, and there are over 40 IVF clinics in Bombay itself ! Sadly, most patients are quite clueless, and do not have the ability to differentiate between a good IVF clinic and a bad IVF clinic.

If we actively involve patients in their IVF treatment, they are better able to understand what makes us one of the best IVF clinics in India. When they understand the science behind IVF, they appreciate all the time and effort we take in monitoring them and in personalising their treatment . We work hard in order to help our patients to have a baby, but only well-informed patients can truly appreciate all the effort which goes on behind the scenes !

Also, well-informed patients have realistic expectations from the IVF treatment . They understand that human reproduction is not an efficient enterprise and do not go to pieces when the IVF cycle fails.

Most IVF clinics are extremely stingy about providing patients with information about their medical treatment. They seem to take the approach that patients are stupid and will not be able to understand anything about their IVF treatment because it's very complex ! Some don't even bother to provide a treatment summary - while very few provide photographic documentation of the embryos.

We routinely provide our patients with photos of their embryos . Making embryos is the heart of what an IVF clinic does and we take pride in our work ! This is a tangible end point I can deliver and seeing high quality embryos reassures the patient that they have received high quality medical care - and this helps to build patient loyalty. Many will frame these photos and use them to start their baby's album !

Educating our patients is an investment in helping them to achieve peace of mind that they have received high quality medical care, so that no matter what the final outcome, they know that they have had their best possible chance at having a baby by taking treatment in our clinic !

In our quest of paternity, we made some treatments in our home country, Spain, but we got no success. After a period to find an alternative, we chose to go to Mumbai, India, and in fact Malpani Infertility Clinic. We had more contact with other clinics in India, through e-mail, forums, testimonials of patients who were with them, etc., but finally we opted for Malpani Infertility Clinic for many reasons that during the treatment were confirmed. In the talks held by e-mail us seemed honest, ethicals, professionals and they offered us a good humane treatment.

Our experience began in summer 2010, and we decided to begin the pre-treatment that Dr. Malpani suggested us by e-mail while we were in Spain before treatment in Mumbai. He explained to me everything that had to do: medicine, testing, planning, guidance and even where to stay in Mumbai. The day that we arrived at the clinic we were surprised by the number of couples who were there, and by their different nationalities.

That day, Dr. Aniruddha Malpani welcomed us into his office and he discussed our case with the evidence and history that we send, and he explained us the steps of treatment and medicines that provided us for the following days. Our stay in Mumbai was not easy, because it is a chaotic and noisy city that never sleeps, but our goal and dream of having a child gave us the strength to withstand all.

Dr. Anjali Malpani, is the wife of Dr. Aniruddha Malpani, she is the one responsible for making the scans, egg collection and check the status of the uterus. She is a woman of easy-going and very understanding. The day of the transfer and before transferring the embryos, she informed me that we could to go to the lab to see it. Saiprasad Gundeti is the biologist and laboratory technician responsible for the selection of embryos, which showed us the embryos which were transferred me.

The day of transfer I went to the clinic and I was there waiting for my turn, I was taken to the operating theater where two nurses were cleaning and talking to me, the truth is that Indian people is very kind people in general. Dr. Aniruddha Malpani came to the operating theater and never stopped talking to me during the transfer process that was a few time, at the end, he literally asked, "How do you feel?" I replied, "Happy" but he said: “not happy, you must to feel pregnant.”

After embryo transfer, Dr. Aniruddha Malpani recommended I rest for 2 days, and then we went to say goodbye to them all, included clinic nurses and staff. At the end, we were in Mumbai about 24 days and we returned to our home to our normal life. Them they spent 14 days, I went to make hormone beta HCG analysis and the result was positive, I'm pregnant!!! I made 3 blood tests to see increased levels of the hormone beta HCG and they informed me that is a multiple pregnancy. I sent results to Dr. Aniruddha Malpani for his information and assessment. After doing some vaginal sonography, my gynecologist confirmed me that I have triplets. Today I am 21 weeks pregnant and I feel great. What concerns us now
is to be born healthy. Our experience was successful with Dr. Malpani.

Dr. Malpani and his wife showed great respect and proper treatment during our stay, although some days of consultation, the waits were long but no problem. They encouraged us and empathize with us. Communication with staff maybe could be most appropriate, because of language, but we asked many times to avoid doubt. They treated us well to know everything about treatment.

Our experience tells us that we must be relaxed, be positive and be communicative to get confidence and no doubts. You need to have patience with several unknown things and to trust in the possibilities. Note that there is no 100% chance and to have no despair.

Dr. Anjali Malpani and Dr Aniruddha Malpani have over 10 years experience in fertility and their nurses and staff also has much experience. We hope our experience will serve to encourage couples to clear up their doubts and encourage them to use this opportunity to be assisted, helped and loved by Dr. Malpani.

casamaria2010@gmail.com

I was watching TV late one night , into the wee hours of the morning…

I was so tired & bored that I started channel-surfing and I stopped on this program called “70&Pregnant” on the Discovery/TLC Cable Channel. Boy! Did it wake me up? Mark & I have tried for years to get pregnant and we realized about 15 years ago that because of my premature ovarian failure, only a donor egg would work for us. So needless to say when I saw this program, I perked up immediately…. On this program, they featured an Indian doctor who helped a 70 year old Indian lady get pregnant and have child with a donor egg. The donor came from a nearby Indian village & the cost was cheap by U.S.A. Standards for IVF.

During the program, the doctor discussed the cost of IVF in Indian and immediately, since fertility treatments for me & Mark are too expensive, when I heard the cost of IVF in India, I jumped up & started researching Doctors in India right then and there. I could barely sleep that night.

When I woke up the next day, I went straight to the Indian Embassy here in D.C. – no appointment, no announcement, nothing…. and just talked to whomever I could about the country. The receptionist was the sweetest and kindest lady in the world. She told me so much about the country, the time differential, how to dial abroad, etc. Then finally I asked, hey do you have a science or medical representative here from India as a part of your staff? She said yes and she directed me to the Counselor of Science for the Embassy. He happened to be free, praise God, so he & I chatted for about 20 minutes. I was so excited about the cost of IVF in India that I didn’t even beat around the bush. I told him exactly what I wanted and he poured out all the information he could. He bent over backwards to help me.

He told me, if you are going to India and you don’t know of a Dr. I’d recommend Dr. A. Malpani. I keep hearing their names and I’ve read extensively on them & their practice. I’m told they are the best in Mumbai. You can’t go wrong with them. They have a lot of good write-ups and in my field, this it he name that comes up when referring to IVF in India. This was a name he had in his memory. He didn’t have to ask anyone or call anyone. This made me feel really good because how many people have an IVF specialist’s name at the tip of their tongue just waiting for someone to come in and ask for it? Then he introduced me to the media and newspaper staff, I had tea, then walked around and met other staff who gave me DVDs, Maps, CDs, Newspapers, Hotel contacts, etc. I was even put on the Embassy’s newsletter’s mailing list for events. The folks at the Embassy were the most pleasant people in the world to deal with. They took all my concerns about traveling abroad to a country where I didn’t speak the language away instantly. They also told me that they would help me an in any way they could in the future.

So I went home, armed with all this good literature, DVDs, CDs, etc. and started researching on the internet and made contact with Dr. Malpani. This was in June 2010. I’ve asked Dr. Malpani questions weekly if not 2 and 3 times a week since June 2010 about IVF, donors, his/her practice, policies, procedures, etc. I’ve inquired about things on the internet, things I’ve heard, etc. and within a 24 hour period including Saturdays, Sundays and all holidays, Dr. Malpani’s answered my questions. I’ve even asked Dr. Malpani about questions that if I knew a little more about the internet I could have found on their web site, but Dr. Malpani, pleasantly & patiently answered them for me anyway.

While over the last 8 months of speaking with Dr. Malpani I’ve come to trust and value the practice, there was only one issue that held Mark and I up from flying to India and seeking IVF treatment immediately. We needed to find a donor that we could see & visually approve of 1st hand before the IVF procedure. Most doctors in India do not allow the recipient to see photos of the donors prior to the IVF treatment. Dr. Malpani’s practice is to match a donor to you and choose the donor anonymously. This didn’t sit well with me & Mark because while having a healthy donor is primary to us, it’s also important to us to see from whom ½ our baby’s identity will come.

After we told Dr. Malpani this, the option of advertising for our own donor was suggested. So we set out to find a donor by advertising in the local papers and on the internet. Dr. Malpani warned us to be patient, that it could take some time. So we placed ads in newspapers in India. We’ve even gone to Donor and Surrogacy Agencies and it’s been a world-wind experience.

We’ve spent about $2,500-$3,000 U.S. dollars on several newspapers, internet services and donor agencies just advertising and viewing photos. While we aren’t happy about the cost, we are delighted that we’ve seen the photos and chosen to see our donor. It’s renewed our resolve to see our donor no matter the cost or length of time it takes to find just the right one.

In the meantime, let me tell you what we’ve experienced while searching…Oh MY GOODNESS! We’ve had men tell us they could provide us with eggs. We had to explain (via email) so many times that men aren’t born with eggs that we just decided to come up with a “cut & paste reply” to all those emails from men that answered “Female Egg Donors ONLY please Advertisements”. Then during our 2nd newspaper, we had men tell us you really need sperm & not eggs, let us supply them. We’ve had people email us nasty comments about what they think of science and what we are doing. Of course we deleted these and moved on as if they were never sent. We’ve had husbands respond to the ads & lie to us about their wives ages only to have the wives tell the truth later when we indicated that official birth certificates and Indian govt identification would need to be submitted to verify the accuracy of the age of the donor. We’ve had people treat us like an ATM because they knew we were calling from the USA and quote astronomical prices that multi-billionaires wouldn’t pay for golden eggs. We’ve had people tell us since we weren’t Catholic they couldn’t supply eggs after they answered the newspaper advertisements. We’ve had husband tell their wives no after their wives answered the advertisement. We’ve had people play really high priced negotiation games with us until we realized that they might not finally give up the eggs or would possibly hold them hostage if we dealt with them. We’ve had people call us back weeks later asking to donate for our original offer, after they realized we never called them back to offer a higher price. We’ve had people offer us eggs if we could guarantee them a job and flight over to the USA. You name it, we’ve had it. Most of it has been funny because we are committed to not get frustrated but I’d be lying if I said it wasn’t getting old at times.

All of this had us thinking once or twice…do we really want to try to find our own donor? Do we really know what we are doing? Then we’d go back and look at some of the photos and say, yes, let’s keep plugging along. Then when we finally were so tired and ready to give up & take an emotional break, the most stunningly beautiful donor replied to our advertisement. She was nice, well educated and seemed to be quite stable. Once we discussed the process, she said oh no. So here we were thinking we landed a donor, only to be stressed out with her back & forth fear of medication-taking, injection phobias and overall paranoia about egg retrieval. While we understood her lack of knowledge about what was required, we were drained emotionally by the process of trying to explain to her what was expected. We also found ourselves perplexed as to why she’d answer an advertisement when she should have expected that at least 1 needle was involved somewhere along the process.

Eventually we told her that this was more stressful than we could endure and we declined to continue further. She came back and said she was willing to think about it again once she had verified the process with Dr. Malpani. So she eventually spoke to Dr. Malpani and finally bowed out one last time. I must admit, I didn’t do a good job of telling her about the medications. I was too honest and this was best something left up to a Dr. to explain because just listing them out is scary to someone who’s not seeking a child and just wants to help, even if it is for monetary gain. I should have thought about that before I blurted out all the medications and injections. I now know it’s best left to a trained physician to tell patients about stuff like that.

So in the end, Mark & I knew it wasn’t meant to be so we didn’t get too upset by her resurfacing only to bow out one more time. We believe what’s meant for us is meant for us and will come our way without a bunch of coaxing and cajoling.

So we continued to plug on. Then Dr. Malpani suggested egg sharing. We were elated with the option but then we ran into a road block when the only person who has offered to share her eggs wasn’t of Indian descent. This mattered greatly to us because of my heritage so we again, prayed about it, declined that egg sharing opportunity and are now moving forward.

So, 8 months later we are still looking for an Indian egg donor. We’ve put our IVF plans on hold until we either find one through an agency willing to allow us to pay them a referral fee and use their donor or until we locate a donor whose photo we approve of. Most practices aren’t interested in sub’ing their donors out so this may result in us going back to the newspapers for more advertising.

Mark and I’ve talked about this until we are blue in the face. It’s most important for us to have a healthy child. But it’s secondly (not equally) but still important to us to have a child that looks like me as much as possible or like she/he could have been related to someone in my family, even with ½ of my husband’s DNA injected in the mix. Because we’ve located two women who fit this bill but who bowed out because of (a) fear of the procedure to extract the eggs and the 2nd because of a family and medical emergency, we’ve decided to press on because we now know that in a country of over 5 Billion and in a city like Mumbai of 22 Million, she’s out there. We just have to be patient and allow God to deliver her to us.

Traci & Mark.

trbrown1@yahoo.com

This is one of the commonest questions patients ask me. Doctor, I did an IVF cycle at this other clinic and it failed - can you please tell me why ?

Obviously, the next thing I need to do is to drill deeper to find out more details about the medical treatment provided, so I can provide an intelligent answer.

I ask patients for more details about their IVF cycle. What were the meds which were used for
superovulation ? What was the dose used ? How many follicles did you grow ? How many eggs were collected ? What was the E2 ( estradiol) level in the blood ? How many embryos were transferred ? What was the embryo quality ? What was the endometrial thickness ?

Most patients look completely blank when I ask them these basic questions - and some even think I am crazy for expecting them to know the answers. A standard reply is - Our doctor never told us anything !

Sadly, very few clinics in India provide patients with any medical details about their IVF treatment. Many of them do not even have the courtesy to provide a simple treatment summary - let alone details of the number of eggs collected or embryos transferred.

I have to spend a lot of time trying to reconstruct the IVF treatment provided with the help of scraps of prescriptions and ultrasound scans - and this can be a very frustrating exercise. While the fact that the clinic does not provide these basic details is a black mark against the clinic, I feel patients are also equally responsible . After the treatment is over, there's very little patients can do - and that is why I feel patients need to ensure that the clinic routinely provides all patients with all these details before they start the IVF treatment !

If I were an IVF patient, I would just ask the IVF doctor one simple question before starting the IVF cycle - Do you provide photos of embryos for all your IVF patients ? And if the answer is no, I'd find another IVF clinic !

Many gynecologists have started offering IVF services and at last count, there were over 45 IVF clinics in Mumbai ! The reason is because IVF is seen to be remunerative and profitable ! After all, why send the patient away to an IVF clinic and lose all that income ? Never mind that these gynecologists have never been trained in doing IVF or have never done a single IVF cycle in their life - after all, how hard can doing IVF be for a MD gynecologist ? Plus, there are now many companies which are happy to offer a 1-week workshop which certifies doctors as being IVF trained !

This is why we are seeing a huge number of " part time IVF doctors" in India. They spend most of their time seeing OB patients and gynec patients - but rather than refer their infertile patients to IVF specialists, they hold on to them and promise to do IVF for them. They will either take the patient to an IVF clinic and do the procedure there ( because they do not have the equipment or the expertise to do the IVF themselves); or they will invite a "travelling" IVF specialist to come to their clinic to do IVF on their patients, which they batch once a month.

This means that you are being treated by a doctor who is a jack of all trades and master of none. These doctors simply do not give their IVF patients the time and energy they need. Infertile couples are treated along with other OB patients and there is no acknowledgment of the fact that their needs are special . It can be very hard for an infertile woman to sit in a clinic full of pregnant women !

Since many of these doctors are gynecologists, they do not have the technical expertise or experience to provide IVF services. They have to depend upon imported IVF specialists who come from other cities. This means the care becomes fragmented, resulting in reduced success rates.

The sad truth is that beggars can't be choosers - and this is a useful service for infertile couples who do not want to ( or cannot afford to ) travel - after all, some service is better than no service at all ! However, if you want the best possible treatment, it's best to go to a full time IVF clinic. While this may initally appear to be more expensive, it may actually be far more cost effective because full-time dedicated IVF clinics have a higher success rates ! They are busier; more experienced; and have more expertise !

This is a story about perseverance, courage but most of all a good understanding between a doctor and a patient.

After some difficult years including infertility treatments, despair and discouragement by infertility doctors (!), my husband and I decided we should take a sabbatical and rest for a while from all the disappointments of the past. We decided to travel to Asia and visit some wonderful countries.
After a few months however, my child wish was very strong again and we decided we should try one more time an IVF treatment.
The question was where? we had all these possibilities in all of these countries.
I decided to do a little research and I wrote to a dozen clinics in Thailand, Singapore, Malaysia and India.
Some clinics did not respond at all (!) other were very short in their information. This was not the case with the clinic of Dr. Malpani, as a well-informed patient I could see the difference very clear with the other clinics. The whole protocol was send to me within a day, including the names of medications, the dosage, the procedures etc.
Among all this clinics the response of Dr.Malpani was the most elaborate and professional.

So we decided to go ahead with the treatment in India.
Once settled in, the treatment began. I never met a doctor that was more helpful then doctor Malpani, providing me with lots of information when asked, even including some scientific articles.
The follicle stimulation went well, the pick-up went well, and then of course the embryo transfer, for us a real all or nothing moment.
2 weeks later, on April the 12th I had my very first positive pregnancy test ever!!!! Nothing could surpass that moment until December the 19th when our baby-girl was born!!
As every birth is a miracle, I strongly believe my pregnancy is a perfect example of an incredible cooperation and understanding between a doctor an his patient.
Dr. Malpani has a very humane approach to his patients, providing them with all the information they ask for, listening very carefully and trying to meet their wishes as much as possible. Last but no least and he is funny too! :)
Professionalism and a very human approach, together with a lovely staff made this experience unforgettable.

For all the couples that have been struggling for years, please don't give up! It took us years to conceive, some dark days and months, but finally all of it was worthwhile as soon as you can hold your baby in your arms!

To Dr. Malpani and his lovely wife, please keep up the good work. Nothing is more important then to make a difference is someone's life.

God bless you.

A couple from the Netherlands

fanmailhome@gmail.com