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Patient education Libraries are a cost-effective option for providing better quality healthcare

Posted Nov 18 2008 12:14am

In the past, housecalls were an integral part of the practice of medicine, and no nineteenth century doctor would even dream of practicing medicine without making housecealls. However, the fact that they are now practically unheard of means we should be taking a hard look at the present traditional ways of practicing medicine so e can come up with newer models of providing healthcare more efficiently and effectively.

The major bottleneck today in providing healthcare is the doctor. Doctors are expensive and scarce resources and the question we need to ask ourselves is simple – are we using this scarce commodity wisely ? The heart of modern medicine is based on the doctor-patient visit in the clinic – but is this really necessary ? Many problems are self-limited and could be better handled without involving a doctor. Many clinical transactions do not require a face-to-face discussion, and can be better done by email or through the web. Also, patients with chronic illnesses can be taught how to manage their own illness better. How can we create an alternative model, which offers a better option ?

Many attempts have been made in the past – and all of these have revolved around using a substitute for the doctor – for example, a village health worker in India, or a “barefoot doctor” in China. The modern “ retail clinic” in the US which is located in a mall is a variant on this model, since they allow a nurse ( who is much less expensive) to offer care for simple medical problems. However , none of these are very effective solutions, because they still keep the patient dependent on an outsider.

How can we create a more patient-friendly model ? I think we can learn from the education sector. In the past, education meant that children were sent to schools, where the experts ( teachers ) “taught” the children what they needed to know to pass their examinations. Today, we understand that teaching is not just the passive transfer of knowledge from teachers to students. Good teaching involves the active participation of students so they learn to learn for themselves. In fact, this is the major reason why the US has been so much more successful than other countries in the past few decades. In most countries, students were taught using traditional rote learning methods, which means they made great clerks or professionals, but they never learnt to take risks or think for themselves . In sharp contrast, thanks to the national network of free public libraries set up by Carnegie in the US, students here were forced to go to public libraries to do their own research for themselves, so they learnt to ask questions and find their own answers.

I think the health-sector can learn from this model by setting up networks of Patient education libraries to help patients get better healthcare. I agree this is an unusual proposal, but it’s worth examining closely.

  1. This is quite inexpensive to do. For the cost of one new MRI scanner, one could setup over 100 libraries , each equipped with about 100 books and 10 PCs with internet terminals !
  2. Librarians are much less expensive than doctors. They are also far better teachers , because they are used to helping and guiding patrons so they can find the information they need
  3. Patients in a library are likely to be much more empowered . They will not feel scared or intimidated, as they do by their doctor. They will treat the librarian as a guide or peer , which means they are much more likely to craft their own answers and make their own decisions . They will formulate their own treatment plans and stick with these, ensuring a higher degree of compliance.
  4. This is a much more enlightened, participatory and democratic model, which puts patients at the center of the healthcare universe. This is where they belong, but in order to reclaim this place, they need to become well-informed, so they can be treated as equals by their doctors

Much more importantly, this model represents a completely different philosophy – one which respects patients, and teaches them to ask questions and find their own answers. This means patients will take much more responsibility for their own health , and this is especially important for patients with chronic illnesses , who can become “expert patients” and help guide others with the same illness !

How is this different from the traditional “patient education model” where the doctor educates the patient by giving them brochures or showing them videos ?

For one thing, the information is likely to be much more reliable ! Since the librarian has no vested interest in pushing surgery or promoting a particular drug, patients will get objective vetted information about cost effective, tried and tested treatments, rather than the newest , most fashionable ( and most
expensive !) drug which is being actively promoted by the drug companies.

Librarians are good at applying evidence-based medicine because they are information specialists. However, since they do not provide the actual care, they are objective and will act as guides or coaches. This allows a two-tier approach , so that armed with this information the patient goes to the doctor and discusses his options more intelligently . This makes better use of the doctor’s time as well – and helps to keep the doctor honest too !

I need to emphasise that my concept of a library is not just a collection of books in four walls. While it is important that each hospital have a patient education library to which patients can go and to which doctors can refer their patients, a lot of this will be done online as well . Information could be delivered through the web and the mobile and queries could be answered by email; or through a call-center. As clinical decision support software becomes more mature, this could also be used by librarians to help patients think through possible diagnostic alternatives.

Patient education libraries represent a great return on investment, as patients will no longer undergo unnecessary ( and expensive !) surgery; or be pressurized into popping the newest ( and costliest ) version of a drug . Since the information is being provided by someone other than the actual clinician, the information is likely to be much more objective and reliable ! These libraries could also form the nucleus of patient communities ; where patients could get together and support each other with a little help from a librarian.

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