Gomantak Times – Weekender, 25 July 2010

More often than not, the average person begins searching for a doctor only when illness strikes, which is not the best time to locate one, explains Orlene D’Souza

Sonia had just moved to Goa with her family, and like all people who change their residence, she took great pains in locating the best school for her children, getting house help, meeting the neighbours etc. However, she overlooked one important aspect, and that was to identify a family doctor.

One morning, Sonia woke up with high fever and a splitting headache. The stress of her new job and settling into a new place had made Sonia susceptible to viral infections. She needed to see a doctor, but unfortunately, she didn’t know any doctor.

Like most of us, she too didn’t bother to look for a doctor until she really needed one.

So, she picked up the yellow pages and looked out for doctors in her locality. She shortlisted a couple of names, but she needed more information, so she asked for references from her friends and colleagues. However, this didn’t help much. Her friends and colleagues gave her contradictory feedback, making her decision making process even more difficult.

Asking for recommendations from friends and coworkers is not always the best way to start; after all, we each have our own needs and expectations of our healthcare provider. Choosing a doctor who best fits our needs is a difficult task and is perhaps one of the most important decisions we make. After all, we put our life in the hands of this person.

Here are few factors you would like to consider while choosing your doctor:

DOCTOR DEMOGRAPHY

The age and gender of the doctor sometimes influences our choice. We all have our preference when it comes to age and gender of the doctors. Some women might be more comfortable discussing their health problem with a female doctor than a male doctor. The age of the doctor seems to be important too. An older person might prefer going to an older and more experienced doctor.

DOCTOR CHARACTERISTICS

All doctors have their unique styles of relating to their patients, and as patients we have different expectations of this doctor-patient relationship. Understanding the doctor’s style will help you find your right doctor. Some of us would need a doctor who is an attentive listener, while there would be others who might need some reassuring or others who need comprehensive treatment information.

HOSPITAL AFFILIATION

It is good to know which hospital the doctor is affiliated to. Find out if the hospital has the facilities you are looking. Is the location of the hospital convenient; is the support staff good, does the hospital pricing match your expectations?

DISTANCE FROM HOME

Another factor you would like to consider is how far you would need to travel every time you need to visit the doctor. This is especially true if you do not have proper transportation facility.

WAITING TIME

If time is a constraint for you, it is important to find out the average waiting time for an appointment. You need to find out whether you could get an appointment the same day you call.

CONSULTATION TIMINGS AND PUNCTUALITY

If you are a working family, consultation timings is something you would need to consider. Look out for a doctor who practices after your regular working hours and who is punctual in honouring appointments.

OTHER FACTORS TO KEEP IN MIND

The other relevant factors to keep in mind when choosing a good doctor should be proximity to chemists, pathology lab and the presence of courteous and helpful staff. Careful consideration of the above will ensure that your choice of a family doctor is better informed.

[The writer is a faculty at the Marian Institute of Healthcare Management, Panjim, and can be contacted at orlenedsouza@marianinstitute.in]

Gomantak Times – Weekender, 18 July 2010

Advances in the field of medicine have made the detection and treatment of illness so much simpler. Yet, one feature is sorely lacking — the human touch. Meena Parulekar examines the need for this human element

Kuldeep Mishra, aged 54 years was diagnosed with a block in his right coronary artery a few days back in Mumbai and is advised to go ahead for a beating heart surgery by his cardiac surgeon after considering the severity of the block. Beating heart surgery is a special kind of by-pass surgery in which the heart is fully functional, use of heart-lung machine is not resorted to. Having undergone an angiography and angioplasty a few months earlier in January 2010, he is not sure of what he is heading for this time and needs reassurance from his doctor. The doctor advises him to choose between by-pass surgery or radiation therapy as there is not much time to lose.

For Mishra, however, there are other concerns like his feeling of discomfort with the stent post angioplasty and the nature and risk of bypass surgery. Is it asking for too much to have his doctor brief him about the nature and technique of medical intervention? Can his fears be allayed in some ways to prepare him physically, mentally and emotionally for the operation ahead?

HUMAN SIDE OF MEDICINE

Science and technology together have created wonders for mankind. Drugs and treatments that were thought impossible have today been discovered, tried and successfully implemented. The future is bright for molecular diagnostics, pharmacogenomics, stem cell engineering and the like. Medicine in itself is considered to be a noble profession and requires a certain amount of human touch to make the patient feel better. What, then, is human touch in medicine?

According to Dr Shobha Patkar, a practicing psychiatrist from Mumbai, the practice of medicine is both an art and a science. In the field of medicine, this very art is exhibited from the medical team in the form of empathy which goes much beyond mere words of sympathy.

Eg, “I feel sorry for you” – Sympathy.

“I feel your sorrow” – Empathy

This is precisely known as human touch and is displayed through the behavior of the physician.

Eg: 1) Attentively listening to the patient.

2) Trying to understand his feelings and attitudes.

3) Explaining the plan of action.

4) Allowing him to make choices if rational.

5) Creating an atmosphere of comfort, confidence and involvement to the extent required.

In short, human touch is nothing but genuinely being with the patient throughout his journey of sickness.

Earlier, the practice of history taking and complete clinical examination allowed the physician to know the patient and not merely know the disease. These days, after a quick initial dialogue, the patient is made to run to multiple numbers of experts, investigations and treatment modalities. In the process, the patient loses the primary anchor — the physician with whom he would have preferred to discuss the issues, clear the doubts and make decisions together. No wonder then, he feels not only exhausted, but rejected and helpless, too.

Advanced technology has not spared the doctors who rightfully expect the ‘humane’ approach from patients and relatives.

The so-called aware patient community who acquires information through advanced e-technology tends to doubt, disagree, and distress the doctor — forgetting that the doctor is a qualified and experienced person who has to be discrete and precise. In fact, many a time, a physician has to face legal consequences for not directing the patient to all possible and available diagnostic tools and treatment procedures, though medically not indicated in the opinion of the treating physician.

So, the patient and the doctor, both, have to be cautious and guarded just because mechanical culture is increasingly losing the human touch.

Dr Kalpana Chodankar at the NIO dispensary, Dona Paula, opines that advances in technology do serve as a boon in aiding the diagnosis, but should not stop the clinical examination of the patient, at large. A number of recent advances like mammography, CT scan are useful in terms of early diagnosis and assist in deciding the line of treatment for the physician. This is a huge benefit when one considers the severity of symptoms as manifested during a clinical presentation when it is too late.

IS HUMAN TOUCH NECESSARY?

It can be argued whether human touch is really required in medicine. In any civilized human society, we create, develop and nurture relationships as part of our social identity. In a virtual world, like today, where smileys take over real people in text messages, how much does the warmth of a real smile, a nice hug or a handshake matter?

Today, thanks to telemedicine, it is possible for a diagnosis to be made by a doctor while sitting in his plush cabin without actually having to go out and meet his patient in a remote village or a town in the country. It is technology that has made it possible to have a blood sugar test done in the convenience of our homes, or for that matter, the cardiac activity can be monitored by a simple device worn on the wrist of a patient. These are advances in the realm of technology that have surpassed our expectations.

For a healthcare professional, who has to deal with the human touch in such interventions, some issues that hold prime importance are: Nature of treatment or surgical intervention; availability of resources in the public or private setting; severity of symptoms/illness; co-ordination in terms of healthcare delivery with other services/service providers.

At the end of the day, a patient-centric approach is most desired for all interventions; however every situation/case has its own set of demands and constraints faced by the hospital administrators/doctors who handle their patients in a hospital.

For Kuldeep Mishra, the decision to go in for the beating heart surgery may be tough, but it may actually be the only best possible way to save his life.

The writer is faculty at the Marian Institute of Health Care Management, Panjim, and can be contacted at meena.sahib@marianinstitute.in

Pratibha Kumar’s children returned home from school with a consent form (see below) for her to sign. A cover note from the school accompanied the form informing her that the Department of Health had issued the form and it had to be filled, signed, and returned immediately. No other details were given to her.

Pratibha had never heard of XYZ before, but had heard that some vaccinations were dangerous. Not knowing what to do she called up a few of her friends and asked them what they were doing.

• Some parents said the disease was very dangerous and affected the brain.
• Others said they would check with their paediatrician.
• Others said that there would be no follow up for the booster doses
• Some said the side effects of the vaccinations were dangerous.
• Others felt they were forced to give consent if the child did not have any of the conditions listed in the form.
• Some said they had heard children had fallen ill after the vaccination and had to be rushed to the hospital.

Pratibha was completely bewildered. She did not know whom to believe and was unable to contact her children’s paediatrician. She decided not to give consent and randomly ticked “yes” to item 1 and 6 on the form. However, a nagging doubt persisted about whether she had made the right decision or not. She felt better the next day knowing that others had made the same decision — an article in the local newspapers reported that the vaccination campaign was not a success since many parents had refused to give consent.

Pratibha might have felt better, but for society, failed preventive health initiatives such as vaccination campaigns are a sad but recurrent reality.

WHY DO VACCINATION CAMPAIGNS FAIL?

Why do people refuse to participate in preventive health programs even when the programs are free and conducted at convenient locations? Social scientists, in the 1950’s, developed a list of factors that helped explain preventive health related behaviour. This model known as the Health Belief Model (HBM) provides useful insights that can help us design better preventive health programs and increase the probability that people will participate in them.

People are ready to act if they:

• Believe they are susceptible to the condition (Perceived Susceptibility)
• Believe the condition has serious consequences (Perceived Severity)
• Believe taking action would reduce their susceptibility to the condition or its severity (Perceived Benefits)
• Believe costs of taking action (Perceived Barriers) are outweighed by the benefits
• Are exposed to factors that prompt action (eg, a television ad or a reminder from one’s physician to get a mammogram) (Cues To Action)
• Are confident in their ability to successfully perform an action (Self-Efficacy)

GOOD VACCINATION CAMPAIGNS

Campaigns must begin with the dissemination of information and discussions that engage decision makers like Pratibha, paediatricians, public health specialists, school representatives, and other key opinion leaders.

Pratibha needs to know:

1. How likely is it that her children will develop the disease if not vaccinated against it? Why and to what extent are her children at risk? Does age, where they live, the changing weather, a recent outbreak, etc make them more susceptible? (Perceived Susceptibility)
2. What is XYZ? How severe is it? Is it fatal? What treatments are available? Are the treatments effective? What are the symptoms? How is it spread? (Perceived Severity)
3. How will the vaccination help? How effective is the vaccination? Will the vaccination have side effects? How serious will these be? Is the school equipped to handle any emergency after the vaccination is administered? What precautions need to be taken?

Do the benefits of the vaccination outweigh the risks? What arrangements have been made for the administration of booster doses? (Perceived Barriers and Benefits)

Distribution of consent forms should be one of the last stages of a well-designed program and accompanied by media messages (Cues to Action) that provide Pratibha with the impetus to make a decision. Discussions and information provided beforehand will ensure that she is now confident and capable of making the right decision (Self-Efficacy).

Pratibha Kumar can actively seek out information, arrange discussions groups, ask for advice from experts, and request that she be given more time and information before being asked to make such a crucial decision. The HBM is a useful starting point for her to gauge how much she knows and what is preventing her from making a confident choice.

[Ayesha Gonsalves is a faculty at the Marian Institute of Healthcare Management and can be contacted at ayeshagonsalves@marianinstitute.in]

Goa’s Health: Are we satisfied?

DATE: Sunday, 11 July 2010

TIME: 11:00 am (and at 9:00 pm on the same day)

PANELISTS:

Dr. Sunanda Amonkar (Associate Professor – GMC)

Mr Ashwin Furtado (Graduate, Health Care Management)

Ms Ayesha Gonsalves (Faculty, Marian Institute of Health Care Management)

Dr. Govind Kamat (OBG & Gynaecologist)

A one-hour panel discussion on the status of health care in Goa will feature in Straight-Talk hosted by Juino De Souza which will be telecast is on Sunday, 11 July at 11 am on HCN (Herald Cable Network). The discussion will address the people’s concern regarding:

• Facilities available to the people in Goa
• Efforts towards better health in Goa
• Areas for improvement in the health sector
• Role of the public and private sector towards betterment of health
• Preventive health ventures

There will be a repeat telecast of the programme on the same day at 9pm

Gomantak Times – Weekender, 4 July 2010

When it comes to dealing with a health problem, several medical options are available. From acupuncture to ayurveda to homeopathy, the choice is endless. Giovanni D’Cunha puts his finger on the pulse of alternative medicine

A grandmother, an old aunt, a mother — these were the experts in health from the time we remember.

They prescribed remedies from common cold and fever to wounds that we thought would never heal. Medicine was not considered the exclusive domain of an expert — experience was the greatest physician. Fast-forward to the 21st century and not only do we have a plethora of medicines to choose from, but also a gamut of medical paths we can follow.

FROM RISHIS TO RETAIL

Two major systems of medicine exist in India, what could be called the conventional and the alternative.

The conventional is the modern system of medicine (allopathy) that is scientifically proven and widely used for treating ailments. It is aligned with the pharmaceutical industry that synthesizes chemicals to produce drugs.

This system of medicine is considered the best when it comes to surgery, emergency and trauma. Alternative medicine is a collective term used to describe any form of healing that does not utilize conventional medical practices or use of synthetic drugs and medications. There are several different forms of alternative medicine innovated during the ancient times and is still being practiced in the modern world. In fact, some of them are considered more effective than conventional medicines. It includes acupuncture, ayurveda, naturopathy, meditation, hypnosis, diet-based therapies, homeopathy, and yoga.

However, what started off with the age old practice of concoctions made by the rishis has now developed into a very popular science by itself. There is a strong belief that alternative medicine, which is more cost effective over the long term, works better for just about everything especially for diseases like cancer, heart disease, rheumatoid arthritis, asthma, gastrointestinal disorders, headaches, sinusitis etc. This system of medicine is believed to work by assisting your body to heal itself rather than exposing it to strong drugs. It incorporates a more holistic and empowering healing philosophy that is seen as a natural step in the growth of medicine.

While Goa displays a healthy trend towards increasing numbers of ayurvedic centres, yoga classes and health clubs, ironically it is also becoming the hub for an unhealthy upsurge of lifestyle diseases. Rapid economic growth coupled with a bad diet and sedentary lives has clearly put more food on our plate than we can healthily handle. Most people today opt for a short term home remedy or hop across to a spa for a massage or a yoga session. Some pop a pain-killer as a quick symptomatic cure. None realize the trouble lies much deeper.

WHICH CAP FITS YOU?

People look for the best option to treat illness and have their reasons for selecting one or both systems of medicine. The “conventionals” are people who have a strong faith in the allopathic system of medicine. They believe that medical doctors are the primary healing experts and authorities. The “unconventionals” on the other hand, are those who see illness and health through a different lens. They believe that health is one’s own responsibility.

Hence, they would prefer natural remedies and discipline going by the adage, ‘prevention is better than cure’. A doctor in homeopathy from Mapusa adds, “While ayurveda as a form of alternative medicine has progressed, it is still a niche market with only a few people being aware of it. Both systems of medicine ultimately need to amalgamate — while the alternative would act like a first line of defense, the conventional would be there for a final cure.”

A study recently conducted aimed to find out if there exists a preference for conventional or alternative systems of medicine to treat lifestyle diseases like heart disease, diabetes and obesity. A questionnaire was administered to a randomly selected population of 125 residents of Panjim (above 30 years) since they are more prone to lifestyle illnesses. The results are quite an eye-opener.

There is indeed a polarization between the conventional and alternative systems of medicine when it comes to lifestyle disorders. People favouring the conventional system affirm that it is scientifically proven, provides quick relief and is more effective, while those in the alternative medicine camp argue that it has less side effects, is a long-term cure and more economical. It would be interesting to note, that people with a stronger willpower tend to use the alternative system of medicine over the conventional, since the alternative calls for a greater amount of self-discipline with regard to lifestyle. However, people covered by health insurance would automatically be led to opt for conventional medicine.

THE WAY FORWARD

Why would such a study be of significance to a manager in a health care setup?

• Such correlations could help plan marketing strategies based on patient preference towards a particular treatment.
• Most health insurance providers currently cover only the conventional system of medicine. The time has come when insurance companies need to re-assess the market need and develop customized policies for insurers who may want to be covered for the alternative system as well.
• Government policy formation and implementation needs to consider such preferences of the population to boost the health status of the state.

Alternative medicine is step by step taking center stage where even allopathic practitioners are prescribing these for the intervention of several complaints. The healthcare profession is starting to become aware of the good contributions made to good health by herbs, yoga, acupuncture, massage therapy, and holistic living.

We need to change our attitudes toward the “practice” of medicine. It’s not about “medicine” or treating bad health. It’s about producing good health. Drugs won’t get you there and most of the times they will set you back by suppressing a symptom that is pointing to the real problem. Instead of treating the symptom, treat the cause. The symptom will then disappear. Only then will you experience a true cure. The choice is yours.

[Giovanni D’Cunha is a faculty at the Marian Institute of Healthcare Management and can be contacted at giovanni.dcunha@marianinstitute.in]