An interview with Dr. Pradeep Gadge

It is easy to trash all doctors as commercially-minded. However, India has a number of doctors who go beyond just healing their patients. They take the effort to guide patients and get them involved in their care. These doctors are part of the patients’ family.

In this post, we introduce one such doctor, Dr. Pradeep Gadge, and share our Q & A with him.

Dr. Pradeep Gadge holds an MD in Medicine, DPH, Diploma in Diabetology, and FRSH (London).

He practices in Mumbai and has positively impacted the lives of over 50,000 patients. This includes treating over 3,000 pregnant diabetics and over 1,000 diabetic children. 

Dr. Pradeep Gadge is known for treating diabetic patients and taking initiatives to educate people about diabetes care. In his own words, the one thing he is proud of is “The unbiased relationship and trust I share with my patients.”

You can learn more about his clinic from here.

Excerpts of the Q & A

Q: Doctor, let me take you back in time. When did you start laying emphasis on educating patients?

See, there’s no such separate phenomenon like “patient education”, I mean for me personally, the journey began much earlier. It wouldn’t be wrong to say that since the day one of my practice, I’ve been actively supporting, empowering, and educating the patients I meet.

Q: That’s interesting. But, even when you started,  it must be an uncommon thing for a doctor to actively educate patients. Is there any trigger that made you start educating patients?

As we all are aware, any patient who suffers from any disease is loaded with too much information, and a list of Do’s and Don’ts from their friends, family, and colleagues.

Diabetes is one such disease where patients have their own beliefs. For e.g. certain food like karela can cure diabetes.

When I came across all these beliefs that the patients had, I realized it is not just medicine that can treat or control diabetes for long term. Rather, educating patient about the facts and making them inclined towards the right practice of managing their diabetes effectively is what helps them. I started taking efforts towards educating and spreading awareness amongst the patients and updating them with the recent and new schools of thought.

Q: Doesn’t spending time in educating patients reduce the number of patients that you see in a day?

Like I mentioned above, for me patient education is a part of the process. It comes as a byproduct of my treatment. And from what I’ve learnt, that is exactly what sets me apart from the other doctors. It encourages my patients to not only start believing in me, but also make other people around them believe me too. This actually adds to the number of patients I see, rather than reduce.

Q: I am curious. How does spending time and effort on educating patients help you in providing patient care?

Basically, bursting some lethal myths amongst patients helps. For example, having two meals a day can have bad consequences on their health. Each diabetic patient is different. I convince people to have small and frequent balanced meals without fasting or feasting. This helps them in controlling their blood sugar levels more smoothly. This approach avoids diabetes related complications and helps me in devising an effective treatment strategy.

Q: What benefits do you expect to see in patients by educating them? Can you share instances of the benefit that accrued to patients due to patient education?

I often quote this, “The most common symptom of diabetes is NO SYMPTOM” which basically means diabetes is diagnosed at a very late stage along with complications. A simple use of glucometer has helped patients diagnose their diabetes at an early stage, avoid complications, and contribute to an early start to his treatment.

Q: Hmm…How do you expect educating patients to help your practice?

The answer to this question is in continuation to an earlier one. See, when a patient is well educated and starts following the correct guidance, it will automatically translate into a positive health outcome. For example, most patients think that jaggery can be consumed by diabetic patients and it is not as harmful as sugar. But, that’s an incorrect piece of information. Once they understand that both come from sugarcane that has a high glycemic index which can spike their blood sugar levels. Now once this is well understood, they will make sure that they will avoid both jaggery and sugar, the next time, which will in turn help in controlling their blood sugar levels and avoid further complications.

And honestly, that’s what I wish to achieve through my practice, to have patients lead a healthy long life without any complications.

Q: Doctor, it’s good to talk about educating patients. Is there a method to this education? Do you have a defined process for educating patients?

My strategy to educate patient is very simple: To educate the patient in a language they understand and in a very basic manner. Showing scientific evidence and talking to patients will not work always.

For example, if a patient asks me what is the difference between type 1 and type 2 diabetes, I usually give them an example of a lock and a key – lock is body cells and key is the insulin. The guest coming to your place is the glucose.

In type 1 DM, the key is lost, so you buy a new key.
In type 2 DM, the key is rusted, so you repair it.

I also believe that along with explaining in simple language, it is very important to add humour to the conversations with the patient. See, diabetes by itself can be very depressive where a patient goes through a lot of psychological issues. Hence, I add fun to the conversation.

Q: The type of educational content that patients require differs with the stage of their journey for the protocol you choose. So, what is the typical patient journey and how does patient education fit into the journey?

I will give you an example. A patient, let’s call him XYZ, 8 years old, gets diabetes and gets started on insulin three times a day. His parents come to me with the hope that I’ll stop their child’s insulin.

Here, I need to educate the parents about the kind of diabetes their child has, why is it different from other diabetic patients, why he has to take insulin life long, why medicine will not work in his case, why he needs to monitor sugars more frequently. Appropriate counselling the parents plays a vital role in the management of diabetes for this child.

Thus, I counselled them and guided them to join JDF (Juvenile Diabetes Foundation). JDF is a registered trust that was set up in 1982 by a handful of doctors and parents of a few insulin-dependent diabetic children. The objective of the foundation is to provide moral support to diabetic children and youth, apart from catering to the physical, emotional, psychological, and medical needs of its members.

As a result, today, both the parents and the child are well updated with the condition and have accepted it in a positive way. They are living a healthy life without thinking of it as burden or disorder.

Q: It is my personal belief that the education process is best not left to the skill of the educator. So, what tools and assets do you use to educate patients?

That’s right. We use multiple tools and techniques. We have been actively hosting events such as “Diabetes Mela” and “Aarambh” for patient awareness. Recently, we also organised a specialized event, “Annual Sports Day” to imbibe the importance of exercise amongst diabetic patients.

Besides, as a everyday practice, at our centres, we arrange talks by diabetes educators, fun playing games, quizzes, etc. Apart from this, I’ve been constantly creating content over social media that empowers the drive.

Q: That’s nice to hear. All the same, how do you ensure that your patients rightly understand your messages?

Honestly, I take feedback’s from the patients.

For example, a patient comes with high post prandial blood sugar levels and gives blood sample two hours post-heavy breakfast.

We make him understand how this is a wrong approach & guide him towards the correct method. Owing to this, next time the patient makes sure he’s following the correct route and observes that blood sugar levels have gone down as compared to the previous reports. This boosts his confidence and he does it in a proper way.

Q: Do you see any opportunities for improvement in your education process?

Yes, the most common problem amongst the patient is that they are updated with half knowledge which is dangerous. They do not know the exact science or logic behind it.

So, we use many mediums through which we educate patients like doing activities, giving talks, playing skits, etc. But I feel that not only the patient, but their relatives and common people who are not the patient should also be updated with authentic knowledge.

Thus, I aim towards educating the mass at larger scale through various means of social media like Facebook, LinkedIn, Instagram, Twitter, and YouTube. I strongly believe that social media is an extremely powerful platform to connect with the masses and educate them towards right direction, and this includes reaching out to all age groups.

Here are his social media accounts and handles. Feel free to use these to connect with him.

Facebook | LinkedIn | Instagram | Twitter | YouTube

How I prescribe Information Therapy

My patients, Mr and Mrs Gupta, are sitting in the waiting lounge of my clinic, awaiting their turn. The usual gamut of magazines is in front of them. But do these serve any purpose?

Instead, my receptionist gives them a comic book about IVF so they can learn more about their treatment options. This puts them in a better frame of mind and many of their doubts get resolved even before they come in. The beauty of Information Therapy is that it can be used in many innovative ways!

I proactively use Information Therapy to clear doubts and answer questions. This helps ensure that everyone is on the same page. Since I provide this information, patients are reassured that I am open and transparent.

Information Therapy needs to be embedded in clinical workflow, and we start providing Information Therapy well before the patients come to us for a consultation.

The internet has become an important source of health and medical information. However, a significant amount of health-related information on the Web is inaccurate, unreliable, or untrustworthy. By creating our own content, we can direct patients to information that is of high quality, appropriate to their condition, and consistent with our approach to treatment. This helps them to save time and stops them from getting confused or misled. Patients still depend on doctors to provide the most credible answers to their health questions.

All our educational materials help to ensure that patients have realistic expectations of their treatment. While it is true that our success rates are excellent, it is also a fact that the outcome of any IVF cycle is always uncertain, and patients need to be prepared for failure. Reading about this in black and white helps them to understand the limitations of our technology.

We know that different patients have different learning styles, which is why we use diverse tools to deliver Information Therapy. On our site at www.ivfindia.com, we have developed a wide variety of educational tools, including e-learning courses, animated cartoon films, games, and you tube movies. Providing this kind of Information Therapy has helped me to become a better doctor. It ensures that I look at the world through my patients eyes, so it is easier for me to be empathetic. Also, since we help patients to have realistic expectations, they dont get emotionally shattered if the cycle fails, and they are able to cope better with the emotional roller coaster ride that often accompanies IVF treatment!

Patient Education and Websites

Every doctor, clinic, or hospital with a website also has pages that provide patient education reading material.

While the pages that talk of the doctor profiles, the departments, the location, etc. are visited regularly,the reading material pages are not frequented. So, despite healthcare professionals and experts taking the time and effort to publish content, the material is not read. All this, while the public continue to search for information over Google!

 

Doctors call such people the Google Patients and such patients get on the nerves of doctors with their inaccurate information!

Thus, at one end, we have doctors who take the effort to create material to educate patients. At another end, patients do not read the material the doctors write for them and choose to say that doctors don’t guide patients properly.

What doctors need to do is to integrate their content with the care journey of the patient. Soon after their consultation, just as they write the prescription for medicines and tests, they should also prescribe their own information or the information from web sources that they can vouch.

The advantage is that patients get reliable information from the person they consulted. They also get only the information that is needed at that point and not a mountain of information that need to wade through.

 

 

 

Doctors, Patients, and Practice Management Software

Image result for doctor with computer

A software is a technology product. I would expect it to provide benefits to its direct or indirect users.

However, when I see a computer system in a clinic OR the signage of a PMS provider outside a clinic, the thoughts that run in my mind are that this doctor has/is:

  • Licenced a software
  • Bought a few desktops/ laptops
  • Bought related hardware
  • Hired people to maintain and operate the app
  • Paying AMC for the app and systems

Consequently, this doctor will be charging me more than what he would have otherwise charged!

Does it help me, as a patient, in any way if the doctor has a PMS?

Let’s look at it from the doctor’s point of view.

Typically, a PMS app provides the following features.

  1. Appointment booking
  2. Consultation Record Maintenance
  3. Consultation Fee Receipt Printing
  4. Prescription Printing
  5. Communication to Patients

Does the PMS help him to reduce costs, or improve patient care, or get increased consultations?

This is not to say that a PMS is unnecessary, but, my question is what is its value to patients and doctors? What is its role in the patient-doctor relationship?

If you develop and market PMS, I would like to talk to you.

You are literate, but are you health literate?

Medicine, as both a science and art, often requires choices and there are no “right” answers – you need to make your own decisions – after all, it’s your life. While you obviously have a vital interest in treatment decisions and outcomes, unfortunately, you lack the medical knowledge and skill to be able to decide alone.

This is where the concept of health literacy comes in; so you and your doctor can function as a team.

Does all this talk about health literacy sound too abstract? Then let’s make it personal!

Do you know the difference between LDL cholesterol and HDL cholesterol? Can you make sense of your hospital bill? Do you know which health insurance policy offers you the best deal? Can you decipher your doctor’s medical gobbledygook? Do you know how to get a second opinion? Do you generate respect in your doctor? Are you empowered enough to hold a discussion of your illness? Have you ever commented with complete knowledge on a healthcare issue?

Health is an invaluable asset and you are given only one body. It is your duty to take the best care of it possible. Although having an expert doctor by your side is very helpful, you cannot outsource this responsibility to someone else. Your doctor cannot solve all your healthcare problems!

Just as financial literacy can help you to become wealthy, health literacy can help you to stay healthy. Remember, all the wealth in the world means nothing if you are not healthy. Healthcare today is complicated and the health care system can be confusing but health literacy can help you to deal with it effectively. If you have low health literacy, you do not have to panic, because it is a condition that is easily treatable and beatable.

Treating low health literacy can improve your ability to get the best medical care.

A doctor’s advice to a fellow-doctor on branding

A strong brand identity that is built and protected over time can create a long-term, consistent image of quality and value. Inevitably, you will attract more patients, based on how you have influenced them with your branding strategies.

Those doctors who take branding action now will be tomorrows leaders.

What about using advertising to attract more patients?

It’s well known that the most effective form of advertising is word of mouth. How we care for our patients and how they perceive our care is what brings us more patients. The next best form of advertising is to our colleagues, by communicating our experience and expertise via scientific presentations and/or publications. In the past, this much was enough.

The Code of Ethics of the Medical Council of India still does not allow doctors to advertise, and most senior doctors in India look upon advertising with suspicion. After all, doctors are professionals – why should they behave like shopkeepers in order to attract customers?

However, times have changed, and we need to change with them. Gone are the days when patients had a family doctor whom they could blindly trust, and who would provide medical care for them from cradle to grave. Today’s reality is that medical care is often provided on a fragmented, piecemeal basis by numerous specialists, and the patient needs to learn to get the best medical care for himself. This is why it is so important that he has access to information on available doctors so that he can select the best one for himself.

Most doctors feel that advertising is unethical, but we need to look at the reality more carefully.

How are young doctors who have just started practise going to get patients?

How will patients know of their skills and their expertise?

Many young professionals, who have spent long years to qualify and taken loans to start practise, simply cannot afford to sit back and starve till patients arrive on their doorstep. This is why new doctors feel they have to resort to unethical practices like cuts and kickbacks today, many of which have been institutionalized by their seniors. It is more honest to allow them to attract patients by allowing them to advertise; at least this is open and transparent.

Preventing advertising favours senior doctors, those who have an established reputation, with many hospital attachments, and lots of patients. They will do their best to maintain the status quo by prohibiting advertising; not to protect patients as they claim, but to prevent new doctors from competing with them, thus safeguarding their own interests.

In the absence of advertising, the next best situation is to educate and engage with patients, the public, and the community, to build a practise.

Advise to Patients from a Doctor

No one likes to fall ill, and as a logical extension, most of us don’t like going to the doctor.

A visit to the doctor also brings back childhood fears of painful injections and unpleasant blood tests. Thus, it is no surprise that a medical clinic is second to unpopularity only to a dentist’s chair! Consequently, most of us do not make the best use of our doctors; we tend to use them as crutches only when we fall ill. However, one should never forget that the doctor-patient relationship is unique; since it is the ultimate one-to-one relationship, in which you confide fully in your doctor and entrust him with your life, you must learn to work as a partner with your doctor!

In order to foster and nurture the relationship with your doctor, treat it with great care and respect.

Don’t forget to say thank you to your doctor when you get better. He gets fed up of attending to droves of patients
with complaints, all day long and would be delighted to hear a patient appreciate his efforts! Unfortunately, this common courtesy is something we often forget; patients tend to remember the doctor only when afflicted by an ailment. This simple expression of gratitude by you will help the doctor to remember you as a person, rather than as just another case. He is likely to then treat you as a special patient and getting VIP attention from him helps improve your medical care a good deal! As in a marriage, the doctor-patient relationship depends on good communication and trust built up over time and it is definitely worth spending time and taking the trouble to maintain a beneficial relationship. Remember that the doctors’ staff plays a key role in your medical care and you need to learn how the clinic functions.

It’s very helpful to build up a rapport with a special staff-member (who can be a receptionist, a nurse or an assistant), and this can prove to be very useful when you need to talk to the doctor on a priority basis. The simple rule is that if you treat the staff well, you will be treated well too! A small thank-you gift for the staff can help ensure that you get personalized attention. It’s useful to learn which days are the busiest and what times are the best to consult the doctor. You should also find out what steps to take if there is an emergency, or when the clinic is closed.

Patient Safety Comes From Patient Empowerment

When we think of medical errors, we think about the mistakes which doctors and nurses make when taking care of patients.

However, it is not uncommon for errors to be caused by clueless patients and poorly informed caregivers as well. The first conclusion that most people jump to when a medical error occurs is, “It was the doctor’s fault!”

Patients still think of themselves as being passive recipients of medical care who are at their doctor’s mercy. However, you need to take an active role in your medical treatment and behave as an enlightened partner, after all, your doctor is not a veterinarian!

Patients can be the first line of defense against errors, and there’s a lot you can do to protect yourself. Patient safety is not just the doctor’s responsibility, it’s the patient’s as well. Patients must play an active role in preventing medical mistakes. One of the commonest mistakes patients make is that they leave everything to their doctor. This kind of passive approach may make sense during an emergency but is completely flawed for most elective medical treatment.

An empowered patient assumes responsibility for managing his or her health, and this reduces the risk for errors.

For example, he or she will call the clinic and makes sure to get the results of the lab tests, the doctor has ordered, rather than wait passively for the clinic to say that the results are ready! When patients actively participate in the treatment plan because they have crafted it in partnership with their doctor, they are much more motivated in complying with the doctor’s advice and this helps reduce the risk of slips and mistakes.

Using the acronym SPEAK UP, JCAHO (the Joint Commission on Accreditation of Healthcare Organisations, USA) has developed a set of steps that patients and their families can follow to ensure that they have a positive healthcare experience.

S: Speak up if you have questions, or if you don’t understand something;

P: Pay attention to the care you are receiving, including medications and treatments. Don’t assume anything;

E: Educate yourself about your diagnosis, the medical tests you are experiencing and your treatment plan;

A: Ask a trusted family member or friend to advocate for you;

K: Know what medications you take and why. This is especially crucial because medication errors are the most common of healthcare errors;

U: Use a healthcare organization that has been evaluated against current quality and safety standards;

P: Participate in all decisions about your treatment.

Family Physician’s Role in Patient Care

Dr. Gayle Stephens says, “Family physicians know their patients, know their patients’ families, know their practices, and know themselves.” Stephens emphasizes patient management, distinguishing it from treatment, saying managing implies, “alleviating most effectively the total impact of illness upon that person.”

Family physicians are usually the first point of contact during an illness. Unlike other medical specialists who focus on specific diseases or organ systems, family physicians specialize in seeing patients who may present with multiple problems that are not slotted into a particular system. Ideally, family doctors have a long-standing relationship with their patients and therefore have a sound basis of understanding the patient’s perspectives and needs so they can offer options that meet their best interests. They have a holistic perspective because they are taught to put the patient first. Globally, healthcare systems that are considered to provide the best quality care are the ones with strong primary care, driven by family physicians.

Dr. Jaya Bajaj writes, “I grew up in a small town and had the privilege of experiencing the kindness of our family doctor. My siblings and I received all our vaccinations at his clinic and he would graciously make home-calls when one of my grandparents got sick. I remember him sitting next to me, reassuring that “everything will be alright” when I got sick during my HSC board exams. When my grandfather developed heart disease, he helped my father arrange medical care for him in the nearest town. He was always available for answering our questions during the long hospitalization of my grandfather. He even travelled to the hospital when my grandfather was getting discharged and discussed the prognosis, discharge instructions; medications etc. with the consulting cardiologist that he then proceeded to explain to my father in simple terms. Any surprise that he took care of three generations in our family?”

Healthcare has a language of its own. Many times healthcare professionals don’t realize how insidiously medical acronyms become a part of their normal lingo. A family doctor who is aware of his patient’s health literacy can explain the diagnoses in a language that the patient can understand, and prepare the patient for the next course of action. An important part of this role is helping to curate and interpret the almost overwhelming amount of information available to patients today, thus helping them make intelligent personal choices for their own care.

Ensuring continuity of care

An engaged patient-doctor team is needed to ensure continuity of care. A huge proportion of medical errors can be attributed to communication breakdowns because of healthcare silos. A family doctor can function as a team leader, coordinating care between the patient, family members, caregivers, and multidisciplinary healthcare providers, thus ensuring clear communication and continuity of care. This is very important for providing patient-centered care.

Doctors, Please Create Effective Partnerships With Patients

Information on its own is sterile. It needs to be put into action in order to be of any value.

Doctors, your first question should NOT be “What do I want my patient to know?” but “What do I want my patient to be able to do?”

Look at your clinic through your patients’ eyes by putting yourself in their shoes.

Patients come to a clinic, ill, scared of doctors and are worried about how much the treatment is going to eventually cost.

Creating a patient-friendly environment will go a long way towards establishing a healthy partnership and engagement with patients, which will lead to better health outcomes. The key to patient engagement lies in ensuring that physicians help patients to help themselves.

Doctor consultation is the primary bedrock of clinical medicine, and each consultation is a learning opportunity for both the doctor and the patient which, in turn, builds up `learning capital which has both individual and community benefits. Both patient and doctor, benefit by learning from each other. Encouraging patients to take control when they are ill is the need of the hour. Paternalistic styles of practice tend to create unhealthy dependency and undermine self-reliance. Promoting involvement and a sense of ownership of their health care could be the best way to ensure that people adopt healthier lifestyles.

“Patients are at the heart of the health service of the future. The principle of patient and user involvement has become ever more important and the health service has moved beyond an `informed consent to an `informed choice approach.” (Wanless Report, 2002).

Lots of doctors give their patients educational hand-outs and brochures and feel they have done their job as far as educating their patient goes. The problem with this approach is that the written word is not interactive. It cannot:

  • Answer questions that the patient asks
  • Provide alternate ways of explaining things
  • Be easily understood by the readers if their reading level is too high

What’s more, while creating suitable patient educational materials in plain language is an important step in the right direction, it is not enough. Please do not blame patients with limited literacy for their lifestyle and health practices. Low literacy limits opportunities and resources and reduces the control they have over their lives.

They do not have the luxury of being able to make informed choices about their lifestyle. They feel powerless and helpless – and they often are. Please don’t wash your hands off their problems or treat them as second-class citizens -they need your help and kindness much more than other patients do, simply because they are feeling vulnerable and lost. If you treat them with respect, your staff will also do so.

Most doctors feel they have excellent bedside manners and communicate well with their patients, so they think they do not need to worry about these fundamentals! However, as George Bernard Shaw pointed out, “The main problem with communication is the assumption that it has occurred.”