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 !

Many medicines are available over the counter ( OTC) . These are usually safe drugs, which have been used for many years . They are effective for common problems; have few side effects; and do not need a doctor's prescription. However, most medicines are still available only with a doctor's prescription. This is because medicines can be powerful , and while they may be very good at treating certain problems, they may also have undesirable side-effects. Experts need to make a decision regarding the risk-benefit ratio of these drugs, so they can select which drugs are so powerful that they can only be dispensed with a doctor's prescription.

Medicines form an important tool in the medical armamentarium. However, not all illnesses need medicines, and an increasingly important addition to the medical arsenal today is Information Therapy.

It's useful to remember that while Information Therapy can be effective and inexpensive, just like any other therapeutic tool, it can have side effects as well ! This is especially true with online medical information, because a lot of this is unreliable, outdated and plain wrong. Unfortunately, many people do not have the ability or sophistication to differentiate between good quality and poor quality information , and wrong information can actually harm a patient. Thus, patients with blocked tubes may end up wasting thousands of dollars on pursuing ineffective therapies such as Clear Passage ( massage therapy which claims to open blocked tubes) rather than do IVF; while men with low sperm counts end up getting frustrated after spending hundreds
on " herbal medications" which claim to boost low sperm counts but are completely useless !

Not only can unreliable information harm patients, it can also waste a lot of the doctor's
time, because he now has to remove the myths and misconceptions which patients have acquired online from unreliable websites, which are just out to earn a quick buck by peddling cures !

Just like powerful medicines need to be "prescribed" by a doctor, it's a good idea for doctors
( and hospitals and governments) to "prescribe" reliable information. Information Therapy is powerful medicine - and it needs to be promoted, so that patients benefit from it.

The best way to do this is to use reliable patient educational content, designed by non-profits such as Healthwise. You can see how well this works in real life by going to www.informationtherapy.in !

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

" In an earlier column, I complained that IT spends a lot of time providing electronic tools for clinicians--electronic health records (EHRs), computerized physician ordering systems (CPOS), etc.--but not enough time developing tools to improve patient education.

I was wrong. Digging deeper into this area has convinced me that there are all sorts of practical technology-based resources to help patients understand their treatment and how to comply with their doctors' advice. Computer-generated questionnaires, medication resolution programs, and sophisticated videos are making a difference in patient care. "

India can be a market leader in this space !

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

What has gone wrong with us?"

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

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

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

" Second, anonymous reviews should not be allowed. Not only can anonymous posts be manipulated by someone bearing a grudge, glowing narratives can be planted by a doctor or his staff. Ratings accountability allows doctors to use real patient feedback to constructively improve their practice. Angie’s List, a leading fee-based consumer rating service, sets an example by not allowing anonymous reviews of health professionals."

I agree ! It's very easy for a disgruntled patient to write a complaint about Dr Malpani - and I am sure our friendly competition may even egg on their patients to do so . These kind of complaints can cause a lot of damage and are very hard to fight, because the poster is anonymous - and can say what he likes and get away with it !

" And perhaps more important, doctors who fail to embrace social media risk becoming irrelevant, as more patients flock to the web as a source of health information, rather than endure the inconvenience of a doctor’s office:

Doctors who are not active online risk being marginalized. Facebook and Twitter users, half of whom are under of age of 34, rely on the web for most of their information. As this demographic ages, it’s conceivable that they will consult social media first to answer their health questions."

In the past, senior doctors had an edge over their juniors because of the "grey-beard" syndrome. Times are changing and doctors need to evolve with them ! Patients will usually go online first when they have a health-related problem - and doctors who are not online may soon find that they have become dinosaurs, who can no longer survive !

When doctors are stumped with a difficult patient, they will often refer the patient to a specialist, in order to help them with the diagnosis and management.

However, while specialists can be very skilled at making the right diagnosis, they are often not very interested in helping the patient to learn to live with his disease. This is not an area which is of much interest to them, and not their core competence either.

However, after the diagnosis has been made, the patient's life still carries on - and he is often unsure where to turn for help.

For example, let's look at a young woman who goes to her family physician with the problem of blurring of vision. The physician dutifully refers her to an ophthalmologist, who then sends her on to a neurologist, who makes the diagnosis of multiple sclerosis. The doctors pat themselves on their backs, for having come to the right diagnosis so efficiently - and the patient is grateful that at least now she knows what her medical problem is. However, she still has to learn how to live with MS, and learning how to cope with a chronic illness is often the hardest part of having MS.

Unfortunately, this is something about which none of her doctors is well-informed ! The neurologist knows a lot about demyelination and how this affects nerve function - but he cannot teach her much about how to come to terms with her illness ; and how to manage her activities of daily living. How does she deal with her fatigue ? with a cranky child ? arm weakness ? her fears that she may become wheel chair bound ?

The best source of this expertise is not going to be a doctor - it's going to be an expert patient - someone who has lived with MS for many years, and is willing to share their heard-earned wisdom and experience.

Good doctors have always done this informally for many years - and it's been proven that support groups are a great way of helping patients to cope with their illness. It's now also possible to have online support groups, where patients can reach out and connect with each other.

Doctors can also learn a lot from expert patients. Thus, while a diabetic specialist knows a lot about the metabolism of insulin and how to program an insulin pump, he may not know much about what you need to do about your diet and activity in real life ( for example, when you have to attend a marriage or go out for a holiday). You may think these are "silly questions" and may not want to bother your doctor with these trifles - but the fact still remains that you need reliable answers !

It's best to learn these pearls of wisdom from other patients. They will be much more
empathetic - and their advise is likely to be much more practical, as it is based on their real-life experience - not on what a text book says ! Also, while it may not always be reliable ( because patients can be poorly informed sometimes), at least you know it will be provided with no vested interest !

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 !

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 !

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 ! )

The newest IVF technology uses a fancy new technique which marries IVF and genetics. This is called PGD ( preimplantation genetic diagnosis) with CGH ( comparative genomic hybridisation) and there are lots of press releases and articles touting this as the newest breakthrough !

Doctors , like all big boys, love to play with new toys - and the newer the better ! This is especially true when they have expensive new technological tools, which no other competitor has. Doctors can be very competitive - and are always trying to be one-up on each other. An easy way of being different is to use the newest technology - but the trouble is that never is not always better ( though newer is always more expensive !)

Because these new tools are so expensive , doctors need to use them extensively, to justify the expense - after all, they need to show the bean counters who pay their salaries and bonuses that the new tool is cost effective !

The key question thoughtful patients need to be asking is - Is it really better ? Or is it a solution looking for a problem ?

I think the truth is we really don't know right now ! It's very likely to be useful for some patients - but to expect it to be useful for everyone across the board is hoping for too much ! While it may seem logical to use PGD, unfortunately, biological systems are not always logical ! What seems to make sense in theory often does not

As a doctor in clinical practise , whose major focus is simply to get as many of my patients pregnant as quickly as possible, I am quite conservative and prefer to wait and watch.

I follow Alexander Pope's dictum,
Be not the first by whom the new are tried,
Nor yet the last to lay the old aside.

Only time will tell how useful PGD-CGH is - but the enormous commercial pressures under which IVF clinics operate - and the constant demand by patients that their doctor use the newest and the latest breakthrough technology they read about in the newspaper means that most IVF clinic will likely end up overusing it !

I always tell me patients to prepare for the fact that their IVF cycle may fail. Many patients dislike this. They feel I am being too negative - and are secretly worried that such negative thoughts are a jinx which will jeopardise the outcome. Most patients want a cheerful optimistic doctor who will promise them a baby.

Intelligent patients appreciate my honesty and frankness - they prefer a doctor who will tell them the unvarnished truth. Others who cannot handle the truth will usually move on to another doctor who is willing to promise them the moon - and who is happy to tell them what they want to hear !

It's very easy to smile; be optimistic - and make false promises. Everyone wants to think positive - and if you believe the book The Secret, then positive thoughts attract success !

While I am personally very optimistic by nature, I feel it's not correct for a doctor to overpromise success ! Patients are emotionally very vulnerable and it's easy to take them for a ride - something which many unscrupulous IVF doctors do all the time, by quoting inflated success rates and promising the moon !

When I tell patients to prepare for the worst , this does not mean that I not hopeful or that I am a defeatist. I am not being negative or being a pessimist - I am just trying to be a realist !

Being prepared does not mean that you are expecting a bad outcome or that your negative thoughts will attract failure - it's just that you are preparing for it. This is something you do in daily life all the time , so why shouldn't you do it during your IVF treatment as well ?

It's always easier to mentally prepare when you do not need to !

Let's assume to decide to be positive, optimistic and upbeat and prepare only for a good outcome. If you do get pregnant, you'll be pleased and happy - and life will move on. However, if you do not get pregnant , you will go to pieces. Bouncing back will be much harder - and you'll find coping with the emotional roller coaster ride much more difficult.

However , if your prepare for a bad outcome and get pregnant, you get double the joy ! And even if you do not get pregnant, while your heart will still break, your mind will help you heal faster because you were mentally prepared for this.

It's harder to deal with a negative outcome when you are not ready for it ! IVF is a scary emotional roller coaster ride and mental preparation gives you some stability.

The trick is to find the right balance - to look for the middle path - what Buddha called the golden mean ! It can be helpful if both partners have different world views because they can balance each other !

However, if the husband is optimistic and the wife is pessimistic, and the cycle fails, he may end up blaming her for the failure because " you are always negative" ! Victim blaming is very common when patients adopt a pessimistic approach in order to protect themselves from heartbreak - and this is just adding insult to injury !

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 !

Many doctors are still worried that it's unethical to have a personal website.They feel that this amounts to advertising, and that a website is a way of soliciting patients.

I strongly disagree. In fact, I feel it's unethical for a doctor not to have their own website ! The word doctor is derived from the word, " docere", which means to teach. This clearly means that one of the key responsibilities of a doctor is to teach their patients. While many doctors do this face to face, the amount of teaching which can be done this way is very limited - and a conversation is not the best way of transmitting information.

Doctors who publish their own websites communicate with their patients online - and a website is a much more powerful tool of reaching out to thousands of people who are looking for information ! If the doctor wants to be sure his website is popular and gets lots of traffic, he needs to provide information on his website which is of value to patients, which means his website has to be full of patient educational content . Good doctor's websites are not all about the doctor - they are all about the patient !

A website allows a doctor to provide authentic , reliable updated information to patients. This information is local - and can be provided in the regional language ! Since it's provided by a trusted figure, patients are much more likely to trust this information.

Doctor's websites are a great way of reducing medical myths and misconceptions; and educating society at large !

Equally importantly, having a website forces a doctor to be transparent and honest. He cannot tell a lie on his website, as this will get him into serious trouble. This is good for patients - and doctors as well ! It also teaches the doctor to be much more patient-centric as he has to use simple words which his patients can understand when talking to them online !

If I were the Health Minister of India, the first thing I would do would be to make sure every doctor had their own website. This would create a win-win situation, which would help both doctors and patients !

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.

One of the most difficult things IVF patients have to deal with is the fact that there are no external symptoms or signs of what’s happening inside their bodies. Are the follicles growing well ? Is the uterine lining maturing properly ? Are you responding well to the medications ? Are the eggs of good quality ? Are the embryos implanting ?

An important marker of the reproductive cycle is bleeding – and this can become a major source of stress during an IVF cycle !

The start of the menstrual period is an event most IVF patients look forward to, because finally the IVF cycle is ready to commence – and you are now ready to take your best shot at having your long desired baby ! You are all pumped up and ready ! You’ve spent a long time waiting for your treatment to begin ( with waiting lists and getting appointments with busy doctors, it can take 2-6 months to actually start the IVF cycle , no matter how ready you are – and this waiting can be very stressful !) Is the period on time ? Early delayed ? Does it look any different ? If it comes too early, does this mean you’ll have to cancel because the doctor is not available ? If it’s delayed, does this mean you doctor will have to postpone your cycle ? When you are 2 days overdue, you wonder if you should ask the doctor to induce a period – or should you just keep on waiting ?

Remember that the day the period starts – or the quality and quantity of flow are completely unimportant ! Day 1 of your cycle is just a marker which informs the doctor that you are ready to start your superovulation, that’s all ! The bleeding is just the shedding of the old uterine lining – and has no impact on the IVF treatment itself.

While a very early or delayed period will not affect the outcome of the IVF treatment , this can be a problem if you are travelling abroad for your IVF treatment; or if your IVF doctor does treatments by batching patients ! This is why many clinics will put patients on birth control pills to regulate their cycle, in order to make scheduling the cycle easier !
You may have some spotting or bleeding after the egg collection. This is because the doctor has stuck a needle through your vaginal wall in order to retrieve your eggs. This is usually minimal, and stops very soon. Excessive bleeding is extremely unusual – and if you do experience this, you should report to your doctor.

Some women may also have some spotting after the embryo transfer. This can be very scary, but can occur if the doctor had technical difficulty during your transfer and had to manipulate your cervix. This is bleeding which comes from the cervix ( the mouth of the uterus); and will not harm your embryos !

What about bleeding during the 2 week wait ? This is not common, because you are taking luteal phase support with estrogen and progesterone to help support your uterine lining. This is why when bleeding occurs, thus can cause panic because you are worried that this represents the start of your period , which means that your IVF cycle has failed ! Your worst nightmare may be coming true ! Women will often obsess over every drop of blood they see – and some will even imagine that they can see their fetus being expelled with the clot. However, remember that the embryos as this stage are microscopic, and cannot be seen with the naked eye !

Also, this bleeding does not always mean that the cycle has failed . In many women, this bleeding is self-limited and stops as suddenly as it started , which means we can never figure out where it came from or why. In others, it is actually a good sign, because it represents an implantation bleed. Unfortunately, there’s no way a doctor can judge what’s happening because ultrasound scanning does not give us any useful information. It may be a good idea to do a blood test to check your progesterone levels ; and if these are low, the doctor can increase your dose of progesterone to provide additional support to the endometrium.

If you get a period in less than 12 days after your embryo transfer inspite of your medications, you should request your doctor to test your progesterone levels 3 days after your embryo transfer in your next IVF cycle . If these are low, then he may want to change the way he is giving you progesterone by using an alternative route ( by switching from vaginal progesterone to IM progesterone or vice versa)