An email from Dr Aniruddha Malpani (with reference to our past discussion on providing information to patients)

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Dear Netrumians,

HIFA is a forum similarly dedicated to providing rational usage of information as Netrum is a forum for rational usage of medicines. Dr Aniruddha is a member of HIFA and I remember Kunda madam posting some interesting material from his writings. I would suggest that some of us could even become members of HIFA and we could even invite people from HIFA (particularly who are working in drug related fields) to become members of Netrum.

rakesh---------- Forwarded message ----------From: Aniruddha Malpani, India <aniruddha.malpani@...

>Date: Oct 1, 2007 6:43 PMSubject: [hifa2015] Patient education libraries are a cost-effective option for providing better quality healthcareHIFA2015 <HIFA2015@...

>In the past, housecalls were an integral part of the practice of medicine,and no nineteenth century doctor would even dream of practicing medicinewithout making housecealls. However, the fact that they are now

practically unheard of means we should be taking a hard look at thepresent traditional ways of practicing medicine so we can come up withnewer models of providing healthcare more efficiently and effectively.

The major bottleneck today in providing healthcare is the doctor. Doctorsare expensive and scarce resources and the question we need to askourselves is simple - are we using this scarce commodity wisely? The heart

of modern medicine is based on the doctor-patient visit in the clinic -but is this really necessary? Many problems are self-limited and could bebetter handled without involving a doctor. Many clinical transactions do

not require a face-to-face discussion, and can be better done by email orthrough the web. Also, patients with chronic illnesses can be taught howto manage their own illness better. How can we create an alternative

model, which offers a better option?Many attempts have been made in the past - and all of these have revolvedaround using a substitute for the doctor - for example, a village healthworker in India, or a " barefoot doctor " in China. The modern " retail

clinic " in the US which is located in a mall is a variant on this model,since they allow a nurse (who is much less expensive) to offer care forsimple medical problems. However, none of these are very effective

solutions, because they still keep the patient dependent on an outsider.How can we create a more patient-friendly model? I think we can learn fromthe education sector. In the past, education meant that children were sent

to schools, where the experts (teachers) " taught " the children what theyneeded to know to pass their examinations. Today, we understand thatteaching is not just the passive transfer of knowledge from teachers to

students. Good teaching involves the active participation of students sothey learn to learn for themselves. In fact, this is the major reason whythe US has been so much more successful than other countries in the past

few decades. In most countries, students were taught using traditionalrote learning methods, which means they made great clerks orprofessionals, but they never learnt to take risks or think forthemselves. In sharp contrast, thanks to the national network of free

public libraries set up by Carnegie in the US, students here were forcedto go to public libraries to do their own research for themselves, so theylearnt to ask questions and find their own answers.I think the health-sector can learn from this model by setting up networks

of Patient education libraries to help patients get better healthcare. Iagree this is an unusual proposal, but it's worth examining closely.1. This is quite inexpensive to do. For the cost of one new MRI scanner,

one could setup over 100 libraries, each equipped with about 100 books and10 PCs with internet terminals !2. Librarians are much less expensive than doctors. They are also farbetter teachers, because they are used to helping and guiding patrons so

they can find the information they need3. Patients in a library are likely to be much more empowered. They willnot feel scared or intimidated, as they do by their doctor. They willtreat the librarian as a guide or peer, which means they are much more

likely to craft their own answers and make their own decisions. They willformulate their own treatment plans and stick with these, ensuring ahigher degree of compliance.4. This is a much more enlightened, participatory and democratic model,

which puts patients at the center of the healthcare universe. This iswhere they belong, but in order to reclaim this place, they need to becomewell-informed, so they can be treated as equals by their doctors. Much

more importantly, this model represents a completely differentphilosophy - one which respects patients, and teaches them to askquestions and find their own answers. This means patients will take muchmore responsibility for their own health , and this is especially

important for patients with chronic illnesses, who can become " expertpatients " and help guide others with the same illness!How is this different from the traditional " patient education model " where

the doctor educates the patient by giving them brochures or showing themvideos?For one thing, the information is likely to be much more reliable! Sincethe librarian has no vested interest in pushing surgery or promoting a

particular drug, patients will get objective vetted information about costeffective, tried and tested treatments, rather than the newest, mostfashionable (and most expensive!) drug which is being actively promoted by

the drug companies.Librarians are good at applying evidence-based medicine because they areinformation specialists. However, since they do not provide the actualcare, they are objective and will act as guides or coaches. This allows a

two-tier approach, so that armed with this information the patient goes tothe doctor and discusses his options more intelligently. This makes betteruse of the doctor's time as well - and helps to keep the doctor honest

too!I need to emphasise that my concept of a library is not just a collectionof books in four walls. While it is important that each hospital have apatient education library to which patients can go and to which doctors

can refer their patients, a lot of this will be done online as well.Information could be delivered through the web and the mobile and queriescould be answered by email; or through a call-center. As clinical decision

support software becomes more mature, this could also be used bylibrarians to help patients think through possible diagnosticalternatives.Patient education libraries represent a great return on investment, as

patients will no longer undergo unnecessary (and expensive!) surgery; orbe pressurized into popping the newest (and costliest) version of a drug.Since the information is being provided by someone other than the actual

clinician, the information is likely to be much more objective andreliable! These libraries could also form the nucleus of patientcommunities; where patients could get together and support each other witha little help from a librarian.

Dr Aniruddha Malpani, MDMedical DirectorHELP - Health Education Library for PeopleExcelsior Business Center,National Insurance Building,Ground Floor, Near Excelsior Cinema,206, Dr.D.N Road, Mumbai 400001

Tel. No.:65952393/65952394.helplib@...www.healthlibrary.comWorld's largest free health library !We help patients to talk to their doctors.

PS Read over 20 books on health online atwww.healthlibrary.com !Read my blog about improving the doctor-patientrelationship at

http://doctorandpatient.blogspot.com/HIFA2015 profile: Aniruddha Malpani is Medical Director of HELP - HealthEducation Library for People, Mumbai, India. www.healthlibrary.com

infoAT drmalpani.com*************************************************THE HIFA2015 GOAL: By 2015, every person worldwide will have access to an informed healthcare provider. Join HIFA2015: Send your name, organization and brief description of interests to HIFA2015-admin@...HIFA2015 email group website: www.dgroups.org/groups/hifa2015Further info on HIFA2015: www.hifa2015.org