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( By Dr Aniruddha Malpani )

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Chapter 21 - Do patients have a Right to Information?

Being afflictedwith a serious disease is a difficult time 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 rate 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, reduces corruption, 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 official concerned 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 levelling
with their patients. This is why patients feel that 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 U.S., 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 submits a claim for medical treatment expenses against his or her 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.

Information Therapy need not be restricted to just providing medical facts about an illness. By providing information about local and regional medical facilities; the names of specialists; their addresses; and the services they provide and their costs, it can actually also help to clean-up the medical system.

It's a sad fact of life that medical practice has become corrupt today, because consultants, hospitals, diagnostic labs, and imaging centres give cuts and kickbacks to doctors to induce them to refer patients to them. Information Therapy can help to eliminate cuts and provide a lot of transparency by informing patients about the costs of procedures, where these are available, and the names of specialists in that field - both in real life and online. Armed with this information, patients need not feel powerless, and can easily get second opinions and shop around for more cost-effectivtreatment options.

By cutting out the middleman, they can get better quality services at a lower cost.

Empowering citizens with the RTIAct 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 patients to assume a more active and involved role in their healthcare - and this can make for happier patients - and happier doctors!