Patients can contribute to Information Therapy

2nd Annual Conference on Using Information Therapy to Put Patients First in India: Register Now !

What patients can contribute to Information Therapy?

Doctor Sourav Bose was finding it difficult to manage Mr Aditya Rao’s diabetes. Though he had changed the dose of the insulin thrice, his blood sugars remained high. He was at his wit’s end and did not know what to do. He put it down to “non-compliance” and wrote Aditya off as a “ difficult
patient “ ! He failed to recognize that by spending more time with his patient, delving into his lifestyle, and asking him why he was having a hard time with following the treatment plan, he could have come up with an effective solution. Aditya was as much to blame ! He should have discussed the practical difficulties he was facing with taking the insulin injections in his office, as advised by the doctor, instead of meekly accepting his doctor’s advise – and then failing to follow it !

Information Therapy traditionally means the prescription of the right information to the right person at the right time to help make a better health decision. However, if we accept the fact that patients are at the center of the medical universe and that it is patients who are the true experts on their illness, then an equally important part of information Therapy should be the provision of information from the patient to the doctor! After all, communication is a two-way street and the patient’s personal perspective is as important as the medical perspective through which the doctor views the world.

Why has this been neglected so far? Why don't more patients provide Information Therapy to their doctors? This kind of patient education has a long and respected history! While writers have written on what it is like to be a patient for hundreds of years, one of the most important books that taught doctors to re-look at things from the patient's perspective was Norman Cousin's classic, Anatomy of an Illness. In fact, there is now an entire a genre of books that does this very well. This is called pathography - a narrative that gives a voice and face to the illness experience, by bringing the person behind the disease to the forefront!

Pathography is a very useful teaching tool! It helps doctors to learn empathy, so they can learn to see things from the patient's perspective. For example, though I am an IVF specialist, I am not infertile myself. By reading first person accounts of the trials and tribulations faced by infertile couples, I learn a lot about the problems that my patients face – problems that they may not be willing to talk about when they meet me for the first time. All doctors learn medicine from their patients. As Sir William Osler said, ‘He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.’ Unsurprisingly, his best-known saying was ‘Listen to your patient, he is telling you the diagnosis,’ which aptly emphasizes how much a good doctor can learn from a patient!

Doctors usually remember their most challenging patients or their most complex and difficult cases all their life – these often form the defining moments in their professional career. It is true that these exceptional patients teach us a lot and good doctors treasure them, since they learn the most from them. These are a doctor's ‘memorable’ patients - many of whom teach us what not to do ! Intelligent doctors learn from their patients all the time, but this can only happen if patients are willing to teach them! These are the ‘expert patients’ - those who are articulate and treat their doctors as partners in their medical care.

Doctors can learn from every patient, but only if patients learn to speak up, and doctors learn to listen. It is not that doctors are going to learn medical facts from each patient – but each patient is unique and has valuable insights to offer. Patient feedback helps doctors to improve their services, and even complaints are gifts, when taken in the right spirit! Unfortunately, there are still many barriers to getting feedback from patients. Most patients are inhibited and scared and do not have the courage to displease their doctor by telling him the unpleasant truth. If patients want their doctors to do a better job, they need to learn to speak up. Most dissatisfied patients today just walk out of the doctor's clinic and never return. They find a better doctor - but by failing to give the doctor honest feedback, they lose the opportunity to help him improve and do a better job with his next patient. Similarly, most doctors are too busy to ask for feedback, and most continue deluding themselves that they do a perfect job with every patient!

Hopefully, the Internet will allow patients to offer critiques and criticism more easily. There are now many doctor-rating websites, where patients are encouraged to provide their opinion about their doctor. This kind of patient-generated content will help doctors to get their act together, if they are willing to keep an open mind and try to correct problems. Thanks to the Web, smart patients have adopted a number of clever initiatives towards improving medical care. These e-patients, of whom the most prominent is Dave, are speaking up and claiming their rightful place in the healthcare ecosystem, so that patients now have a voice which is heard, and more importantly, respected.

Online patient support groups have a lot of clout – and crowdsourcing the collective experiences of hundreds of patients can actually help advance medical research, as proven by innovative sites such as PatientsLikeMe (www.patientslikeme.com). Patients are also collaborating to fund clinical studies, so that doctors can do research on topics that are of interest to patients , and not just on areas which pharmaceutical companies find remunerative . Patients have also taken a lead role in simplifying medical research so that it becomes understandable to other patients. Cochrane Collaboration (www.cochrane.org) is a fine example of how it is important for researchers, providers, practitioners, and patients to collaborate. 28,000 people from over 100 countries work together to help healthcare providers, policy makers, and patients make informed decisions about healthcare. Such collaboration is imperative in today’s times. When individual knowledge turns into collective knowledge, medical care is substantially enhanced!

Second Pre-conference Seminar: Using Information Therapy To Put Patients First in India

Invitation to

Second Pre-Conference Seminar@HELP on

Using Information Therapy to Put Patients First

on Saturday, 3rd September, 2011at 11.30a.m. at

HELP LIBRARY - Phone: 22061101, 22031133

Pls click here if you are unable to read this email:

Using Information Therapy to Put Patients First

Speaker	Topic
Dr.Taufiq Panjwani	A medical intern’s perspective on the application of Information Therapy.
Dr.Ninad Maniar	Information therapy and the medical student – a feasible symbiosis
Dr.Akanksha N.Thakkar	Using information therapy to effectively deal with neurodevelopmental disorder related childhood stress
Dr.Mihir Gangakhedkar	Information Therapy and Tackling Pandemics In Developing Nations

Health Education Library for People,
National Insurance Building, Gr Floor,
206, Dr.D.N.Road,
Mumbai - 400 001.
Tel Nos.65952393/ 65952394/22061101
www.helpforhealth.org
www.healthlibrary.com

Have a health query ? ASK US FOR FREE - Click here -

Patient as a Teacher for his Doctor

There is no doubt that the one person who will look after his own interests the best is the patient himself. You need to do your homework thoroughly, find out more about your problem, and then discuss the results of your research with your doctor. This is your right and your responsibility as well! Every honest doctor will agree that his patients are his best teachers!

When you play the Role of a Communicator

It is vitally important that you be open and honest with your doctor. When in doubt, ask questions, listen to the answers carefully and take notes. A prudent measure would be to write down your questions before your appointment, so that you do not forget important matters during the stress of consultation. Remember, the only stupid question is the one you don't ask! So, to re-emphasize, don't hesitate to ask questions! And if you don't understand the answers, the fault is not all yours; it could be that your doctor is not explaining the facts well!

Patient Community Meeting : Pre - Conference Seminar

Patient Community Meeting : Pre - Conference Seminar

The first pre-conference was held at HELP on 20th August, 2011.

Young doctors and medical students shared their thoughts on how Information Therapy will help patients and doctors to get better medical care.

Some interesting ideas presented by Dr.Shaivi, Dr.Soumil, Dr.Manasi and Dr.Amar were:

1. The problem is not too little but too much information - how should the patient sieve through all the information
2. Patients are not aware of resources at hand;
3. Support groups are found to be helpful; online support groups equally helpful;
4. What makes the patient happy - is sitting down and talking to the patient - they don't care if the doctor is better known or better qualified;
5. Convert patients from being passive to active
6. Group therapy works better than individual therapy
7. How can IT be used: every hospital should have
- all health information available for patients
- EMR for each patient to help patients and also for research for specific populations
- information should be easily accessible
- translated information
- online access to pharmacies to purchase/refill medicines
- easy communication with your doctor (email/sms)
- obviate need of human communication
- online services should be interactive
8. End Goal of Information Therapy should be Happy Patient ...... Happy Doctor + Staff
9. A website to put up reviews of doctors/services by patients.
10. Arrange the hospital sections to provide a single window to patients for all services including information therapy.
11. Dr.Amar working at Tata welcomed the idea of patient education center at all hospitals.

When you play the Role of a Financial Manager

Medical treatment can be very expensive these days, and you must make it a point to know the costs involved. Many patients are hesitant to talk to their doctor about money matters, but this reluctance can prove to be very costly! Also, if you are claiming reimbursement (either from an insurance company or from your employer) you must make sure that you have complete records of payments made along with their receipts.

When you play the Role of a Medical Record Keeper

You must keep all your records safely, and this can be very helpful especially if you have a complex problem a chronic disease, or need to change doctors or get a second opinion. File all your records in reverse chronological order; and number all your documents in sequences. Also prepare a one-page summary sheet of your medical experiences. Software packages are available nowadays, which help you document all medical details very efficiently.

When you play the Role of a Treatment Decision Maker

You will have to decide which treatment to choose among the alternatives. Sometimes the choices are straightforward, but sometimes they can be very confusing. A good doctor will offer you all the options and help you to decide, but ultimately, you have to exercise your right (and responsibility!) to select a course of treatment. You cannot afford to leave everything to god, or to the doctor either!

When you play the Role of a Medical Team Manager

You will have to find, evaluate, select, hire - and sometimes fire - members of your medical team. As an enlightened patient, you need to remember that you are the one in charge of your body --- and that it's your medical team you are managing!

INFORMATION THERAPY AND THE RTI ACT

2nd Annual Conference

Using Information to Put Patients First in India
Being afflicted with a serious disease is a difficult period for a patient. So when Mrs Shah was diagnosed with cancer, she wanted to know everything from her doctor. “Why do I need radiation?”, “Is there any alternative?”, “What are the possible side effects of such a treatment,” “What stage of cancer is this, and will I be completely cured?”, “What is the success ratio of radiation treatment?” were some of her queries. Years ago, such questions would not even occur in a patient’s mind, and he or she would trust her doctor blindly. Even worse, many doctors would not even bother to explain the treatment options to patients. However, today, just like the RTI Act has made government officials accountable and thus enhanced the relationship between the government and the public, information therapy helps to build a more transparent doctor-patient relationship.

The Right to Information (RTI) act has come as major breakthrough in good governance. It encourages transparency and inspires citizens to be more assertive about their rights, because bureaucrats are now more accountable to the public. Earlier, some government officials abused their power with impunity. They could easily manipulate the ‘rule book’ to suit themselves, as a result of which, ordinary citizens ( who were usually in the dark about their rights) were rendered helpless. However, with the advent of the RTI Act , citizens are now in a position to ask questions – and demand written answers ! The concerned official has no choice but to respond with the needed documentation. This has resulted in a healthy respect for the average citizen among officials and bureaucrats , who now think twice about hiding information from citizens.

If Information Therapy was similarly made compulsory, this would help to improve the doctor-patient relationship as well – after all, good doctors have always been happy to share information with their patients !

Unfortunately, some doctors still do not believe in leveling with their patients. This is why patients feel they are at their doctor’s mercy, and every word from their doctor’s mouth is treated as the gospel truth. When doctors had the upper hand and were used to making all the decisions, this resulted in a paternalistic style of practice. While this might have been advantageous in certain situations, it does not fit in with today’s times. Patients today want to play a more active role in making decisions that impact their lives. They do not like feeling handicapped as a result of incomplete and insufficient information. Good doctors understand the importance of having a well-informed patient and will do all they can in their capacity to provide information therapy. Some doctors may not be so proactive, and will require patients to ask for information before they dispense any. In the US, progressive health insurance companies are making it mandatory for doctors to keep patients in the loop about any risks or complications arising from their treatment, however small or insignificant. Even better, they are actually reimbursing doctors for dispensing information therapy, and this incentive is helping to create a win-win situation for everyone !

There is a great opportunity in India today for the IRDA ( Insurance Regulatory and Development Authority) to make the documentation of information therapy compulsory every time a patient claims for medical treatment expenses against his health insurance policy. This will ensure that patients are kept fully informed , and will also help the insurance company to reduce their expenses, as unnecessary surgery and overtreatment will be nipped in the bud.

Patients have the right to be thoroughly informed about their illnesses. Doctors who invest that extra effort in providing their patients with substantial doses of information therapy initiate a positive cycle , where there is transparency in the relationship. This helps foster confidence among patients , who feel that their doctors are interested in helping them get better, and that the relationship between them is not just a monetary one. Doctors also benefit from intelligent patients who ask questions ! Healthy discussions might reveal some issues that a doctor might have overlooked, which could have resulted in a poor outcome.

Empowering citizens with the RTI Act has helped to encourage them to take a proactive role in governance, thus helping to create a more vibrant democracy. Similarly, embedding Information Therapy within every medical encounter can also help to patients to take a more active and involved role in their healthcare – and this can make for happier patients – and happier doctors!

To register for the conference log on to: www.patientpower.in

When you play the Role of a Medical Information Researcher

The more knowledgeable you are about your problem and its treatment, the better are your chances of getting the right treatment. Educate yourself: you need to become an informed participant in your medical care in order to ask the right questions and to participate in making decisions about your treatment. This step will also help you to critically assess media reports about 'new breakthroughs in medical treatment', and whether these 'breakthroughs' are relevant to your problem or not.

Your role as a Patient

While you obviously have a vital interest in your medical treatment, unfortunately, you lack the specialized medical knowledge and skills to be able to take decisions in this context alone. This is why the concept of a team - which consists of you and your doctor, becomes very important. As a patient, your responsibilities are wide and varied. And you'll need to play several "roles" at various times.

Your Responsibility as a Patient

As a patient, you have to shoulder a wide variety of responsibilities, some of which are as follows:

1. You should provide your doctor with accurate and complete information about your medical history, past illnesses, allergies, hospitalizations and medications.
2. You should report changes in your condition (however minor they may seem to you) to your doctor - don't keep him in the dark!
3. If you do not understand what your doctor says or wants you to do, you should let him know without any hesitation!
4. You should strictly follow your doctor's treatment plan.
5. You should keep your appointments on schedule, and if you cannot do so for any reason, let your doctor know well in advance.
6. You should pay your medical bills promptly!
7. You should follow hospital rules and regulations without fail.
8. You should have realistic expectations of what the doctor can do for you. Everyone would like to get well completely, but one should always bear in mind that the doctor is not a miracle worker.
9. You should help your doctor to help you! If you cannot stick to a particular treatment plan, let your doctor know, so that he can formulate an alternative plan.
10. You should maintain good health habits.
11. You should participate actively in your medical care. Patients who are highly motivated get better faster: in other words, help your body to heal it!
12. You should ask questions to clarify any doubts or dispel any misconceptions in your mind. A doctor or nurse may not know when you're confused, uncertain or just want more information. Therefore, do not refrain from asking questions.
13. You should respect the doctors and the nurses. The medical staff deserves your respect and courtesy: treat them the way you would like to be treated by them!
14. You should not ask for false medical certificates or padded medical bills (in order to get additional reimbursement).

Lost in the health information maze?

Mrs Chopra. 45, was recently diagnosed with diabetes. Her doctor followed the standard protocol, prescribing her medicines, and advising her on diet and exercise. She was not content with the advice though. This was something that was affecting HER body, and she wanted to dig deeper for answers. She wanted to know how she could better take care of herself, and while she respected her doctor’s advice, she wanted more information that would set her confused mind to rest. She did what most patients in India and around the world would do – log on to the world wide web. A casual search for ‘Diabetes’ returned 268,000,000 results, with the first as always being Wikipedia, a helpful but often inaccurate portal. Mrs Chopra did not receive accurate, definitive information on her ailment, with different websites suggesting different measures to control diabetes. Frustrated, she simply stuck to her doctor’s advice. Whether she could have done do more for herself, she would never know.

Fifty years ago, the major problem was that patients had insufficient information. All the knowledge was locked up in medical books and journals, and this information asymmetry forced patients to put their doctors on a pedestal. Patients felt helpless, and they were unable to question their doctors due to their limited knowledge on medical matters. Today, there has been a sea change, but ironically, patients are still helpless! This is because they have access to too much information, a major chunk of which is wrong, inaccurate or outdated. Thanks to Google, patients can effortlessly unearth thousands of pages of information on any topic, but this information is poorly organised and is not put in context, which means that patients often find themselves at sea while surfing the web to find specific answers to their queries.

Why is too much information as dangerous as too little? This is because there is a marked difference between data, information, knowledge and wisdom! Moreover, there is no effective quality control when it comes to the internet which further aggravates the problem. It is common to find two different websites suggesting diametrically opposite things. This frustrates and confuses patients, and they wonder who to trust and why.

How can patients judge whether the information is reliable or not? There have been numerous initiatives to assist them in evaluating the sifting of information but, unfortunately, most patients are not equipped with sufficient knowledge to be able to differentiate between ‘good’ information and ‘bad’ information. The sad truth is that many commercial websites can be well-designed and attractive, but under that garb, the information they provide is completely false. Their primary agenda is to sell you something, and not to educate you, which means it is easy to be misled.

This is where Information Therapy comes in ! Information therapy is the prescription of the right information, to the right person, at the right time to help make a better health decision. Information therapy will both revolutionize the role of information in health care and enable patient-centered care.

What about the role of the government? While the UK and USA governments appear to be on track, the Indian government lags behind in providing the required confidence to patients. The NHS in the UK (www.nhs.uk) provides a comprehensive database for patients, assisting them in self-help. One can easily navigate through the myriad conditions and take the appropriate measures to treat their ailments. There are also links that inform you of the nearest hospitals, pharmacies, GPs, rehabilitation centres and the like. In the USA too, the FDA website (www.fda.gov) does a splendid job of informing and educating patients about the recent developments in healthcare. The section on ‘public health focus’ educates patients about the current trends in healthcare, often warning them of a potentially hazardous product or course of treatment. Moreover, patients in these countries are well aware of their rights, enabling them to make informed choices and adopt a no-nonsense approach to healthcare. In India, such an approach is seriously lacking, and patients are generally left to fend for themselves, relying on information on the web that could take them down the wrong path.

Patients need reliable information – a trusted guide who takes them through the healthcare information maze. Ideally, one’s personal doctor should assume this role, but sadly, most doctors cannot afford to spend so much time. So where do patients turn for help? High quality information can be provided by librarians, who are information specialists, and can help in separating the wheat from the chaff. Moreover, the positive aspect about relying on them is that they have no commercial interest in selling patients anything. The Medical Library Association of USA (www.mlanet.org) has taken phenomenal strides in this direction. It comprises 1,100 institutions and 3,600 individual members in the field of health sciences, all working to ensure that the best healthcare information is available to all.

There are also initiatives that provide quality seals to ensure that the information being provided to patients is reliable and of topnotch quality. An example of this is the Health on the Net Foundation (www.hon.ch). Health insurance companies in the USA such as United Healthcare and Aetna ( website url) invested a lot of time and energy in educating their patients, and it makes business sense for them to produce high quality information for their clients, as prevention is far better than cure. However, Indian companies are still lagging behind and have a long way to go before they can catch up!

To fill this gap in India, HELP has partnered with , Healthwiseto use the latest technology to empower patients. The sole mission of the Healthwise Knowledgebase is to empower patients with Information Therapy! Healthwise helps patients make better healthcare decisions by

1.Promoting self care and helping them to do as much for themselves as possible.
2.Providing them with evidence-based guidelines, so that they can ask for the right medical treatment that they need – no more and no less.
3.Equipping them with veto power, so they can say ‘No’ to medical care when they don’t need it, thus preventing overtesting and unnecessary surgery.
The Healthwise Knowledgebase (www.informationtherapy.in) is a free database that acts as a virtual guide, enlightening patients on their ailments, so they can take the right path to healthcare. One can also log on to the Health Education Library for People website (www.healthlibrary.com) where one can ask any question about a particular ailment

What of the future ? With advances in telemedicine and internet penetration and speed, it’s possible that the web will allow patients to access an online virtual doctor with impeccable bedside manners, who can guide and reassure patients , enabling them to take informed choices about their health!

The Ideal Doctor's Code of Practice

The People's Medical Society in the USA encourages doctors to display the following code of practice in their clinics. This code comprises are excellent guidelines for all doctors to follow, and you might consider sharing it with your doctor!

The code runs as follows:

I will assist you in finding information resources, support groups and health care providers to help you maintain and improve your health. When you seek care for specific problems, I will abide by the following code of practice:

1. I will post or provide a printed schedule of my fees for office visits, procedures, testing and surgery, and provide itemized bills.
2. I will provide certain hours each week when I will be available for non-emergency telephone consultations.
3. I will schedule appointments to allow the necessary time to see you with minimal waiting. I will promptly return your phone calls and inform you if your test results.
4. I will allow and encourage you to bring a friend or relative into the examining room with you.
5. I will facilitate your getting your medical and hospital records, and will provide you with copies of your test results.
6. I will let you know your prognosis; including whether your condition is terminal or will cause disability or pain, and will explain why I believe further diagnostic activity or treatment is necessary.
7. I will discuss diagnostic, treatment and medication options for your particular problem with you (including the option of no treatment) and describe in understandable terms the risk of each alternative, the chances of success, the possibility of pain, the effect on your functioning, the number of visits each would entail and the cost of each alternative.
8. I will describe my qualifications to perform the proposed diagnostic measures or treatments.
9. I will let you know of organizations, support groups, and medical and lay publications that can assist you in understanding, monitoring and treating your problem.
10. I will not proceed until you are satisfied that you understand the benefits and risks of each alternative and I have your agreement on a particular course of action.

Promoting Information Therapy in India

All does not seem to be well with the Indian healthcare system. To put it succinctly, it has become sick. Today, doctors assume the role of illness specialists, and not healthcare experts. India appears to be crumbling under the increasing demands that the burgeoning population is putting on the healthcare infrastructure. But is there a way out? Is there a plausible solution to this very real crisis? Yes, there is one, and it’s got a name – Information Therapy. The right information at the right time for the right person can be a powerful medicine!

However, this concept is still in its infancy in India. When people talk about the problems facing Indian healthcare, the primary focus is on the shortage of doctors, and how we need to invest more money in training new ones. While opening medical colleges is rather profitable for politicians (which is why they do this all the time), this does not address the underlying issue. More doctors just create more demand for medical services, and much of this medical care is unproven, unnecessary and expensive! Too many doctors often leads to overtesting and overtreatment – and not always to better medical care !

Our initiative, Health Education Library for People (HELP), has adopted an innovative approach. Conceived over ten years ago, it’s India’s first patient education library. Our website, www.healthlibrary.com, focuses on empowering patients with information. As time progressed though, we realized that this was not sufficient. The entire ecosystem needs an overhaul to fix the underlying issues that plague healthcare in India.

What is the point in educating patients if their doctors themselves do not have access to reliable information? In India, the tragedy is that doctors rarely bother to be abreast of the latest advancements in healthcare. A majority are content with depending on their friendly medical representative and attending conferences sporadically. With the phenomenally rapid advances that occur in medicine on a regular basis, their knowledge base is shockingly confined to outdated medical textbooks. Precious few invest in buying new editions of these textbooks or subscribing to medical journals. This is why our next step , in partnership with Elsevier, the world’s largest medical publisher , was to provide the MDConsult database – the world’s largest online medical library, with over 100 full-text medical books and journals, to Indian doctors, at half the price that US doctors pay.

Then, another aspect of the problem dawned upon us. While many Indian patients spend hours online scurrying for information, much of the content provided by Indian hospitals is devoid of any real, definite value to the patient. An example of this is evident in the contrast between the Apollo Hospital and Mayo Clinic websites! Our next initiative has been to tie up with Healthwise, USA, the market leader in providing online patient educational content, so that Indian hospitals now have access to affordable and reliable content for their websites.
We have also realized that there is a major shortage of graphic content designed for Indian patients. This is why we have invested in PEAS (www.peasonline.com), the market leader in making patient-friendly content for patients in India. We feel this market is now set to boom, as more and more patients demand reliable, easy to understand educational materials from their doctors and hospitals.
While there are millions of Indian patients online, where are all the doctors? To address this, we have invested in Plus91 (www.plus91.in) to help encourage doctors to publish their own websites. We have made this process easy and inexpensive, so that every Indian doctor can establish his or her own digital clinic. We hope this will help set up a positive cycle.
The road ahead is still a long one, but one that’s filled with promise. And our ultimate goal, a superlative Indian healthcare system, makes the journey all the more worthwhile. This book is one step in that direction. Our next action steps are to invest in companies which provide e-learning courses for patient education, mobile smartphone apps for educating patients, and companies which will create content in Indian regional languages – a completely untapped, but huge market!

These are exciting times, and we are happy to be playing such an active role in this transformation!

Be Careful

Remember you have only one life, and you may not get a second chance to rectify a medical mishap. Many patients (or their relatives) who are victims of adverse medical outcomes, later regret not consulting another doctor, but by then the damage has already been done! The best method is to avoid a problem in the first place - by getting a second opinion!

Important point to be noted

An important point to be noted is that a second opinion should be sought under certain circumstances:

* If surgery is recommended. About 80 per cent of all surgery is elective (i.e., performed on a non-emergency basis). Recent studies have shown that one out of five operations is not really required -- what is considered 'unnecessary surgery.' A second opinion can definitely prevent you from becoming an unsuspecting victim of an overenthusiastic surgeon's knife!
* If the diagnosis reveals a rare, potentially fatal, or disabling disease. The original diagnosis could be incorrect and may need to be revised. Or, even if it is correct, there may be new or experimental treatments available at an institution specializing in the treatment of such a disease.
* If your symptoms persist unrelieved and the doctor can provide no satisfactory explanation for them.
* If the risks and benefits of the proposed procedures are not satisfactorily explained. The patient has a right to know the details about risks and the cost involved and the potential benefits of any procedure, test or surgery. It is preferable to get the relevant details in writing, so that you can digest them at leisure.
* If the diagnostic procedures seem unnecessarily complex or expensive, or both. Some doctors are prone to making excessive use of technology in borderline situations, either due to insecurity or to protect themselves against malpractice litigation.
* If the patient lacks confidence in the doctor's ability to do all that can reasonably be done. Effective treatment demands trust, and a lack of trust is as valid a reason as any other for getting a second opinion.

Other Sources for a Second opinion

You should also keep in mind that there are other ways of getting a 'second opinion' apart from going to another doctor. Presently, many sources of information can be tapped to verify and countercheck your doctor's opinion; for instance, health books and encyclopedias (all of which are available free at the Health Education Library for People, Bombay) as well as the Internet! For example, you can "Ask the Doctor" at www.flora.org/ask-doctor/, a free site which forwards your medical queries to specialists from all over the world, who then give their respective opinions on your problem.
You can also log in to our website – www.healthlibrary.com for any health related queries.

Second opinion from an Alternative Medicine specialist

Remember that it is also possible to get a second opinion from a doctor who practices alternative medicine, for example, homoeopathy or ayurveda. Such an opinion will provide a completely different perspective of looking at a problem, and you may prefer this alternative.

Excellent source for a Second opinion

An excellent source for getting an objective second opinion is the medical faculty of public hospitals - government or municipal. This source, unfortunately, has been grossly underused. The staff members here are basically academicians. Since they teach medical students and residents, they are usually well read and well informed. Moreover, since they do not have a financial stake in providing you with advice, their information is likely to be reliable and accurate. Of course, this procedure does involve the bother of waiting for a long time to get to see the doctor, but this wait is often well worth the effort!

What to tell and what not to tell your second doctor?

A crucial question is: Should you let the expert know your first doctor's opinion? Many patients do not tell the specialist that they have already consulted another doctor, because they want an unbiased opinion. However, most doctors do not appreciate patients who play games with them. It's far better to be forthright and explain to the expert that you are looking for a second opinion, so that he can explain the pros and cons of all the available options.

Looking for a Second opinion, but where?

Keeping all the foregoing factors in mind, the question then arises: From whom should you get a second opinion? You should seek a second opinion from an expert who has the courage to give you an unbiased independent conclusion. Such an expert would, obviously be difficult to find, but it's well worth searching for him!

Doctor’s insecurity over referring for second opinions

They can even ask the doctor (whom they are consulting) himself to refer them to a second or even a third doctor for further consultation. No competent doctor will feel threatened if a patient wants a second opinion! However, many doctors in India do have reservations about referring a patient seeking a second opinion to someone else, as they are worried that the new consultant may 'snatch' their patient away. To solve this problem, some countries abroad have set up specialized second opinion clinics which consist of senior experts who have retired from active practice, but who use their experience wisely to provide unbiased second opinions! Many doctors are happy to refer their patients to such clinics, because they are confident that they will not lose their patients in the process!

Take a second opinion for Yourself!

However, by getting a second opinion, patients should realize that they are not casting aspersions on a doctor's competence or judgment, but are rather adopting a responsible attitude towards their own health and well-being. All patients have a right to seek a second opinion, and certain circumstances may arise in which it would be appropriate, if not mandatory, for them to exercise this right.

Anxiety for a Second opinion

Many patients also worry about getting a second opinion on their own accord. For one, they are apprehensive that if their first doctor were to find out that they have gone in for a second opinion, he may be offended. Another source of anxiety is the confusion that would result if they get differing opinions; they are worried they would not know what to do when confronted with such a situation. Most patients are quite passive and they tacitly feel that it much easier to trust their doctor and do whatever he suggests, rather than go through the trouble of getting a second opinion.