Helen: Hello. Welcome to Health Literacy Out Loud. I am so excited to be here in Mumbai, India, at the HELP library. Please introduce yourself.
Dr. Malpani: I am Dr. Aniruddha Malpani, the founder and medical director of the Health Education Library for People.
Helen: That’s called HELP. That’s pretty clever. You are a physician and you founded this library. I know you care about health literacy. That’s why we are meeting. You asked me to come to India to do some work with you and to speak at a conference about health literacy.
I have a few questions for you. Let’s take it from the top. Why does health literacy matter so much to you?
Dr. Malpani: I think it matters to every physician because what we do day in and day out is talk to patients, help them get better and operate on them. Health literacy is such an integral part of our DNA, but it is a term which is unfamiliar to us because we don’t realize its importance.
Part of the problem is that most of us as doctors think our bedside manners are great. We explain everything and assume patients understand everything instantly. We actually don’t realize what a bad job we do until we read books on health literacy written by people like Helen and think, “Am I really making all of these mistakes? How can I go back and fix this and do a better job?”
Helen: Your interest in this was really just trying to be better at being a doctor, and then you thought, “Maybe I’m not doing as good a job as I could be doing.”
I talk to a lot of doctors, and I’ve gotten to know you a little bit. You really are special. I applaud you for that. You take these messages to heart and really want to change that. What have you learned along the way about communicating more clearly now that you do know about health literacy?
Dr. Malpani: I’m happy to use any available tool which helps me become a better doctor. You can’t be a better doctor until your patient trusts you. How do you inculcate that trust? How do you make sure that the patient knows that what you are saying is reliable?
You need to earn that trust because the patient is not going to give it away. Health literacy actually provides basic rules which doctors can follow in order to make sure that the message they want to get across is coming across.
Helen: Tell me more. I want a real example.
Dr. Malpani: A lot of it is about the way you write stuff or talk. I’ll give you an example. I am an IVF specialist.
Helen: What is IVF?
Dr. Malpani: IVF is in vitro fertilization, or test-tube babies. See, I’m making the same mistakes.
Helen: You are, and I’m catching you at it.
Dr. Malpani: This is the problem with being a doctor. You have all of these ingrained bad habits and you need to unlearn some of them. When you remember health literacy, it helps you think, “Maybe I’m not doing such a good job.”
We wrote our first book because we wanted to educate our patients. It’s called How to Have a Baby. I’m proud of the book. We explained the emotional impact, physical problems and how we fix them.
Even though I thought I’d written the book well, we found that patients weren’t reading it, so back to the drawing board. Then we converted the book to a comic book because a lot our messages use images.
Helen: You had this book, and it wasn’t just about how to have a baby, but how to have a baby with IVF. You did the usual patient handout, but it had a lot of pages to it. How did you come up with the idea for a comic book?
Dr. Malpani: I said, “What would I like to read or make my patients read it?” Like you said, images are so much more interesting. We said, “Is it possible for us to actually convert a textbook into a comic book?”
Part of the problem as a doctor is you are left-brain thinking. You are logical and analytical, and that’s perhaps why you become a doctor. Those are skills which you respect yourself and which patients expect from you.
I needed to partner with an artist who had much more of a right brain to convert that into a visual format. Then everyone read the book because it was much easier, much quicker and much more interesting. I find it more interesting as well.
Helen: Are you finding that your patients know more after seeing the comic book? Can you do your own little testing? Do they understand concepts a little bit more?
Dr. Malpani: It makes my consultations so much easier. The whole comic book is online on our website.
Helen: What is your website?
Dr. Malpani: It is www.DrMalpani.com. The great thing is that you make out how much the patient knows by how they talk to you. The quality of questions is much better, and so is the comprehension. We use talk back. We tell patients, “Let me figure out exactly how much you understood.”
Thanks to the fact that they have read the book, I actually need to spend much less time explaining stuff because I can always tell them, “The comic book is there. You can always read it after we finish the consultation.” They don’t have to worry about needing to understand everything in the five minutes they have with the doctor.
Helen: It’s faster and it works. Is that anything special about India? I come from the U.S. I see people of all varieties here. Is there anything special about meeting the needs of people in India that the comic book helps with, or do you think that this would help worldwide?
Dr. Malpani: I think patients are patients and doctors are doctors. We all have the same needs and requirements. We are all starved for time and patients want to know more. The great thing about the comic book is that because it is a visual format, it cuts across all borders.
Helen: As I’ve been learning, you have so many languages and dialects in India. A lot of people don’t just speak English or Hindi. They speak many languages. Is anybody ever offended or say, “I came to see you. Why are you giving me a comic book?”
Dr. Malpani: No one has ever complained. People actually appreciate it. Often what will happen is that patients will doctor shop. That’s perfectly okay. They can find out who they can trust.
Because you are the only doctor to actually give them something tangible which they can go back and refer to and help them to understand their problem and make better sense of it, they are actually grateful that we’ve taken the additional time and trouble.
Helen: It’s a wonderful story about going from, “I think I could do a better job,” to really doing a better job.
Can you put this in a bigger context for us? You really are a health literacy champion. You are running conferences on health literacy, and you have this health library here. Talk about your journey in both of those things.
Dr. Malpani: One of the reasons you become a doctor is you want to help other people. Then sometimes you realize that what you’re doing may not be helpful because patients don’t get the message.
Some of the skill sets that medical school leaves you with may not necessarily equip you with some of this stuff because not all doctors are necessarily good communicators. They may not have very good role models.
Therefore, we need to acquire some of these skills. The great thing is that doing some of this stuff has helped me become a better doctor, so I am very grateful. If you need to learn and remain young, you need to remain curious.
Helen: Is that why you have the conferences?
Dr. Malpani: It is for selfish reasons because that way I can learn a lot from people like you, Helen. Honestly, there are so many people doing so many clever things and they inspire you. If that doctor can make a video, why can’t I? Maybe I can’t make it, but can I use his skills to do something similar?
There are so many people doing so many clever things, so it inspires you. It helps you realize that you’re not a crackpot and that there are other people doing equally clever stuff. There’s actually a community.
The most important thing is I think it helps you respect your patients. That’s the biggest advantage.
Helen: I was honored to be keynoting your conference. I saw that there were many professionals, doctors, patient advocates and patients. There was a whole range there. I was so impressed by all of the different ways people were communicating.
I can hear your enthusiasm for it because your conference brings a variety of different people together. You do the conferences, and you do it in your own clinical practice. Tell us a little bit more about the health library, please.
Dr. Malpani: The health library has evolved. We didn’t just want to teach theory. We wanted to tell people that it can actually be done in real life. When we would say something, people would have a hundred objections. “I’m too busy. I don’t have the time. Who is going to do this? Who is going to explain? I don’t know how to do this.”
Therefore, we said, “Let’s set up a physical facility which can actually be proof of concept.” It has now grown to be the world’s largest patient education library. What we would really like is for hospitals in the U.S. to say, “This is great for my patients and their relatives who come, so why don’t I set up a mini consumer health library within my hospital?” That’s a big dream.
Equally important, and one of the things we’ve realized over the last 10 years, is that digital, online information is as important as a physical library. That’s where the patients are, so the library has evolved. It is no longer just a collection of books within four walls.
Helen: When you say that it is the world’s largest patient education library, it’s not that big of a physical space. Do you mean the digital capacity for it?
Dr. Malpani: What has happened is that doctors and hospitals don’t realize what a wealth of patient education and material there is. Most libraries are medical libraries designed for doctors or medical professionals. There are actually very few patient education or consumer health libraries.
Helen: That is worldwide.
Dr. Malpani: Yes. There are very few.
Helen: I know of some. I have visited a few. I always wanted to have one myself when I worked at a hospital. There were just too many hurdles to figure out how to do that.
Dr. Malpani: It’s actually a lost opportunity. You have a doctor-patient population and patients who have relatives who have questions. This is such a cheap way of answering those questions and improving patient satisfaction scores without eating into your doctor’s time.
Helen: We have this physical place here, and you have a group of librarians too. You have books, models, audios, lectures and videos. How do people know about the health library?
Dr. Malpani: Some of it is word-of-mouth and some of it is our location. We often have people who are happy with our services tell their friends about it. Hopefully at some point we will reach a tipping point.
Our major focus is that the problem with the healthcare system today is that it is too doctor-centric. It is all about the doctor. Hospitals are created around doctors. It’s the doctor’s brand name. You have long waiting lines. I don’t think that is a sign of a good system.
We need to put patients first. The only way we can make sure patients are first is if the information asymmetry goes away. Part of that has to do with doctors educating patients, but part of that also has to do with patients taking responsibility for educating themselves.
That’s our biggest challenge in India because we still use a very paternalistic system. It is like, “The doctor knows best. I went to my doctor. My doctor told me what to do and I’m doing it, so that’s fine.” The trouble is that if things go well, your doctor is God. If things don’t go well, you call your doctor a butcher.
Helen: You’re really changing the mindset of patients, families and caregivers with it. Is your library just accessible to people in Mumbai or India, or can all of our great podcast listeners take a look?
Dr. Malpani: That’s an excellent question. The physical library is only in Mumbai, but you can see our website atwww.HEALTHLibrary.com. We have a digital knowledge base and an online librarian, so we’re happy to use the digital platform to be able to reach out to everyone in this country, and everyone in the world for that matter.
Helen: You have done so much. I don’t know what the timeframe is from your first realization to all you’ve accomplished. How many years was that?
Dr. Malpani: It has been a long time. I no longer count them because then people will know how old I am.
Helen: I’m older than you. Has it maybe been 10 years?
Dr. Malpani: It has been longer than that. It has been about 12 years.
When we first started, it was basically that we needed to do this for our own patients. It has gradually just taken on a life of its own and kept on growing. We think that some things are going to change now within the healthcare system because the healthcare systems in the world are no longer sustainable.
Creating more doctors and hospitals doesn’t solve the problem because the more doctors you have, the greater the demand it creates for their services. We need to look for alternatives. We think the alternative is making sure patients have the right information so they can make sense of the advice the doctor gives.
I can only see benefits. I can see no downsides. Do you know what, Helen?
Dr. Malpani: What amazes me is why every doctor doesn’t do it.
Helen: I was just going to ask you that. We’ve got people listening to this and watching this. What one message do you want them to take away from this? You’re an inspiration. I’m getting to know you and have seen all you have accomplished in just 10 or 15 years. What would you like to tell your colleagues, peers and everybody who cares about health literacy?
Dr. Malpani: I would say to do it for selfish reasons. Do it if you want to improve the quality of your life and quality of the time you spend with your patients, if you want your patients to respect you or if you want to become a busier physician. Do it for selfish reasons.
Not only will you have much more happiness and satisfaction, because that’s why you became a doctor in the first place, but the only way to have happy doctors is to have happy patients.
Helen: I love the way you switched that. You are indeed an inspiration. Thank you so much for all that you are offering to all of us, to me for having been part of this, and to everybody worldwide about your passion about patient education. Thank you so much.
Dr. Malpani: Thank you so much, Helen.