Super User

Super User

Thursday, 03 March 2016 05:18

SUCCESSFUL MEDICAL PRACTISE

Winning Strategies for Doctors,successful-medical-practise.html

Thursday, 03 March 2016 05:18

USING INFORMATION THERAPY

Put Patients First,using-information-therapy.html

Thursday, 03 March 2016 05:11

DECODING MEDICAL GOBBLEDDYGOOK

Health Literacy Puts Patients First,decoding-medical-gobbleddygook.html

Thursday, 03 March 2016 05:16

HOW TO GET THE BEST MEDICAL CARE

A guide for the intelligent patient,how-to-get-the-best-medical-care.html

Monday, 18 July 2016 04:44

patient safety

PATIENT SAFETY,patient-safety.html

Wednesday, 16 November 2016 06:41

PATIENT ADVOCACY GIVING VOICE TO PATIENTS

PATIENT ADVOCACY BOOK,patient-advocacy-book.html

Thursday, 03 March 2016 06:06

About Us

Dr Aniruddha and Dr Anjali Malpani are IVF specialists, practicing in Bombay, Indias medical capital. We believe patients are the largest untapped healthcare resource; and that Information Therapy can be powerful medicine ! The reason the healthcare system today is sick is because it is so doctor-centric. We feel the best way to heal the system is by putting patients at the center of it; and that the most efficient way of doing this is by allowing patients to own their PHR - personal health records.

We founded HELP, the Health Education Library for People (www.healthlibrary.com) , Indias first Consumer Health Education Resource Center , in order to empower people by providing them with the information they need to promote their health , and prevent and treat their medical problems in partnership with their doctor. This is a free public library located on DN Road, Bombay 400 001, with over 8000 books and 300 videos, and is now the worlds largest consumer health library. HELP provides access to a reliable and upto-date collection of health materials, so that people can become better informed about their own health. We are expanding and plan to build a national network of consumer health libraries in India. HELP helps patients to talk to their doctors.

We started Indias first Sperm Bank in Bombay , and Malpani Infertility Clinic (www.drmalpani.com) provides comprehensive services, including IVF , GIFT , PGD and ICSI. Over 1500 babies have been born as a result of their treatment, since 1990. They have achieved Indias first pregnancy after the procedure of embryo biopsy for preimplantation genetic diagnosis. They founded Indias first support group for infertile patients, Infertility Friends (www.infertilityfriends.org) They have written 3 books, How to Have a Baby - a Guide for the Infertile Couple, which was published in 1994 and has been translated into Hindi, Marathi and Gujarati as well. Their second book, How to Get the Best Medical Care - A Guide for the Intelligent Patient (www.thebestmedicalcare.com) , was released in Jan 2000; and their third book, Successful Medical Practise - Winning Strategies for Doctors was published in 2002.

Dr Malpani writes for a number of newspapers and magazines, including the Times of India, as well as a number of websites. He is a Net enthusiast, who believes every doctor should have their own website ! You can read his blog about improving the doctor-patient relationship at http://doctorandpatient.blogspot.com/

Thursday, 03 March 2016 06:06

Books

Books
Thursday, 03 March 2016 06:06

Contact Us

Dr Aniruddha Malpani, MD
Medical Director
HEALTH EDUCATION LIBRARY FOR PEOPLE
Ashish, 5th Floor,
Tardeo end of Bombay Central Bridge,
Mumbai - 400034.
India.

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., This email address is being protected from spambots. You need JavaScript enabled to view it.

Tel: 91-22-65952393 / 65952394

Thursday, 03 March 2016 06:06

Sitemap

Sitemap
Thursday, 03 March 2016 06:06

Promoting Information Therapy in India

Promoting Information Therapy in India

Thursday, 03 March 2016 06:06

What is Information Therapy?

What is Information Therapy?

Thursday, 03 March 2016 06:06

Chapter 1: Lost in the information maze?

Chapter 1: Lost in the information maze?

Chapter 2: Bridging the doctor-patient communication gap

Chapter 3: Synergising alternative medicine with conventional therapy

Chapter 4: How can we get doctors to prescribe Information Therapy?

Chapter 5: How I prescribe Information Therapy

Chapter 6: Doctors need Information Therapy too!

Chapter 7: How patients can contribute to Information Therapy

Chapter 8: Please ask for Information Therapy!

Chapter 9: Minimizing risk, Maximizing safety

Chapter 10: Medicines - The good, the bad and the ugly

Thursday, 03 March 2016 06:06

Chapter 11: Listening to the patient

Chapter 11: Listening to the patient

Chapter 12: How hospitals can earn patient loyalty

Chapter 13: Promoting Information Therapy is good for pharmaceutical companies

Chapter 14: Why Information Therapy makes business sense for health insurance companies

Chapter 15: Healthcare entrepreneurs, disruptive innovation, and Information Therapy

Thursday, 03 March 2016 06:06

Chapter 16: IT for IT

Chapter 16: IT for IT

Thursday, 03 March 2016 06:06

Chapter 17: Doctor.com

Chapter 17: Doctor.com

Chapter 18: Switched on - Using mobile phones to deliver Information Therapy

Chapter 19: Medical librarians - An underrated resource!

Chapter 20: Healthier reporting using Information Therapy

Chapter 21: Do patients have a Right to Information?

Chapter 22: FutureGov - Transforming healthcare by prescribing information

Chapter 23: Creating content in India on a shoestring budget

Chapter 25: E-patients - Engaged, Empowered, and Enabled experts

Chapter 25: E-patients - Engaged, Empowered, and Enabled experts

Thursday, 03 March 2016 06:06

About the authors

About the authors
Thursday, 03 March 2016 06:06

Preface

Preface

Chapter 1: What Is Health Literacy? An Overview of a Complex Problem

Chapter 2: Why is Health Literacy Important? Taming the Elephant in the Room

Time is an important factor in building trust and collaboration between doctor and patient. For adults with literacy barriers, new skills for self-management are best learned through listening to explanations, watching demonstrations, asking questions, clarifying doubts and practicing self-care over repeated visits. Limited time for direct contact gets in the way of this learning process.

In the past, doctors had access to specialised medical knowledge that was denied to the patients. Patients used to be very impressed with the depth of the doctor's clinical acumen, and were pleased when he made the right diagnosis and provided the correct treatment. Today, thanks to the Internet, patients have access to a glut of health information that was previously only available in medical schools and libraries. This is both a blessing and a curse.

Due to the accessibility of information and limited availability of doctors, patients now rely on the Internet for their health information needs instead of seeking the advice of their doctors. However, the format in which this information is available does not make their job easy.

Because medicine is an art, there is usually not one clear answer to address a particular health issue and the choice of treatment depends on many factors related to both the disease and the patient's unique healthcare needs and personal preferences. Doctors now have to work with patients, so they can understand all the options available to them, and come up with a treatment plan that is tailored to the needs of the patient. If doctors don't invest in this effort, non-compliance with treatment can be a serious risk.

Meanwhile, patients now have more responsibility than ever to take part in their treatment, and for patients with limited health literacy, this responsibility can be overwhelming and frustrating. While there is a lot of information on the Internet, some of it can be patently false, misleading, unreliable and out-dated. Many patients are not sophisticated enough to separate the wheat from the chaff and get easily exploited by quacks. Freely accessible Internet health forums offer hundreds of explanations and treatments for illnesses, but many of these are incorrect.

However, naive readers may not even consult their doctor before following the advice of someone they have never met, because he or she seems to share their symptoms, or understands their concerns. Following the advice may or may not be appropriate, and can be quite dangerous if it involves the use of medications - medications that can easily be bought online at the click of a mouse, without a prescription.

Healthcare professionals often feel frustrated when dealing with patients with low health literacy because they do not know how best to help them. The reasons for this are many:

  • The medical and nursing education curricula are already crowded and health care professionals are not taught how to communicate effectively with patients who are literacy challenged
  • Low health literacy is not considered a priority issue
  • A doctor usually has only about 15 minutes to talk to a patient, and this is not enough to ensure clear communication

Patients now live an average of 10 years longer than they did in 1948. Older patients have more chronic medical conditions, which can often be managed for many years thanks to modern technology. However, this management may require multiple medicines, an army of specialists, regular monitoring of side effects and response, as well as adherence to complex treatment regimens.

Older patients are particularly badly hit by poor health literacy. This is a double whammy for them, because even though the complexity of their medical problems increases exponentially as they age, their reading and comprehension abilities decline because of a progressive loss of vision, hearing and cognitive skills. This means that even if they were able to cope when they were younger, they face a much harder time as they age - and this can prove to be a huge burden on them, their caregivers and their doctors. The ageing of developed countries means that the magnitude of these problems will soon become unmanageable.

As our lifestyles progressively deteriorate thanks to urbanisation, the burden of chronic diseases and lifestyle illnesses (such as diabetes, heart disease and obesity) will increase exponentially. When a person with low health literacy has a chronic disease, serious barriers to self-care can arise. People living with chronic disease usually have more than one condition and may have a complex care plan, involving several medications and multiple healthcare providers, many of whom have no idea what the other is doing. There is usually no co-ordination of care, and patients may receive inconsistent messages from different doctors as they make their way through the system, leaving them even more confused.

Getting the right treatment and keeping track of medications and appointments is difficult even for highly educated patients, so we can imagine the plight of uneducated patients. What chance do they have of being able to cope? Many will fall between the cracks, but the bigger tragedy is that rather than fix the system, we will blame them for not seeking medical care at the right time!

Most patients living with chronic diseases are expected to manage their own care, under the supervision of their doctor. This includes using monitoring devices such as glucometers, and knowing how to modify their medication, diet, exercise or other behaviour based on the results. Despite the complexity of their diseases, these patients have limited time with their doctors. A typical physician visit to monitor diabetes takes place every three months, unless there are serious complications, and typically, this visit lasts only about 15 minutes. In that time, the provider must carry out an assessment, order any tests required, answer questions and provide instructions for self-care. Under the best of circumstances, this can be challenging for both the doctor and the patient. To be able to expect patients with low literacy to learn everything they need to in these 15 minutes is a tall order.

Time is an important factor in building trust and collaboration between doctor and patient. For adults with literacy barriers, new skills for self-management are best learned through listening to explanations, watching demonstrations, asking questions, clarifying doubts and practicing self-care over repeated visits. Limited time for direct contact gets in the way of this learning process.

How the media makes the problem worse:

One would have hoped that the various mass media, such as newspapers, television, radio and the Internet would help to alleviate some of these problems, because patients would be able to obtain reliable information about their health from sources other than their doctors. However, modern trends in mass media have exacerbated the problem of poor health literacy. Gary Schwitzer of Health News Review examined over 1600 health stories over a five year span and found recurring problems such as:

  1. News stories, press releases and commercials are often misleading because they exaggerate the benefits of interventions and minimise the harms. For example, you read an article that claims that a new drug reduces the risk of a heart attack by 50%. Your loving wife promptly takes you to the doctor and pressurizes him into prescribing that drug to you, not realising that the 50% mentioned in the article refers to relative risk not absolute risk. Relative risk means that there could be a reduction from two heart attacks in 100 untreated patients to one heart attack in treated patients. This implies just 1% absolute risk reduction. In other words, the remaining 99 patients would be spending money on buying the drug and risk attracting its side effects, without getting any medical benefit, whatsoever. These are not easy concepts to explain to anyone, much less to low-literate people.
  2. News stories seem to equate "association" with "causation". There may be an association between A and B, but this does not mean that A causes B. For example, NBC News once reported that eating chocolate may decrease heart disease by as much as 37%, and MSNBC reported that drinking coffee may protect against breast cancer. What's worse is that subsequent stories contradict earlier ones, leading to a lot of confusion and scepticism among viewers.
  3. The third problem is the promotion and overuse of "screening" tests even for people with no symptoms of a disease. These are often heavily promoted for everyone, which leads to unnecessary testing, anxiety, and harm due to excessive testing.

Thus rather than help doctors dispel myths and misconceptions, media channels often make a bad situation worse by misinforming patients. To counter this, we need to tap alternative options to deliver trustworthy information to patients. These may include: expert patients and self-help groups; curated websites; and consumer alth libraries, to name a few.

Chapter 4: Health Literacy: A Powerful Shield Against Medical Errors

Chapter 5: Does My Patient Have Low Health Literacy? (Hint: You Can’t Tell by Looking!)

Chapter 6: Creating Effective Partnerships With Patients: Delivering on the Promise

Chapter 7: Improving Doctor-Patient Communication: Bridging the Gap

Chapter 8: Translating English to Hindi: Experts Needed

You might think that readability formulas measure reading ease or comprehension, but they do not. They only count syllables, words, and sentences to calculate a grade level score, and ignore everything else. If the grade level score is high, it means the material is too difficult for most readers. However, a low score does not always mean the material will be easy for readers to understand because short words and sentences are only one of many things that help readers make sense of the document.

While it is the patient's responsibility to carry out the doctor's advice, it is the responsibility of healthcare providers as well to offer health educational materials that are easy to understand, culturally relevant, and motivating. Written materials still make up the majority of health information for patients, but most are written at too high a reading level for an average patient to understand. In fact, the four common shortcomings of written health material include:

  • Too much information. Long pages crammed with text discourage people with limited reading ability and obscure important points for all readers.
  • Too high a reading level. Since most material is written by people with extensive educational backgrounds, the reading level is simply too high.
  • A lack of interaction, which results in poor recall.
  • The use of difficult words that are not defined with examples.

While many doctors believe they can solve this problem by simplifying the language of their documents, the truth is that making the text easier to read only marginally improves comprehension among patients with low literacy skills. This is because low-literate patients have different ways of looking at text. With this group, it's important to remember that:

  • If just text is presented, low literate readers may try to form their own mental visuals and connect them with the text. This is a complex task, at which many fail.
  • When low-literate patients read, they usually focus on each word rather than on key concepts.
  • Low-literate adults let their eyes wander around the page and have difficulty finding key points.
  • They have trouble scanning text, so they may miss important concepts.

You need to routinely ask yourself: How suitable is your material for patients with low literacy skills? Will they be able to understand the information provided? A quick way to assess health information is to use the 3 A's: Accurate, Actionable, and Accessible.

Accurate: Does the information correctly describe the condition or treatment?

Accessible: Is the information not only easily available to your patients, but is it also accessible in terms of its reading level, cultural suitability and relevance?

Actionable: Are there clear action steps provided for the patient to follow?

Three approaches can help answer these questions:

  1. A checklist for easy-to-read health education materials
  2. A readability analysis, and
  3. An analysis using an instrument called Suitability Assessment of Materials.

Let's begin with the checklist for easy-to-read health education materials:

  • The presentation is attractive. It is clear what the material is about and for whom it is intended.
  • Only one or two objectives are covered -no information overload.
  • The piece uses headers and summaries to organise and reinforce information
  • The writing is active rather than passive
  • The reading level is 5th grade or lower (short words with one or two syllables)
  • The piece uses little or no technical jargon
  • There is ample white space
  • Culturally relevant pictures of people and places are included
  • Interaction is invited with the use of questions or suggested behaviours
  • Bulleted lists are used instead of wordy paragraphs

As you review your materials, check off the attributes on the list. You may find that part of the material meets the checklist, while other parts do not. This difference indicates areas that may require extra teaching or the use of supplemental materials. You do not have to discard materials that aren't perfect, just be aware of their shortcomings and compensate for them. The effectiveness of the materials you use will increase if you read them aloud to your patients, and highlight important points while doing so.

While medical jargon can be difficult to understand because it often has many syllables and refers to complex technical concepts, what about supposedly simple words we think most people would comprehend?

Multiple interpretations - Words like "may" and "might" are vague and can confuse patients. Scientists know that if a medication may help, it also may not help.

However many patients interpret "may" and "might" as "will" and assume that the prescribed medication will help. You'll need to explain the difference.

Acronyms - Acronyms use the first letter of words to create a shorthand version of a phrase. For example, CAT refers to Computed Axial Tomography or ADL for Activities of Daily Living. Do not assume your patients know what any of these acronyms mean. To help your patients understand, the first time an acronym is used, explain what it means and write it down for them.

Readability formulas

To check how reader-friendly your text is, you can use a number of online readability analysers. A good resource is "8 Readability Web Tools to Test Your Writing Quality, "which is available (@http://www.makeuseof.com/tag/writing-reader-friendlycheck-8-readability-testing-web-tools/). For a general patient population, you want your materials to be written at a 6th grade level or lower. If you know you have many patients from disadvantaged backgrounds, you may wish to lower this reading level even further.

You might think that readability formulas measure reading ease or comprehension, but they do not. They only count syllables, words, and sentences to calculate a grade level score, and ignore everything else. If the grade level score is high, it means the material is too difficult for most readers. However, a low score does not always mean the material will be easy for readers to understand because short words and sentences are only one of many things that help readers make sense of the document. Formulas cannot measure whether the purpose is clear, the words are familiar, or the explanations make sense. They don't clarify whether the main points are easy to find, whether the formatting helps to guide the reader; if the text is too small or the page is too crowded.

These issues are better addressed using SAM (Suitability Assessment of Materials), which was developed by Ceci and Len Doak, pioneers in the field of teaching patients with low literacy skills. SAM offers a score (a percentage) that falls into one of three levels: superior, adequate, or not suitable. You can download this book free (@http://www.beginningsguides.com/upload/SAM-for-Beginnings.pdf)

There are also commercial organisations that offer paid services to help design patient-friendly materials. For example, Communicate Health (@ http://www.communicatehealth.com) is the website of a team of health literacy experts who provide consulting, writing and editing, user-centred design, and knowledge transfer.

Photonovels

Photonovels are a clever way of reaching out to your patients. These are storybooks, that use photos to tell a story, and they can be created by patients themselves. From Junk Food to Healthy Eating: Tanya's Journey to a Better Life (@ ttp://www.photonovel.ca), is a good example. This photonovel was written by immigrant women in Canada who created the script and the characters for the story, took the photographs, and constructed the book themselves. As one said, "You don't need English to understand it, you just have to point at the picture and look at it." The photonovel became a useful tool towards greater health literacy because it made the subject matter comprehensible to the target patient.

Speaking Books

Books of Hope is a company that publishes "speaking books" that are directly aimed at people with low literacy skills. The books are created in 15 languages and cover 45 important topics such as HIV/AIDS, malaria, immunisations and depression. One of the malaria books was converted into an animated version that can be viewed on a mobile phone. The books are used in India, China, South America, and the USA and over 300,000 have been purchased by sponsors. (@http://endtheneglect.org/ 2011/06/speaking-books-bringing-hope-to-low-literacy-populations/)

Comics and Graphic Novels

Medikidz (@http://www.medikidz.com/) produces comic books especially for children. These cover a wide range of topics, ranging from leukaemia, ADHD, swine flu and broken bones. The comics have an engaging story line because they are built around action heroes with whom children can identify. Not only are they medically accurate, they are fun to read and are attractively produced.

If you want additional inspiration as to how artists and doctors are using graphics to discuss health and illness, please visit http://www.graphicmedicine.org/. In addition to reviews of health-related comics, Graphic Medicine offers articles and podcasts.

When it comes to evaluating health materials for your patients, it's important to not rely on any one tool, especially an electronic tool, to replace your own experience and judgment. Just as we know we can't depend on an automatic spell-checker to correct all our mistakes, we cannot rely on a machine to assess our materials on its own.

You know your patients better than anyone else, and your patients should play a key role in determining the suitability of the materials you use. Please utilise the expertise and assistance of your patients in developing your own materials. I am always amazed by how poorly doctors make use of the extensive skills that their patients have. Patients are true experts on their illness, and many will be happy to help you develop suitable materials to help educate other patients.

In a sense, patients are the largest untapped healthcare resource, and doctors need to make better use of them. Some of your patients may be graphic designers; others may be teachers, and others may be willing to translate your materials into local languages. Ask them for help. They will be happy to volunteer their services. By working together, you can ensure your materials help serve your patients better.

It's important that patients have access to trusted reliable sources of information - and patients would rather get this information from their doctor, whom they trust.

One of the key responsibilities of a doctor is to teach his patients - both about his illness, as well as how to remain healthy! Since I'm an IVF specialist, my focus is on educating patients about IVF and infertility. My personal blog @ http://www.blog.drmalpani.com is the viewpoint of a practicing opinionated IVF physician, and while I don't claim that I have all the answers, I believe my viewpoint can provide valuable insights to infertile couples.

I like teaching and I think I am good at it. I get a lot of positive feedback and encouragement from my patients, who tell me how helpful they find my blog and our websites. Thanks to the ubiquity of the Internet, I can now reach out to thousands of patients from across the world. I like being able to leverage technology, because it enables me to positively influence the lives of many more couples than I would have been able to, had I been restricted to educating patients in real life.

There are a lot of other advantages as well. Thanks to my blog, I'm forced to learn, keep up-to-date and sharpen my thinking. Every time I write, I also have to do my homework to make sure I am providing patients with reliable information. There are many controversial issues in IVF, and I have to make sense of fairly complex issues when I write a post. Articulating where I stand and presenting my viewpoint in a public forum, where others can critique it, helps me to clarify my thought processes.

As Sir Francis Bacon said, "Reading maketh a full man, conference a ready man, and writing an exact man."

Teaching patients is good for my professional reputation. It is also very good for my practice, and infertile patients who want high quality personalised medical care from an expert will come to our clinic from all over the world. Teaching patients has taught me to be creative. While I personally prefer learning by reading books, I have found that not many patients like reading, because they find it boring. This is why I partner with artists, film makers and graphic companies to repackage text into comic books, e-learning courses and videos - all of which form an unique library of novel patient educational materials that patients appreciate and other doctors admire (@ http://www.ivfindia.com).

Making services more patient-centred creates a lot of energy and fun. Patients are the experts of their lives and have a lot of power - after all, they are the fuel of the engine of patient-centred innovations. "Let patients help" was the title of the performance of e-Patient Dave at the TEDx conference in Maastricht. Our patients have shown that they are ready for this new participative role. We as doctors should trust them and should realise that listening to patients is the best catalyst for change.

Thanks to my patients, I learn all the time - and I feel that as long as I remain curious and enjoy learning, I will remain young and productive!

One of the most effective ways to deal with health literacy issues is through a multi-disciplinary approach. It may seem like extra work for you initially, but if you can help build a network of support for your patients both in and out of the clinic, you will actually reduce your burden. You will also be seen as a supportive and caring doctor in the community, and this will mean that patients will prefer coming to you.

Health literacy is not an issue just for the doctor's clinic. It affects the whole community and since prevention is better than cure, we need to work on improving the entire community's health literacy rather than work on only one patient at a time.

There are myriad opportunities to improve a community's health literacy skills and just as communication requires at least two active participants, community health literacy programs also thrive on partnerships. These efforts enable literacy experts and health professionals to share ideas and resources, leverage funds and expand networks. Doctors need to step outside the four walls of their clinics and engage with the community if they hope to have a significant impact on public health. The good news is that because doctors are highly respected members of society, they will usually find it easy to do so, if they are willing to invest their time and energy.

Community development approaches

Most people, especially people with low literacy, get most of their health information through word of mouth. The information which doctors in "five star hospitals" provide is not always seen as credible, because poor patients often believe, quite justifiably, that doctors working in hospitals live in ivory towers and inhabit a world which is completely different from theirs. This is why the advice they give is usually impossible to implement in real life. (For example, a doctor may tell the mother to wash her hands before preparing food in order to prevent her child from getting repeated attacks of diarrhoea. But if her taps are dry, where will she get the water from?) Rather than view this as a barrier to effective health communications, why not approach it as an opportunity? This requires a somewhat different role for many health professionals. Rather than viewing their role as providing health information directly, they need to act as facilitators, and to work in partnership with others in the community. The best partners would be patients from the community, who are literate enough to understand what the doctor is saying, and are smart enough to translate this into terms their community members can understand.

These health literacy advocates are best drawn from the community and because they talk the local language; understand the local culture; and are aware of the everyday practical difficulties their people face, they are trusted by the community. They can help to design customised health education tools, which are intelligible and practical enough to be followed by other members of their community.

All this may require tapping into existing community networks, such as peer groups, social workers, religious gurus, and political workers. An excellent example of this is the work PUKAR (@http://pukar.org.in/) has done with using barefoot researchers to improve healthcare in a slum in Mumbai.

Participatory health education. A variety of literacy and public health programmes have enabled low-income, low-literacy individuals to actively explore health issues of concern to them. Health professionals take part, not as experts, but as one among a group of equals that includes people with various life experiences and levels of education.

There are many barriers that keep the poor - especially poor women - from using available health resources. By working together, health workers and groups of people can bring about changes in the medical system so that it becomes a resource rather than a hurdle for citizens, as they try to solve their health problems. The poor maybe illiterate, but they are thirsty for knowledge, which can help them to improve their lives and those of their children. The medical system will not change on its own, though. It will change only when people demand it, and when they offer creative ways to bring the health care that people need within the reach of all. Participatory approaches enable individuals to become more confident and identify ways in which they can gain more control of their health. They can then go on to teach what they have learned to others.

Here are some opportunities which can be explored.

A. Integrating health literacy into adult basic education

Adult educators work directly with people who face problems with health literacy. The significance of health literacy classes might be visualised as a pebble thrown into a pond. It starts with an initial splash: students learn information and acquire skills to improve their own health behaviour. Then, they share their learning in expanding circles of positive influence through family, friends, and community. Sharing information helps them to take ownership of it, thus increasing likelihood of later use.

Adult educators are experts in teaching. They can play an important role in supporting the activities of health professionals by improving their students' ability to:

  • Ask clarifying questions in order to understand a problem better
  • Locate information related to a specific health problem
  • Fill out forms and ask for help in doing so
  • Navigate a hospital
  • Understand test reports and results
  • Read and understand medication labels and prescriptions

This is an opportunity for learning to solve real life problems, and their students are much more likely to remember these lessons, because they are directly relevant and help them to solve their day-to-day difficulties.

Some adult educators may be reluctant to deal with health issues. They feel that because medical research and information evolves so rapidly, it is impossible to them to stay on top of it all, and they fear giving incorrect information to their students. However, it is not necessary that adult educators also be experts in health education. The most important approach to use for adult learners is skills-based education, which focuses on the fundamental reading, writing, math and communications skills that people need in order to manage their healthcare. A benefit to this approach is that it is transferable to other areas of daily living beyond health. Adults who are able to ask clarifying questions, navigate new buildings and environments, advocate for themselves and understand instructions can improve not only their own healthcare but their children's education as well! Adults who learn to assert themselves become politically more aware, and function better as citizens who are not afraid to speak up.

In addition, adult education classes help students to:

  • Interact with bureaucracies and find their way around hospitals
  • Better understand their rights and responsibilities as patients
  • Understand and follow written and verbal instructions
  • Administer medicines safely based on a prescription or the label
  • Find and make sense of health information to help patients in decision-making

B. Integrating health literacy into children's education

The Robert Wood Johnson foundation, well known for funding innovative and effective health education programmes, has chosen an inspiring project on health literacy: puppet shows! The MicheLee Puppets travel the state of Florida in the United States, showing parents and children ways that help kids eat nutritious food for better health. The goal is to counter the problem of childhood obesity. An advantage with plays and puppet shows is that families watch them together, and reinforce each other's learning at home.

C. Health literacy through gaming and role-playing

Gaming is another way to involve the whole family. Games have the advantages of being engaging, interactive, fun, personalised, and accessible 24/7. They can simulate real situations without presenting any real risks. And of course, people of every age enjoy games.

Researchers at James Madison University in Virginia, USA, developed an interactive game called "Face the Case," which is an online role-playing game. Players are given "cases" or health situations involving health literacy issues, such as a cancer patient who wants to explore alternative treatments, or a person who needs home-based health care. They need to acquire necessary skills to solve the problems presented. The 30 cases in the game present various health literacy issues, all of which must be solved in order to win the game.

Games can also be used to increase empathy with others, which is an important part of improving communication between doctors and patients, and between patients and caregivers. At the Games for Health 2011 conference, Dr. Doris Rusch presented a game called "Elude", which is designed to educate people to support others with depression.

Fitwits (@http://www.fitwits.org) is a research project from Carnegie Mellon University in the US that is designed to help prevent obesity and improve health literacy simultaneously. Since 2007, Fitwits uses fun cartoon characters, the Fitwits and the Nitwits, to provide a hands-on educational experience that teaches basic health information about obesity and helps to transform unhealthy behaviours into healthy ones. Fitwits provides parents with an easy way to initiate conversations about obesity with their kids at home, and teachers can use Fitwits in the classroom to engage students in learning about their health. Finally, paediatricians can use Fitwits to lower barriers to talking about obesity and obesity-related illnesses with their patients.

D. Driving home the message through storytelling

Health information needs not only to be accurate, but enjoyable and inspirational as well. The real health literacy challenge may not be a lack of information, but rather the ability of the healthcare consumer to act on that information. Anything that can improve that ability is worth trying. Story telling is a great way of ensuring that the message sticks. Patients dealing with a diagnosis of diabetes, for example, often learn far more from hearing stories told by other diabetics than they do from information sheets, tables of foods, and sample menus that are dry and boring.

Storytelling makes problems and solutions come alive, because it's easier for listeners to relate to stories. Storytelling is a valuable tool in the quest to improve health literacy - and the good news is that all of us have lots of stories to share - we just need to learn how to do so.

E. Spreading the message in schools.

While solutions to low health literacy understandably target adult populations, primary and secondary schools are important partners in crafting long term solutions. Schools are responsible for developing lifelong learning skills, and just like schools teach students physics and calculus, they need to teach them how to remain healthy by transforming health education into health literacy education.

Such a student will be:

  • A critical thinker and problem solver, who can make sound judgments for himself.
  • A responsible, productive citizen who avoids behaviours such as unsafe sex, drunk driving or smoking, which place his health or that of others at risk.
  • A self-directed learner, who has a basic knowledge of health promotion and disease prevention, and can grow this knowledge throughout his life.

Health literacy is as important as "teaching a man to fish" rather than just giving him a fish. Many countries have designed standards to guide schools in implementing effective health education classes. These will help today's students to gain the skills necessary to become health literate adults of the future. In this context, the National Health Education Standards (NHES) from the US can be viewed @ http://www.cdc.gov/HealthyYouth/SHER/standards/index.htm

F. Integrating the skills to teach health literacy into medical and nursing education

Health professionals may feel frustrated when confronting patients with low literacy skills because their education and training did not provide them with the tools needed to work with these patients. Research has shown that health professionals lack awareness, knowledge, and skills related to teaching health literacy, and that many best practices for effective communication with low literate patients are not routinely used by physicians (Coleman, 2011). Health professionals cite three barriers to screening for health literacy in their practices: lack of time, lack of reimbursement, and lack of expertise.

According to DeWalt et al (2010) the three best practices to improve health literacy that health professionals need to follow include:

1- Plain language: Use common words when speaking to patients
2- Slow down: Speak clearly and at a reasonable pace.
3- Teach-back: Ensure patient comprehension by asking them to teach back the information and instructions received in every encounter.

Your non-medical clinic staff can be a valuable resource in communicating with low-literacy patients, so make use of them. Many of them are fluent in the local languages and can act as a bridge between you and your patients.

G. Health Literacy in Libraries

Libraries are playing an important role in supporting efforts to improve health literacy. Margot Malachowski, a medical librarian, believes libraries are poised to play a greater role in "patient activation," or helping to motivate people to find out more about their health (Malachowski, 2011). Consumer health libraries (such as - the Health Education Library for People, (@ http://www.healthlibrary.com) can also help to empower people by providing them with the health information they need.

H. Teaching health literacy using popular television programming

In one experiment school students in the USA were shown a clip from the popular medical TV show, "ER", in which an elderly man complained of chest pains, followed by a discussion of the possible causes of chest pain. Then a second clip was shown, in which a doctor suggests that the man may be having a heart attack. This was followed by a discussion of the causes of heart attack. A third clip showed the man being diagnosed with congestive heart failure, followed by a summary of all points that had been discussed so far. Most students found the curriculum interesting, and learned a great deal from it. Integrating TV programming into school health classes can help to make them fun and easy to learn.

I. Patient support groups

Patient support groups for people living with certain conditions (e.g., diabetes, HIV/AIDS, etc.) can be extremely useful in providing a non-threatening environment in which patients can ask lots of questions and discuss their needs. These groups also help patients feel less isolated when it comes to dealing with critical health issues.

J. Creating social support networks

Remember that patients have support systems to help them deal with their daily routine - for example, housing, transportation, and childcare. These include: social service organisations; temples, churches and other religious organisations, nongovernmental organisations (NGOs), charities and workers from local political parties.

You may be able to make use of these resources to support your patients' healthcare needs by piggybacking on them. If your patients already have a local social service agency that helps them, they may be able to assist with their healthcare needs as well. You can even directly connect with these resources by simply calling and asking for their help -most are very happy to work with doctors.

One of the most effective ways to deal with health literacy issues is through a multidisciplinary approach. It may seem like extra work for you initially, but if you can help build a network of support for your patients both in and out of the clinic, you will actually reduce your burden. You will also be seen as a supportive and caring doctor in the community, and this will mean that patients will prefer coming to you.

If you want to be socially responsible and improve the living conditions of the poor patients in your community, tackling low health literacy is a great starting point. Doctors are respected members of society, and if you want to take on more responsibilities as a leader in your community, you can champion the cause of improving health literacy. You and your staff may be able to create a local team, which includes the various agencies listed above. In this way, you can share the load and provide the community reinforcement that is so important to reaching people with limited literacy skills. This also reduces the financial burden on each member of the team, which can be helpful when faced with limited resources. Just remember: health literacy is a big problem, but you don't have to tackle it alone.

Chapter 11: Patient Support Groups: Building a Safety Net

Chapter 12: Improving Your Own Health Literacy: One Step At A Time

Chapter 13: Health Literacy in India: A Unique Challenge

Chapter 14: Lessons in Health Literacy: What India and the US Can Learn From Each Other

Chapter 15: Employing Multimedia and Mobile Technologies: Making Modern-day Tools Work for You and Your Patients
Chapter 16: Effective Online Information for Low-Literate Patients: Going Beyond the Written Word

Chapter 17: Creating Health Literate Hospitals: From Admission to Discharge

Chapter 18: Contemporary Issues in Health Literacy: Action Needed NOW

Chapter 19: Promoting Health Literacy: Spread the Word!

Chapter 20: What Marketing Strategies Work to Promote Health Literacy?

Chapter 21: Why Doctors Need to be Politically Engaged...and Engaging

Thursday, 03 March 2016 06:06

Chapter 23: Final Thoughts From Dr. Malpani

Chapter 23: Final Thoughts From Dr. Malpani
Thursday, 03 March 2016 06:06

Chapter 22: Future Perfect

Chapter 22: Future Perfect

Wednesday, 23 March 2016 13:35

Chapter 25 : consult for testing

Hi, Test book here..

 

Thank you.

Thursday, 03 March 2016 06:06

Humour

A Chuckle a Day Keeps the Doctor Away !

Please do browse through our collection of cartoons ! The talented artist responsible for them is Dr Hemant Morparia, MD a radiologist, whose work appears daily on the front page of Bombay Times!

 
 
 
 

Search for cheap life insurance quotes at this specialist life insurance comparison website.

Thursday, 03 March 2016 06:06

Information for Patients

Information for Patients

Take two aspirin and look it up on the Internet - this advice is fast becoming the standard prescription for anyone facing a new or major illness in the West. Medical journals, text books, encyclopedias, research papers, and huge international databases once available only to doctors are now just a mouse click away.

Savvy patients can even learn about a breakthrough before their doctor does, and the internet has given birth to a new group of informed, empowered patients who want to make medical decisions in partnership with their doctors, instead of just blindly following the doctors advise.

While everyone knows that theres a wealth of medical information on the Net, why are most patients in India still so reluctant to make use of this ? For one, most Indians have become very used to passively following their doctors advise.

Questions are not encouraged in India - either in the classroom when we are students, or in the doctors clinic when we become patients. Also, medical jargon can be intimidating, because it is unfamiliar ( since many words are derived from the classic languages such as Greek and Latin) and is therefore difficult to follow - so must of us would rather not take the trouble of researching our problem independently.

Many intelligent people are also worried that a " little knowledge is a dangerous thing " and are anxious that they may become "half-baked" doctors or hypochondriacs. There is also the worry that knowledge about medical diseases ( and all the nasty complications they can cause ) can result in an increased fear about death and dying - and most people would much rather not come to terms with their own mortality.

Many people also prefer to leave everything upto their doctor - after all, thats what you pay him for, isnt it - why confuse yourself with alternatives and options ( the " doctor as a highly paid technician " approach). Another problem is that there are still very few sites about health and medicine in India ( most websites are US in origin) with the result that a lot of the information on the Net is irrelevant to Indians.

So how can you use the internet intelligently to find out more about your medical problem ? Let me start with a warning - it is unwise to try to diagnose yourself - dont try to play doctor ! If you have a medical problem I strongly recommend that you seek a qualified medical opinion from your own doctor, who can see you, conduct tests if necessary, and diagnose you properly.

Once you have a diagnosis, your search for information on the Net can become focussed and productive.

 

Search Engines

Searching for information on the Net is very similar to looking up a book. You turn to the index to look for a particular topic, and on the Net you can use google !

The trouble is that these engines are unintelligent, so that a search usually retrieves thousands of websites- the majority of which are completely irrelevant to your query - and its hard to separate the wheat from the chaff.

Search engines are most useful when you are looking for information on a rare problem, or very specific information only.

Be sure to try several different search engines when looking for information since each one can have different listings included in their data base.

You also need to double check your spellings - an error can mean you may not retrieve any useful information at all ! Try to be as precise as possible in order to retrieve relevant information only ( for example, if you are looking for information on eye problems in diabetes, do a search on " diabetic ocular complications".)

Its easy to get lost in the flood of garbage which a standard search produces, which is why many patients often despair of ever being able to find anything useful or understandable on the Net. In order to make their life easier, experts have put together evaluated subject gateways or medical search engines, to make directed searching for relevant information easier. As their name implies these search services provide the user with a gateway to medical resources on the Internet.

However, rather than provide a comprehensive ( but unranked or unsorted ) listing of Internet sites, only those that meet a defined quality threshold are included.

The websites are also ranked, according to their quality and usefulness, as determined by these experts.

These gateways are produced by medical libraries, doctors and other organizations, and are useful to both new Internet users - who may be unsure where to begin - and experienced surfers who are frustrated with ploughing through the inevitable volume of irrelevant dross when using any of the more general search tools.

If you are a novice, it can be helpful to have a friendly doctor ( or medical student ) or a librarian to guide you with your first few searches, to teach you how to search efficiently. ( Librarian-mediated searches are available at HELP.) If you want a comprehensive search of the Internet you must be prepared to search multiple gateways and search engines - the much sought after one-stop information medical source has yet to appear. Remember that theres a lot more on the Net than just tons of textual information on thousands of websites -you can admire anatomy in three dimensions thanks to virtual reality, and even watch video clips of surgery online ! However, mining the Net for information need not be a one-dimensional affair - the real charm of the Net lies in its interactivity , so that you can get a response to your queries !

 

Online Doctors

There are many doctors and health professionals on the internet who will respond to medical questions.
These responses are meant to educate the questioner and the public and cannot be a method of rendering personal medical care. Occasionally a response might be directly by email, but most sites use the bulletin board forum and archive all the responses ( what are called FAQs or frequently asked questions) , so that everyone can search, view, and benefit from the information.

 

Chat Sessions

There are also a few live question and answer chat sessions. If you cant make the scheduled chat time, then at many of the sites you can post your question ahead of time and return later to view the transcripts of the chat and see if your questioned was answered. During the live discussion sessions, you need to ask your question through a moderator and whether or not your question gets answered depends on the number of participants and their questions.

 

Email, Newsgroups, Listsevs and Mailing Lists

The Internet also provides a cloak of anonymity, and this is particularly important with illnesses that carry a social stigma, such as infertility or AIDS.

If you have been able to identify an expert on your problem, it is also possible to send him an email directly, and he may then reply to you. You can find email addresses of doctors through a little bit of lateral thinking. Many leading clinics, hospitals and medical colleges have websites which list the names, addresses and emails of their faculty members. You can also find these by searching PubMed ! Also, many authors of medical journal articles now include their email addresses along with their institutional address.

Once youve found the information, how do you evaluate it ? This is still the most difficult part of searching for medical information, and unfortunately many patients become misinformed thanks to the Net.

The problem, of course, is anyone can publish on the net - and its not easy to make out whether the information being presented is credible or not ! A good website should be accurate, useful, credible , readable, uptodate and have useful links to other sites - but the most important guideline is to find the source of the information !

Remember that a lot of the medical information on the Net is designed for the doctor, and this can be quite complex to understand, because it is primarily written for medical professionals.

However, this is usually the most reliable, and many leading medical journals now available on the Net , such as the British Medical Journal, the Lancet, New England Journal of Medicine and the Journal of the American Medical Association, only publish studies after they have been carefully reviewed by leading doctors .

Though these may look intimidating, you dont need a medical degree to read them - each one has a conclusion and a summary that contain most of what youll need to know.

It is important to think about how much information you need from the Net to make yourself comfortable with your diagnosis and treatment options.

Some people need as much information as they can possibly gather, while others find less information, or information with a specific focus, is best for them.

 

A warning - do not accept the contents of any single website as definitive.

It is in the nature of medical research that many studies contain errors, many conclusions are false, and many reports flawed.

This is why you need your doctors help to make sense of your information search, because he can best explain to you how the information you have unearthed applies to you as an individual. You need to form a partnership with your doctor - but it should be a partnership of well-informed equals , for which you need to do your homework first ! Remember that the information you retrieve on the Net is simply a tool to help you to get better medical care - it should help to improve the communication between you and your doctor - not replace it !

This is based on an article I wrote for Times Computing.

Sometimes it is easy to take a doctors word as law, and to follow them completely. However they are human, and do make mistakes. Alexander Harris Solicitors understands that no ones infallible, and that you shouldnt suffer because of it.

Dr Aniruddha Malpani, MD
Medical Director
HELP - Health Education Library for People
Bombay. India.

The major attraction of the web for doctors is that it contains a wealth of medical information which is increasing daily - its like the worlds largest medical library, which is open 24 hours.

However, this vastness is its Achilles heel as well, because the information is not organised logically or systematically.

This is hardly surprising, considering the fact that the Web is a free for all jungle - everyone can publish on it ! This means that for every good site, there are likely to be ten bad sites. With so many thousands of medical sites, its easy to get lost in this maze.

This article will serve as a tourist guide, and show you some of the webs highlights, so that when you actually start exploring on your own, you know where to go and how to get there

Starting Point

Legal Medicine

Searching The Medical Literature

Medical Students, Jobs And Careers

Medical Databases, Biomedical Research, Clinical

Alternative Medicine

Medical News

Specialties

Medical Products , Equipment And Supplies, And Conferences

Drugs And Medicines

Directories Of Doctors And Hospitals

Practise Management Patient Education Medical Journals

Medical Bookstores

Medical Textbooks

Medical Humour

One Stop Shop

Guidelines And Protocols

The Best Of The Best

Doctors Ethics

Expert System For Differential Diagnosis

Medical Images

Why Every Doctor Should Have Their Own Website

The next step

Thursday, 03 March 2016 06:06

Alternative Medcine

Alternative Medcine
Thursday, 03 March 2016 06:06

Specialities

Specialities
Thursday, 03 March 2016 06:06

Drugs & Medicines

Drugs & Medicines
Thursday, 03 March 2016 06:06

Practise Management

Practise Management
Thursday, 03 March 2016 06:06

Medical Textbooks

Medical Textbooks
Thursday, 03 March 2016 06:06

One Stop Shop

One Stop Shop
Thursday, 03 March 2016 06:06

Best Of The Best

Best Of The Best
Thursday, 03 March 2016 06:06

The Next Step

The Next Step
Thursday, 03 March 2016 06:06

Doctors Ethics

Doctors Ethics
Thursday, 03 March 2016 06:06

Expert System For Differential Diagnosis

Expert System For Differential Diagnosis
Thursday, 03 March 2016 06:06

Medical Students

Medical Students
Thursday, 03 March 2016 06:06

Legal Medicine

Legal Medicine
Thursday, 03 March 2016 06:06

Starting Point

Starting Point
Thursday, 03 March 2016 06:06

Searching Medical Literature

Searching Medical Literature
Thursday, 03 March 2016 06:06

Medical Databases

Medical Databases
Thursday, 03 March 2016 06:06

Medical News

Medical News
Thursday, 03 March 2016 06:06

Medical Products

Medical Products
Thursday, 03 March 2016 06:06

Directories of Doctors & Hospitals

Directories of Doctors & Hospitals
Thursday, 03 March 2016 06:06

Medical Bookstores

Medical Bookstores
Thursday, 03 March 2016 06:06

Medical Humour

Medical Humour
Thursday, 03 March 2016 06:06

Guidelines & Protocols

Guidelines & Protocols
Thursday, 03 March 2016 06:06

Medical Images

Medical Images
Why Every Doctor Should Have Their Own Website

Chapter 1: Planning your career – carve out a niche for yourself

Chapter 2: Beginning practise – get off to a flying start !

Chapter 3: Designing your clinic - make it patient-friendly

Chapter 4: Assessing your practice – take a critical look at what you are doing

Chapter 5: Marketing your practice – how to get more patients

Chapter 6: Business management 101 - basic business skills you need to know

Chapter 7: Financial planning and management – boosting your bottomline

Thursday, 03 March 2016 06:06

Chapter 8: Making your money work for you

Chapter 8: Making your money work for you

Chapter 9: Hiring the right people – your most valuable investment

Chapter 10: Creating superb employees by taking good care of them

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