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 !

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

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

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

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

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

When Osama was tracked down, Obama was advised that there were two options to deal with him - a bomb attack; or a finely crafted precise surgical strike using helicopters. Obama quickly figured out that a bomb was too heavy duty to use and would cause a lot of collateral damage. Why use a hammer to kill a fly ?

This is equally true when you want health information. While it's true that google indexes millions of pages and billions of kilobytes, a lot of what google crawls is just rubbish, and the results only end up distracting users; confusing them; and infuriating their doctors . Google's focus is on being comprehensive and regurgitating as many pages as it can find ( which makes sense , because they make their money by showing as many ads as possible).

When you need health information, what you need is reliable trustworthy information which has been screened and tested for its authenticity and readability. The last thing you want to do when you are sick is to wade through pages of garbage. You need a tool which offers you what you need, quickly and efficiently, without wasting your time !

This is exactly where specialised patient education companies such as Healthwise shine. Healthwise provides you with high quality accurate information you can trust - this is all they do, and they do it very well indeed !

Seeing is believing, and if you want to see what "prescription quality information" looks like, when you have a health-related query, please do your next search at Healthwise ! I promise you it will save you a lot of time - and a lot of headaches as well !

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

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

This may be a terrible confession for a doctor to make, but when I have a medical problem, I'd trust an expert patient rather than a doctor. Let me explain.

I have chronic back pain and this can be quite severe at times. However, I am very reluctant to go to an orthopedic surgeon, because I know pretty much what he is going to say. He's going to do a cursory examination and then ask me do do a MRI scan. The MRI scan will find some bulges in my intervertebral discs - and the radiologist will happily report this as prolapsed intervertebral disk ( slipped disc, in layman's terms). The doctor will be happy he's made the right diagnosis; and will advise bed rest; pain-killers ; and physiotherapy - with the caveat that if it gets worse, he'll be happy to do "minimally invasive surgery" to fix the problem.

This is the standard medical paradigm for managing back pain - and while it's completely reasonable ( and follows medical textbook advise) , it's does not add to the quality of my life. I want to continue playing tennis daily - and want advise on how to manage my back pain without having to stop my tennis ! This is not something most orthopedic surgeons know much about, because they spend more time in the Operating Room than on the tennis court !

I'd much rather talk to a tennis player who has had back pain for many years, and ask him how he's managed it. He is the true expert on my problem and I'd be happy to learn from him. For one, his advise would be much more applicable to my problem - and for another, he has no hidden agenda !

Of course, not every patient is an expert patient. I want someone who's smart, well-read and well-informed - and who has taken the time and trouble to explore his options. ( If he also happens to be a doctor, that's an additional bonus !)

While doctors are good at making the right diagnosis, how to live with the disease ( how to manage what medical textbooks call "activities of daily living" ) is something patients can learn much better from other patients. This is not an area in which doctors are well-informed , because it's not something which interests them !

Really smart doctors will refer their newly diagnosed patients to other expert patients , to help them cope better with their illness !

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/

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.

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 !

Dr Vartabedian has an interesting blogpost. " I was thumbing through Seth Godin’s Poke the Box and stumbled on this quote. I couldn’t help but put it in the context of physicians and their obligation to make content:

I hope we can agree that there’s a moral obligation to be honest, to treat people with dignity and respect, and to help those in need.

I wonder if there’s also a moral obligation to start.

I believe there is. I believe that if you’ve got the platform and the ability to make a difference, then this goes beyond “should” and reaches the level of “must.” You must make a difference or you squander the opportunity. Wasting the opportunity both degrades your own ability to contribute and, more urgently, takes something away from the rest of us."

Some old-fashioned doctors still think it's unethical for doctors to have a website. They fell this is like advertising - and not something which medical professionals should do !

It's interesting to see Dr Vartabedian's viewpoint, which I agree with completely ! The word doctor is derived from the word "docere" = to teach; and I feel doctors have an ethical obligation to do so. They need to teach not just the next generation of doctors, but their patients as well. The internet is a very powerful means of teaching and doctors who do not use it to educate their patients are doing a disservice - to themselves, the medical profession; and their patients !

We were a happy carefree couple, enjoying our freedom to do things that we liked, for the first four years of our marriage. And then when we finally thought of starting a family…. It didn’t happen for another year and we were happy childfree couple. Couldn’t figure out initially what can go wrong, but when we decided to do a reality check, we landed up at a neighborhood Obs&G’s clinic. She ran a few preliminary tests which didn’t point to anything in particular, prescribed few medicines for me. Six months later, the same tests were repeated again, and again. And then I was referred to a urologist for surgery for a suspected varicocele. That’s when it dawned upon us that may be we are knocking on the wrong door!

After a couple of months & a million clicks on the net, we decided to go to a specialist. The research on the net had classified us suffering from “unexplained infertility”. We landed up at Dr Malpani’s in search of explanation. Few new tests were prescribed for my wife and same old ones for me. Everything looked normal to the doc, which was a source of confidence that it would happen sooner or later. We were suggested to try IUI at our local gynec for 3 cycles. There was a hint of sadness creeping up after every unsuccessful IUI. Doubts started cropping up… Did we leave it for too late to start the family? We were back to the drawing board. Dr Malpani assured that everything was ok and he suggested IVF and we decided to go ahead. It’s to the clinic’s credit that the entire process is handled so systematically & in such an organized way that it gives you the confidence that every thing possible will be done, without going overboard,
to make it a success. The entire IVF process went as planned by the doctors and bingo…now we have graduated from being TTC couple to 12 weeks pregnant!

A BIG thanks to both Dr Aniruddha & Dr Anjali and their team!

mum.pgs@gmail.com

An IVF cycle is full of uncertainty and suspense , like any other biological system. However, being prepared for these can help you cope better !

Think of an IVF cycle as being a series of hurdles - and you need to cross all these to reach the finish line ! While most patients will cross these hurdles with ease in a good IVF clinic, each of these is a " moment of truth ".

• You should grow many follicles
  
• These follicles should mature
• Your uterine lining should also mature in synch with your follicles
• Ovulation should not occur before the eggs can be collected
• Mature eggs must be retrieved by the doctor during the "pick-up"
• Your sperm must fertilize the eggs ( with IVF or ICSI)
• The embryos must divide and grow healthily in the IVF lab
• Your embryos should be transferred by the doctor smoothly into your uterus
• Your embryos should implant

Think of it as a series of hurdles, all of which have to be cleared , in order to win the race !

As you can see, how well you negotiate these hurdles will depend to some extent on your biology ( how good your ovarian reserve is , for example); while others will depend upon the skill of the doctor !

A good clinic will guide you through these moments of truth, and share information with you, so that you can rejoice when things are going well - and be prepared in case things do not go as planned. Unfortunately, as with any biological system, IVF is also full of ups and downs - and the more you know about what is happening - and what is going to happen next, the more easily you'll be able to go through your IVF treatment !

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 ?

We deal with a number of difficult patients who have failed multiple IVF cycles elsewhere. Many of these are poor ovarian responders and a common question is - How many follicles do you need to go ahead with the treatment ? Is there a number in your clinic below which you will cancel the cycle ?

These patients suffer from a lot of anxiety and apprehension during the superovulation, because they know they are not likely to grow many eggs. They have already had many of their cycles cancelled in the past - and this can be quite a cruel thing to do , because these are eggs which they have produced with a lot of effort ! Their eggs are precious - and represent their best chance of their having a baby with their own genes. This is why when the doctor cancels the cycle because they have not produced enough eggs, their heart breaks.

From the doctor's point of view, cancelling the cycle seems to be a very rational thing to do . Why make the patient spend so much money when the chances of success are so slim ?

What they forget is that the patient knew prior to starting the cycle that the chances of success were slim, so that the fact that she has grown few eggs has not really changed anything. If she's prepared to take that slim chance it can be cruel to deprive her of it

It's especially cruel when the real reason doctors cancel the cycle is because of "clinic policy" - because they do not want to mess up their success rate statistics !

These are challenging patients, and during superovulation, the major worry is - Will we reach the stage of egg colleection ?

Many doctors will cancel cycles if there are less than 4 follicles, because poor responders have a lower success rate and they do not want to harm their clinic IVF succcess rate. These are league table games clinics play, where they weed out the difficult patients to artificially elevate their published succcess rate figures.

We need just one follicle to go ahead, as long as the patient has realistic expectations and understands that there are still many more hurdles to be crossed after egg collection: there may be no egg; or the egg maybe immature; or it may not fertilise. We can be aggressive and are happy to do our best to help the patient to have a baby, but sometimes biology can be cruel !

With this approach , our patients have peace of mind they did their best ; that they explored all possible medical options and did not leave any stone unturned. With this approach, it's often easier for them to move on to Plan B ( adoption or donor eggs) because they know they've given it their best shot.

The outcome is always uncertain, and I do not want them to regret the fact that they did not try. We do our best to work with our patients - even if this brings down our success rates.

We see many patients who have failed multiple IVF treatment cycles in other clinics. Most of them are quite depressed and frustrated. They are not sure whether it's worth trying another IVF cycle with us, or whether they should explore alternative options .

The key question in their mind is - What can you do differently from the other IVF clinics ? What makes you better ?

I enjoy treating these patients . For one, they are a challenge, and if our treatment works where other clinics have failed, this is a feather in our cap ( doctors can be very competitive !)

Also, because they have done IVF earlier, they understand the basics of the treatment, so I can have an intelligent conversation with them and explain what we are going to differently. Because we are a full-service clinic, we can offer additional options which other clinics may not be able to.

These patients can be quite emotionally labile, but because we offer a lot of hand holding in our clinic, along with plenty of personalised support, we can help them to cope quite effectively.

Because we are very transparent in our approach and make it a point to educate patients and actively involve them in their treatment, most patients are appreciative of our approach because it's a refreshing contrast from what they have experienced in other clinics.

What has our experience with these patients been ?

While it's true that success rates do tend do drop in women who have had failed IVF cycles, this is not always true, and there are some refreshing exceptions !

Thus, many patients have taken treatment at sub-standard clinics. Their quality of care has been so poor, that for all practical purposes, all they have done is throw their money away. Doing an IVF cycle for them properly ( the way it should be done !) helps many of them to get
pregnant !

Similarly, some patients with PCOD have been very poorly managed in other clinics. Many doctors are so scared of OHSS, that they end up mistiming the HCG injection, as a result of which they get few eggs and poor quality embryos. We have extensive experience in doing IVF for PCOD patients, and our pregnancy rates are better than 45% per cycle for PCOD patients.
You can read more about this at www.drmalpani.com/pcod.htm !

Patients with male factor infertility are also often poorly managed in many IVF clinics. This is especially true for patients who need TESE and PESA. Because we do these procedures ourselves , we can use fresh sperm, giving us a much higher success rate ( unlike other clinics which have to depend upon an outside andrologist and therefore often have to use frozen testicular sperm which has a much lower success rate )

The other group of patients who are very fulfilling to treat are those with poor ovarian reserve. Because we are willing to use alternative medicine; supplements; and aggressive superovulation, we can often achieve a pregnancy in these patients ( whom other clinics shun because they are considered to be heartsink patients !)

Another interesting trend has been that most clinics in the West use gentle stimulation these days, because they want to transfer only a single embryo. While this works well for women with a good ovarian reserve, it's not the best approach for women with poor ovarian reserve. For these women, because we can superovulate more aggressively, we can often find the one good egg they have in their ovaries, and help this to become a baby !

There is a shortage of doctors. This is true all over the world because of many reasons. Medical training is expensive and arduous, and not many people are capable of surviving the grind. Also, doctor are unevenly distributed, which means that there are too many in large cities, but not enough in the villages. Finally, a lot of the doctor’s time , energy and expertise is wasted in handling problems which do not really need their expert attention. These are problems which can easily be handled by the patient and his family himself.

The standard solution to the chronic shortage of doctors has always been the standard knee-jerk response - train more doctors ! This solution comes in many different flavours - open more colleges; or create a new cadre of barefoot village doctors. However, these are just short-term fixes - and the problem recurs every few years, because doctors create a demand for their own services. This means that churning out more doctors will never help - it will just exacerbate the problem !

The solution is surprisingly simple - empower patients to take better care of their own health !
How can patients figure out when they need to go to the doctor ( and when they can take care of themselves as home ? ) How do they determine which problems they can solve for themselves and which should make them seek medical attention ? Is this headache a migraine ? or a brain tumour ? Is the fever because of a viral URTI ? or is it TB ? How is the poor patient going to figure this out ? Isn’t that what you need a doctor for ?

Right now the standard response for all patient queries is - Ask your doctor ! ( Isn't it ridiculous that most books and websites on fitness and exercise have this disclaimer - Please check with your doctor before starting an exercise program ! ) All we end up doing is making patients more dependent on the doctor and unnecessarily increasing the doctor's workload ! What we need to do is make patients more independent, so they can fend for themselves !

The trick to making patients do all the work is to develop clever tools which will help the patient to make sense of what is happening to them so they can communicate clearly with their doctor. The vast majority of health problems are self-limited and just need reassurance. They can easily be managed by a phone call or an email.

Doctors can learn a lot from retailers. In the past, customers went to the shop and the shopkeeper would have to physically carry the selected objects and then pack them and bill for them. The shopkeeper was the major bottleneck - and had to do all the grunt work. The new supermarkets make the customer do all the work, thus allowing them to service a much larger number of customers - for much less ! It's true that the retailing ecosystem had to change to allow this evolution to occur ( better packaging; better shelf displays; better branding; and more customer education), but this has now become the standard - and the retail industry is doing very well for itself, thank you !

Here's a simple example . A lot of the doctor's time is spent on taking a medical history. Many busy doctors do not have the time to do this themselves, which is why they get an assistant ( who may not be very competent !) to do it for them. We make our patients do this themselves by making them fill a very detailed and complex form ( see a copy at www.drmalpani.com/malpaniform.htm)

This has many advantages. It saves me time. It ensures the history is complete and that I have not overlooked any important information. Even more important, it helps to educate my patients ( because they need to do their homework to be able to fill in the form intelligently !). It also ensures they are better organised, because they need to collate all their medical test results and summarise their history !

Please note that I do not expect patients to make their own diagnosis ! However, patients are the experts on their problem, and helping them to help the doctor will help everyone !