As he resides and practices in India, most American won't be able to take advantage of Dr. Malpani's patient care expertise. That's a shame. This medical professional elevates bedside manner and respect for the patient into sheer art forms on his compelling and comprehensive blog. And readers would expect the blog to focus primarily on the Indian healthcare scene, Dr. Malpani is globally minded, regularly posting important thoughts on the American medical community, among others.
How health insurers can earn trust
The most important missing ingredient the healthcare system today is trust .Life used to be much easier in the past, when patients could trust that their family doctor ( with whom they had a relationship for many years) would do what's right for them . Unfortunately , that trust has been eroded for multiple reasons .The entire medical profession has damaged its reputation , and it's an open secret that doctors take kickbacks from pharmaceutical companies, labs, imaging centers and other doctors. Patients no longer trust doctors, and this lack of trust has affected the other players in the health ecosystem as well. Pharmaceutical companies are seen to be greedy corporates, who are out to maximize their profits at the expense of the patient’s wallet,. Similarly, health insurance companies are generally perceived as being gatekeepers , who do their best to try to block access to medical treatment , in order to keep their costs down and their profits up. They are considered to be bloated bureaucratic organizations, manned by heartless clerks, who do their best to refuse, reject and delay claims.This creates a lot of resentment and angst in the patient , who feels his treatment is being wrongfully denied . This often sets up a conflict between the doctor and the insurer as well . Doctors now believe that insurers are trying to strangle them by capping their payments; and even worse, are starting to play doctor and second guess them , by performing utilization reviews, and judging their medical decisions.The problem has been that health insurers have been very short-sighted. Financial transactions have been their only points of contact with their customers so far. Thus, they talk to the customer only when they want to collect the annual premium; or when the customer submits a claim, which they need to pay.While they are happy to collect the premium every efficiently, they can be extremely tardy when it comes to paying the claim. Since the customer interactions are usually done under negative circumstances ( after all, no one likes paying a premium when they are healthy; and it can be very stressful to have to fill out medical insurance claim forms when one is ill !), it’s quite natural that the general perception of health insurers is negative. They are treated as a necessary evil, which one has to put up with, much like the tax man.This is such a shame, because health insurers can do so much to create positive interactions with their customers ! If health insurers want to earn their customers’ trust , they need to be proactive . The best way of doing this is by providing their customers with Information Therapy .Knowledge is power , and a patient desperately hunts for reliably trustworthy information about the his problem when he is ill, to ensure he is getting the best medical care. This is why patients spend hours trawling the Internet , googling for information. While the information should ideally come from their doctor, most doctors are too busy to educate their patients. Internet searches can be very frustrating, and Dr Google sometimes causes more harm than good, because patients are not sophisticated enough to differentiate good information from bad.Health insurance companies can position themselves as being the preferred first point of contact when their customer has a medical problem. They can provide patients with Information Therapy – prescription strength information, which is provided to the right person , at the right time .Patients can be very vulnerable, and if the health insurance company proactively provides them with trustworthy, reliable, and easy to understand health information, they will be able to convert their customers into raving fans !Not only is this very good for creating a positive buzz , it also makes a lot of business sense for insurance companies to invest in this. Providing Information Therapy before the patient goes to the doctor , helps the patient to have an intelligent conversation with his doctor, and saves the doctor time as well ! It reduces avoidable care and unnecessary surgery and medical treatments. Doctors are much more respectful when they have to treat a well-informed patient ! A good doctor and a well-informed patient can form a partnership which will ensure that patients get the best possible medical care.If health insurers adopt this model, they will be able to earn their customer’s trust, and this is invaluable !
Can free medicines really help to improve medical care ?
The Maharashtra health minister just announced that in order to improve healthcare for the citizens of the State , the government is going to provide medicines free of cost in government hospitals . Statements like this grab headlines, because they project that the government as taking concrete steps towards making medical care more affordable . How can anyone argue with this proposal ? Isn’t it the government’s responsibility to provide healthcare for the poor ? And if they cannot afford it because doctors and hospitals are greedy and charge too much , doesn’t it make sense for the government to intervene and provide this free ? What could the possible harm be ?Sadly, the law of unintended consequences ensures that these populist steps cause more harm than good. Measures such as this are announced before an election ( the Maharashtra Assembly State election is just around the corner) and are always helpful in getting a few more votes, but we know from bitter experience that subsidies never work well in real life. The ground reality is that when the poor patient goes to the hospital medical store to fill the prescription which has 5 medicines on it, 9 times out of 10, the store keeper will hand over a strip of aspirin tablets, and claim that the rest of the medicines are “out of stock”. It seems that they are always out of stock ! The reason is that most of them are sold in the black market , to enrich corrupt government and hospital officials . Poor patients do not benefit from these schemes, but the reason government officials are very fond of launching these is because government officials do benefit from them ! These schemes are a great way of making money ! They are big-ticket items, which usually add up to hundreds of crores. The tender is usually awarded to a “ friendly company “, and the process allows scope for a lot of corruption. Even worse, this money comes from the taxes we pay, and is just being wasted. WE also need to think of the opportunity cost. These funds could have been better utilised for other more constructive purposes.Patients rarely value anything which is given free – and most of them still believe that the medicines provided in government hospitals and sub-standard and of poor quality. They do not trust these, and prefer buying branded medicines using their own money.Rather than try these cheap popularity stunts, it would be far more effective for an enlightened Health department to provide free Information Therapy for patients . This is such a huge opportunity for the government ! While patients are hungry for information, their problem is that they are not sure if online information is reliable or not. If the government provided this, not only would this be trusted, it would also allow the government to prove that it was spending its funds sensibly, in order to improve the health of its citizens !Even better, this is an intervention which does not have any side effects . Bad doctors will no longer be able to take patients for a ride by exploiting their ignorance . Good doctors would be happy with this solution, because it’s much easier to talk to a well-informed patient, and it would save them time.
Endometriosis - should we treat the pain or the infertility first ?
Many patients with endometriosis have both infertility and pain , and often receive poor quality medical care. They are confused as to whether they should treat the pain first, or focus primarily on their fertility. While having a baby is an important long-term goal for them , getting relief from their pain is often far more urgent. Their pain causes them a lot of distress, and they need a quick solution for this.When they go to their gynecologist ( most of whom are not infertility specialists ), the doctor prioritizes the management of the pain . Sadly, this ends up harming their fertility in the long run.Often the pain is suppressed by “ treating “ the endometriosis with birth control pills , danazol or GnRH agonists. These can provide dramatic pain relief, which can be very reassuring for the patient. However, while taking the medicines, she cannot get pregnant, and this medical treatment wastes valuable fertile time, as her biological clock ticks away .The other popular technique for managing the pain is surgical. While laparoscopic surgery is touted as being “minimally invasive”, the truth is that often this unnecessary surgery reduces fertility as normal ovarian tissue is also removed along with the cyst wall of the chocolate cyst, thus reducing ovarian reserve. This trade-off is very shortsighted, and a few months of pain relief often translates into a lifetime of infertility.Patients with endometriosis who have both pain and infertility are far better off concentrating on getting pregnant. They should prioritise getting pregnant first .Once they conceive, they will be pain-free for the nine months of their pregnancy and while they are breast feeding. Pregnancy can also often have a positive impact on the natural history of the disease, and many women find their endo pain goes away after they have had a baby.But how do they cope with their pain while waiting to get pregnant ? The trick is to learn to manage the pain more aggressively. Sadly, this is not something most doctors teach their patients to do well.The commonest mistake endo patients make is that they wait for their pain to become unbearable before taking pain-killers. They are scared that they will get addicted to pain killers; and are worried about the long term consequences of taking too many analgesics. Many of them manage their pain so poorly, that they end up having to go to the ER for taking injections , because they pain is unbearable. When this happens 2-3 times, most are very happy to sign up for surgery ! The real tragedy is that the surgery is often not needed. What they need is to learn to manage their pain more intelligently.Endo pain usually creates problems for the 3-4 days during which they have their periods. This means that most patients know exactly when their pain is going to strike. Rather than wait passively and miserably for the cramping to start , they need to begin taking pain killers before the pain starts. They need to take adequate doses, around the clock, for the 3-4 days of their period. This ensures that they have adequate blood levels of pain killer during their painful periods. This will allow the painkiller to act much more effectively, and make the pain much more bearable.So why don’t doctors teach them how to manage their pain ? For one thing, doctors would rather be doing surgery ! For another, they are worried that taking pain killers on a long term basis can have side effects ( such as causing kidney damage) . However, remember that the patient will end up taking medicines for only about 3-4 days every month. ,This means that even if she needs 4 tablets daily, she will take only about 10 tablets during the entire month. This kind of intermittent use, even if it is chronic, will not cause harm. Taking inadequate doses of pain killers as a result of the fear of side effects is worse, because it results in the pain not being treated properly.If they take the pain killer properly, their ability to manage their pelvic pain becomes dramatically better . This allows them to take a more patient, mature long term approach, and they don’t go to pieces everytime their period starts. Similarly, learning simple techniques such as using lubricants during sex or trying different sexual positions can help to relieve pain during sex as well.By using an aggressive approach to treating the pain conservatively , they can focus on getting pregnant , rather than running to the doctor for pain relief.
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- Jun 20, 2014 Computers in the clinic - Oversold and Underused
- Jun 19, 2014 To , for and with
- Jun 18, 2014 The health insurance industry is sick
- Jun 17, 2014 Believing is seeing - how doctors fool themselves and their patients !
- Jun 17, 2014 What is wrong with health insurance today
- Jun 16, 2014 Anecdotes can be harmful to your health !
- Jun 16, 2014 Why do doctors continue to do the wrong things ?
- Jun 16, 2014 Surrogacy Checklist for US citizens who want to do surrogacy in India
- Jun 15, 2014 Health care fraud
- Jun 14, 2014 Tandem IVF for older women
- Jun 13, 2014 My Fertility Choices?
- Jun 13, 2014 Freezing eggs and embryos - suspending time !
- Jun 10, 2014 IVF success story at Malpani Infertility Clinic
- Jun 09, 2014 Pregnancy destroying factor – taking patients for a ride
- Jun 07, 2014 How IVF can reduce stress levels
- Jun 06, 2014 Why PCOD patients are like a Porsche
- Jun 05, 2014 Work now, conceive later
- Jun 05, 2014 The Munde Seatbelt Law
- Jun 02, 2014 Never give up hope, never ever!
- May 31, 2014 IVF success story at Malpani Infertility Clinic
- May 30, 2014 Why hysteroscopy before IVF is not a good idea
- May 29, 2014 Gynecologists , infertility and TB
- May 28, 2014 Is your doctor referring you to the best IVF clinic ?
- May 27, 2014 Aligning the interests of the patient and the IVF clinic